Neurology DM
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| Where is CSF produced? | it is produced by the choroid plexus of the intracranial ventricles.
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| Where is CSF found? | In the ventricles and in the subarachnoid space; also surrounds the spinal cord
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| What is the total volume of CSF? | 140ml
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| LP is diagnostic for | CNS infections (meningitis, encephalitis), Headaches (subarachnoid hemorrhage), pseudotumor cerebri, MS
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| Contradindications to LP | Suspected brain abscess (CSF studies not helpful) and elevated intracranial pressure (especially if papilledema is present)
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| What is the patient's position for a LP? | Lie on side with knees bent and pulled up and chin touching chest
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| Where is the needle inserted for an LP? | Into L3-L4 space
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| What is used to limit bacterial infection from the surrounding skin? | A fenestrated drape
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| In children, what consideration needs to be taken? | Spinal cord extends more caudally, do a low LP
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| What may extreme elderly patients require? | A cisternal procedure
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| 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
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| 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
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| Lumbar Puncture risks | headache, pain, allergic rxn, brain herniation/damage/death, infection, bleeding and paralysis
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| 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
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| 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.
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| What factors are being analyzed with a LP? | Opening pressure, appearance/color, consistency, tendency to clot, differential cell count, protein, glucose
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| In which disease is there an increase in oligoclonal IgG? | MS
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| Most CSF constituents are present in equal or _____ levels than in plasma | lower
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| Cloudy CSF suggests | increased WBC count or protein
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| Xanthochromia (yellow tinge) suggests | hyperbilirubinemia, hypercarotenemia, melanoma
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| Red tinged CSF can be caused by | blood from bleeding into the subarachnoid space or traumatic tap
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| 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)
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| What level of WBC's in the CSF indicates infection? | >100 (less than 100 but more than 5 indicates inflammation)
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| What is found in bacterial infections? | PMNs
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| Viral infections have _______ in the CSF. | Lymphocytes. Also, if you see lymphocytes, consider TB, fungal, cancer
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| When are eosinophils seen? | shunt, parasitic infection and allergic reactions
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| Normal CSF pressure | 60-200mmH20
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| What instrument measures CSF pressure? | Manometer
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| How much does CSF pressure drop for each ml of CSF removed? | 5-10mmH20
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| Marked CSF pressure elevation should raise your suspicion for | Purulent meningitis or intracranial tumors
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| Moderate CSF pressure elevation should raise your suspicion for | mild inflammation, encephalitis, neurosyphilis
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| What is the one instance where LP is done despite the presence of papilledema? | Pseudotumor cerebri (benign intracranial HTN). Elevated pressure with nl CSF
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| When would you see higher protein levels in CSF? | infants (nl), increased permeability of BBB (tumor, trauma, inflammation), increased intrathecal synthesis of Igs
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| What would cause decreased protein levels in CSF? | protein leak, hyperthyroidism, water intoxication
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| Low levels of CSF glucose are found in which conditions? | bacterial or TB infection
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| CSF lactate levels are normally equal to blood levels. What increase CSF lactate levels? | CVA, intracranial bleed, bacterial meningitis
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| What concentration of organisms is necessary in order to be picked up on smear detection? | 10 to the 5th power/ml
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| 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
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| Fluorescent treponemal antigen (FTA) is a serology used to detect | Syphilis
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ltm12