CEREBROSPINAL
FLUID
EXAMINATION
CONTENT
• Preface
• Specimen Collection
• Opening Pressure
• Total cell count
• Differential cell count
• Glucose
• Protein
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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).
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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.
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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.
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Opening Pressure
• Normal opening pressure in
adults is 90~180mmH2O,
10~100mmH2O in children.
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Elevated pressure
• Congestive heart failure
• Meningitis
• Superior vena cava syndrome
• Cerebral edema
• Mass lesion
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Decreased pressure
• Spinal-subarachnoid block
• Dehydration
• Circulatory collapse
• CSF leakage
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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
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• Increase Lymphocytes:
Viral meningitis
Multiple sclerosis
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Glucose
• The normal Glucose is about 60%
compared to serum level.
• Normal 50~80mg/dl
• Elevated Glucose:
Diabetes mellitus, DM
• Decreased Glucose:
Bacterial Meningitis
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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.
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Elevated CSF protein
Reason
• Increased permeability of the
blood-brain barrier.
• Decreased resorption
• Mechanical obstruction of CSF
flow
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Elevated CSF protein
• Arachnoiditis
• Meningitis
• Hemorrhage
• Endocrine/Metabolic disorders
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