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CSF PPT.pptx important topic on the image and hematology
- 1. IDENTIFY ETIOLOGY OF MENINGITISBASED ON CSF FINDINGS
- 2. ANATOMY AND PHYSIOLOGY •Cerebrospinal fluid (CSF) is present within the subarachnoid space surrounding the brain in the skull and the spinal cord in the spinal column. • It is a clear , colorless , transparent fluid present in the cerebral ventricles, spinal canal and subarachnoid spaces. • Formed mainly by choroid plexus
- 3. Function of CSF •_It's main function is to protect the brain and the spinal cord from injury by acting as a fluid cushion. • It is the medium through which nutrients and the waste products are transported between brain/spinal cord and the blood.
- 4. Formation of CSF •CSF is derived by ultra filtration of plasma and by secretion through the choroid plexus located in the ventricles of the brain. • Reabsorbtion of CSF occurs at the arachnoid villi which projects in the venous sinuses in the duramater. • CSF is produce at the rate of 500 mL/day. • Rate of formation – about 20ml/hr
- 5. Circulation of csf •Lateral ventricle foramen of monro third ventricle cerebral acqueduct fourth ventricle foramen of Luschka subarachnoid space of brain and spinal cord
- 6. Indication of csfexamination Diagnosis of suspected cases- 1) CNS Infections: Meningitis, Encephalitis 2) Inflammatory conditions: multiple sclerosis, Guillain bare syndrome. 3) Infiltrative conditions: Leukemia, lymphoma 4) Administration of drug in CSF (therapeutic aim): Antibiotics Anticancer drugs Anesthetic drugs 5)Introduction of radiographic contrast media for myelograpghy.
- 7. Complications of Lumbarpuncture A)Post puncture headache (d/t leakage of csf) B)Introduction of infection if aseptic precautions. C)Herniation of brain D) Dry tap (failure to obtain csf)
- 8. Contraindication of lumbarpuncture • Patient does not give consent. • Raised intracranial pressure • Skin infection at puncture. • Coagulpathy/ bleeding disorder • Any mass lesion at or above lumbar puncture site.
- 9. Csf collection • Lumbarpuncture • Cisternal puncture • Lateral cervical puncture • Site: adult L3-L4 OR L4-L5 • Infant/children L4-L5
- 10. Lumbar puncture needle •Atraumatic needle • Standard needle
- 11. Composition of csf Totalvolume-100-150ml( 10-60ml in newborn) Opening pressure – 60-180mmhg ( 10-100mmhg in children/ infant). Appearance- clear and colourless WBC- adult- 0-5 cells/cumm infants- 0-30 cells/cumm 1-4 yrs-0-20 cells/cumm 5-18 yrs- 0-10 cells/cumm Erthrocytes - none • Protein - 15-45 mg/dl • Glucose - 45-80 mg/dl • Lactate -9-26mg/dl • Bilirubin - Absent • Oligoclonal band - negative ( increase production of protein )
- 12.
- 13. • After collectioncsf sample should be sent to lab immediately, and examined without delay. - Cells disintegrate rapidly - Reduction of glucose (Glycolysis) • Examined within 1 hour of collection . • Specimen for bacterial culture should not be refrigerated, because fastidious organism do not survive in cold temperature.
- 14. GROSS EXAMINATION • OPENINGPRESSURE • APPEARANCE • VISCOSITY
- 15. OPENING PRESSURE • Byattaching Manometer to hub of spinal needle . • CSF Opening pressure 60-180mmH20 Adults • 10-100mmH20 Newborn • CSF PRESURE INCREASED- CSF PRESSURE DECREASED- • Tense/Anxious patients - Leakage of spinal fluid • Intracranial mass lesion -complete spinal block (tumour) • Meningitis • SAH
- 16. GROSS APPEARANCE • Normallyclear and colourless with no clot. • Abnormal csf :- Turbid - blood mixed Xanthochromic clot formation ( increased protein)
- 17. TURBIDITY • WBC- >200cells/ul • RBC->400CELLS/ul • Microorganism –bacteria , fungi . • Aspirated epidural fat • Protein level >150mg/dl.
- 18. Clot formation • Traumatictap • Complete spinal block ( froin’s syndrome). • Suppurative or tuberculous meningitis • Not seen in SAH.
- 19.
- 20. Differential diagnosis ofbloody csf • Usually indicate presence of blood . • Grossly bloody when red blood cell counts exceed 6000/ul. • Causes- SAH -Intracerebral hemorrhage -cerebral infarct -traumatic spinal tap
- 21. MICROSCOPIC EXAMINATION • TOTALCELL COUNT • DIFFERENTIAL CELL COUNT
- 23. DIFFERENTIAL CELL COUNT •Preparation by centrifuge • Other technique- cytocentrifuge, sedimentation , filtration • Normally Lymphocytes and monocytes are present in small numbers in a ratio of 70:30 • . Monocytes are more in number in neonates and children.
- 24.