AUBF CSF

Predominant WBCs in meningitis (indicate bacterial and viral)

Bacterial - Neutrophils

Viral - Lymphocytes

Microorganism detected in india ink

Cryptococcus neoformans

Macrophages containing ingested RBCs

Erythrophages

Most abundant CSF protein

Albumin

Normal CSF glucose in relation to plasma glucose

60 to 70% of plasma glucose

Organism appearing as intracellular gram-negative diplococci

Neisseria meningitidis

Condition showing oligoclonal bands

Multiple sclerosis

CSF abnormality causing cloudiness or turbid appearance

Increased WBCs, Protein, Microorganism

Pleocytosis

What happens if RBC concentration decreases from tube 1 to tube 3?

Traumatic tap

Stain used for cryptococcus (fungal organisms)

Primary: India ink

Other: Mucicarmine, Periodic Acid-Schiff, Gram stain variable

Term used for supernatant of CSF

Xanthochromia

Machine used to measure normal opening pressure

Manometer

This leukocyte is increased in bacterial and viral meningitis

Neutrophils

Chemical test that increases in all types of meningitis

CSF Protein

Chemical test that decreases in all types of meningitis

CSF Glucose

Test used to confirm if the specimen is CSF and not other bodily fluids

Electrophoresis

3 tubes for CSF testing and their storage conditions

Tube 1: Chemistry, serology - frozen

Tube 2: Microbiology - room temperature

Tube 3: Hematology - refrigerate

3 Visual examination to observe for CSF

Uneven distribution of blood

Clot formation

Xanthochromic supernatant

Organism that can be seen in india ink

Fungal organism

Indicates very recent hemorrhage 

Macrophage and Siderophage

Where does the spinal needle inserted for CSF collection?

Subarachnoid space of the cranium

Maintained CSF volume for adults

90 to 150 mL

CSF volume for neonates

10 to 60 mL

The brain and spinal cord are lined by ____

Meninges

Three layers of meninges

Dura mater - outer

Arachnoid - inner

Pia mater - surface of brain and spinal cord

Capillary networks that form the CSF from plasma by mechanisms of selective filtration under hydrostatic pressure and active transport secretion

Choroid plexus

Tight-fitting structure of the endothelial cells in the choroid plexuses

Blood-brain barrier

Where does lumbar puncture occur?

Between 3rd, 4th, 5th lumbar vertebra

What is measured before performing lumbar puncture to prevent infection or neutral tissue damage?

Intracranial pressure

Tube 1 in CSF is used for what test?

Chemical and Serological tests

Why is tube 1 assigned to chem and serotonin test?

Least affected by blood or bacteria

Tube 2 is assigned to what section?

Microbiology

Tube 3 is assigned to what section?

Cell count / Hematology

What is the initial appearance of a normal CSF

Crystal-clear

If a CSF is cloudy, turbid, or milky, what could be the cause?

Increased protein or lipid concentration

Infection

A term to describe CSF supernatant that is pink, orange, or yellow

Xanthochromia

Common cause of the presence of xanthocromia

RBC degradation products

If the color of CSF is pink to orange, what could be the cause of this?

slight amount of oxyhemoglobin and heavy hemolysis

If the CSF color is orange to yellow, what could be the reason?

Conversion of oxyhemoglobin to unconjugated bilirubin

What are the other causes of xanthochromia?

Elevated serum bilirubin

Presence of carotene

Markedly increased protein concentrations

Melanoma pigment

What are the 3 visual examinations of CSF?

Uneven blood distribution

Clot formation

Xanthochromic supernatant

Grossly blood CSF can be an indication of what disease?

Intracranial hemorrhage

A traumatic tap will leave the heaviest concentration of blood in what tube? 

Tube 1

A web-like pellicle is associated with what disease?

Tubercular meningitis

Diseases that damages the blood-brain barrier allows increased filtration of ________ and ______

protein and coagulation factor

How long does RBC remain in the CSF before noticeable hemolysis begins?

2 hours

A very recent hemorrhage would produce what color?

clear supernatant

What are the functions of CSF?

Provides physical support to the brain so that it remains suspended

Provides an excretory waste function for the brain

Maintains CNS ionic homeostasis

Normal opening pressure is measured by what tool?

Manometer

In what position should the patient be if you’re gonna perform CSF collection?

Lateral position

This test is routinely performed on CSF

WBC count

What stain is used for WBC count on CSF?

Wright’s stain

What is the method of choice for CSF concentration technique?

Cytocentrifugation

If the CSF WBC count is very high and the majority of the WBCs are neutrophils, this is indicative of what disease?

Bacterial meningitis

If the CSF WBC count is moderately high and there is high percentage of lymphocytes and monocytes what is this indicative of?

Viral, Fungal, Tuberculous meningitis

Eosinophils in CSF is an indicative of _____

Parasitic infections

Eosinophils in the CSF is commonly caused by what bacteria?

Coccidioides immitis

Increased macrophages are indicative of a _______

Previous hemorrhage somewhere in the CNS

The major beta-globulin present in CSF

Transferrin

Separate carbohydrate-deficient transferrin

Tau

Normal constituents of CSF gamma globulins are?

IgG and small amount of IgA

CSF protein electrophoresis is used to detect _____ which represent ________ within the CNS

Oligoclonal bands, inflammation

The band of CSF are located at what region in protein electrophoresis?

Gamma region

What could be the result of diagnosing multiple sclerosis using protein electrophoresis?

Increased IgG index

Markedly decreased CSF glucose level accompanied by an increased WBC count and a large percentage of neutrophils indicates _____

Bacterial meningitis

Markedly decreased CSF glucose level accompanied by an increased WBC count specifically lymphocytes and a large percentage of neutrophils indicates _____

Tubercular or Viral meningitis

Most frequently performed chemical test on CSF

Protein

The unique proteins found in the CSF

Transthyrethin or Prealbumin

Twin peak or Extra peak

The most frequent electrophoretic method for CSF utilizes what gel and stain?

Agarose gel

Coomassie brilliant blue

Presence of this protein indicates recent destruction of the myelin sheath

Myelin basic protein

A structure that normally protects the axons of the neurons in the brain and spinal cord

Myelin sheath

CSF lactate is known to be helpful in the diagnosis and management of _____

Meningitis

If CSF lactate levels are >35 mg/dL

Bacterial meningitis

If CSF lactate levels are <25 mg/dL

Viral meningitis 

Brain cells can produce glutamine from ____ and ____

Ammonia

Alpha-ketoglutarate

Markedly increased CSF glutamine can result in ____

Comatose

Increased glutamine levels in children are associated to what disease?

Reye syndrome

Detects bacterial and fungal organisms in CSF

Gram stain

CSF is concentrated by centrifugation at ____ for how long?

1500 g-force for 15 minutes

This CSF test is used to detect mycobacteria when tubercular meningitis is suspected

Acid-fast stain

This test is used for detecting mycobacteria but provides a quicker diagnostic alternative

Fluorescent antibody stain

This test is CDC-recommended for neurosyphilis and less sensitive

VDRL test

This serological test is not recommended due to lower sensitivity

RPR test

This serological test is more sensitive

FTA-ABS