Cerebrospinal Fluid Interpretation
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04/08/23 1E. S. MOKGWANE; 4TH YR MED
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CHARECTERISTICS OF NORMAL CSFTotal Volume: 150mlColour: colourless, like waterTransparency: clear, like waterOsmolality at 37o C: 281mOsm/LSpecific Gravity: 1.006 to 1.008Presure: 80-100 mm H2O
04/08/23 2E. S. MOKGWANE; 4TH YR MED
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ACID-BASE BALANCEpH 7.31pCO2 47g mmHgHCO3 22g mEq/LSodium 138 – 150 mEq/LPotassium 2.7 to 3g mEq/LChloride 116 to 127 mEq/LCalcium 2.0 to 2.5 mEq/LMagnesium 2.0 to 2.5 mEq/LLactic Acid 1.1 to 2.8 mmol/L
04/08/23 3E. S. MOKGWANE; 4TH YR MED
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APPEARANCE1. BRIGHT RED
•Recent haemorrhage involving the subarachnoid
•Damage to a blood vessel during puncture
04/08/23 4E. S. MOKGWANE; 4TH YR MED
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APPERANCE
2. XANTHOCROMIA•Suggests subarachnoid haemorrhage in
recent past (days).
Rarely Xanthochromia may be due to:• Severe Jaundice• Carotenaemia• Rifampicin
04/08/23 5E. S. MOKGWANE; 4TH YR MED
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APPERANCE
3. TURBID
white cells presentsuggest bacterial infection.
04/08/23 6E. S. MOKGWANE; 4TH YR MED
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APPERANCE
4. PIGMENTS• Oxyhaemoglobin – Released with lysis of red
cells detected in the supernatant fluid within 2h after SAH.
• Bilirubin – maximum at 48hrs after SAH.
04/08/23 7E. S. MOKGWANE; 4TH YR MED
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TOTAL PROTEIN
0.5% or 1/200 that of plasmaTypical reference values for a lumbar tap:Age g/L<1 month <1.91-3 months <0.953-12 months <0.51-10 years <0.4>10 years <0.7
04/08/23 8E. S. MOKGWANE; 4TH YR MED
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TOTAL PROTEIN IS RAISED IN:
1. Infection (white cells, pus) e.g. bacterial meningitis
2. Blood Contamination3. Chronic inflammatory diseases of the CNS.4. Froin’s syndrome5.Lysis of contaminated blood from traumatic tap6.Increased permeability of the epithelial
membrane7.Increased production by CNS tissue
04/08/23 9E. S. MOKGWANE; 4TH YR MED
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DECREASED CSF GLUCOSE
• Disorder in carrier –mediated transport of glucose into CSF
• Active metabolism of glucose by cells or organisms
• Increased metabolism by CNS eg Brain tumor, diffuse, meningeal neoplasia.
04/08/23 10E. S. MOKGWANE; 4TH YR MED
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SUMMARY OF A TYPICAL CSF FINDINGS
NORMAL BACTERIA VIRAL TB
Cells 0-5 >1000 <1000 <500
Polymorphs 0 Predominate
Early +/- Increased
Lymphocytes
5 Late Predominate
Increased
Glucose 60-80 Decreased Normal Decreased
CSF Plasma: Glucose ratio
66% <40% Normal <30%
Protein 5-40 Increased +/- Increased
Increased
Culture Negative Positive Negative +TB04/08/23 11E. S. MOKGWANE; 4TH YR MED
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END
04/08/23 12E. S. MOKGWANE; 4TH YR MED