CEREBROSPINAL FLUID EXAMINATION

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CEREBROSPINAL FLUID EXAMINATION

• Institute of Diagnostics
• Zhong Ning
• Email ningzhong_at_sdu.edu.cn

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CONTENT

• Preface
• Specimen Collection
• Opening Pressure
• Total cell count
• Differential cell count
• Glucose
• Protein

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Preface

• Cerebrospinal fluid (CSF) is mostly derived
  through the choroid plexuses.
• 500mL/day approximately
• CSF protects the brain and spinal cord, and
  collects waste, circulates nutrients, cushions
  and lubricates the central nervous system (CNS).

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The blood-brain barrier

• BBB is a concept derived from dye-exclusion
  studies rather than a specific anatomic
  structure.
• Certain substances in the CSF are tightly
  regulated by specific transport systems.

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Specimen Collection

• Lumbar puncture (LP) is the insertion of a needle
  into the subarachnoid space (the area under the
  membrane that surrounds the brain and spinal
  cord) of the lumbar (lower back) region for
  diagnostic or therapeutic purposes. This allows
  access to the cerebrospinal fluid (CSF) in which
  the brain and spinal cord float.
• Although the subarachnoid space can be accessed
  from other levels, the lumbar region is most
  often used as it allows the needle to be inserted
  below the end of the spinal cord.

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Opening Pressure

• Normal opening pressure in adults is 90180mmH2O,
  10100mmH2O in children.

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Elevated pressure

• Congestive heart failure
• Meningitis
• Superior vena cava syndrome
• Cerebral edema
• Mass lesion

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Decreased pressure

• Spinal-subarachnoid block
• Dehydration
• Circulatory collapse
• CSF leakage

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Total cell count DC

• The normal leukocyte cell count in adults is 05
  cells/ul.
• Increased neutrophils
• Bacterial Meningitis
• cerebral abscess
• subdural empyema
• CNS hemorrhage
• CNS infarct

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• Increase Lymphocytes
• Viral meningitis
• Multiple sclerosis

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Glucose

• The normal Glucose is about 60 compared to serum
  level.
• Normal 5080mg/dl
• Elevated Glucose
• Diabetes mellitus, DM
• Decreased Glucose
• Bacterial Meningitis

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Total Protein

• Over 80 of CSF protein content is derived from
  the plasma.
• An increased CSF protein serves as a useful but
  nonspecific indicator of disease.
• Normal level 1545mg/dl.

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Elevated CSF protein

• Reason
• Increased permeability of the blood-brain
  barrier.
• Decreased resorption
• Mechanical obstruction of CSF flow

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Elevated CSF protein

• Arachnoiditis
• Meningitis
• Hemorrhage
• Endocrine/Metabolic disorders

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