Test of Cerebrospinal Fluid and Serous Membrane Effusion

Zhongsheng XiaZhongsheng Xia

The Second Affiliated Hospital, Sun Yat-sen UniversityThe Second Affiliated Hospital, Sun Yat-sen University

Test of cerebrospinal fluid (CSF)

Test of serous membrane effusion

Test of CSF

Indications and contraindications of lumbar Indications and contraindications of lumbar puncturepuncture

Normal reference value of CSF and clinical Normal reference value of CSF and clinical significance of abnormalitysignificance of abnormality

Characteristic changes of CSF in common Characteristic changes of CSF in common central nervous system diseasescentral nervous system diseases

Test of serous membrane effusion

clinical significance of serous membrane effusionclinical significance of serous membrane effusion

Differentiation of transudate and exudateDifferentiation of transudate and exudate

The cerebrospinal fluid (CSF)

Definition: CSF is a clear, colorless liquid that fills the ventricles, the subarachnoid spaces surrounding the brain and the spinal cord.

Anatomy:

Indications of lumbar puncture patients with meningeal irritation signs patients are suspected to have intracranial hemorrhage patients with serious headache, coma, twitch or paralysis

contraindications of lumbar puncture patients with high intracranial pressure patients with local infection of the skin in the lumbar area

Test of CSF

The position of lumbar puncture: The patient is placed in lateral kneel-chest position with the neck flexed

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Video for lumbar puncture

General test Pressure: 80~180mmH2O, or 40~50drops/min

Increased: intracranial infection, intracranial hemorrhage, intracranial tumor, blood hypertension, cough, sneeze, et al.

Decreased: blocked circulation of CSF, CSF is lost,

shock, coma, dehydration, et al.

Test of CSF

General test Color: colorless and clearColor: colorless and clear

milk white:milk white: pyogenic meningitis pyogenic meningitis

red:red: subarachnoid hemorrhage, traumatic hemorrhage, subarachnoid hemorrhage, traumatic hemorrhage, et al. et al.

yellow:yellow: old intracranial hemorrhage, CSF containing a old intracranial hemorrhage, CSF containing a lot of protein, serious jaundice, et al.lot of protein, serious jaundice, et al.

brown or black:brown or black: meningeal melanoma meningeal melanoma

Test of CSF

General test Diaphaneity and clot: clear

cloudy or clot: meningitis

Test of CSF

Chemical test Protein : Pandy’s test (-) Protein : Pandy’s test (-)

protein quantification: 0.15~0.45 g/L protein quantification: 0.15~0.45 g/L

increased:increased: encephalic infection, intracranial tumor, encephalic infection, intracranial tumor, intracranial hemorrhage, subarachnoid obstruction, intracranial hemorrhage, subarachnoid obstruction, et al.et al.

Separation of protein and cell:Separation of protein and cell: Guillain-Barre syndr Guillain-Barre syndromeome

Test of CSF

Chemical test Glucose: 2.5~4.4 mmol/L

decreased: nervous system infection, intracranial tumor, hypoglycemia, et al.

increased: viral nervous system infection, diabetes, et al.

Test of CSF

Chemical test chloride: 120~130 mmol/L

decreased: bacterial or fungal intracranial infection, hypochloremia, et al.

increased: chronic renal failure, hyperchloremia, et al.

Test of CSF

Chemical test Enzyme: LDH=1/10 serum level, ADA=0~8U/L

high: nervous system bacterial infection,

cerebrovascular disease, cerebroma

Test of CSFTest of CSF

Microscopic examination Cell count: white blood cell (0~10) ×106/L no red blood cell Cell differential: majority is lymphocyte neutrophil is increased: nervous system infection lymphocyte is increased: tubercular meningitis, fungal meningitis plasma cell: viral nervous system infection, tuberculosis, parasite, Guillain-Barre syndrome, et al. macrophage: meningitis, subarachnoid hemorrhage, brain trauma, et al. Pathogen: no pathogen

Test of CSF

Characteristic changes of CSF in common central nervous system diseases

normal Pyogenic meningitis

Tubercular meningitis

Viral meningitis

Brain tumor Subarachnoid hemorrhage

Pressure

(mmH2O)

80~180 ↑ ↑ ↑ ↑ ↑

Gross appearance

clear cloudy mild cloudy clear or mild cloudy

colorless or yellow

red

Protein

(qualitative)

- + + + + +

Protein (g/L)

(quantitative)

0.2~0.4 ↑ ↑ ↑ ↑ ↑

Glucose

(mmol/L)

2.5~4.5 ↓ ↓ → or ↑ → ↑

Chloride

(mmol/L)

119~129 ↓ ↓ → → →

Cell count and differential (×106/L)

0~10 lymphocyte

↑ neutrophil

↑ lymphocyte ↑ lymphocyte

→ or ↑ lymphocyte

↑

red blood cell

Pathogen No Can be found

tubercular bacillus

virus No No

↑↑ : increased; ↓↓ : decreased; →→ : normal

ascites

Pleural effusion

Pericardial effusion

Test of serous membrane effusion General test

color

transudate: light yellow

exudate: dark yellow, red or milk white.

diaphaneity

transudate: clear

exudate: cloudy

gravity

transudate: <1.018

exudate: >1.018

Chemical test Protein Rivalta test (qualitative analysis) transudate: negative exudate: positive quantitative analysis transudate: <25 g/L exudate: >30 g/L

Test of serous membrane effusion

Chemical test

Glucose

transudate: similar to serum glucose

exudate: decreased

pyogenic inflammation: <1.12 mmol/L

tuberculosis: <3.30 mmol/L

malignant: 1.68~3.30 mmol/L

Test of serous membrane effusion

Chemical test

Enzyme

LDH

transudate: similar to serum LDH

exudate: increased

ADA

transudate: similar to serum ADA

exudate: increased

Test of serous membrane effusion

Microscopic examination

cell count

red blood cell

increased: malignant, tuberculosis, trauma

white blood cell

transudate: <100×106/L

exudate: >500×106/L

Test of serous membrane effusion

Microscopic examination

cell differential

neutrophil increased: pyogenic, early tuberculosis

lymphocyte increased: tuberculosis, syphilitic, malignant

eosinophil increased: allergic disease, parasites, SLE, et al.

Test of serous membrane effusion

Microscopic examination

cytology examination

cancer cell: malignant

Test of serous membrane effusion

Differentiation of transudate and exudate

transudate exudate

Main cause not from infection or tumor infection, malignant, etc.

Gross appearance light yellow yellow, red or green

diaphaneity clear cloudy

Gravity <1.018 >1.018

Rivalta test negative positive

Protein quantitate <25 g/L >30g/L

Glucose Similar to serum glucose decreased

Cell count <100×106/L >500×106/L

Cell differential lymphocyte neutrophil, lymphocyte,etc

Pathogen

Fluid/serum Protein

Fluid/serum LDH

LDH

negative

<0.5

<0.6

<200 IU

can be positive

>0.5

>0.6

>200 IU

uestionsuestions

1. What are the characteristic changes of CSF in common central nervous system diseases?

2. What are the differential points of transudate and exudate in serous membrane effusion?

CSF is a clear, colorless liquid that fills the ventricles, the subarachnoid spaces surrounding the brain and the spinal cord. Its total volume is approximately 90~150ml.

Measure pressure of CSF with manometer