Cerebrospinal Fluid -Composition, function, CSF Examination As the channel name suggests, our channel will be a perfect lounge for the malayali medicos..we wil be covering videos which will be like lecture classes related to the subjects biochemistry and microbiology in which we are specialised.. It will be a better learning experience for the students especially for those who are not able to understand and follow the normal classes in college..we assure the students that you will get a basic idea regarding the topic and extra reading can be done from the reference textbooks.. Qualification AHLAD T O MSc MLT (Biochemistry) Assistant Professor Baby memorial college of allied Health science Kozhikode Maneesha M Joseph MSc MLT (Microbiology) Assistant Professor Baby memorial college of allied Health science Kozhikode Our Partner Channel Health & Voyage channel link - https://youtu.be/nzKqRVjlwc0 #CSF #cerebrospinalfluid #Biochemistry #Medical #Microbiology #Mallu Medicos Lounge ##MalluMedicosLounge #MLT #Channel introduction #HealthAndVoyage #New Youtube Channel introduction #Csf examination #CSF Tutorial

1. Cerebrospinal Fluid
AHLAD TO
Assistant Professor
Baby Memorial college
Kozhikode
VIDEO CLASS OF THIS TOPIC IS UPLOADED IN – YOUTUBE CHANNEL MALLU MEDICOS LOUNGE
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2. Cerebrospinal fluid
Formation and Physiology
• ~First recognized by Cotugno in 1764, CSF is the third major
fluid of the body.
PHYSIOLOGIC SYSTEM
1.To supply nutrients to the nervous system
2.To remove metabolic wastes
3.To produce a mechanical barrier to cushion the brain and
spinal cord against trauma.
MENINGES LAYERS
1.Dura mater - outer layer
2.Arachnoid mater - middle layer
3.Pia mater - inner layer
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3. Anatomy and Physiology
• It is present within the subarachnoid space
• Surrounding the brain in the skull and the spinal cord
• In the spinal column.
• Daily production 500 mL
• Total volumes:
• Adults: 140 - 170 mL
• Children: 10 - 60 mL
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4. (a semipermeable membrane separating the blood
from the cerebrospinal fluid, and constituting a
barrier to the passage of cells, particles, and large
molecules.)
Functions of CSF
•To protect the brain and the spinal cord from injury
•Acts as blood brain barrier
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5. •CSF flows through the subarachnoid space between the arachnoid
and pia mater
•20 ml of fluid produced every hr in choroids plexus and reabsorbed by
arachnoid villi
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6. Specimen Collection and handling
• CSF is collected by lumbar puncture between third, fourth, fifth
lumbar vertebrae. It requires certain precautions and careful
technique to prevent the introduction of infection or the damaging of
neural tissue.
• CSF usually collected in three sterile tubes
Label 1 / Tube 1 – used for microbiology lab
Label 2 / Tube 2 – used for chemical and serologic test
Label 3 / Tube 3 – used for hematology (cell count)
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9. Clinical Application
In the diagnosis of
• Bacterial, viral or fungal meningitis.
• Encephalitis.
• Malignant infiltrates like in acute leukemia,
lymphoma.
• Subarachnoid hemorrhage.
• Spinal canal blockage leading to elevated
intracranial tension.
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10. •metastatic tumors (e.g., leukemia) and
central nervous system tumors that shed
cells into the CSF
•Syphilis
•bleeding (hemorrhaging) in the brain and
spinal cord
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11. Characteristics of normal CSF
• Color - Colorless
• PH - 7.28 – 7.32
• Appearance - Clear
• Sp. Gravity - 1.003 – 1.004
• No clot formation on standing
• Total solids - 0.85 – 1.70 g/dL
• PO2 - 40 – 44 mmHg
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12. Composition of Normal CSF
• Protein - 15 - 45 mg/dL
• Glucose - 50 - 80 mg/dL
• Urea - 6.0 - 16 mg/dL
• Uric acid - 0.5 - 3.0 mg/dL
• Creatinine - 0.6 - 1.2 mg/dL
• Cholesterol - 0.2 - 0.6 mg/dL
• Ammonia - 10 – 35 μg/dL
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13. • Sodium - 135 – 150 mEq/L
• Potassium - 2.6 – 3.0 mEq/L
• Chloride - 115 – 130 mEq/L
• Magnesium - 2.4 – 3.0 mEq/L
• Cells - 0 – 5 Lymph/µL
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14. Total protein
Determination:
• Sulphosalicylic acid test.
• Pandy’s test.
• Biuret method.
• Trichloroacetic acid method:
Interpretation:
• Lumbar CSF range is 15 – 45 mg/dl
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15. • ↑ due to blood-CSF & brain-CSF barriers breakdown as a
consequences of inflammation or CSF flow obstruction.
• bacterial
• fungal meningitis,
• tumors,
• subarachnoid hemorrhage,
• traumatic tap.
• Multiple sclerosis- small increase in both cells & TP
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16. Glucose:
• The normal range for lumbar is 45 – 80 mg/dL
• Ventricular range as same as plasma.
• In bacterial meningitis – may be completely absent.
• In Tuberculous meningitis – 10 – 40 mg/dL
• In Viral meningitis – Normal
• Cryptococcosis is accompanied by low level
• In syphilitic meningitis – Normal
• Hypoglycemia & carcinomatous infiltration of
meningitis – low level
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17. METHODS
1.Glucose oxidase peroxidase method (GOD-POD)
2.Ortho toluidine method.
3.Benedict’s quantitative test.
4.Quantitative test: Modified Folin - Wu method
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18. • Increased CSF glucose is of no clinical significance.
Causes of decreased CSF glucose
• Meningitis-Bacterial, fungal tubercular and syphilitic
meningitis.
• Tumors involving the meninges.
• Subarachnoid hemorrhage.
• Cerebral ameobiasis.
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19. Chloride:
Silver nitrate titration method
• Range is 115 – 130 mEq/L
• Decrease seen in meningitis b/n 100 – 115 mEq/L
• In Tuberculous meningitis decrease seen
• In viral & all other neurological states- normal unless
plasma conc is reduced.
• Increase seen in hyperchloraemic acidosis of chronic
renal failure.
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20. Enzymes:
• AST increases in metastatic carcinoma following
cerebral infarction and in some cases of multiple
sclerosis.
• LDH: Elevated in bacterial and fungal meningitis,
malignancy, subarachnoid hemorrhage.
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21. Xanthochromia
• Pink, orange, or yellow discoloration
• RBC lysis or hemoglobin breakdown
• Severe jaundice
• May be seen within hours of LP
• Peak intensity at 24 - 36 hours
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22. Disease with the CSF findings:
1. Acute meningitis:-
a). Bacterial Meningitis:-
- Appearance: opalescent or purulent (usually)
- Cells: > 1000 x 106/L (P)
- TP: 1.0 & 4.0 g/L
- Glucose: Low/Absent
- Chloride: ↓ 110 – 115 mmol/L
- Organisms: Streptococci, Staphylococci,
pneumococci, meningococci
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23. b). Viral Meningitis:
- Appearance: Clear
- Cells: 50 - 1500 x 106/L (L)
{In Lymphocytic choriomeningitis- 1000 x 106/L (mainly M, some P with
glucose 20 mg/dL)}
- TP: 0.5 - 1.0 g/L
- Globulin: +ve
- Glucose: Normal
- Chloride: Normal
- Organisms: Picornavirus, Poliomyelitis, Arenavirus,
Paramyxovirus, Herpes virus, Epstein Barr Virus
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24. 2. Subacute & Chronic Meningitis:
a). Tuberculous meningitis:
- Appearance: Clear & colourless
- Cells: 10 – 350 x 106/L (usually 100 x 106/L)
L & P (early)
- TP: 0.5 – 2.0 g/L (web on standing 24h with entangled
bacilli).
- upto 4.0 g/L (in delayed treatment)
- Glucose: < 57 mg/dL (complete absent rare)
- Chloride: 100 mmol/L
- Org.: Mycobact, tuberculosis
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25. 3. Acute Encephalitis:
- cells response vary with the virus involved.
- Cells: 50 – 500 x 106 /L (L & also P; Red cells in Herpes
simplex encephalitis)
- Globulin: +ve
- TP: 1 – 2 g/L
4. Subacute & chronic Encephalitis (Neurosyphilis):
- Appearance: Clear, colourless (without coagula)
- Pressure: ↑ed to 200 mm
- Cells: 20 – 100 x 106 /L (mainly M)
- TP: 0.5 – 1.0 g/L
- Glucose & Chloride: Normal
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26. Test Appearance Pressure WBC/μL Protein mg/dL Glucose mg/dL Chloride
Normal CSF Clear 90 – 180 mm 0-8 lymph. 15-45 50-80 115-130 mEq/L
Acute bacterial
meningitis
Turbid Increased 1000 -10000 100 – 500 < 40 Decreased
Viral meningitis Clear Normal to
moderate
increase
5-300, rarely
>1000
Normal to mild
increased
Normal Normal
Tubercular
meningitis
Slightly opaque
cobweb
formation
Increased/
decreased,
spinal block
100-600 mixed
or lymph.
50-300 due to
spinal block
Decreased Decreased
Fungal
meningitis
Clear Increased 40-400 mixed 50-300 Decreased Decreased
Acute syphilitic Clear Increased About 500
lymph
Increased but
<100
Normal normal
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