selective secretion of plasma, not an ultrafiltrate

contained in higher levels in CSF than in plasma

contained in lower levels in CSF than in plasma

the three membranes surrounding the brain and spinal cord

outer layer next to the bone

middle layer resembling a spider web

innermost layer adhering to the surface of neural tissue

the space between arachnoid mater and pia mater where CSF is held

purpose of CSF

the build up of CSF if reabsorption process is blocked

normal adult volume of spinal fluid

neonate normal volume of spinal fluid

interface between blood and CSF only allowing certain substances to cross

routinely measured tests for CSF analysis

cerebrospinal fluid specimen collection

amount of CSF that should be removed if CSF pressure is less than or greater than normal

CSF #1

CSF #2

CSF #3

examination and testing timing of CSF

inaccurate results caused by delated testing

three physical characteristics of normal CSF

increased number of cells in CSF

associated with white blood cells greater than 200 cells/mL or red blood cells greater than 400 cells/mL

associated with microorganisms or increased protein

abnormal color of CSF, usually yellow, orange, or pink due to various conditions

greatest amount of blood in tube 1, least in tube 3; colorless supernatant after centrifugation

consistent amount of blood in all three tubes; xanthochromic supernatant after centrifugation; macrophages with phagocytized RBCs which stain positive for hemosiderin and may include hematoidin crystals

normal cell count for CSF

used to perform cell counts on CSF

used if a dilution is needed to perform microscopic examination

performed to aid in the differentiation of a recent hemorrhage from a traumatic tap experience

performed to diagnose CNS disease and variety of other conditions

used to lyse RBCs and enhance visualization of WBC nuclei

predominate white blood cells in CSF

present in bacterial meningitis, early viral, fungal, TB, or parasitic infections, and some noninfectious conditions

increased in viral, TB, fungal, or syphilitic meningitis particularly in later stages

abnormal when seen in MS and acute viral and chronic inflammatory conditions

may be increased in a mixed cell pattern such as TB or fungal meningitis, chronic bacterial meningitis, or rupture of cerebral abscess

>10% presence in parasitic, fungal, or allergic reactions (sometimes caused by malfunctioning shunt)

often found after hemorrhage because of phagocytic ability

need to be distinguished between malignant cells and others

normal CSF total protein

in CSF caused from contamination with blood during tap, change in blood-brain barrier, decreased reabsorption into venous blood, and increased synthesis in CNS

seen in disorders such as bacterial, viral, and other meningitis, cerebral infarction, hemorrhage, endocrine disorders, MS, obstruction of CSF flow, and trauma

seen in increased reabsorption because of increased intracranial pressure and loss of fluid because of trauma or invasive procedures

used to assess permeability of blood-brain barrier; <9 normal, 9-14 minimal impairment, and 15-100 moderate to severe, >100 complete breakdown of barrier

CSF to IgG Index reference range

CSF/IgG Index associated with increased intrathecal production of IgG

CSF/IgG Index that indicates compromised blood brain barrier

most patients (90%) have IgG index greater than .70

second band of transferrin specific for CSF

performed to identify oligoclonal bands that are present in CSF but absent in serum in MS

surrounds axons of nerves and is necessary for proper nerve conduction; may be seen in MS and other demyelinating diseases

values reflect plasma value 30-90 minutes before CSF collection (60-70% of plasma concentration)

normal glucose range in CSF

associated with many conditions including meningitis hypoglycemic states, and metastatic or primary tumors

has no clinical significance

increased in conditions impairing blood supply or transport of oxygen to CNS (anaerobic conditions)

normal lactate range in CSF

cerebral infarction, intracranial hemorrhage, hydrocephalus, traumatic brain injury, and meningitis

lactate level rarely exceeds 25-30 mg/dL

lactate levels greater than 35 mg/dL and decreased glucose

look for bacteria and fungi

for Cryptococcus neoformans

for TB meningitis

for ameba Naegleria fowleri

to detect bacterial cause

to assist in identifying bacterial and fungal antigens in CSF