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csf examination


CSF examination (examination of cerebrospinal fluid). Measured puncture cerebrospinal fluid pressure, lateral adults 0.78-1.96kPa (80-200mm water column), and the baby for children for the 0.39-0.98kPa (40-100mm water column), neonatal 0.098-0.14kPa (10 - 14mm water column). Observing initial pressure should pay attention to whether the cerebrospinal fluid liquid level respiratory beat (with respiratory generate 0.098-0.197kPa (10-20mm liquid level of the water column pulsation) and pulse-beat (with pulse generated 0.02-0.039kPa (2-4mm water column the pulsating liquid level). former disappeared, suggesting that spinal obstruction or foramen magnum hernia are advised to be careful. jugular vein of

(1) the oppression the test (Queckenstedt test)

hand oppression bilateral jugular vein, the intracranial congestive venous system caused the increased intracranial pressure, increased pressure to convey to the lumbar puncture needle connected to the pressure on the glass tube, can cause the liquid level is significantly higher, the liquid level decreased rapidly relax oppression when the spinal canal obstruction oppression after the liquid level rising and falling slowly or even not. the precise determination wrapped around the neck using a sphygmomanometer airbags were inflated to 2.7-5.3-8kPa (20-40-60mm Hg) oppression 30 seconds and relax for 30 seconds during every 5 seconds record time pressure, and map. increased intracranial pressure or suspected intracranial tumor, bleeding Forasmuch

results to determine:

no obstruction of cerebrospinal fluid pressure in the neck pressure after 15 seconds, quickly rose to the highest point, to pressure after about 15 seconds and can quickly dropped the initial pressure level; or pressure above the to 8kPa (60 mm Hg) may be elevated to 4.9kPa (500mm water column). partial obstruction pressure rise, down are slow, or can not decline to the level of initial pressure rise; complete obstruction, pressure in the neck, piezometric cerebrospinal fluid pressure does not rise or rise very little.

(2) pressure abdominal test (Stookey the test)

hard fist oppression patient on the abdomen or make it breath-hold, the inferior vena cava and the lower thoracic following dural venous congestion, caused by the rapid rise of cerebrospinal fluid pressure above a level below, you can understand the lower thoracic and lumbosacral spinal subarachnoid space and lumbar puncture needle and manometry tube without obstruction. pressure rise is about twice the initial pressure is normal, the repression ends pressure quickly dropped to the level of initial pressure. pressure rise is slow or does not rise to so-called the positive instructions the lower thoracic following subarachnoid obstruction. lumbar puncture needle is not smooth and piezometric also positive, shall be noted.

(3) double-needle joint puncture test: suspected spinal obstruction The upper and lower parts of lumbar 5 sacral 1, two puncture by obstruction of the cerebrospinal fluid pressure in the jugular vein compression test show the difference of the plane up and down two. rough measurement of lumbar 2-5 obstruction such as lumbar 2-3.

(4) unilateral jugular vein compression test (Tobey-Ayer test): the the oppression side of the neck veins cause cerebrospinal fluid pressure rise, but when the oppression of the other side of the jugular vein pressure did not change, said the unilateral jugular vein compression test was positive. suggesting that the side lateral sinus or jugular vein obstruction, such as thrombosis the.

final pressure measured after the release of cerebrospinal fluid pressure, when less than 1/2 of the original pressure often is abnormal brain pressure normal people put after the 2-3 ml liquid reduce generally does not exceed 0.098-0.197kPa (10-20mm water column) or remained unchanged. drain 3-5ml pressure drop is greater than 0.5kPa (50mm water column), you should consider that there are already various spinal canal or foramen magnum the lower the degree of obstruction of parts, this phenomenon is more obvious; complete obstruction, the final pressure can sometimes drop to zero if the release of a few milliliters of cerebrospinal fluid, brain pressure drop little or quickly restored to the level of initial pressure, the prompt communicating hydrocephalus or increased intracranial pressure.

edit this paragraph, the appearance of normal cerebrospinal fluid colorless transparent neonatal cerebrospinal fluid (due to the presence of bilirubin), the stale bleeding or high protein content, cerebrospinal fluid may be yellow new bleeding occult blood test was positive when into the red or bloody, shall be to identify and puncture accidental injury caused bleeding, concentration of former cerebrospinal fluid of blood-stained uniform before and after the supernatant after centrifugation yellow or light yellow, shrinkage or rupture of the edge of the red blood cell morphology, while trauma hemorrhage and vice versa. bacterial meningitis, cerebrospinal fluid is milky white or green opacity, vertical stand for after a film-like precipitate, such as tuberculous meningitis hung upside down by the liquid level to the bottom of the tube funnel-like cobweb-like film find a film like precipitate bacteria generally higher positive rate.

edit this paragraph cytology adult normal white blood cell count 0.01 × 109/L or less (less than 0.03 × 109/L, the premature children and newborns time), but multicore white blood cells should not be more than five, mainly small, lymphocytes when meningeal irritation or inflammatory lesions, cerebrospinal fluid white blood cell count can be increased. therefore central nervous system infection lesions, multiple nuclear or monocytes increased in various degrees; various brain tumors, especially near the meninges, ventricle or malignant, there are an increase in leukocyte.

the use of special CSF cells were pelleted by centrifugation, and will be concentrated on the slides of cells give kinds of stain, but also careful observation of cell morphology changes, greatly improving the diagnostic efficacy, such as increased eosinophils suggesting parasitic disease of the central nervous system; and within phagocytes hemosiderin obsolete bleeding prompted cerebrospinal fluid. can also directly observed in the tumor cells and the parasite eggs, as well as on cell immune function.

edit this paragraph biochemical tests protein normal CSF protein content in the subarachnoid space for the 150-400mg/L, newborn 1g/L, premature children up to 2g/L. increased protein increased simultaneously with the cells, found in a variety of central nervous system infection only protein increased white blood cell count was normal or slightly more, called "protein - cell separation more common in intracranial and spinal cord tumors, spinal canal obstruction, acute infectious polyneuritis, hyperthyroidism, diabetes, lead, mercury and other metal poisoning normal

sugar content of 450-750mg/L, about blood glucose about 1/2-2/3 of the amount of sugar drops seen in bacterial or cryptococcal meningitis, malignant brain tumors, sugar glycolysis acceleration therefore increased the amount of sugar found in the blood sugar levels increased (it should also check blood sugar the amount check), and central nervous system infection, traumatic brain injury, posterior fossa and the bottom of the Ⅲ intraventricular tumor and fever, above and to the blood-brain barrier permeability increase.

chloride normal content of 72-75g/L, compared with blood chloride content of 5.7-6.2g/L higher bacterial (especially tuberculous) and fungal meningitis and blood chloride content is reduced (such as vomiting, adrenocortical insufficiency) decrease in the blood increased chloride content (such as uremia, dehydration, etc.) the higher.

bacteriological examination of bacterial infection of the nervous system is necessary, including bacterial, fungal smear and culture, necessary for needed animal inoculation, to identify pathogens for clinical drug reference.

immunological tests used complement fixation test and immunoglobulin Determination former cysticercosis, paragonimiasis, leptospirosis and viral infections have a certain value of the artifact, which is: IgG, IgA , IgM, IgD, IgE, and other immune globulin, wherein the highest concentration of IgG, IgM difficult Richard as IgG increased and Richard IgM, suggesting that central nervous system infections, demyelinating disease or BBB permeability increases Protein Electrophoresis examination was normal cerebrospinal fluid protein electrophoresis of

bar area with similar serum electrophoresis, divided into pre-albumin, albumin, α1, α2, β1, β2 and γ globulin, due to the use of electrophoresis method levels varied a lot, but also associated with CSF protein content prealbumin

increased amount of protein in the cerebrospinal fluid, reducing the proportion, or even disappear; albumin from serum, small molecular weight, easy to pass the blood-brain barrier, increased CSF protein α1, α2 globulin increase mainly seen in the atrophic and degenerative diseases of the central nervous system. gamma globulin and total amount of protein normally found in multiple sclerosis and neurosyphilis, chronic inflammation is seen both increased albumin also increased. and brain parenchyma malignant tumors, also associated with increased BBB permeability, oligoclonal bands (oligoclone) appeared in the gamma globulin zone a discontinuous, generally can not be seen in the peripheral blood area with within the nervous system can be synthesized IgG sign than IgG increase of 95% in patients with multiple sclerosis occurs early and important value of the artifact, but the positive is also seen in acute infectious polyneuritis, optic neuritis, serous the meningitis.

the enzymatic examination normal human blood-brain barrier integrity of cerebrospinal fluid within the enzyme concentration is lower than the concentration of serum enzyme; When the head injury, intracranial tumors or cerebral hypoxia and the BBB, cell membrane permeability also change, so that the increased amount of cerebrospinal fluid within the enzyme, and is not the total amount of protein, sugar content and cell number; mainly related to the degree of brain cell necrosis and the extent of damage of the cell membrane. aspartate aminotransferase, lactate dehydrogenase, phosphate isomerase and lysozyme; including lactate dehydrogenase in malignant tumors and bacterial meningitis than benign tumors and viral meningitis increased significantly, differential diagnosis, but also to reflect the disease severity. lysozyme change with protein, sugar, white blood cells, especially neutrophils closely related, purulent, tuberculous and viral meningitis content separate, independent effects of medication, therefore, to identify and judge greater value in the nature of meningitis.

edit this paragraph conventional test color check (CSF)

colorless watery fluid of normal reference values].

clinical significance

1 red: common in subarachnoid hemorrhage, brain hemorrhage, subdural hematoma. observed outflow of cerebrospinal fluid Xianhong lumbar puncture turn colorless, yellow to puncture traumatic bleeding.

2.: found in old subarachnoid hemorrhage and cerebral hemorrhage, cyst hard film hematoma, purulent meningitis, meningeal adhesions, cerebral embolism; spinal canal obstruction; brain, spinal cord tumor and severe tuberculous meningitis; various causes severe jaundice; ventricular dysfunction, hemosiderosis disease the, Carotenemia preterm children.

3. milky: found in purulent meningitis.

4. slightly green: found in Pseudomonas aeruginosa meningitis the Streptococcus meningitis.

5. brown or black: found in the central nervous system, melanoma, melanoma transparent clear

the transparency check the [normal value].

clinical significance]

1 slightly mixed: common in Japanese encephalitis, polio, brain abscess (not rupture ).

2. opacity: common in purulent meningitis, tuberculous meningitis.

3. frosted glass: common in tuberculous meningitis, viral meningitis.

4. clots: seen in purulent meningitis, cerebral syphilis , polio and other

5 film: common in tuberculous meningitis.

cell count [normal reference values ​​

Adult: (0-8) x 106/L;

Children: (0-15) x 106/L; newborns: (0-30) x 106/L.

clinical significance

1 cell count was significantly higher (> 200 × 106/L): common in purulent meningitis epidemic cerebrospinal meningitis.

2 The moderate increase (

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