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Csf analysis

csf

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Csf analysis

  1. 1. CSF ANALYSIS INTERPRETATION
  2. 2. 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
  3. 3. Composition of Normal CSF  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
  4. 4. 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
  5. 5. Diagnosis by CSF • High sensitivity, high specificity – Bacterial, TB, and fungal meningitis • High sensitivity, moderate specificity – Viral meningitis, SAH, CNS syphilis, abscess • Moderate sensitivity, high specificity – Meningeal malignancy • Moderate sensitivity, moderate specificity – Intracranial hemorrhage, viral encephalitis, subdural hematoma
  6. 6. Xanthochromia • Pink, orange, or yellow discoloration • RBC lysis or hemoglobin breakdown • May be seen within hours of LP • Peak intensity at 24 - 36 hours • RBC > 6000/μL (SAH, ICH, infarct, traumatic) • Oxyhemoglobin, bilirubin, increased protein • Carotinoids, melanin, rifampin therapy
  7. 7. Reference Intervals for CSF Cell type Adults(%) Neonates(%) Lymphocytes 62 20 Monocytes 36 72 Neutrophils 2 3 Histiocytes Rare 5 Ependymal Rare Rare Eosinophils Rare Rare
  8. 8. Increased Neutrophils in CSF • Meningitis (bacterial, early TB, fungal) • Other infections • Following seizures • Following CNS hemorrhage • Following CNS infarct • Reaction to repeated LP • Foreign materials • Metastatic tumor
  9. 9. Increased Lymphocytes in CSF • Meningitis (aseptic, viral, L monocytogenes) • Parasitic infections • Degenerative disorders – Encephalopathy due to drugs, GBS • Other inflammatory conditions – Sarcoidosis, polyneuritis, periarteritis involving the CNS
  10. 10. Increased CSF Total Protein • Increased blood-CSF permeability – Meningitis (bacterial, fungal, TB) – Hemorrhage (SAH, ICH) – Endocrine disorders – Mechanical obstruction (tumor, disc, abcess) – Neurosypilis, MS, CVD
  11. 11. •Causes of decreased CSF glucose • Increased CSF glucose is of no clinical significance. • Meningitis-Bacterial, fungal tubercular and syphilitic meningitis. • Tumors involving the meninges. • Subarachnoid hemorrhage. • Cerebral ameobiasis.
  12. 12. Bacterial Meningitis • 0 - 1m: Group B strept & E. coli (GNR) • 1m - 5y: H. influenzae • 5 - 29y: N. meningitidis • >29y: S. pneumoniae • Listeria monocytogenes common in newborns, elderly, and other immunocompromised hosts
  13. 13. 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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