Csf

The cerebrospinal Fluid [CSF] is a clear, colorless, transparent fluid present in the cerebral ventricles, spinal canal, and subarachnoid spaces.

1. CSF EXAMINATION Ms Ankita R Bhatiya Assistant Professor Shree P.M.Patel COLLEGE OF PARAMEDICAL SCIENCE N TECHNOLOGY

2. It include: 1.What is CSF? 2.Function of CSF. 3.Collection of CSF. 4. Examination of CSF.

3. CSF Introduction: The cerebrospinal Fluid [CSF] is a clear, colorless, transparent fluid present in the cerebral ventricles, spinal canal, and subarachnoid spaces. CSF Formation: CSF is largely formed by the choroid plexus of the lateral ventricle and remainder in the third and fourth ventricles. CSF is a selective ultrafiltrate of plasma. Small amount of the CSF is also formed from the ependymalcells lining the ventricles and other brain capillaries. There is about 125ml of csf at any one time,and about 500ml is generated every day.

4. CSF Circulation of CSF: Lateral ventricle ↓ Third ventricle ↓ Fourth ventricle ↓ Subarachnoid space of Brain and Spinal cord

5. CSF Composition of CSF :

6. CSF Function of CSF: Protection: It helps to protect the brain and spinal cord from injury by acting like a fluid buffer . Also acts as a medium for the transfer of substances from the brain tissue and spinal cord to blood . Nutrition : Removal of waste : Lubrication :

7. CSF Indication of CSF : Infections: Meningitis,Encephalitis,Myelities , Tuberculosis. 2. Inflammatory conditions: Sarcoidosis , Multiple sclerosis, Guillian Barre syndrome, Neurosyphilis , SLE. 3. Oncologic: Leukemia,Lymphoma 4.Metabolic disorder

8. CSF Collection of CSF: A lumbar puncture also called a spinal tap is a procedure where a sample of cerebrospinal fluid is taken for examination. First performed by Quincke in 1891.

9. CSF Procedure: Take consent of a patient. Ask to sleep in lateral recumbent position. Overlying skin is prepared with antiseptics. It is done by using special lumber puncture needle under local anesthesia.

10. Collection of csf 4. The lumber puncture needle stylet is pushed forward n slightly upward middle between L3 N L4 vertebra. 5.Now the stylet is removed then the pressure is measured by fitting manometer to the needle or by drop counting method. 6. Up to 20 ml of spinal fluid may be normally be removed. 7. CSF is collected in 3 tubes: 1. EDTA Bulb: Cell count n differential count. 2. Flouride Bulb: For glucose examination. 3. Plain Bulb: Chemical n immunology study.

11. CSF Contraindication: In bleeding and coagulation disoeder like hemophilia. Papilloedema (Increase presure around brain part) Septicemia In convulsions condition

12. CSF Complication: Extradural n subdural hematoma. In case of spinal cord tumors , paralysis. Post puncture headache, due to leakage of CSF.

13. CSF Examination of CSF: Physical examination: Chemical examination: Microscopic examination:

14. Examination of CSF Physical examination of CSF: 1.Volume: Normally – 100 to 150 ml Abnormally – More than 150 ml Condition: Meningitis( Bacterial, Viral,Fungal ) Encephalitis Subarachnoid hemorrhage Tuberculosis Multiple sclerosis Guilliain barre syndrome

15. Physical examination of CSF: 2. color : Normally: colorless Abnormally: Light yellow: Presence of billirubin Orange: Hypercarotenemia Brown: Melanin Green: Pseudomonas infection

16. Physical examination of CSF: 3.Appreance: Normally: Clear or transparent Abnormally: Turbid: Bacterial n viral meningitis.Tuberculosis Cloudy: Bacterial n fungal meningitis Purulent: Bacterial meningitis Xanthochromia : Meningitis( Bacterial,viral,fungal ) Subarchnoid hemorrhage, Guillain barre syndrome

17. Physical examination of CSF 4. Clot: Normally: absent Abnormally: Present Firm clot: Pyogenic meningitis Cob-web: Tuberculous meningitis 5.Viscosity: Normally: Same as water Abnormally: High viscous Meningitis Multiple sclerosis

18. Physical examination of CSF 6. Opening pressure: Normal: Inadult : 90 to 180mmH 2 O Young children: 10 to 100 mmH 2 O Abnormal: Increase opening pressure Hypertension, Congestive heart failure, Meningitis Superior vena cava syndrome,Thrombosis Cerebral edema Decreased opening pressure spinal subarchnoid block Dehydration Circulatory collapse Csf Leakage

19. Chemical examination of CSF 1.Glucose: Normal range: 40-85mg/dl Method: 1.Visualised method Benedict test 2.Colorimetric method GOD-POD Condition for decrease glucose: Bacterial meningitis, Viral meningitis Fungal meningitis Subarachnoid hemorrhage, Tuberculous meningitis

20. Chemical examination of CSF 2. Protein: Normal range: 15-45mg/dl Method: 1.Turbidometric method method SSA Heat n acetic acid 2.Colorimetric method Biuret Condition for Increase protein: Meningitis( Bacterial,fungal,viral ) Multiple sclerosis Syphilis

21. Chemical examination of CSF 3.Chloride : Normal range: 110-125mEq/L Method: 1.Turbidometric method 2.Colorimetric method Condition for decrease Chloride: Meningitis (Bacterial, fungal, viral) Tuberculous meningitis Vomiting

22. Chemical examination of CSF 4.Globulin: Method: 1.Turbidometric method Pandy’s Test Condition for increase Globulin: Multiple sclerosis Guillain barre syndrome

23. Chemical examination of CSF Special Test: 1.CSF Protein electrophoresis: Multiple sclerosis Lyme disease 2. CSF IgG : Multiple sclerosis Herpes encephalitis Connective tissue disease 3. CSF Lactic acid: Increase in bacterial n fungal meningitis Normal in Viral meningitis

24. Chemical examination of CSF Special Test 4. CSF Lactate dehydrogenase : Increase in bacterial meningitis Leukemia Stroke 5. CSF Glutamine: Increase in liver disease Hepatic encephalopathy 6.CSF C-Reactive protein: Increase in bacterial meningitis 7.Tumor marker: CEA,AFP,HCG Increase in metastatic

25. Microscopic examination of CSF 1.TLC (Total leukocyte count): Normally: 0-50 cell/ ul Method: Same as Blood Condition in increase TLC count: Bacterial Meningitis Viral Meningitis Fungal Meningitis Parasitic Infection Syphilis Tuberculous meningitis

26. Microscopic examination of CSF 2. DC: Method: Same as Blood Neutrophilia : Bacterial Meningitis Subarachnoid hemorrhage Tuberculous Meningitis Encephalitis,Metastatic Tumor Fungal Meningitis Lymphocytosis : Viral Meningitis, Laptospiral Meningitis Parasitic Infection, CNS Disorder Leukemia, Guillain Barre syndrome Eosinophilia : Parasitic Infection Primary brain tumor Leukemia

27. Microscopic examination of CSF 3.Gram’s Stain: Normally: Bacteria absent Abnormally: Bacteria present Clinical Condition: Bacterial Meningitis Encephalitis Bacteria: Group B streptococcus Neisseria Meningitis, S.pneumoniae Homophiles influenza 4.AFB Stain: Normally: Bacteria absent Abnormally: Bacteria present Clinical Condition: Tuberculous Meningitis Bacteria: Mycobacterium Tuberculosis