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FLUID (CSF)
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CEREBROSPINAL FLUID (CSF)
• Major fluid of the body that circulates in the Central
Nervous System (CNS)
• First recognized by Contugno in 1764
• Three meninges that lines the brain and spinal cord
a) Dura Mater (“hard mother”) – outermost layer; lines
the skull and vertebral canal
b) Arachnoid Mater (“spider-web like”) – middle layer;
filamentous inner membrane
• CSF flows in the SUBARACHNOID SPACE
c) Pia Mater (“gentle mother”) – innermost layer; thin
membrane lining the surfaces of brain and spinal cord
CEREBROSPINAL FLUID (CSF)
• Produced by the choroid plexuses, capillary networks
found in the 2 lateral ventricles and the third and fourth
ventricles
– The endothelial cells of the choroid plexuses have BLOOD-BRAIN
BARRIER (very-tight fitting junctures that prevent the passage of
many molecules)
– BBB protect the brain harmful chemicals in the blood and prevent
the passage of helpful substances including antibodies and
medications
• CSF is reabsorbed back into blood capillaries through the
arachnoid villi/granulations
– Arachnoid villi/granulations – ONE-WAY VALVE ; responds to
pressure within the CNS and prevents reflux of the fluid
CSF
• CSF is produces from selective filtration under
hydrostatic pressure and active transport
secretion. Thus, the chemical composition of the
CSF DOES NOT resemble an ultrafiltrate of plasma
• 20mL of CSF is produced per hour
• Total CSF Volume in ADULTS
– 90-150mL
• Total CSF Volume in NEONATES
– 10-60mL
CSF Collection and Handling
• CSF COLLECTION
– Ventricular puncture
• Done in infants with open fontanels
– Cisternal puncture
• Dangerous ; done in sub-occipital region
• Performed if there is (1) blockage of spinal canal, (2) vertebrae
deformity, (3) infection of the back
– Spinal tap (lumbar puncture – L3, L4, L5)
• The volume of CSF removed is dependent on the
age (adult vs neonate) and opening pressure of the
CSF
– ↑Opening pressure – CSF withdrawn slowly, collect
SMALL AMOUNTS only.
CSF Collection and Handling
Specimens are collected in three sterile tubes
– Tube 1 – CHEMISTRY and SEROLOGY
– Tube 2 – MICROBIOLOGY
– Tube 3 – HEMATOLOGY
– Tube 4 – May be used for microbiology to exclude skin
contamination or for additional serologic tests
If only one tube can be collected, it must be tested
first by MICROBIOLOGY
CSF Collection and Handling
• CSF tests are performed in a STAT basis
• If not possible,
– Hematology(Tube 3) is REFIGERATED
– Microbiology (Tube 2) remains at ROOM TEMP.
– Chemistry and Serology (Tube 1) must be FROZEN
CSF Appearance
• Normal: COLORLESS and CRYSTAL CLEAR
• Abnormal Variations
1. Cloudy / Turbid / Hazy / Milky
o Increased protein and lipids
o Infection due to increased WBC (>200 cells/ul)
Centrifugation of CSF must be done in CAPPED TUBES
2. Oily
o Radiographic contrast media
CSF Appearance
3. Xanthochromic – CSF supernatant is
pink/orange/yellow
CAUSES
o Presence of RBC degradation products – most common
cause
PINK – slight amount of oxyhemoglobin
ORANGE – increased hemolysis
YELLOW – oxyhemoglobin that is converted to unconjugated
bilirubin
o Elevated serum (unconjugated) bilirubin
o Presence of carotene pigment
o Markedly increased serum protein (>150mg/dL)
o Other pigments: melanin, rifampin, etc.
CSF Appearance
4. Bloody (approximately 6000 RBCs/uL)
CAUSES
a. Intracranial hemorrhage
b. Traumatic tap
REMEMBER: RBCs begin to lyse within 1
hour; 40% of leukocytes disintegrate after 2
hours
INTRACRANIAL TRAUMATIC TAP
HEMORRHAGE