Test Of Cerebrospinal Fluid And Serous Membrance Effusion


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Test Of Cerebrospinal Fluid And Serous Membrance Effusion

  1. 1. Test of Cerebrospinal Fluid and Serous Membrane Effusion Zhongsheng Xia The Second Affiliated Hospital, Sun Yat-sen University
  2. 2. <ul><li>Test of cerebrospinal fluid (CSF) </li></ul><ul><li>Test of serous membrane effusion </li></ul>
  3. 3. Test of CSF <ul><li>Indications and contraindications of lumbar puncture </li></ul><ul><li>Normal reference value of CSF and clinical significance of abnormality </li></ul><ul><li>Characteristic changes of CSF in common central nervous system diseases </li></ul>
  4. 4. Test of serous membrane effusion <ul><li>clinical significance of serous membrane effusion </li></ul><ul><li>Differentiation of transudate and exudate </li></ul>
  5. 5. The cerebrospinal fluid (CSF) <ul><li>Definition: CSF is a clear, colorless liquid that fills the ventricles, the subarachnoid spaces surrounding the brain and the spinal cord. </li></ul><ul><li>Anatomy: </li></ul>
  6. 6. <ul><li>Indications of lumbar puncture </li></ul><ul><li>patients with meningeal irritation signs </li></ul><ul><li>patients are suspected to have intracranial hemorrhage </li></ul><ul><li>patients with serious headache, coma, twitch or paralysis </li></ul><ul><li>contraindications of lumbar puncture </li></ul><ul><li>patients with high intracranial pressure </li></ul><ul><li>patients with local infection of the skin in the lumbar area </li></ul>Test of CSF
  7. 7. The position of lumbar puncture: The patient is placed in lateral kneel-chest position with the neck flexed
  8. 8. http://www.chinavbox.cn/show/PWTVH3C3.html Video for lumbar puncture
  9. 9. <ul><li>General test </li></ul><ul><li>Pressure: 80~180mmH 2 O , or 40~50drops/min </li></ul><ul><li>Increased: intracranial infection, intracranial hemorrhage, intracranial tumor, blood hypertension, cough, sneeze, et al. </li></ul><ul><li>Decreased: blocked circulation of CSF, CSF is lost, shock, coma, dehydration, et al. </li></ul>Test of CSF
  10. 10. <ul><li>General test </li></ul><ul><li>Color: colorless and clear </li></ul><ul><li>milk white: pyogenic meningitis </li></ul><ul><li>red: subarachnoid hemorrhage, traumatic hemorrhage, et al. </li></ul><ul><li>yellow: old intracranial hemorrhage, CSF containing a lot of protein, serious jaundice, et al. </li></ul><ul><li>brown or black: meningeal melanoma </li></ul>Test of CSF
  11. 11. <ul><li>General test </li></ul><ul><li>Diaphaneity and clot: clear </li></ul><ul><li>cloudy or clot: meningitis </li></ul>Test of CSF
  12. 12. <ul><li>Chemical test </li></ul><ul><li>Protein : Pandy’s test (-) </li></ul><ul><li>protein quantification: 0.15~0.45 g/L </li></ul><ul><li>increased: encephalic infection, intracranial tumor, intracranial hemorrhage, subarachnoid obstruction, et al. </li></ul><ul><li>Separation of protein and cell: Guillain-Barre syndrome </li></ul>Test of CSF
  13. 13. <ul><li>Chemical test </li></ul><ul><li>Glucose: 2.5~4.4 mmol/L </li></ul><ul><li>decreased: nervous system infection, intracranial tumor, hypoglycemia, et al. </li></ul><ul><li>increased: viral nervous system infection, diabetes, et al. </li></ul>Test of CSF
  14. 14. <ul><li>Chemical test </li></ul><ul><li>chloride: 120~130 mmol/L </li></ul><ul><li>decreased: bacterial or fungal intracranial infection, hypochloremia, et al. </li></ul><ul><li>increased: chronic renal failure, hyperchloremia, et al. </li></ul>Test of CSF
  15. 15. <ul><li>Chemical test </li></ul><ul><li>Enzyme: LDH=1/10 serum level, ADA=0~8U/L </li></ul><ul><li>high: nervous system bacterial infection, </li></ul><ul><li>cerebrovascular disease, cerebroma </li></ul>Test of CSF
  16. 16. <ul><li>Microscopic examination </li></ul><ul><li>Cell count: white blood cell (0~10) ×10 6 /L </li></ul><ul><li>no red blood cell </li></ul><ul><li>Cell differential: majority is lymphocyte </li></ul><ul><li>neutrophil is increased: nervous system infection </li></ul><ul><li>lymphocyte is increased: tubercular meningitis, </li></ul><ul><li>fungal meningitis </li></ul><ul><li>plasma cell: viral nervous system infection, </li></ul><ul><li>tuberculosis, parasite, Guillain-Barre syndrome, et al. </li></ul><ul><li>macrophage: meningitis, subarachnoid hemorrhage, brain </li></ul><ul><li>trauma, et al. </li></ul><ul><li>Pathogen: no pathogen </li></ul>Test of CSF
  17. 17. Characteristic changes of CSF in common central nervous system diseases ↑ : increased; ↓ : decreased; -> : normal No No virus tubercular bacillus Can be found No Pathogen ↑ red blood cell -> or ↑ lymphocyte ↑ lymphocyte ↑ lymphocyte ↑ neutrophil 0~10 lymphocyte Cell count and differential (×10 6 /L) -> -> -> ↓ ↓ 119~129 Chloride (mmol/L) ↑ -> -> or ↑ ↓ ↓ 2.5~4.5 Glucose (mmol/L) ↑ ↑ ↑ ↑ ↑ 0.2~0.4 Protein (g/L) (quantitative) + + + + + - Protein (qualitative) red colorless or yellow clear or mild cloudy mild cloudy cloudy clear Gross appearance ↑ ↑ ↑ ↑ ↑ 80~180 Pressure (mmH 2 O) Subarachnoid hemorrhage Brain tumor Viral meningitis Tubercular meningitis Pyogenic meningitis normal
  18. 18. ascites Pleural effusion Pericardial effusion
  19. 19. Test of serous membrane effusion <ul><li>General test </li></ul><ul><li>color </li></ul><ul><li>transudate: light yellow </li></ul><ul><li>exudate: dark yellow, red or milk white. </li></ul><ul><li>diaphaneity </li></ul><ul><li>transudate: clear </li></ul><ul><li>exudate: cloudy </li></ul><ul><li>gravity </li></ul><ul><li>transudate: <1.018 </li></ul><ul><li>exudate: >1.018 </li></ul>
  20. 20. <ul><li>Chemical test </li></ul><ul><li>Protein </li></ul><ul><li>Rivalta test (qualitative analysis) </li></ul><ul><li>transudate: negative </li></ul><ul><li>exudate: positive </li></ul><ul><li>quantitative analysis </li></ul><ul><li>transudate: <25 g/L </li></ul><ul><li>exudate: >30 g/L </li></ul>Test of serous membrane effusion
  21. 21. <ul><li>Chemical test </li></ul><ul><li>Glucose </li></ul><ul><li>transudate: similar to serum glucose </li></ul><ul><li>exudate: decreased </li></ul><ul><li>pyogenic inflammation: <1.12 mmol/L </li></ul><ul><li>tuberculosis: <3.30 mmol/L </li></ul><ul><li>malignant: 1.68~3.30 mmol/L </li></ul>Test of serous membrane effusion
  22. 22. <ul><li>Chemical test </li></ul><ul><li>Enzyme </li></ul><ul><li>LDH </li></ul><ul><li>transudate: similar to serum LDH </li></ul><ul><li>exudate: increased </li></ul><ul><li>ADA </li></ul><ul><li>transudate: similar to serum ADA </li></ul><ul><li>exudate: increased </li></ul>Test of serous membrane effusion
  23. 23. <ul><li>Microscopic examination </li></ul><ul><li>cell count </li></ul><ul><li>red blood cell </li></ul><ul><li>increased: malignant, tuberculosis, trauma </li></ul><ul><li>white blood cell </li></ul><ul><li>transudate: <100×10 6 /L </li></ul><ul><li>exudate: >500×10 6 /L </li></ul>Test of serous membrane effusion
  24. 24. <ul><li>Microscopic examination </li></ul><ul><li>cell differential </li></ul><ul><li>neutrophil increased: pyogenic, early tuberculosis </li></ul><ul><li>lymphocyte increased: tuberculosis, syphilitic, malignant </li></ul><ul><li>eosinophil increased: allergic disease, parasites, SLE, et al. </li></ul>Test of serous membrane effusion
  25. 25. <ul><li>Microscopic examination </li></ul><ul><li>cytology examination </li></ul><ul><li>cancer cell: malignant </li></ul>Test of serous membrane effusion
  26. 26. Differentiation of transudate and exudate can be positive >0.5 >0.6 >200 IU negative <0.5 <0.6 <200 IU Pathogen Fluid/serum Protein Fluid/serum LDH LDH neutrophil, lymphocyte,etc lymphocyte Cell differential >500×10 6 /L <100×10 6 /L Cell count decreased Similar to serum glucose Glucose >30g/L <25 g/L Protein quantitate positive negative Rivalta test >1.018 <1.018 Gravity cloudy clear diaphaneity yellow, red or green light yellow Gross appearance infection, malignant, etc. not from infection or tumor Main cause exudate transudate
  27. 27. uestions <ul><ul><li>What are the characteristic changes of CSF in common central nervous system diseases? </li></ul></ul><ul><ul><li>What are the differential points of transudate and exudate in serous membrane effusion? </li></ul></ul>Q
  28. 28. CSF is a clear, colorless liquid that fills the ventricles, the subarachnoid spaces surrounding the brain and the spinal cord. Its total volume is approximately 90~150ml.
  29. 29. Measure pressure of CSF with manometer