Cerebrospinal fluid (CSF) test

 

Physico-chemical properties of cerebrospinal fluid (CSF)

Relative density of cerebrospinal fluid (CSF)

Relative density (specific gravity), lumbar cerebrospinal fluid of 1,005-1,009, suboktsipitalnogo - 1,003-1,007, ventricular - 1.002 - 1.004.

Increasing the relative density is observed for meningitis, uremia, diabetes, etc., and decline - in hydrocephalus.

 

Transparency of cerebrospinal fluid (CSF)

Normal CSF is transparent as distilled water, is to 98,9-99,0% of the water and 1,0-1,1% of the dry residue.
Turbidity of the liquor depends on the substantial increase in the number of cellular elements (erythrocytes, leukocytes, tissue cellular elements), bacteria, fungi, and increase protein content.

Turbidity caused by the cells and fungi, decreases or disappears after centrifugation, in contrast to the turbidity caused by bacteria. An increase of fibrinogen in the CSF also notes the change of transparency in the form of a light opalescence.

The degree of turbidity of the liquor is determined by comparing it with distilled water, poured into the same tube, in transmitted daylight on a black background.

 

Fibrin (fibrinous) film in cerebrospinal fluid (CSF)

Normally, in the cerebrospinal fluid contains virtually no fibrinogen. The appearance of fibrinogen in the CSF due to diseases of the CNS, causing a violation of BBB - purulent and serous meningitis, CNS tumors, cerebral hemorrhage, compression, etc.

 

Color of cerebrospinal fluid (CSF)

Normal cerebrospinal fluid is colorless, as distilled water. The appearance of color usually indicates a pathological process in the CNS. To determine the color of the CSF compared with distilled water, poured into the same tube.

 

Erythrocyt (erythroarhia) in cerebrospinal fluid (CSF)

The presence of blood in the cerebrospinal fluid can be detected macro-and microscopically. Distinguish waypoint (artifact) and true eritrotsitarhiyu.

Track eritrotsitarhiya called for blood in the cerebrospinal fluid of injury of blood vessels during the execution puncture.

True eritrotsitarhiya occurs when haemorrhage in the cerebrospinal fluid space due to rupture of blood vessels in hemorrhagic stroke, brain tumors, traumatic brain injuries.

The amount of blood released to the cerebrospinal fluid space may vary from 0.01 to 90 ml. When the concentration of red blood cells less 0,1-0,15 * 109 / l of liquor is colorless. Positive reaction zone diagnostic test strips for blood and the detection of red blood cells in the microscopic study of the native preparation of the CSF to diagnose hidden eritrotsitarhiyu.

When the concentration of red blood cells 0,6-1,0 * 109 / l of liquor becomes grayish-pink color, with 2-50 * 109 / l - a pinkish-red, at 51-150 * 109 / L - the color of fresh meat, with> 150 * 109 / L - bloody.

Eritrotsitarhiya evidence of intracranial bleeding due to rupture of the aneurysm of the brain vessels, hemorrhagic infarction, hemorrhage into the brain, a hemorrhagic encephalitis, traumatic brain injury. Subarachnoid hemorrhage may occur as a result of paralysis of vasomotor nerves and is accompanied by vasodilatation, stasis of blood in the capillaries, and diapedesis of red blood cells.

Red blood cells disappear from the CSF in mild traumatic brain injury and the exclusion of bleeding for 5-10 days, with hemorrhagic stroke and severe traumatic brain injury - a 10-20 day break with aneurysms of the brain - in 40-80 days.

 

Bilirubinarhiya (xanthosis) in cerebrospinal fluid (CSF)

Pink, orange, yellow, brown coloration of the CSF caused by the decay products of the blood - hemoglobin and bilirubin - and is called xanthosis. Distinguish between hemorrhagic and congestive xanthosis, which can be divided depending on the decay products of blood gemoglobinarhiyu (pink color) and bilirubinarhiyu (yellow color).

Hemorrhagic bilirubinarhiya called hitting the liquor spaces of blood, the decay of which leads to staining of cerebrospinal fluid in the pink, then orange and yellow. In hemorrhagic stroke, rupture of aneurysms of the brain or head injury, accompanied by massive hemorrhage, xanthosis appears in the 1-st day, with subarachnoid hemorrhage, its intensity increases by 2-4 per day.

Reducing bilirubinarhii and its disappearance are directly dependent on the etiology of hemorrhage. So, at break of cerebral aneurysms bilirubinarhiya kept 1-1,5 months, and for stroke and head trauma are not accompanied by bleeding - 10-14 days.

Congestive bilirubinarhiya - is the result of slow blood flow in the vessels of the brain. Hemodynamic disturbances increases the permeability of vessel walls and entering colored in yellow (bilirubin), blood plasma in cerebrospinal fluid. This bilirubinarhiya constant and accompanied giperproteinarhiey.
Congestive bilirubinarhiya encountered in vascularized tumors of the CNS, directly communicating with the cerebrospinal fluid spaces during blockade of subarachnoid space, compression, meningitis (mainly in TB), arachnoiditis, etc.

Physiological bilirubinarhiyavstrechaetsya in infants and nearly all of prematurity. This phenomenon can be explained by increased permeability of blood-brain barrier in relation to bilirubin plasma.

False bilirubinarhiyavyzyvaetsya penetration into the cerebrospinal fluid lipohromov or drugs, such as penicillin.

Green coloration of the CSF observed in severe bilirubinarhii the oxidation of bilirubin to biliverdin. Also, the green coloring liquor gives the admixture of pus, and the liquor turbid. This character of the liquor gets in purulent meningitis, brain abscess is a breakthrough in the subarachnoid space or into the cavity of the ventricles of the brain.

 

ðÍ of cerebrospinal fluid (CSF)

pH is a relatively stable biochemical parameters of cerebrospinal fluid. In healthy people, lumbar cerebrospinal fluid pH of 7,28-7, 32. The change in pH in the cerebrospinal fluid is reflected in alveolar ventilation, cerebral blood flow and consciousness.

Metabolic acidosis is most common in uremia, diabetic ketoacidosis or alcohol intoxication. pH of liquor when it remains within the normal range or only very slightly reduced.

Metabolic alkalosis observed in liver disease, prolonged vomiting, admission of alkaline substances. In this case, the pH of the CSF may paradoxically decrease to 7.27.

With respiratory acidosis, caused pulmonary disease, pH of CSF is reduced slightly.
Respiratory alkalosis caused by brain injuries, poisonings (especially salicylates), liver disease, did not significantly affect the pH of the cerebrospinal fluid.

Primary CSF acidosis manifested in diseases of the nervous system: severe subarachnoid and cerebral hemorrhage, head trauma, cerebral infarction, purulent meningitis, status epilepticus, metastasis to the brain and other.

 

Total protein in cerebrospinal fluid (CSF)

The protein content of lumbar cerebrospinal fluid of 0,22-0,33 g / liter. The indicator of 0.33 g / l is considered as the quantity, bordering on pathology, and protein 0.22 g / l - as hydrocephalic lumbar cerebrospinal fluid.

Gipoproteinarhiya - a reduction of protein content in the lumbar cerebrospinal fluid below 0.2 g / l is considered as hydrocephalic CSF.

Gipoproteinarhiya may occur:

• a result of reduced income of whey protein in cerebrospinal fluid
  
• by increasing the rate of exchange of liquor
  
• when you delete a large number of liquor at the Hydrocephalus
  
• during pneumoencephalography (PEG)
  
• patients with benign intracranial hypertension, hyperthyroidism, and some leukemias

Hyperproteinarhia - is to increase the protein content in CSF is possible at:

• subarachnoid hemorrhage
  
• brain tumors
  
• acute and chronic inflammatory processes of various etiology (arachnoiditis, arahnoentsefality, encephalitis, meningitis, etc.)
  
• brain abscess
  
• cysticercosis of the brain
• with traumatic brain injury (TBI)

In healthy adults approximately 83% of the proteins of the CSF falls on serum proteins, but 17% is the origin of the intrathecal (prealbumin, prostaglandin-D-synthase, a neuron-specific enolase, S100 protein, etc.).

The bulk of the total liquor protein is albumin, which has only serum origin. In normal CSF albumin ranges from 0.07 to 0.36 g / l and above. Almost any breach of the BBB leads to an increase in the concentration of albumin in the CSF and the increase in the ratio of CSF albumin / serum albumin. Ratio of albumin / globulin in the cerebrospinal fluid regulates the osmotic pressure in the central nervous system.

 

Glucose in cerebrospinal fluid (CSF)

At normal blood glucose levels in lumbar cerebrospinal fluid glucose concentration is approximately 60% of the level in plasma. When hyperglycemia is the difference between liquor and blood rises significantly in the cerebrospinal fluid glucose reaches only 30-35% of the level of the plasma. Glucose level in CSF is an important indicator of the BBB.

Hypoglikoarhia - a reduction of blood glucose below 2.2 mmol / l or ratio of blood glucose / cerebrospinal fluid glucose is less than 0.3. Observed at:

• bacterial, tuberculosis, amoebic, or fungal meningitis
  
• cysticercosis and echinococcosis (50% of patients)
  
• primary and metastatic tumors of the meninges (gliomas, sarcomas, lymphomas, neuroleukemia, melanoma, metastatic carcinoma of the lung, stomach, etc.)
  
• first day after subarachnoid hemorrhage

Hyperglikoarhia - increasing glucose levels of CSF is rare, not typical, even for diabetes. Reveals the increased level of glucose:

• during sleep (due to slow blood circulation and reduce the total brain metabolism)
  
• with brain damage and some types of meningoencephalitis
  
• in patients with ischemic stroke

 

Ketone bodies in cerebrospinal fluid (CSF)

Normally, ketones in the cerebrospinal fluid are not detected. Ketonarhiya develops after:

• operations in the meninges
  
• TBI
  
• subarachnoid hemorrhage
  
• strong excitation and stimulation of the CNS

Ketonarhia due to the collapse of the protein, as well as a violation of utilization of ketone bodies, which normally is a substrate for the cells of the CNS.

 

Nitrites in cerebrospinal fluid (CSF)

Nitrites - a waste product of many bacteria. Thus, a positive reaction to nitrites indicates bacterial meningitis. At the same time it must be remembered that this test will be negative for tuberculous and staphylococcal meningitis, as These agents do not restore the nitrate to nitrite.
 

Microscopic examination of cerebrospinal fluid (CSF)

In normal adult human CSF virtually no cellular elements: a ventricular CSF - 0-1 cells / ml in suboktsipitalnom - 2-3 cells / ml in lumbar - 3-5 cells / ml.

Increasing the number of cells in the cerebrospinal fluid (CSF pleocytosis) is considered as a sign of the organic CNS. CSF pleocytosis is:

• easy - 6-70 * 106kl / l;
  
• moderate - 70-250 * 106kl / l;
  
• pronounced - 250-1000 * 106kl / l;
  
• pronounced -> 1000 * 106 / l;
  
• massive -> 10 * 109kl per liter.

Modern methods for cytological studies indicate that cells of the CSF, except arahnoendotelialnyh cells and ependyma, hematogenous origin.

Liquor formula of healthy people is mainly represented by lymphocytes (70%) and monocytes (30%). In CSF, there are also neonatal neutrophilic granulocytes, whose content varies from 6 to 50%.

 

Lymphocytes in cerebrospinal fluid (CSF)

Lymphocytes in the amount of 4.2 cells / mm are part of a normal cell count of CSF. Normally, in the liquor contains only small lymphocytes.

State, accompanied by lymphoid CSF pleocytosis:

1. Meningitis (viral, tuberculosis, mycotic)
   
2. Amebic encephalomyelitis
   
3. Syphilitic meningoencephalitis
   
4. Parasitic CNS infection (cysticercosis, toxoplasmosis)
   
5. Degenerative diseases (subacute sclerosing panencephalitis, multiple sclerosis, medical encephalopathy, acute dissimenirovanny encephalomyelitis)
   
6. Other pathology (sarcoidosis, polyneuritis, periarteritis involving vessels of the brain)

 

Monocytes in cerebrospinal fluid (CSF)

Monocytes - the second major population of cells in normal CSF, is 1-3 cells / ml.
Increasing the number of monocytes in the liquor formula indicated for chronic smoldering inflammation in the CNS:

• tuberculous meningitis
  
• cysticercosis
  
• neurosyphilis
  
• viral meningitis
  
• multiple sclerosis
  
• hyperkinetic progressive panencephalitis
  ischemic diseases and brain tumors

 

Macrophages in cerebrospinal fluid (CSF)

Macrophages belong to the mononuclear phagocytic system in the normal cerebrospinal fluid not found. The presence of 1.2 macrophages / ml in normotsitoze - a sign of the former bleeding or inflammation of the CNS.

Macrophages were always found in the cerebrospinal fluid of patients with brain tumors growing in the lumen of the ventricles. A large number of macrophages in the postoperative period, evidence of active remediation of the CSF.

 

Neutrophils in cerebrospinal fluid (CSF)

Neutrophils in the cerebrospinal fluid of healthy person almost never occur. The cells of hematogenous origin. State, accompanied by neutrophilic CSF pleocytosis:

1. Meningitis (exudative phase of bacterial meningitis, the early stage of viral meningitis, an acute phase of tuberculous meningitis, the initial stage of mycotic meningitis, amebic meningoencephalitis)
   
2. Brain abscess
   
3. Cerebral and spinal syphilis
   
4. Subdural empyema
   
5. Hemorrhagic and ischemic stroke
   
6. Subarachnoid hemorrhage at 1-3 day
   
7. The response to the first and repeated puncture
   
8. The introduction of drugs into the subarachnoid space
   
9. Metastasis of malignant neoplasms in the CNS

 

Eosinophils in cerebrospinal fluid (CSF)

Eosinophils in the cerebrospinal fluid of healthy people do not meet. Their appearance is regarded as a special reaction vessels of the connective tissue in the subarachnoid space alien proteins.

Eosinophils in the cerebrospinal fluid function as phagocytosis, consuming bacteria, fungal spores and antigen-antibody complexes, especially with immunoglobulins and complement components.

Eosinophilia in the cerebrospinal fluid is not accompanied by eosinophilia in the blood and vice versa. Liquor eosinophilia can be observed both at normotsitoze, and when CSF pleocytosis. Eozifily may be at a specific stimulation to enter the cerebrospinal fluid from the mesenchyme of pia mater, or directly from the blood.

State, accompanied by the appearance of eosinophils in the cerebrospinal fluid (CSF, cerebrospinal fluid):

1. Parasitic infection (cysticercosis, echinococcosis)
   
2. Meningitis (eosinophilic, bacterial, tuberculosis, toxic, epidemic, syphilitic, viral)
   
3. Fungal infections
   
4. The introduction of drugs or contrast agents in the CNS
   
5. Acute polyneuritis
   
6. Idiopathic gipereozinofilny syndrome
   
7. Brain cyst
   
8. Ischemic and hemorrhagic stroke
   
9. Brain tumors (meningioma, neuroblastoma, eosinophilic adenoma)
   
10. Leukemia, neurosarcoidosis
    
11. Postoperative conditions meninges

 

Basophils in cerebrospinal fluid (CSF)

Basophils in normal cerebrospinal fluid not found. They are involved in inflammatory processes of allergic origin, are found in cerebrospinal fluid in severe neuroinfections occurring, especially in children.

 

Plasma cells in cerebrospinal fluid (CSF)

Plasma cells are found in the cerebrospinal fluid only during pathological processes. Formation of plasma cells from B-lymphocytes in the follicles of the cortical zone of lymph nodes and marginal zone of white pulp of the spleen, where the meeting with the antigen, they undergo a stage antigenzavisimoy differentiation. The main function of plasma cells - the synthesis and secretion of antibodies.

State, accompanied by the appearance of plasma cells in the cerebrospinal fluid (CSF, cerebrospinal fluid):

1. Long-term slow-inflammation of the brain and the meninges (chronic encephalitis, meningitis of various etiologies, arachnoiditis)
   
2. Multiple sclerosis
   
3. Hyperkinetic progressive panencephalitis
   
4. Neurosyphilis (in conjunction with normotsitozom or minor CSF pleocytosis)
   
5. Some tumors of the CNS
   
6. Tuberculous meningitis
   
7. Sarcoidosis
   
8. Collagen with involvement in the process of CNS
   
9. Subarachnoid hemorrhage

 

Blasts in cerebrospinal fluid (CSF)

Do leukemia patients with involvement of the meninges occurs leukemic meningitis - neuroleukemia. Neuroleukemia develops most often in acute leukemia. Typically, the number of cells in the CSF ranged from 100 to 300 * 106 / l, is not excluded, and higher CSF pleocytosis, are 2-5 * 109 / l and more.

In malignant lymphomas in patients during treatment with chemotherapy and immunosuppressive therapy may develop kriptokokkosis, koktsidiomikosis, kandidamikosis blastomikosis or meningitis, encephalitis or meningoencephalitis.

 

Arachnoid endothelium cells in cerebrospinal fluid (CSF)

Arachnoid endothelium cells - is a single-layer epithelium ependimalnogo origin, morphologically similar to the mesothelium lining the space of all central nervous system, filled with liquor, except in the ventricles of the brain.

Arachnoid endothelium cells found in cerebrospinal fluid of patients with brain tumors, and traumatic brain injury and after surgery for brain membranes.

 

Tumor cells in cerebrospinal fluid (CSF)

Tumor cells of the brain and other organs and tissues found in the study of cerebrospinal fluid in patients with primary and metastatic tumors of the CNS. Tumor cells enter the CSF as a result of rejection of the tumor tissue adjacent to the liquor spaces, as well as during germination of the walls of ventricles of the brain or meninges, with kantseromatoze meninges.

 

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