10. Gross examination
Appearance
Normal – crystal clear, colourless and no coagulum
1.Colour
Any change in colour is always pathological
Red
Yellow
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11. xanthochromia
Pale pink to yellow colour in supernatant of CSF
Froin’s syndrome
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12. D/D of bloody CSF
Traumatic tap - hemorrhagic fluid clears between
first and third tubes; remains uniform in SAH
Pathological
- RBC have crenated appearance
Xanthochromia, erythrophagocytosis and hemosedrin
laden macrophages indicate a subarachnoid bleed in
absence of prior trauma
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13. Gross examination(contd)
2. Turbidity
o WBC >200 cell/μl
o RBC >400 cell/μl
o Microorganisms, radiographic contrasts, aspirated
epidural fat
o Protein > 150 mg/dl
Clot formation
Viscous CSF
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14. Pressure of CSF
Normal
Adults – 90 – 180 mm water
Infants and children – 10 – 100 mm water
>250 mm water
Intracranial hypertension
Tumors
Decreased pressure
Dehydration
Circulatory collapse
CSF leakage
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15. Biochemical analysis of
CSF
1. Glucose
Normal – 45 – 100 mg/100 ml
decreased – coccal meningitis
TB meningitis
intrathecal streptomycin
Increased – diabetic hyperglycemia
In assessing response to treatment
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16. 2.Proteins
Normal – 15 – 45 mg/dl
Term infants – 90 – 150 mg/dl
Pre term - 115 – 170 mg/dl
Increased CSF protein
I. Increased permeability of blood brain barrier
II. Increased intrathecal IgG secretion
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19. Permeability of blood brain
barrier
CSF/serum albumin index
index
permeability
<9
intact barrier
9 – 14
slight impairment
14 – 30
moderate impairment
>30
severe impairment
Index slightly elevated in infants up to 6 months of age
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Dr.Rittu Chandel
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20. CSF serum immunoglobulin
ratio
Increases in multiple sclerosis
Increased CSF IgM and kappa light chains – marker of
multiple sclerosis
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21. CSF proteins and CNS
diseases
proteins
Diseases or disorders
Α2 - macroglobulin
Subdural hemorrhage, bacterial meningitis
Β – amyloid protein 42 and ζ protein
Alzheimer’s disease
Β 2 - microglobulin
Leukemia/lymphoma, bechets syndrome
C- reactive protein
Bacterial and viral meningitis
fibronectin
Lymphoblastic leukemia, AIDS, meningitis
methemoglobin
Mild subarachnoid/subdural hemorrhage
Mylein basic protein
Multiple sclerosis, tumors
Protein 14- 3 -3
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Dr.Rittu Chandel
Creutzfeldt – jacob disease
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34. Gross examination
Total volume – recorded at bedside
Normal= 3.5 mL
Diseased / inflamed = up to 25
mL
Colour – colourless
xanthochromia
red brown
Clarity –transparent
opaque
oily
floating rice bodies
ground pepper appearance
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35. Biochemical analysis
Mucin clot test
Non specific finding
Glucose
Serum synovial difference < 10 mg/dl
Septic arthritis – difference 20 – 60 mg/dl
Protein
Normal – 1-3 g/dl
Increased in inflammation
Uric acid
RF
ANA
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40. lymph
The lymphatic system is an extensive vascular network
responsible for the transport of fluid , immune cells ,
proteins and lipids .
The failure to transport lymph fluid results in a
number of disorders and diseases .
Lymphedema , for example , is a pathology
characterized by the retention of fluid in limbs
creating extreme discomfort , reduced mobility.
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41. slightly basic fluid
Resembles plasma in its content
Protein content varies widely from 2% to 8%
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