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DU PA CSF DM
Duke PA CSF/Lumbar Puncture Diagnostic Methods
| Question | Answer |
|---|---|
| normal CSF pressure __ mm H2O | 60-200 |
| normal protein in CSF __ mg/dl | 15-45 |
| normal glucose in CSF __mg/dL | 50-75 |
| CSF contains __% of the blood glucose | 60-70 |
| when doing a lumbar puncture the needle is placed in the __ space of the spinal column | subarachnoid |
| CSF is made by selective secretion from the plasma by the __ in the ventricles of the brain | choroid plexus |
| CSF exists in the space between the __ and arachnoid mater | pia |
| there is about __ mL of CSF in a normal person | 150-200 |
| Chloride levels are __ in the CSF than in the plasma | higher |
| causes of increased intracranial and spinal pressure | tumors, infection, hydrocephalus, intracranial bleeding |
| obstruction of __ veins will increase intracranial pressure | jugular |
| causes of reduced intracranial and spinal pressure | shock, dehydration, leak from previous LP, nasal sinus fracture with a dura tear |
| if there are significant differences between beginning and ending LP pressures suspect __ | spinal cord obstruction (tumor), or hydrocephalus |
| if high LP pressures are noted do not drain a normal volume of CSF because of the risk of __ | cerebellar herniation |
| a cloudy appearance to CSF may indicate | increase in WBC's or protein level |
| if there is blood in the CSF no __ will occur if the blood is froma subarachnoid hemorrhage | clotting |
| if the initial CSF tube contains some blood but each additional tube becomes successively more clear, this indicates __ | a traumatic puncture |
| the presence of polymorphic leukocytes (neutrophils) is indicative of __ | bacterial meningitis, or cerebral abscess |
| when mononuclear leukocytes are present, __ is suspected | viral or tubercular meningitis, or encephalitis |
| leukemia or other primary or metastatic malignant tumors may cause elevated __ | WBC's |
| __ is a term used to indicate turbidity of CSF because of an increased number of cells within the fluid | pleocytosis |
| the most common cause of meningitis in children | Haemophilus influenzae |
| the most common cause of meningitis in adults | Neisseria or Streptococcus |
| causes of increased protein in the CSF due to a more permeable blood brain barrier | meningitis, encephalitis, or myelitis |
| a non-inflammatory cause of elevated CSF protein | malignancy |
| because __ are not made in the CNS increased levels of these indicate increased permeability of the blood-brain barrier | albumin and prealbumin |
| a __ is usually obtained before the spinal tap is performed | blood glucose |
| a CSF glucose level <60% of the blood glucose may indicate | meningitis or neoplasm |
| quantification of __ is helpful in diagnosing bacterial meningitis | lactic dehydrogenase (LDH) |
| the source of LDH in the CSF is from __ | neutrophils fighting infection |
| elevated levels of __ indicate anaerobic metabolism associated with decreased oxygenation of the brain, decreased glucose levels, or increased WBC's | lactic acid |
| because __ does not readily pass through the blood-brain barrier, elevated blood __ levels are not reflected in teh CSF | lactic acid |
| chronic cerebral hypoxemia or cerebral ischemia is associated with elevated CSF __ levels | lactic acid |
| elevated __ levels are helpful in the detection and evaluation of hepatic encephalopathy and hepatic coma. Elevated levels are also often increased in Reye syndrome | glutamine |
| failure to find elevated CRP levels in CSF appears to be strong evidence against __ | bacterial meningitis |
| increased intracranial pressure is a __ to lumbar puncture | contraindication |
| post lumbar puncture keep the patient in a reclined position for up to __ hours to avoid the discomfort of potential postpuncture spinal headache | 12 |
| postpuncture assess the patient for __ of the extremities | numbness, tingling, and decreased movement |
| CSF is reabsorbed back into blood vessels by __ in the brain's sagittal sinus | arachnoidal villi |
| function of CSF | enhance brain nutrition, remove metabolic byproducts, protect against mechanical injury |
| indications for lumbar puncture | obtain CSF for laboratory analysis, determine spinal fluid pressure, administer radiopaque diagnostic agents (dyes) into CNS, administer drugs, remove excess CSF |
| contraindications to LP | suspected brain abscess (CSF studies usually not helpful), elevated intracranial pressure (especially if papilledema is present) |
| in children the spinal cord extends more __ | caudally |
| LP risks | headache, pain, allergic reaction, infection, bleeding, paralysis, brain herniation/damage/death |
| most common adverse effect to LP | postdural puncture headache |
| attributed to leakage of CSF through the dural puncture site, decreasing CSF volume | postdural puncture headache |
| xanthochromia (yellow tinge) of CSF may be caused by | hyperbilirubinemia, hypercarotenemia, melanoma |
| normal # of cells in CSF | 0-5 small lymphs/ml |
| cells that are always abnormal in CSF | granulocytes, large mononuclear cells, and RBCs |
| increased WBC's >100 are probably | infection |
| __ seen in shunt, parasitic infection and allergic reaction | eosinophils |
| __ are consistent with viral infection or other (TB, fungal, cancer) | lymphocytes |
| __ consistent with bacterial infection | PMN's |
| pressure normally drops __ mm for each ml of CSF removed | 5-10 |
| elevated pressure with normal CSF confirms __ | pseudotumor cerebri (benign intracranial hypertension) |
| one instance where LP is done despite presence of papilledema | pseudotumor cerebri |
| not typically altered in viral meningitis, so lactate may help differentiate between viral and bacterial meningitis | CSF Lactate |
Created by:
bwyche
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