Public Health and Community Medicine byIlyas and Ansari (Pakistani Author) • Lecture Notes

1. Clinical Pathology
Presented By: (Boys) Group 3
Submitted To: Madam Mishal
From BS(Hons) MLT-3
1. Muhammad Asim (Head)
2. Khizar Hayat
3. Muhammad Usman
4. Ali Haider
Topic: Examinationof CSF

2. CerebroSpinal Fluid : (CSF)
• CSF is clear, colorless and transparent fluid present
in the brain (subarachnoid space) and spinal cord.
• Approximately 125 - 150 ml of CSF is present in brain
and spinal cord.
Formationof CSF:
• CSF largely formed by the coroid plexus of the lateral
ventricle and reminder in the third and fourth
ventricles.
• CSF is a selective ultrafiltration of plasma.
• Approximately 500 – 600 ml CSF produced daily.

3. Function of CSF:
• Provide protection and support to the brain
and spinal cord.
• It acts as a shock absorber and provide
protection to the soft part of the brain.
• Carries nutrients and remove waste products.
• It keep moist brain and spinal cord.
Purpose/Diagnosis of CSF collection:
• Meningitis ( bacteria, virus, fungi, protozoa)
• Infectious diseases of brain and spinal cord
• Detect inflammatory conditions

4. • Spinal cord tumor
• For diagnosis of virus infection such as Rabies virus
present in the saliva of dogs. (Cats,mouse,foxes)
Destroy brain cells
Collection of CSF:
• Cerebrospinal fluid is collected by lumber puncture (LP)
under strict aseptic conditions similar to any surgical
procedure.
• An experienced physician or well trained nurse collect the
CSF sample.
• After properly positioning the patient the sterile LP needle
with the stylet is inserted between third and fourth lumber
vertebrae to a depth of 4 – 5 cm.

5. • The stylet is withdrawn and the fluid flows freely into a
sterile test tube through the needle.
• The total amount between 6 – 7 ml of CSF is collected in
three sterile tubes, which are chemically cleaned and
washed with distilled or deionized water.
• The needle is remove and the area is cleaned and
bandage over the needle site.
• After collection test start within
hour.
• Do not refrigerate sample if
bacteriological examination.
Because Neisseria meningitidis
killed 2 – 8 degree Celsius.

6. Physical examination of CSF :
• Normally CSF is colorless and clean If color of CSF is change due
to some reason:
• Yellow CSF due to Bilirubin (jaundice) Xanthrochromia
• Red CSF due to RBC
• Turbid CSF due to WBC
• Specific Gravity .…. 1.003-1.008 determined by Refractometer
• Appearance ..…. Clear, liquid form If cloudy due to pus
formation
• PH … 7.3-7.4 check by litmus paper.
• Normally no clot..… Clot is formed in the presence of fibrinogen
when BBB is disturbed.

7. Microscopic examination of CSF :
• For direct microscopy take clean and dry slide.
• Add one drop of CSF on slide.
• Now place cover slip on drop and observeunder
microscope.
Blood cell examination :
For the detection of cell in CSF special type of staining
used called Leashman Stain.
1. Increase neutrophils:
• Bacterial meningitis
• The early stage of TB
• cerebral abscess

8. 2. Increase Lymphocytes :
• Leukemia
• Lymphoma
• Tuberculosis meningitis
3. Increase Monocyte :
• Chronic meningitis
• Tumor
4. Increase Eosinophils :
• Parasitic infection
• Fungal infection

9. Bacteriological Examination :
• CSF is best for diagnosis bacterial meningitis.
• For diagnosis of bacteria a special type of staining
used called Gram staining.
• For diagnosis of TB bacteria Acid Fast Staining
(AFS) used.
Biochemistry Examination :
Normal protein in CSF 15 - 45 mg/dl
If increase due to :
• Bacterial meningitis
• Viral meningitis
• Cerebral hemorrhage

10. Glucose Examination :
Normal glucose level in CSF
50 - 80 mg/dl
Increase glucose level in CSF due to
Diabetes mellitus