Cerebrospinal Fluid 2
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Transcript of Cerebrospinal Fluid 2
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Cerebrospinal FluidCerebrospinal Fluid
PjfvselisanarmtPjfvselisanarmt
CEREBROSPINAL FLUID
pjfvselisanarmt
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Types of FluidsTypes of Fluids
TransudateTransudate is uid pushed through the capillary dueis uid pushed through the capillary due
to high pressure within the capillaryto high pressure within the capillary
ExudateExudate is uid that leaks around the cells of theis uid that leaks around the cells of the
capillaries caused by inammation.capillaries caused by inammation.
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TR!"#$T%"TR!"#$T%"
$ecrease plasma albumin$ecrease plasma albumin
&ncrease venous pressure&ncrease venous pressure
&ncrease venous obstruction&ncrease venous obstruction Cardiac failureCardiac failure
$isturbance of circulation with$isturbance of circulation with
passive congestion and edemapassive congestion and edema
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%'#$T%"%'#$T%"
$amage of mesothelial linings$amage of mesothelial linings
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C(&!&C( C)!$&T&)!"C(&!&C( C)!$&T&)!"
TransudatesTransudates
*ypoproteinemia*ypoproteinemia
Congestive heart failureCongestive heart failure
(iver cirrhosis(iver cirrhosis
%+udates%+udates
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T,P%" )F %'#$T%"T,P%" )F %'#$T%"
"erous"erous
FibrinousFibrinous
"ero-brinous"ero-brinous PurulentPurulent
*emorrhagic*emorrhagic
PutridPutrid ChylousChylous
"erosanguinopurulent"erosanguinopurulent
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Diffrences Transudates Exudates
Origin Non-inflammator Inflammator
p! Al"aline A#i$i#
Spe#ifi# gravit %&'(&)*%&'(&+ ,&'(&)',&'(&+
Coaglation No #lot Clot formation presentProtein %.'( grams ,.'( grms
/l#ose Same 0it1 2loo$ gl#ose Lo0er t1an 2loo$ gl#ose
LD! %3(( IU*L ,3(( IU*L
C1lori$e Lo0er t1an 2loo$ #1lori$e !ig1er t1an 2loo$ #1lori$e
Cells Lmp1o#tes4rare5 Netrop1il 4P6N5
Crstals a2sent Present
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Cerebrospinal FluidCerebrospinal Fluid
PjfvselisanarmtPjfvselisanarmt
CEREBROSPINAL FLUID
4 li7or #ere2rospiralis5
pjfvselisanarmt
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rief historyrief history Robertson claims thatRobertson claims that
C"F came fromC"F came fromamniotic uid byamniotic uid by
conversion of theconversion of the
colloidal moleculescolloidal molecules
throughout thethroughout the
embryonic life.embryonic life.
$omenico Felice Cotugno$omenico Felice Cotugno/ 01234/ 01234
The third major uid ofThe third major uid of
the body.the body.
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The Flow of C"FThe Flow of C"F
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&mportance 5&mportance 5
cts as a mechanical bu6ercts as a mechanical bu6er "erves as an e+cretory channel"erves as an e+cretory channel
"erves as a nutrient to the brain"erves as a nutrient to the brain
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&mportance of C"F nalysis&mportance of C"F nalysis
To detect infection 7 to di6erentiateTo detect infection 7 to di6erentiate
meningitismeningitis
To detect C!" disordersTo detect C!" disorders
To detect subarachnoid blockTo detect subarachnoid block
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8ethod of Collection8ethod of Collection
0. (umbar0. (umbar
puncturepuncture
"ite"ite
9 lumbar :9 lumbar :
7373
/adults4/adults4
9 lumbar 3 79 lumbar 3 7
;; /children4/children4
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(umbar Puncture(umbar Puncture
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Cisternal PunctureCisternal Puncture
RecommendeRecommende
d in casesd in cases
of paralysisof paralysis
andandmeningitismeningitis
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The !eedleThe !eedle
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TubesTubes
0st tube =0st tube = chemistrychemistry
and serologyand serology
>>ndnd
tube =tube =microbiologymicrobiology
sectionsection
::rdrdtube =tube =
hematology sectionhematology section 33ththtube =tube = additionaladditional
testtest
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8acroscopic %+amination8acroscopic %+amination
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'antochromic/pale pink to'antochromic/pale pink to
orangeAyellow4orangeAyellow4 Causes5Causes5
*gb.*gb.
9old hemorrhageAlysed rbc9old hemorrhageAlysed rbc
ilirubinilirubin
9RC breakdown9RC breakdown
ProteinProtein
9 Rbc breakdown9 Rbc breakdown
8elanin8elanin
98eningeal98eningeal
melanosarcomamelanosarcoma
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BrayishBreenishBrayishBreenish
Cause5Cause5
increase pus cellsincrease pus cells
99acute meningitisacute meningitis
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$&FF%R%!T&T&!B "#9RC!)&$ ()CD$&FF%R%!T&T&!B "#9RC!)&$ ()CD
FR)8 TR#8T&C TPFR)8 TR#8T&C TP
"#9RC!)&$"#9RC!)&$
()CD()CD
%ven distribution%ven distribution
of bloodof blood
Clot formationClot formation
Presence ofPresence ofsiderophagesiderophage
Euekensted testEuekensted test
TR#8T&C TPTR#8T&C TP
#neven#nevendistribution ofdistribution of
bloodblood
!o clot!o clot !o siderophage!o siderophage
$9dimer /94$9dimer /94
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Euekensted test / Tobey9yer test4Euekensted test / Tobey9yer test4
8ethod used8ethod used
to detect sub9to detect sub9
arachnoidarachnoid
blockblock
$one by$one by
comprising thecomprising the
internalinternaljugular veinjugular vein
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CHEMICAL EXAMINATION OF CSF
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ProteinProtein
!ormal value5 0;93;mgdl!ormal value5 0;93;mgdl
&ncrease C"F protein may be found in&ncrease C"F protein may be found in55
&nfectionsA meningitisA multiple&nfectionsA meningitisA multiple
sclerosisA hemorrhagesclerosisA hemorrhage
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Eualitative testEualitative test
Ross onesRoss ones
!onne apelt!onne apelt
Pandy@s testPandy@s test !oguchi@s test!oguchi@s test
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Euantitative TestEuantitative Test
Turbidimetric methodTurbidimetric method !ephelometric method!ephelometric method
$ye binding techniGue$ye binding techniGue
iuret methodiuret method
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Blucose &n C"FBlucose &n C"F
)ormal *alue)ormal *alueH ;I 9JI mgdlH ;I 9JI mgdl +ncrease in+ncrease in55
diabetes mellitusdiabetes mellitus
&nfectious encephalitis&nfectious encephalitis
,ecrease in -,ecrease in - *ypoglycemia*ypoglycemia
Pyogenic meningitisPyogenic meningitis
Fungal miningitisFungal miningitisTo+oplasmosisTo+oplasmosis
"ub arachnoid hemorrhage"ub arachnoid hemorrhage
Primary tumor of the brainPrimary tumor of the brain
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ComparisonComparison
Ba#terialBa#terial
meningitismeningitis8iral8iral
meningitismeningitis92er#lar92er#lar
meningitismeningitis
/l#ose/l#ose $e#rease$e#rease normalnormal De#reaseDe#rease
CellsCells P6NP6N lmp1o#teslmp1o#tes lmp1o#teslmp1o#tes
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ChloridesChlorides
!ormal value5 00:90>1 8%E(!ormal value5 00:90>1 8%E(
Tests5Tests5 "chales 7 "chales"chales 7 "chales
Cotlove chloridometerCotlove chloridometer
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(actate(actate
!ormal vaule 5!ormal vaule 5 !ewbornK 0I9>> mgdl /0.0 to 2.1!ewbornK 0I9>> mgdl /0.0 to 2.1
mmol(4mmol(4
)lder children 7 adults H L.I 9>2)lder children 7 adults H L.I 9>2mgdl/0.I H >.L mmol(4mgdl/0.I H >.L mmol(4
s adjuct to detect viral from bacterialAs adjuct to detect viral from bacterialAmycoplasma AtuberculousA and fungalmycoplasma AtuberculousA and fungal
meningitismeningitis
8ethods5 automated analyMers8ethods5 automated analyMers
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BlutamineBlutamine
!ormal value5 J to 0J mgd(!ormal value5 J to 0J mgd(
Reects brain ammonia /ammonia NReects brain ammonia /ammonia Na9ketoglutarate4a9ketoglutarate4
&n cases of coma of unknown origin&n cases of coma of unknown origin
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C"F %nMymesC"F %nMymes
(actate $ehydrogenase/($*4(actate $ehydrogenase/($*4 #PP%R (&8&T5 3I #(#PP%R (&8&T5 3I #(
1I #(1I #(
&soenMymes5&soenMymes5
($0 and ($> 9 produce by the brain cells($0 and ($> 9 produce by the brain cells
($> and ($: H produced by the($> and ($: H produced by the
lymphocyteslymphocytes
($3 and ($; H produced by the($3 and ($; H produced by the
neutrophilsneutrophils
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Creatine DinaseCreatine Dinase
!ormal value5 O; #(!ormal value5 O; #(
O01 mgm(O01 mgm(
CD99 brain is the isoformCD99 brain is the isoform
CD9889 muscles is the isoformCD9889 muscles is the isoform
CD98CD98 HH brain and muscles is the isoformbrain and muscles is the isoform
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ParametersParameters BacterialBacterial iraliral Tu!ercularTu!ercular Fun"alFun"al
#BC#BCc$untc$unt
Ele%ated&NEle%ated&Neutr$'(ilseutr$'(ils
Ele%ated&l)m'Ele%ated&l)m'($c)tes($c)tes
Ele%ated&l)mEle%ated&l)m'($c)tes'($c)tes
*m$n$c)tes*m$n$c)tes
Ele%ated&Ele%ated&l)m'($c)tesl)m'($c)tes
andand
m$n$c)tesm$n$c)tes
Pr$teinPr$tein Mar+edMar+ed
increaseincrease
M$derateM$derate
increaseincrease
M$deerate t$M$deerate t$
mar+edmar+edincreaseincrease
M$derate t$M$derate t$
mar+edmar+edincreASEincreASE
,luc$se,luc$se Mar+edMar+eddecreasedecrease
N$rmalN$rmal DecreaseDecrease N$rmal $rN$rmal $r
decreaseddecreased
LactateLactateIncreaseIncrease N$rmalN$rmal IncreaseIncrease IncreasedIncreased
Ot(erOt(er
teststests
-./ Limulus-./ Limulus
l)sates 0it(l)sates 0it(
"ram-1/ $r""ram-1/ $r"
PelliclePellicle
f$rmati$nf$rmati$n-./ India in+-./ India in+
f$rf$r
cr)'t$c$ccuscr)'t$c$ccus
C$mm$nC$mm$n
a"entsa"ents
Enter$%irusesEnter$%iruses
234234
M5M5
Tu!ercul$sisTu!ercul$sis
C5C5
ne$f$rmansne$f$rmans
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!ote5!ote5
C"F leakage
usually present as )torrhea or Rhinorrhea
%lectrophoresis9garose gel
electrophoresis of concentrated C"Fwidely used to look for C"F )ligo Clonalbonds
C"F9)ligo Clonal bonds= J:9L3ofpatient with de-nite multiple sclerosis
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"erologic %+amination"erologic %+amination
C% Hmetastatic carcinomaC% Hmetastatic carcinoma
hCB H choriocarcinoma and germ cellhCB H choriocarcinoma and germ celltumorstumors
C"F ferritin H C!" malignancyAC"F ferritin H C!" malignancyApatients with inammatory diseasepatients with inammatory disease
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8icrobiologic %+amination8icrobiologic %+amination
0.0. "taining"taining
0.0. Bram stain H most importantA di6erentiatesBram stain H most importantA di6erentiatesbacterial pathogensbacterial pathogens
>.>. &ndia ink H C. neoformans and otheer fungi&ndia ink H C. neoformans and otheer fungi:.:. cid fast stain H tuberculous agentscid fast stain H tuberculous agents
3.3. uramine9Rhodamine stain H tuberculousuramine9Rhodamine stain H tuberculousagentagent
;.;. cridine orange H diferentiate amoebacridine orange H diferentiate amoeba/brick redI from leukocytes /bright green4/brick redI from leukocytes /bright green4
>.>. >. Culture>. Culture
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&mmunologic tests&mmunologic tests
0.0.CounterimmunoelectrophoresisCounterimmunoelectrophoresis
0.0.(imited for the detection and(imited for the detection and
identi-cation of5identi-cation of5
0.0.*. inuenMae H 0 month to ; years*. inuenMae H 0 month to ; years
>.>.". pneumoniae H >L yrs and older". pneumoniae H >L yrs and older
:.:.!. meningitidid H ; to >L yrs old!. meningitidid H ; to >L yrs old
3.3.%. coli H%. coli H
;.;.Broup "treptococciBroup "treptococci
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gglutination testsgglutination tests
0.0.(ate+ gglutination tests(ate+ gglutination tests
For bacterial antigen tests /Ts4A forFor bacterial antigen tests /Ts4A for
C. neoformansC. neoformans
>.>.%(&"%(&"
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(imulus lysate ssay(imulus lysate ssay
0.0.For detection ofFor detection ofthe presence ofthe presence of
endoto+inendoto+in
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ssignment5ssignment5
0. ?hat is P8Q0. ?hat is P8Q a. Causative agenta. Causative agent b.Pathogen /cause of infection4b.Pathogen /cause of infection4 c. $iagnosis and $etectionc. $iagnosis and $etection
d. Treatmentd. Treatment
C"F cell count /Refrence range for adult andC"F cell count /Refrence range for adult andchildren4children4
bnormal wbcrbc count in the following5/speci-c4bnormal wbcrbc count in the following5/speci-c4 encephalitisencephalitis multiple sclerosismultiple sclerosis meningitismeningitis cerebral aneurismcerebral aneurism lymphoma in the brainlymphoma in the brain neurosyphilisneurosyphilis strokestroke deliriumdelirium
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T*!D ,)#