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CSF Analysis

Cerebrospinal fluid is produced in the ventricles and circulates through the subarachnoid space. It is reabsorbed in the arachnoid villi. A lumbar puncture can be used diagnostically to check for conditions like meningitis or subarachnoid hemorrhage, and therapeutically to relieve increased intracranial pressure. During the procedure, CSF is collected and analyzed for pressure, appearance, and cell count to check for abnormalities that could indicate different conditions.

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197 views

CSF Analysis

Cerebrospinal fluid is produced in the ventricles and circulates through the subarachnoid space. It is reabsorbed in the arachnoid villi. A lumbar puncture can be used diagnostically to check for conditions like meningitis or subarachnoid hemorrhage, and therapeutically to relieve increased intracranial pressure. During the procedure, CSF is collected and analyzed for pressure, appearance, and cell count to check for abnormalities that could indicate different conditions.

Uploaded by

EB
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CSF ANALYSIS

PHYSIOLOGY
Cerebrospinal fluid (CSF) is produced by

the choroid plexus in the lateral, third, and


fourth ventricles and

circulates through the subarachnoid space


between the arachnoid mater.
• CSF is
reabsorbed in the arachnoid villi, located along
the superior sagittal and intracranial venous
sinuses and around the spinal nerve roots.
CHARACTERISTICS
•  Normal cerebrospinal fluid (CSF) is clear and
colorless.
•
• The normal CSF pressure as measured with a
manometer in a patient lying flat in the lateral
decubitus position is between 60 and 180 mmH20 

• The CSF volume is 125 to 150 mL; approximately 20


percent of the CSF is contained in the ventricles
and the pia mater.
LUMBAR PUNCTURE
INDICATIONS

DIAGNOSTIC THERAPEUTIC
Indications for lumbar puncture
• Suspicion of meningitis
• Suspicion of subarachnoid hemorrhage
• Suspicion of central nervous system diseases
such as Guillain-Barré syndrome and
carcinomatous meningitis
• Therapeutic relief of pseudotumor cerebri
• Injection of drugs and anesthetics
Contra Indications of lumbar punctures

• Increased intracranial pressure (ICP) of and unidentified origin


- Can cause cerebral herniation
- Exception: therapeutic use of lumbar puncture to reduce ICP
• Infections
- Skin infections at puncture site may cause sepsis
• Abnormal respiratory pattern
-Hypertension with bradycardia and deteriorating consciousness
-Vertebral deformities (scoliosis or kyphosis), in hands of an
inexperienced physician.
• Bleeding diathesis
-Coagulopathy
-Decreased platelet count (<50 x 109/L)
PROCEDURE
Lumbar puncture
• The patient is placed in a lateral position with the
knees bent in full flexion up to the chest(fetal position)
(sit and bend position also possible)
• Introduction of 1% lidocain into the subcutaneous
space
• Insertion of a spinal needle into the subarachnoid
space at the L3-L4 or L4-L5 intercostal spaces (inserted
until the second “give”- subarachnoidal space).
• Removal of the stylet of the needle in order to collect
the fluid
CSF analysis - Pressure
• Measured with a column manometer (fetal position is
optimal)
• Increased pressure: congestive heart failure, cerebral
edema, subarachnoid hemorrhage, hypo-osmolality
resulting from hemodialysis, purulent or tuberculous
meningitis, hydrocephalus, or pseudotumor cerebri.
• Decreased pressure: complete subarachnoid blockage,
leakage of spinal fluid, severe dehydration,
hyperosmolality, or circulatory collapse
• Xanthochromia — Normal cerebrospinal fluid (CSF) is
clear and colorless.
• Both infectious and noninfectious processes can alter
the appearance of the CSF.
• As few as 200 white blood cells (WBCs) or 400 red
blood cells (RBCs)/microL will cause CSF to appear
turbid
• The breakdown of hemoglobin first to oxyhemoglobin
(pink) and later to bilirubin (yellow) leads to a yellow or
pink discoloration of the CSF known as xanthochromia.
• Cells — The CSF is normally acellular.
• However, up to 5 WBCs and 5 RBCs are considered
normal in adults when the CSF is sampled by lumbar
puncture (LP).
• . 
CSF analysis- cell count
99% of patients with bacterial meningitis have >100
WBC’s/mm (less than that is only common for viral
meningitis)
Viral meningitis: predominance of lymphocytes T
Bacterial meningitis: predominance of PMN’s
Fungal and tubercular meningitis: predominance of
lymphocytes and high content of proteins, decrased
glucose
RBC’s: abnormal finding(be careful with traumatic taps,
3 samples are needed)

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