Ch. 9: Cerebrospinal Fluid Analysis

How many leukocytes are normally present in the CSF obtained from an ADULT

0 to 5 cells

CSF fluid clarity can be graded from ____ to ____

0-(clear) TO 4-(newsprint cannot be read thru the fluid)

Normal Segs in CSF

0-6

A typical IgG reference interval index

0.30-0.70

Normal Lactate range in CSF

10-22 mg/dL

Normal Total Volume of CSF in NEONATES

10-60 mL

Normal Monocytes in CSF

15-45

Normal Total Protein in CSF

15-45 mg/dL

Normal Lymphocytes in CSF

40-80

Normal CSF: Diff Count- Age Adults (>18yr) Lymphs: ____ - _____ % Monos: ____ - _____ % Segs: ____ - _____ %

40-80% 15-45% 0-6%

Normal CSF: Diff Count- Age Neonates (0-2 mo) Lymphs: ____ - _____ % Monos: ____ - _____ % Segs: ____ - _____ %

5-35% 50-90% 0-8%

Normal CSF pressure for ADULT in LATERAL recumbent position

50-180 mm Hg

Normal Glucose in CSF

50-80 mg/dL

Normal PLASMA GLUCOSE

65-99

Normal Total Volume of CSF in ADULTS

85-150 mL

Which of the following procedures frequently provides a rapid presumptive diagnosis of bacterial meningitis? - a blood culture - a CSF culture -A CSF Gram stain - Immunologic tests on CSF for microbial antigens

A CSF Gram stain

What protein in the CSF is used to monitor the integrity of the blood-brain barrier?

Albumin

In CSF what finding indicates a traumatic puncture? -Erythrophagocytic cells in CSF -Hemosiderin granules within macrophages in the CSF sediment -An uneven distribution of blood in the CSF collection tubes -a xanthochromic supernatant after CSF cetrifugation

An uneven distribution of blood in the CSF collection tubes

Which is TRUE about CSF? CSF is constantly produced. CSF is reabsorbed into the blood CSF is composed of diluted plasma

CSF is constantly produced.

All of the following proteins are normally present in the CSF EXCEPT: Albumin Fibrinogen Transthyretin Transferrin

Fibrinogen

Which of the following substances DOES NOT normally pass thru the blood-brain barrier? Albumin Glucose Fibrinogen

Fibrinogen

ANY condition that impairs the blood supply or the transport of OXYGEN to the CNS results in __________

Increased CSF Lactate levels

Which of the following statements about CSF glucose is false? -Increased CSF glucose values are diagnostically significant -Glucose enters the CSF by active transport and simple diffusion

Increased CSF glucose values are diagnostically significant

pleocytosis

Increased number of cells in CSF

Cell Types and Causes of CSF Pleocytosis- Predominant Cell Type: Neutrophils

Infectious Causes: Bacterial Meningitis

Cell Types and Causes of CSF Pleocytosis- Predominant Cell Type: Monocyte

Infectious Causes: Meningitis TB Fungal

Cell Types and Causes of CSF Pleocytosis- Predominant Cell Type: Plasma Cells

Infectious Causes: Multiple sclerosis Guillain-Barre syndrome

Cell Types and Causes of CSF Pleocytosis- Predominant Cell Type: Eosinophils

Infectious Causes: Parasitic infestations Fungal infections

Cell Types and Causes of CSF Pleocytosis- Predominant Cell Type: Macrophages

Infectious Causes: TB Meningitis Fungal Meningitis

Cell Types and Causes of CSF Pleocytosis- Predominant Cell Type: Lymphocytes

Infectious Causes: Viral Meningitis

Which of the following is NOT an analytical concern when the processing & testing of CSF are delayed? Viability of microorganisms Lability of the immunoglobulins Lysis of leukocytes and RBCs

Lability of the immunoglobulins

Which cell type is predominate in CSF during a classic case of viral meningitis?

Lymphocytes

Which of the following cells can be present in small numbers in normal CSF ? RBCs Lymphocytes Macrophages Plasma cells

Lymphocytes

Which cell type is predominate in CSF during a classic case of bacterial meningitis?

Neutrophils

Cell Types and Causes of CSF Pleocytosis- Malignant Cell Type: Tumor Cells

SEND to PATHOLOGIST

Cell Types and Causes of CSF Pleocytosis- Malignant Cell Type: Blasts

SEND to PATHOLOGIST Possible: Leukemia or Lymphoma

Normal CSF pressure for ADULT in in SITTING position- higher or lower

Slightly higher pressures obtained

Normal CSF lactate levels (less than 25 mg/dL) are commonly found in patients with A. Bacterial meningitis B. Fungal meningitis C. Tuberculous meningitis D. Viral meningitis

Viral meningitis

Cloudy CSF is associated with..

WBC >200 & RBC >400

Pleocytosis is a term to describe

an increased number of cells in the CSF

CSF fluid is found between the

arachnoid and pia mater

WBC counts >50,000 cells in CSF occur with

bacterial meningitis

When choroid plexus cells and ependymal cells are present in CSF, they A. are often clinically significant. B. represent the demyelination of nerve tissue. C. can closely resemble clusters of malignant cells. D. indicate breakdown of the blood-brain barrier.

can closely resemble clusters of malignant cells

During lumbar puncture, the FIRST collection tube of CSF removed should be used for _______-

chemistry tests

Microorganisms or Increased Protein content can produce ___________ CSF specimens

cloudy

India ink preparations and microbial antigen tests on CSF can aid in the diagnosis of _______

fungal meningitis

To enhance the visualization of WBC nuclei & to eliminate any RBCs present, the CSF can be treated with _______

glacial acetic acid

choroid plexus

highly vascular folds of capillaries, nerves, & ependymal cells in the pia mater. it actively synthesizes cerebrospinal fluid

All of following can cause xanthochromia in CSF EXCEPT: High concentrations of protein High concentrations of bilirubin increased # of WBCs RBCs from a traumatic tap

increased # of WBCs

meningitis

inflammation of the meninges

An IgG index > than 0.70 indicates?

intrathecal synthesis of immunoglobulin G

stat

meaning immediately

oligoclonal bands

multiple discrete bands in the gamma region noted during electrophoresis of plasma or other body fluids (CSF)

IgG index >0.70 is diagnostically sensitive for this disease

multiple sclerosis

cerebrospinal fluid (CSF)

normally clear, colorless fluid present between the arachnoid and the pia mater in the brain and spinal cord.

Blood-brain barrier

physiological interface between the vascular system & CSF. changes can result in the normal chemical & cellular composition of the CSF

an unknown fluid can be positively identified as CSF by determining the A. Lactate concentration B. Albumin concentration C. Presence of oligoclonal banding on electrophoresis D. presence of carbohydrate-deficient transferrin on electrophoresis

presence of carbohydrate-deficient transferrin on electrophoresis

Cerebrospinal fluid (CSF) is produced primarily from ____

secretions by the choroid plexus

subarachnoid space

space between the arachnoid and the pia mater

Which of the following statements about oligoclonal bands is false? -In the CSF, these bands indicate increased intrathecal concentrations of immunoglobulin G -the bands usually correlate with the stage of disease & can be used to predict disease progression

the bands usually correlate with the stage of disease & can be used to predict disease progression

ventricles

the four fluid filled cavities in the brain lined with ependymal cells. the choroid plexus is located in here.

xanthochromia

the pink, orange, or yellowish discoloration of supernatant cerebrospinal fluid after centrifugation

meninges

three membranes that surround the brain & spinal cord. the innermost membrane is the pia mater, the outermost is the dura mater, centrally located is the arachnoid

Which of the following events does not result in an increased CSF total protein? -traumatic puncture procedure -alterations in the blood-brain barrier -trauma to the CNS, resulting in fluid loss -decreased re-absorption of CSF into the peripheral blood

trauma to the CNS, resulting in fluid loss

intrathecal

within the spinal cord or subarachnoid space