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CEREBROSPINAL FLUID
EXAMINATION
CEREBROSPINAL FLUID
EXAMINATION
Institute of DiagnosticsZhong Ning
Email: [email protected]
Institute of DiagnosticsZhong Ning
Email: [email protected]
2005-5-17 Medicine School of Shandong University 2
CONTENTCONTENT
• Preface• Specimen Collection• Opening Pressure• Total cell count• Differential cell count• Glucose• Protein
• Preface• Specimen Collection• Opening Pressure• Total cell count• Differential cell count• Glucose• Protein
2005-5-17 Medicine School of Shandong University 3
PrefacePreface
• Cerebrospinal fluid (CSF) is mostly derived through the choroid plexuses.
• 500mL/day approximately• CSF protects the brain and spin
al cord, and collects waste, circulates nutrients, cushions and lubricates the central nervous system (CNS).
• Cerebrospinal fluid (CSF) is mostly derived through the choroid plexuses.
• 500mL/day approximately• CSF protects the brain and spin
al cord, and collects waste, circulates nutrients, cushions and lubricates the central nervous system (CNS).
2005-5-17 Medicine School of Shandong University 4
2005-5-17 Medicine School of Shandong University 5
The blood-brain barrier
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.
• 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.
2005-5-17 Medicine School of Shandong University 6
2005-5-17 Medicine School of Shandong University 7
2005-5-17 Medicine School of Shandong University 8
Specimen CollectionSpecimen 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.
• 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.
2005-5-17 Medicine School of Shandong University 9
2005-5-17 Medicine School of Shandong University 10
2005-5-17 Medicine School of Shandong University 11
Opening PressureOpening Pressure
• Normal opening pressure in adults is 90~180mmH2O, 10~100mmH2O in children.
• Normal opening pressure in adults is 90~180mmH2O, 10~100mmH2O in children.
2005-5-17 Medicine School of Shandong University 12
Elevated pressureElevated pressure
• Congestive heart failure• Meningitis• Superior vena cava
syndrome• Cerebral edema• Mass lesion
• Congestive heart failure• Meningitis• Superior vena cava
syndrome• Cerebral edema• Mass lesion
2005-5-17 Medicine School of Shandong University 13
Decreased pressureDecreased pressure
• Spinal-subarachnoid block• Dehydration• Circulatory collapse• CSF leakage
• Spinal-subarachnoid block• Dehydration• Circulatory collapse• CSF leakage
2005-5-17 Medicine School of Shandong University 14
Total cell count & DCTotal 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
• The normal leukocyte cell count in adults is 0~5 cells/ul.
• Increased neutrophils: Bacterial Meningitis cerebral abscess subdural empyema CNS hemorrhage CNS infarct
2005-5-17 Medicine School of Shandong University 15
2005-5-17 Medicine School of Shandong University 16
• Increase Lymphocytes: Viral meningitisMultiple sclerosis
• Increase Lymphocytes: Viral meningitisMultiple sclerosis
2005-5-17 Medicine School of Shandong University 17
GlucoseGlucose
• The normal Glucose is about 60% compared to serum level.
• Normal 50~80mg/dl• Elevated Glucose: Diabetes mellitus, DM• Decreased Glucose: Bacterial Meningitis
• The normal Glucose is about 60% compared to serum level.
• Normal 50~80mg/dl• Elevated Glucose: Diabetes mellitus, DM• Decreased Glucose: Bacterial Meningitis
2005-5-17 Medicine School of Shandong University 18
Total Protein 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.
• 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.
2005-5-17 Medicine School of Shandong University 19
Elevated CSF proteinElevated CSF protein
Reason• Increased permeability of the bl
ood-brain barrier.• Decreased resorption • Mechanical obstruction of CSF f
low
Reason• Increased permeability of the bl
ood-brain barrier.• Decreased resorption • Mechanical obstruction of CSF f
low
2005-5-17 Medicine School of Shandong University 20
Elevated CSF proteinElevated CSF protein
• Arachnoiditis• Meningitis• Hemorrhage• Endocrine/Metabolic disorders
• Arachnoiditis• Meningitis• Hemorrhage• Endocrine/Metabolic disorders
2005-5-17 Medicine School of Shandong University 21
