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CEREBROSPINAL FLUID EXAMINATION

CEREBROSPINAL FLUID EXAMINATION. Institute of Diagnostics Zhong Ning Email: ningzhong@sdu.edu.cn. CONTENT. Preface Specimen Collection Opening Pressure Total cell count Differential cell count Glucose Protein. Preface.

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CEREBROSPINAL FLUID EXAMINATION

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  1. CEREBROSPINAL FLUID EXAMINATION Institute of Diagnostics Zhong Ning Email: ningzhong@sdu.edu.cn

  2. CONTENT • Preface • Specimen Collection • Opening Pressure • Total cell count • Differential cell count • Glucose • Protein Medicine School of Shandong University

  3. Preface • Cerebrospinal fluid (CSF) is mostly derived through the choroid plexuses. • 500mL/day approximately • CSF protects the brain and spinal cord, and collects waste, circulates nutrients, cushions and lubricates the central nervous system (CNS). Medicine School of Shandong University

  4. Medicine School of Shandong University

  5. The blood-brain barrier • BBB is a concept derived from dye-exclusion studies rather than a specific anatomic structure. • Certain substances in the CSF are tightly regulated by specific transport systems. Medicine School of Shandong University

  6. Medicine School of Shandong University

  7. Medicine School of Shandong University

  8. Specimen Collection • Lumbar puncture (LP) is the insertion of a needle into the subarachnoid space (the area under the membrane that surrounds the brain and spinal cord) of the lumbar (lower back) region for diagnostic or therapeutic purposes. This allows access to the cerebrospinal fluid (CSF) in which the brain and spinal cord float. • Although the subarachnoid space can be accessed from other levels, the lumbar region is most often used as it allows the needle to be inserted below the end of the spinal cord. Medicine School of Shandong University

  9. Medicine School of Shandong University

  10. Medicine School of Shandong University

  11. Opening Pressure • Normal opening pressure in adults is 90~180mmH2O, 10~100mmH2O in children. Medicine School of Shandong University

  12. Elevated pressure • Congestive heart failure • Meningitis • Superior vena cava syndrome • Cerebral edema • Mass lesion Medicine School of Shandong University

  13. Decreased pressure • Spinal-subarachnoid block • Dehydration • Circulatory collapse • CSF leakage Medicine School of Shandong University

  14. Total cell count & DC • The normal leukocyte cell count in adults is 0~5 cells/ul. • Increased neutrophils: Bacterial Meningitis cerebral abscess subdural empyema CNS hemorrhage CNS infarct Medicine School of Shandong University

  15. Medicine School of Shandong University

  16. Increase Lymphocytes: Viral meningitis Multiple sclerosis Medicine School of Shandong University

  17. Glucose • The normal Glucose is about 60% compared to serum level. • Normal 50~80mg/dl • Elevated Glucose: Diabetes mellitus, DM • Decreased Glucose: Bacterial Meningitis Medicine School of Shandong University

  18. Total Protein • Over 80% of CSF protein content is derived from the plasma. • An increased CSF protein serves as a useful but nonspecific indicator of disease. • Normal level 15~45mg/dl. Medicine School of Shandong University

  19. Elevated CSF protein Reason • Increased permeability of the blood-brain barrier. • Decreased resorption • Mechanical obstruction of CSF flow Medicine School of Shandong University

  20. Elevated CSF protein • Arachnoiditis • Meningitis • Hemorrhage • Endocrine/Metabolic disorders Medicine School of Shandong University

  21. Medicine School of Shandong University

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