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Duke PA CSF/Lumbar Puncture Diagnostic Methods

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