Chapter 10 - Cerebrospinal Fluid

CSF proteins

CSF proteins

________ are measured using principles of turbidity production or dyebinding ability.

Acid fast

________ or fluorescent antibody stains are not routinely performed on specimens unless tubercular meningitis is suspected.

Isoelectric focusing

________ (IEF) is followed by silver staining.

Immunofixation electrophoresis

________ (IFE) is more sensitive and does not require concentration.

Spindle

________- shaped cells represent lining cells from the arachnoid.

RBCs

________ contain high concentrations of lactate, and falsely elevated results may be obtained on xanthochromic or hemolyzed fluid.

AIDS

Increased lymphocytes are seen in cases of both asymptomatic HIV infection and ________.

concentrated

CSF must be ________ if protein levels are low before performing electrophoresis.

choroid

In the ________ plexuses, the endothelial cells have very tight- fitting junctures that prevent the passage of many molecules, making a blood- brain barrier.

Albumin

________ makes up the majority of CSF protein.

Immunoassay techniques

________ are used for measurement.

rapid plasma reagin

The ________ (RPR) test is not recommended for use on CSF, because it is less sensitive and specific than the VDRL.

predominance of lymphocytes

Adults usually have a(n) ________ to monocytes (70: 30), whereas the ratio is reversed in children; occasionally, neutrophils are also present.

Nucleoli

________ are often more prominent than in blood smears.

eosinophils

Increased ________ are associated with parasitic infections, fungal infections (primarily Coccidioides immitis), and introduction of foreign material, including medications and shunts into the CNS.

cytocentrifugation

Following ________, neutrophils may also contain cytoplasmic vacuoles and have no granules.

Detection

________ of the fibrin degradation product, D- dimer, by latex agglutination immunoassay indicates the formation of fibrin at a hemorrhage site.

Fluid

________ can be frozen until serum results are available.

Macrophages

________ appear within 2 to 4 hours after RBCs enter the CSF and are frequently seen following repeated taps.

levels

Decreased ________ are caused by fluid leaking from the CNS.

blood brain

Elevated levels are caused by damage to the ________ barrier, production of immunoglobulins within the CNS, decreased clearance of normal protein from the fluid, degeneration of neural tissue, meningitis and hemorrhage conditions.

pia mater

The ________ is a thin membrane lining the surfaces of the brain and spinal cord.

lipid concentration

A cloudy, turbid, or milky specimen can be the result of an increased protein or ________, but it may also be indicative of infection, with the cloudiness being caused by the presence of WBCs.

iron free

They are ________, consisting of hemoglobin and unconjugated bilirubin.

subarachnoid space

The fluid flows through the ________ located between the arachnoid and pia mater.

Plasma protein

________ can be artificially introduced into a specimen by a traumatic tap, so corrections to calculation must be made.

the second tube

In CSF collection, ________ is usually designated for the microbiology laboratory and are stored at room temperature.

Cellular distortion

________ may include cytoplasmic vacuoles, nuclear clefting, prominent nucleoli, indistinct nuclear and cytoplasmic borders and cellular clumping that resembles malignancy.

Glutamine

________ is produced from ammonia and α- ketoglutarate by the brain cells to prevent toxicity from building- up in the CNS.

Agarose gel electrophoresis

________ is followed by Coomassie brilliant blue staining.

Neutrophils

________ may also be increased following central nervous system (CNS) hemorrhage, repeated lumbar punctures, and injection of medications or radiographic dye; however, these are of little significance.

Cells

________ are counted in the four corner squares and the center square on both sides of the hemocytometer.

25 mg/dL

In viral meningitis, lactate levels remain lower than ________.

Xanthochromia

________ that is caused by bilirubin due to immature liver function is also commonly seen in infants, particularly in those who are premature.

choriod plexuses

The ________ are capillary networks that form the CSF from plasma by mechanisms of selective filtration under hydrostatic pressure and active transport secretion.

fungal meningitis

In bacterial, tubercular, and ________, the elevation of CSF lactate to levels greater than 25 mg /dL occurs much more consistently than does the depression of glucose and provides more reliable information when the initial diagnosis is difficult.

yellow specimens

Pink, orange or ________ are xanthochromic and are caused by the presence of RBC degradation products.

Cerebrospinal fluid (CSF)

________ supplies nutrients to nervous tissue, removes metabolic waste, and produces a mechanical barrier to cushion the brain and spinal cord.

Serologic testing

________ is performed to detect the presence of neurosyphilis.

CSF culture

The ________ is actually a confirmatory rather than a diagnostic procedure; however, several methods are available to provide information for a preliminary diagnosis.

Glucose

________ enters the CSF by selective transport across the blood- brain barrier, which results in a normal value that is approximately 60 % to 70 % that of the plasma ________.

Neubauer counting chamber

A(n) ________ is routinely used for performing CSF cell counts.

microscopic finding of macrophages

The ________ containing ingested RBCs (erythrophagocytosis) or hemosiderin granules is indicative of intracranial hemorrhage.

Ependymal cells

________ are from the lining of the ventricles and neural canal.

CSF lactate levels

________ remain elevated during initial treatment but fall rapidly when treatment is successful, thus offering a sensitive method for evaluating the effectiveness of antibiotic therapy.

0-5

Normal adult CSF contains ________ WBCs /μL.

Metastatic carcinoma cells of nonhematologic origin

________ are primarily from lung, breast, renal, and gastrointestinal malignancies.

cell count

The ________ that is routinely performed on CSF specimens is the leukocyte (WBC) count.

index value

A(n) ________ less than 9 represents an intact blood- brain barrier, and it increases relative to the amount of damage to the barrier.

Adults usually have a predominance of lymphocytes to monocytes (70

30), whereas the ratio is reversed in children; occasionally, neutrophils are also present

blast form

The presence of ________ cells in CSF indicate acute leukemia.

macrophages

The presence of ________ in CSF indicate RBCs in spinal fluid or radiographic contrast media.

3% glacial acetic acid

If only WBCs are needed for cell counts, ________ is used for dilution to lyse the RBCs.

traumatic tap

A(n) ________ produces visible blood in all collection tubes that diminishes from the first to third tube.

pink

Specimens with a ________ color indicate a slight amount of oxyhemoglobin.

3rd, 4th or 5th

CSF is routinely collected by lumbar puncture between the ________ lumbar vertebrae.