2/6: Physical Examination

Normal Result of Parameters: Color

Colorless

Normal Result of Parameters: Transparency

Clear

Normal Result of Parameters: Osmolality

281 mOsm/L at 37*C

Normal Result of Parameters: Specific Gravity

1.006 - 1.008

Normal Result of Parameters: pH

7.3 - 7.5

Normal Result of Parameters: Viscosity

Similar to water

Abnormal Appearance:

Indicates presence of lipid, proteins, or infection (WBCs)

Turbid or Milky

Abnormal Appearance:

Indicates > 200 WBC/uL

Cloudy

Abnormal Appearance:

Indicates

• intracranial hemorrhage

• traumatic tap

Bloody

Abnormal Appearance:

Pink, yellow, or orange CSF

Xanthochromic

Causes of Xanthochromic CSF

• Presence of RBC degradation products in CSF

• > 400 RBC/uL

• Elevated bilirubin in neonates (immature liver)

• Presence of carotene, melanoma, proteins

Xanthochromic: Color of CSF when it has slight amount of oxyhemoglobin

Pink

Xanthochromic: Color of CSF when there is conversion of oxyhemoglobin to unconjugated bilirubin

Yellow

Xanthochromic: Color of CSF when there is heavy hemolysis

Orange

Abnormal appearance: clotted

Due to?

• clotting factors

• presence of protein

• possible disorders in the blood-brain barrier

• meningitis

• froin’s syndrome

Abnormal appearance indicating a web-like clot, possibly tubercular meningitis

Pellicle

Turbidity: crystal clear fluid

0

Turbidity: faintly cloudy, smoky, hazy

1+

Turbidity: clearly visible, newsprint read easily through tube

2+

Turbidity: newsprint not easily read through tube

3+

Turbidity: newsprint cannot be seen through tube

4+

Clotting: Pellicle forms in a short time; large clot formation follows

Bacterial meningitis

Clotting: Web-like clot (pellicle) after 12-24 hours (enhanced by refrigeration)

TB Meningitis

Clotting: incomplete clot

Paresis (type of neurosyphilis)

Clotting: completely clotted due to protein

Blockage of CSF circulation

Pathologic Bleeding vs Traumatic Tap

Blood Distribution:

Clot Formation:

Supernatant:

Erythrophages:

D-dimer:

PB/IH Blood dis: Evenly distributed

TT Blood dis: Unevenly distributed

PB/IH Clot formation: (-)

TT Clot formation: (+)

PB/IH Supernatant: Xanthochromic

TT Supernatant: Clear

PB/IH Erythrophages: Present

TT Erythrophages: Absent

PB/IH D-dimer: (+)

TT D-dimer: (-)

Differentiate pathologic bleeding/intracranial hemorrhage and traumatic tap

PB/IH - any bleeding within the intracranial wall of the skull including brain parenchyma and surrounding meningeal spaces

TT - caused by the procedure