1. CEREBROSPINAL FLUID EXAMINATION Institute of Diagnostics Zhong Ning Email: ningzhong@sdu.edu.cn Institute of Diagnostics Zhong Ning Email: ningzhong@sdu.edu.cn

2. 2 2005-5-17Medicine School of Shandong University CONTENT Preface Specimen Collection Opening Pressure Total cell count Differential cell count Glucose Protein Preface Specimen Collection Opening Pressure Total cell count Differential cell count Glucose Protein

3. 3 2005-5-17Medicine School of Shandong University Preface Cerebrospinal fluid (CSF) is mostly derived through the choroid plexuses. 500mL/day approximately CSF protects the brain and spinal cord, and collects waste, circulates nutrients, cushions and lubricates the central nervous system (CNS). Cerebrospinal fluid (CSF) is mostly derived through the choroid plexuses. 500mL/day approximately CSF protects the brain and spinal cord, and collects waste, circulates nutrients, cushions and lubricates the central nervous system (CNS).

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5. 5 2005-5-17Medicine School of Shandong University The blood-brain barrier BBB is a concept derived from dye-exclusion studies rather than a specific anatomic structure. Certain substances in the CSF are tightly regulated by specific transport systems. BBB is a concept derived from dye-exclusion studies rather than a specific anatomic structure. Certain substances in the CSF are tightly regulated by specific transport systems.

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8. 8 2005-5-17Medicine School of Shandong University Specimen Collection Lumbar puncture (LP) is the insertion of a needle into the subarachnoid space (the area under the membrane that surrounds the brain and spinal cord) of the lumbar (lower back) region for diagnostic or therapeutic purposes. This allows access to the cerebrospinal fluid (CSF) in which the brain and spinal cord float. Although the subarachnoid space can be accessed from other levels, the lumbar region is most often used as it allows the needle to be inserted below the end of the spinal cord. Lumbar puncture (LP) is the insertion of a needle into the subarachnoid space (the area under the membrane that surrounds the brain and spinal cord) of the lumbar (lower back) region for diagnostic or therapeutic purposes. This allows access to the cerebrospinal fluid (CSF) in which the brain and spinal cord float. Although the subarachnoid space can be accessed from other levels, the lumbar region is most often used as it allows the needle to be inserted below the end of the spinal cord.

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11. 11 2005-5-17Medicine School of Shandong University Opening Pressure Normal opening pressure in adults is 90~180mmH 2 O, 10~100mmH 2 O in children.

12. 12 2005-5-17Medicine School of Shandong University Elevated pressure Congestive heart failure Meningitis Superior vena cava syndrome Cerebral edema Mass lesion Congestive heart failure Meningitis Superior vena cava syndrome Cerebral edema Mass lesion

13. 13 2005-5-17Medicine School of Shandong University Decreased pressure Spinal-subarachnoid block Dehydration Circulatory collapse CSF leakage Spinal-subarachnoid block Dehydration Circulatory collapse CSF leakage

14. 14 2005-5-17Medicine School of Shandong University Total cell count & DC The normal leukocyte cell count in adults is 0~5 cells/ul. Increased neutrophils: Bacterial Meningitis cerebral abscess subdural empyema CNS hemorrhage CNS infarct The normal leukocyte cell count in adults is 0~5 cells/ul. Increased neutrophils: Bacterial Meningitis cerebral abscess subdural empyema CNS hemorrhage CNS infarct

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16. 16 2005-5-17Medicine School of Shandong University Increase Lymphocytes: Viral meningitis Multiple sclerosis Increase Lymphocytes: Viral meningitis Multiple sclerosis

17. 17 2005-5-17Medicine School of Shandong University Glucose The normal Glucose is about 60% compared to serum level. Normal 50~80mg/dl Elevated Glucose: Diabetes mellitus, DM Decreased Glucose: Bacterial Meningitis The normal Glucose is about 60% compared to serum level. Normal 50~80mg/dl Elevated Glucose: Diabetes mellitus, DM Decreased Glucose: Bacterial Meningitis

18. 18 2005-5-17Medicine School of Shandong University Total Protein Over 80% of CSF protein content is derived from the plasma. An increased CSF protein serves as a useful but nonspecific indicator of disease. Normal level 15~45mg/dl. Over 80% of CSF protein content is derived from the plasma. An increased CSF protein serves as a useful but nonspecific indicator of disease. Normal level 15~45mg/dl.

19. 19 2005-5-17Medicine School of Shandong University Elevated CSF protein Reason Increased permeability of the blood-brain barrier. Decreased resorption Mechanical obstruction of CSF flow Reason Increased permeability of the blood-brain barrier. Decreased resorption Mechanical obstruction of CSF flow

20. 20 2005-5-17Medicine School of Shandong University Elevated CSF protein Arachnoiditis Meningitis Hemorrhage Endocrine/Metabolic disorders Arachnoiditis Meningitis Hemorrhage Endocrine/Metabolic disorders

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