1
Q
Structure of brain
A
- Cerebrum made of white and gray matter and divided into 4 lobes
- Brainstem connects the brain to the spinal cord
- Cerebellum communicates with the cerebral cortex
- Spinal cord carries information to and from the brain to the body
2
Q
CSF found in
A
Subarachnoid space between the arachnoid layer and the pia matter (outside the arachnoid is dura matter)
3
Q
CSF production
A
- Ventricles: open areas deep in the brain with passageways between them.
- The choroid plexus within the ventricles contribute to CSF
- One thick layer of epithelium surrounding capillaries allows the passage of ions, water, amino acids, protein, and glucose –> ultrafilter plasma to make CSF
4
Q
CSF circulation
A
- CSF goes through ventricles to the subarachnoid space
- CSF enters the venous sinuses of the brain –> arachnoid space –> bloodstream
- Turn over time: 6 hours
5
Q
CSF function
A
- Protect and supports the brain, the spinal cord
- Shock absorber for the movement
- Delivers nutrients
- Washes out metabolic wastes and impurities
6
Q
Lumbar puncture
A
- Adult: 3&4 lumbar space. Children: 4&5 lumbar space
- Sites depends on infections
- Local anesthetic
- Closing CSF pressure should be 10-30 mmHg less than the opening pressure
- Record the pressure and V
7
Q
CSF sample collection
A
- Sample: up to 20mL of CSF
- Pressure: 50-80 mmHg
- 3-4 tubes total in order:
+ chemical and immunologic.
+ microbial testing
+ microscopic of cellular components - If the sample volume is low: 1-2mL when pt has high pressure, infants, 1 tube can be used with priotized tests.
8
Q
CSF sample timing & handling
A
Testing immediately
Chemical: keep frozen (-15 to -30C)
Microbiological: RT
Cell counts and cytology: 2-8C
9
Q
CSF physical appearance
A
- Normal: colorless, clear, watery, no clot
- WBC, protein, bacteria: cloudy, turbid, milky
- Xanthochromic: pink/orange/yellow. RBC degradation products, and others: bilirubin, carotene, protein, melanin
- Hemolyzed/Bloody: RBC. Caused by trauma tap or hemorrhage
10
Q
Trauma tap
A
- Puncture of blood vessel
- Uneven blood distribution among tubes
- No xanthochromia
- Clot formation
- No hemosiderin
11
Q
CSF Microscopic - Normal
A
- WBC < 5 cells/uL: lymphocytes and macrophages
- Neutrophils, RBC: rare to none
- Brain matter: following surgery or infarction, amorphous pink, variable vacuolation, may contain nuclei
- Lining cells (ependymal cells): made up the surfaces of CNS: round, regular nuclei, mature chromatin w/o nucleoli, abundant pink cytoplasm.
12
Q
CSF Microscopic - Abnormal
A
- Neutrophils: bacterial meningitis, early stage of viral, TB, fungal, cerebral hemorrhage, repeat lumbar puncture, injection of medications/radiographic dye.
- Lymphocyte (incr): Viral, TB, fungal meningitis. Multiple sclerosis
- Macrophage: viral meningitis, hemorrhage
- Eosinophils: Parasite, fungal, foreign materials
- Plasma cells: Acute viral infx, chronic inflammation: syphilis, TB, sarcoidosis
13
Q
CSF - Fungal
A
- Cryptococcus (dark nuclei and abundant clear cytoplasm): cause meningitis on both immunocompromised and immunocompetent.
- Antigen testing
14
Q
Cells found in Hemorrhage
A
- Erythrophage: RBC-ingested macrophages, seen within hours, can be artifacts in an old specimen
- Hemosiderin Laden Macro: hemosiderin-ingested macrophage (iron storage), shows up after days and last months
- Endothelial cells: strands of meningeal or endothelial cells. Following intracranial procedure
15
Q
Cells found in Malignancy
A
- Melanoma: round nu, pale blue cytoplasm, not similar bw cells. Metastatic melanoma
- AML: distinct nucleolus, blue cytoplasm, pink granule nu
- ALL: no nucleolus, pale cytoplasm, fine chromatin
- Lymphoma: large, mature chromatin, irregular nu, blue cytoplasm
- Carcinoma: large nu, frayed borders, blue cytoplasm, varied vacuoles, “signet-ring” cells
16
Q
Oligoclonal band pattern
A
- Indicate inflammation of CSF: overproduction of Ig in the CNS
- Other conditions: encephalitis, neurosyphilis, GB syndrome,
17
Q
Subarachnoid Hemorrhage
A
- Assess if a pt has bleeding in space between the brain and subarachnoid space
- Analytes: oxyhemoglobin, bilirubin
- RBC released through subarachnoid space degrade releasing oxyhemoglobin and converted bilirubin
18
Q
Subarachnoid Hemorrhage Sample
A
- Deliver within 2 hours
- Protect from light
- Refrigerate up to 72 hrs
- Minimum V = 1.5mL
420 Body fluid
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