Cerebrospinal fluid (CSF).pptx

MLT syllabas

1. Cerebrospinal fluid (CSF) Cerebrospinal Fluid Sanjay yadav

2. Content Introduction Formation of CSF Function of CSF Composition of CSF Collection of CSF Physical examination Chemical examination Microscopic examination Cause of CSF Symptoms of CSF Diagnosis of CSF Treatment of CSF Prevention References

3. Introduction The cerebrospinal fluid (CSF) is a clear, color less transparent fluid present in the cerebral ventricle. CSF is a fluid of central nerve system CSF is a ultra filtration of the blood. Properties volume:- 100 - 200 ml Rate of formation :- 0.3 ml/ min/ 600 – 700 ml daily Specific gravity:- 1.005 Reaction:- alkaline 7.3 to 7.4 ph.

4. Formation of CSF CSF is largely formed by the choroid plexus of the lateral ventricle and remainder in the third and fourth ventricles. CSF production in ventricle of brain by choroid plexus. Four interconnected cavities brain that produce cerebrospinal fluid and transparent it around the brain and spinal cord. Each ventricle is lined by ependymal cell which from choroid plexus ( where CSF is produce) Production Rate 0.5 ml/min. 20-30 ml/hr. 720 ml/day In subarachnoid space the constant amount of CSF is reabsorbed 600 ml by arachnoid villi .

5. Function of CSF The major Function of CSF is to provide basic mechanism sport and immunological protection of the brain. Provide fluid cushion for protection and support the brain the spinal cord. ( by act like a fluid buffer) CSF supplies nutrients to the nervous system tissue (carries nutrient and CSF removes waste products from cerebral metabolism. Act as shock absorbed for brain and Spinal cord. Maintain the constant pressure inside the brain and around the spinal cord. It act as a medium for the transfer of substance from tissue of the brain spinal cord to the blood stream.

6. Composition of CSF Water – 99% Solids – 1% Solids present in two forms Organic substance Inorganic substance Organic substances present Protein – 15-47 mg/dl Sugar – 40-80 mg/dl Amino acid – few amount Cholesterol – 0.2-0.5 mg/dl Urea – 6-16 mg% Uric acid – 0.5-4.5 mg% Creatine – 0.5-1.2 mg% Lactic acid – few amount Few – 0.8 lymphocyte/ per cumm WBC cell – Neutrophils absent Inorganic substance Na – 144-154 meg/l K – 2.0 to 3.5 meg/l Chloride – 118-132meg/l Bicarbonate Calcium etc. CSF normal pressure – 5-15 mm hg CSF pressure measurement machine hydromenometer .

7. Collection of csf Cerebrospinal fluid is collected by lumber puncture (LP) under strict aseptic condition similar to any surgical collection. An experience physician or a specially trained nurse dose the LP and specimen collection. After properly positioning the patient the sterile LP needle with the stylet is inserted b/w the third –fourth (L3-L4) and (L4-L5) a depth of 4 to 5 cm. The stylet is with drown and the fluid flows freely in to a sterile test tube through the needle. A total between 6-7 ml of CSF is collected in 3 sterile tubes which are chemically cleaned and washed with distilled and deionized water. The needle is remove the area is cleaned and bandage over the needle site. 3 sterile tubes used Bacterial examination 1ml Chemical examination 2.5 ml Microscopic examination 2.5 ml After collection test sterile with hr. Do not refrigerate sample if bacteriology examination Sone bacterial kill in 2-8 C

8. Physical examination Absorbed the specimen and note down. Color – color less Red color – presence of blood Yellow color – presence of bilirubin (known as xanthochromia) jaundice condition Appearance – clear Cloudy – due to pus condition (bacterial infection) Specific gravity – 1.003 to 1.008 PH – 7.3 to 7.4 Clot formation normal CSF does not clot Clot formation is the presence of fibrinogen fibrin to produce clot ( when BBB is disturb.

9. Chemical examination Total solids - counting Protein – 15 to 45 mg/dl Albumin – 50-70% Globulin – 30-50% Some method used to increased in globulin in pondy’s method Glucose – 40-80 meg/l Chloride – 118-132 meg/l Sodium – 144-154meg/l Potassium – 2.0-3.5 meg/l Creatine – 0.5-1.2 mg/dl Urea – 6-16 mg/dl Uric acid – 0.5-4.5 mg/dl Pandy’s method Globulin are precipitated by a saturated solution of phenol in water and cause fine turbidity. Reagent – (pandy’s reagent) Phenol – 10 g Distilled water – 150 ml Procedure – Take 1 ml of pandy’s reagent in to a small test tube. Add 2-3 drop of CSF (specimen) Examine the tube after addition of each drop (do not mix) Read result immediately. Result - depending upon the degree of precipitation of globulin. Trace – 1+, 2+, 3+, 4+

10. Microscopic examination Cell counting - TLC, DLC Normal CSF contain few 0.8 lymphocytes / cumm Lymphocyte present normally in few amount about 0.5 WBC / cumm increased cell count in CSF is know as pleocytosis. Used Neubauer chamber. Increased leucocyte – infective meningitis Lymphocyte increase – viral infection Neutrophils – increase bacterial infection High count DLC – pyogenic infection High lymphocyte count – mycotic infection, TB, viral meningitis - trypanosomiasis

11. 2. Gram staining used for gram+ve, gram- ve , morphology, cocci, bacilli, size etc. Organism that commonly cause meningitis. Neisseria meningitides (- ve ) Streptococcus pneumonia (+ ve ) Hemophilus influenzas (- ve ) 3. Acid Fast staining For tuberculosis meningitis. 4. ( i ) Wet mount of CSF performed case of sleeping sickness trypanosomiasis Take 1 drop of CSF top of slide and cover with cover slip after that examine in 40x . (ii) Indian Ink preparation Specimen - CSF sediment used cryptococcus infection Take 1 drop of CSF top of slide and 1 drop of Indian ink preparation after that examine in microscope. Result – round budding spores (surrounded by colorless capsule )

12. Culture of CSF Culturing the specimen :- (if CSF contain cell and total protein are raised. Inoculate chocolate agar – incubate in carbon dioxide Incoculate – MacConkey agar and blood agar in the case of specimen collected from a new bornt infant. Incoculate sabouraud agar if cryptococci meningitis is suspected 1. Examine the chocolate agar plate For Neisseria meningitis's Hemophilus influenzae Streptococcus pneumonia 2. Examine the MacConkey agar and blood agar plates for. Escherichia coli Staphylococcus aureus Streptococcus agalactia Note:- whenever passible perform biochemical test to confirm the result.

13. Causes of CSF CSF (Cerebrospinal Fluid) can be caused by a variety of factors, including: Normal production and circulation of CSF Infections or inflammation of the brain or spinal cord Head injury or trauma Brain tumors or other abnormalities Hydrocephalus (excess CSF accumulation in the brain)Bleeding in the brain or spinal cord Certain medications or medical procedures Autoimmune disorders affecting the nervous system.

14. Symptoms The symptoms of CSF (Cerebrospinal Fluid) vary depending on the underlying cause and can range from mild to severe. Some common symptoms of CSF include: Headaches Nausea and vomiting Stiff neck or back Vision problems Sensitivity to light Hearing problems Cognitive difficulties seizures Loss of balance and coordination Incontinence or urinary problems Sleep disturbances Fatigue It's important to note that some cases of CSF may not produce any noticeable symptoms. If you're experiencing any of the above symptoms, it's important to seek medical attention promptly as they may indicate a serious underlying condition.

15. Diagnosis of CSF CSF Chemical Tests Protein level : This test measures the amount of protein in the CSF. Elevated levels of protein can be a sign of inflammation or damage to the nervous system. Glucose level : This test measures the amount of glucose in the CSF. Decreased levels of glucose can be a sign of bacterial meningitis or other infections. CSF lactate dehydrogenase (LD, LDH) —used to differentiate between bacterial and viral meningitis; the level is usually increased with bacterial meningitis and not with viral meningitis; may also be elevated with leukemia or stroke. Tumor markers —carcinoembryonic antigen ( CEA ), alpha-fetoprotein ( AFP ), and human chorionic gonadotropin ( hCG ) may be increased in cancers that have spread from other sites in the body (metastatic) ).

16. Cell Counts, Differential and Microscopic Exam CSF total cell counts Red blood cell (RBC) count—normally no red blood cells are present in the CSF. The presence of red blood cells may indicate bleeding into the CSF or may indicate a “traumatic tap” – blood that leaked into the CSF sample during collection. White blood cell (WBC) count—normally very few white blood cells are present. A significant increase in white blood cells in the CSF can be caused by infection or inflammation of the central nervous system. CSF white blood cell (WBC) differential —identifies and counts the different types of WBCs that are present. Small numbers of lymphocytes, monocytes (and, in neonates, neutrophils) are normal in a sample of CSF. CSF Gram stain —this test is always performed on CSF when infection is suspected. A sample of CSF is centrifuged and the concentrated portion is placed on a slide and treated with a special stain. A laboratory professional examines the slide using a microscope to look for bacteria or fungi, which can indicate bacterial or fungal meningitis. CSF culture —culture is used to detect any bacteria or fungi in the sample. A negative culture does not rule out an infection because the microbes may be present in small numbers or unable to grow in culture due to prior antibiotic therapy. CSF AFB testing—used to detect infection with mycobacteria, such as  Mycobacterium tuberculosis;  molecular tests  specific for  M. tuberculosis  may be performed when tuberculosis is suspected.

17. MRI (magnetic resonance imaging) - CSF can indicate conditions such as hydrocephalus, which is an abnormal buildup of CSF in the brain. In addition, the appearance of CSF in the brain and spinal cord can provide important information for the diagnosis of conditions such as multiple sclerosis or other demyelinating disorders. In combination with other diagnostic tests, such as CSF analysis and clinical examination, CSF MRI can provide important information for the diagnosis and management of various neurological conditions.

18. CT scan – This imaging test uses a combination of X-rays and computer technology to create detailed images of any part of the body, including bones, muscles, fat, and organs. CT scans are more detailed than general X-rays. They are used to diagnose disorders of the brain, spine, or other parts of the nervous system. Electroencephalogram (EEG). This test records the brain's continuous electrical activity through electrodes attached to the scalp. Ultrasound (sonography). This imaging test uses high-frequency sound waves and a computer to make images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function. They also assess blood flow through various vessels.

19. Treatment Lumbar puncture : This is a procedure where a needle is inserted into the lower back to remove a small amount of CSF for diagnostic or therapeutic purposes. CSF replacement : In rare cases, CSF may need to be replaced due to a condition known as hydrocephalus, in which there is an excess buildup of CSF in the brain. This can be done through a procedure known as a ventriculoperitoneal shunt, which involves redirecting the flow of CSF from the brain to the abdomen.

20. Intrathecal drug delivery: This involves using a small catheter to deliver medication directly into the CSF. This can be an effective way to treat conditions such as chronic pain or spasticity. Intrathecal administration is a route of administration for drugs via an injection into the spinal canal, or into the subarachnoid space so that it reaches the  cerebrospinal fluid  (CSF) and is useful in spinal anesthesia, chemotherapy, or pain management applications Medication - As a hormone produced by the body that stimulates the bone marrow to produce more white blood cells, G-CSF can be taken as a drug that can reduce the severity and duration of neutropenia in patients with some types of cancer. Acetazolamide (ACTZ) Ceftriaxone cefotaxime

21. Prevention Preventing CSF-related neurological conditions often involves reducing the risk factors that can lead to these conditions. Here are some measures that can help prevent CSF-related neurological conditions: Vaccination: Vaccines can prevent several infections that can lead to meningitis and other neurological conditions, such as Haemophiles influenzae type b, meningococcal disease, and pneumococcal disease. Practice good hygiene: Practicing good hygiene, such as washing your hands regularly, can help prevent the spread of infections that can lead to neurological conditions. Wear protective gear: If you are participating in sports or other activities that can lead to head injuries, wearing protective gear, such as helmets, can reduce the risk of a head injury that can lead to CSF-related neurological conditions. Avoid risky behavior: Avoiding risky behavior, such as using illicit drugs or engaging in unprotected sex, can reduce the risk of infections that can lead to neurological conditions. Manage chronic conditions: If you have a chronic condition, such as diabetes or hypertension, managing it effectively can reduce the risk of complications that can lead to CSF-related neurological conditions. Seek prompt medical attention: If you experience symptoms of a neurological condition, such as headaches, neck stiffness, or changes in vision, seek prompt medical attention to prevent the condition from worsening.

22. References Cerebrospinal Fluid (CSF) Testing - Testing.com Hydrocephalus - Symptoms and causes - Mayo Clinic Cerebrospinal Fluid (CSF) Leak: Symptoms & Treatment (clevelandclinic.org) Cerebrospinal fluid - Wikipedia Cerebral Spinal Fluid (CSF) Analysis (healthline.com) V. H. Talib book Praful B. Godkar, Darshan P. Godkar book