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Neurology CSF Analys
Neurology DM
| Question | Answer |
|---|---|
| Where is CSF produced? | it is produced by the choroid plexus of the intracranial ventricles. |
| Where is CSF found? | In the ventricles and in the subarachnoid space; also surrounds the spinal cord |
| What is the total volume of CSF? | 140ml |
| LP is diagnostic for | CNS infections (meningitis, encephalitis), Headaches (subarachnoid hemorrhage), pseudotumor cerebri, MS |
| Contradindications to LP | Suspected brain abscess (CSF studies not helpful) and elevated intracranial pressure (especially if papilledema is present) |
| What is the patient's position for a LP? | Lie on side with knees bent and pulled up and chin touching chest |
| Where is the needle inserted for an LP? | Into L3-L4 space |
| What is used to limit bacterial infection from the surrounding skin? | A fenestrated drape |
| In children, what consideration needs to be taken? | Spinal cord extends more caudally, do a low LP |
| What may extreme elderly patients require? | A cisternal procedure |
| What is intrathecal variability and what causes it? | Higher concentration of protein and cells in lumbar sac than in ventricular or cisternal fluid; caused by stagnation |
| What is used to shunt fluid away from the brain into the peritoneum? | An indwelling ventricular peritoneal shunt (VP shunt). Used in encephalitis, brain tumors, spina bifida |
| Lumbar Puncture risks | headache, pain, allergic rxn, brain herniation/damage/death, infection, bleeding and paralysis |
| What is the most common AE of LP? | Postdural Puncture Headache (25%); increased risk in ages 20-40, women, pts with hx of HA, large volume of CSF removal, inexperienced LP provider |
| What is the treatment for Postdural puncture headache (PDPH)? | epidural blood patch (EBP), an injection of your own, freshly drawn blood into the subdural space near the original injection site. |
| What factors are being analyzed with a LP? | Opening pressure, appearance/color, consistency, tendency to clot, differential cell count, protein, glucose |
| In which disease is there an increase in oligoclonal IgG? | MS |
| Most CSF constituents are present in equal or _____ levels than in plasma | lower |
| Cloudy CSF suggests | increased WBC count or protein |
| Xanthochromia (yellow tinge) suggests | hyperbilirubinemia, hypercarotenemia, melanoma |
| Red tinged CSF can be caused by | blood from bleeding into the subarachnoid space or traumatic tap |
| When is a cell count of CSF performed? | Within 1 hour of obtaining the specimen. (otherwise cells will settle and/or adhere to the tube giving a false low) |
| What level of WBC's in the CSF indicates infection? | >100 (less than 100 but more than 5 indicates inflammation) |
| What is found in bacterial infections? | PMNs |
| Viral infections have _______ in the CSF. | Lymphocytes. Also, if you see lymphocytes, consider TB, fungal, cancer |
| When are eosinophils seen? | shunt, parasitic infection and allergic reactions |
| Normal CSF pressure | 60-200mmH20 |
| What instrument measures CSF pressure? | Manometer |
| How much does CSF pressure drop for each ml of CSF removed? | 5-10mmH20 |
| Marked CSF pressure elevation should raise your suspicion for | Purulent meningitis or intracranial tumors |
| Moderate CSF pressure elevation should raise your suspicion for | mild inflammation, encephalitis, neurosyphilis |
| What is the one instance where LP is done despite the presence of papilledema? | Pseudotumor cerebri (benign intracranial HTN). Elevated pressure with nl CSF |
| When would you see higher protein levels in CSF? | infants (nl), increased permeability of BBB (tumor, trauma, inflammation), increased intrathecal synthesis of Igs |
| What would cause decreased protein levels in CSF? | protein leak, hyperthyroidism, water intoxication |
| Low levels of CSF glucose are found in which conditions? | bacterial or TB infection |
| CSF lactate levels are normally equal to blood levels. What increase CSF lactate levels? | CVA, intracranial bleed, bacterial meningitis |
| What concentration of organisms is necessary in order to be picked up on smear detection? | 10 to the 5th power/ml |
| A WBC fount of <250/ml with higher levels of lymphocytes is likely to be viral meningitis or bacterial meningitis? | Viral meningitis. Bacterial has WBCs around 1,000 and higher PMNs |
| Fluorescent treponemal antigen (FTA) is a serology used to detect | Syphilis |
Created by:
ltm12