Csf analysis

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CSF ANALYSIS INTERPRETATION

Transcript of Csf analysis

Page 1: Csf analysis

CSF ANALYSIS INTERPRETATION

Page 2: Csf analysis

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

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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

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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

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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

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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

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Reference Intervals for CSFCell type Adults(%) Neonates(%)

Lymphocytes 62 20Monocytes 36 72Neutrophils 2 3Histiocytes Rare 5Ependymal Rare RareEosinophils Rare Rare

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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

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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

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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

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•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.

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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

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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