Csf acts as a cushion, protecting the brain and spine from injury. This guideline aims to help with the interpretation of csf results for the purpose of diagnosing or excluding meningitis. Csf white cell count and protein level are higher at birth and fall fairly rapidly in the first 2 weeks of life. Rbc count is of limited use, but can be used to correct csf leukocyte counts of a traumatic tap csf. Enterovirus from csf subcritical values in addition, the results of some tests, while not immediately life threatening, are considered to pose a significant risk if not addressed in a timely fashion i. If your fluid contains rbcs, this may indicate bleeding. Approx 150mls 50% 75mls in cranium 20% residing in ventricles 30% elswhere 50% 75mls in spinal cord daily production is approxiamtely 500ml, representing a turnover of 34 times csf formation 6070% of the csf is formed by the choroid plexuses 3040% by the cerebral vessels lining the ventricular walls.
Cerebrospinal fluid reference values for young infants. This process depends on having wellestablished reference normal values. Cerebrospinal fluid csf interpretation geeky medics. With the patient in the supine position, the subarachnoidal space was infused with artificial csf at several constant pressure levels. Total csf protein is elevated in 80% of patients with leptomeningeal metastases with a. Nursing exam cram sheet for the nclexrn the final mountain that nursing students must summit before becoming a registered nurse is the nclex.
An index value values of 914 are interpreted as slight impairment, 14. However, evidencebased, standardized assessments of. Decrease in glucose levels during a cns infection is caused due to glycolysis by both white cells and. This investigation was undertaken to establish baseline values for a wide spectrum of components in the serum and csf of the monkey. The predominant finding of polymorphonuclear elements points to a suppurative lesion and the scope of differential diagnosis is relatively limited. Cerebrospinal fluid results csf interpretation other. Because the relationship between csf protein values and age appeared to be nonlinear for children aged csf protein values as the dependent variable in group 2. Csf analysis neurology michigan medicine confluence. Normally, there are no rbcs in the cerebrospinal fluid, and there should be no more than five wbcs per cubic millimeter of csf. Bloody fluid may indicate a traumatic puncture pushing the needle in too far, into the venous plexus along the anterior spinal canal or subarachnoid hemorrhage. Ucsf clinical laboratories critical and subcritical values. Lumbar puncture lp and cerebrospinal fluid csf analysis is crucial for the diagnosis of bacterial meningitis. Normal cerebrospinal fluid values in fullterm gestation and. Complex assessment of csf flow quantification using phase.
Always handcarry csf down to the lab and ask for evaluation of xanthochromia wcentrifugation of cloudycolored specimens. Clinical examination a comprehensive collection of clinical examination osce guides that include stepbystep images of key steps, video demonstrations and pdf mark schemes. The goal of our study is to obtain normal values of cerebrospinal fluid csf circulation and volumetric indices of ventricle size in healthy subjects in order to create a reference dataset for monitoring patients with hydrocephalus. A lumbar puncture needle with stylet is inserted into the l3to l4 or l4tol5 interspace the l4 spinous process is typically on a line between the posteriorsuperior iliac crests. May 26, 2018 you will not be expected to know this skill for examinations, however you may be asked to interpret some csf results. Educational commentary differential cell count on cerebrospinal fluid cont. Reference values vary based on several factors, including the demographics of the healthy population from which specimens were obtained and the specific methods andor. Aug 09, 2015 analysis of cerebrospinal fluid is used in the diagnosis of a wide variety of diseases and conditions affecting the central nervous system. Cerebrospinal fluid csf analysis is a group of laboratory tests that measure chemicals in the cerebrospinal fluid. It is produced by specialised ependymal cells in the choroid plexuses of the ventricles of the brain, and absorbed in the arachnoid granulations. Cerebrospinal fluid interpretation csf interpretation geeky medics. Conclusion the differential cell count is an important component of csf analysis that should always be performed if the total wbc count is elevated. Csf flow quantification through the fourth ventricle by. You will not be expected to know this skill for examinations, however you may be asked to interpret some csf results.
By draining csf at a low pressure the csf production rate was determined. Csv to pdf convert your csv to pdf for free online. Albumin csf serum ratio q alb should be preferred to total protein measurement and normal upper limits should be related to patients age. Normal cerebrospinal fluid values in fullterm gestation. Furthermore, since the concentrations of csf glucose and csf lactate in ventricular csf differ from lumbar csf values, we have excluded all ventricular csf samples. Pdf the cerebrospinal fluid csf is contained in the brain ventricles and the cranial and spinal subarachnoid spaces. Protein concentration in cisternal and ventricular csf is lower. If there is a high clinical suspicion of meningitis, children who have a normal csf should still be treated with iv antibiotics, pending cultures. This station tests your knowledge of both the normal values of various components of csf, and also your ability to make a differential diagnosis of a condition purely from a set of csf results. Headache which may require medication and bed rest. Lumbar puncture csf interpretation oxford medical education. Using qflow technique the normal values of csf flow through investigated structures and crosssectional area of this structures were defined fig.
This is where this cram sheet can help it contains condensed facts about the licensure. Lymphocytosis in the cerebrospinal fluid annals of. However,as few as 200 white blood cells wbcs per mm3 or 400 red blood cells rbcs per mm 3 will cause csf to appear turbid. Preparing for the nclex can be stressful as taking in colossal amounts of information has never been easy. Csf cell counts in children with shunts children may have different csf counts compared to adults. Reference values of normal horses article pdf available in american journal of veterinary research 388. Please refer to intermountain laboratory services labnet cp0008a1 or contact client services 8015072110 or 8773531106 for the most current critical values list. Pmn leukocytes in the csf may occasionally be a normal finding, but their presence should not be taken lightly, especially if anc is 1mm 3 15. Reference range for cerebrospinal fluid protein concentration. Cerebrospinal fluid csf is a clear, colorless body fluid found in the brain and spinal cord. Csf is a clear fluid that surrounds and protects the brain and spinal cord. Common laboratory values cheat sheet diagnostic tests are crucial in any aspect of clinical practice since they assist clinicians in establishing and determining the particular condition of the patient.
The risks and complications with this procedure can include but are not limited to the following. Decreased protein is a sign of rapid csf production. It contains policies for color images, such as web graphic color definitions, colorsync colors, prepress colors for different countries, and other color settings. Agespecific reference values for cerebrospinal fluid protei. Csf glucose 95 th percentile values were highest in neonates 5. The reference range for csf glucose is generally set at 2. Cerebrospinal fluid protein and glucose levels in neonates. Mar 14, 2018 aims were also to establish whether csf protein and glucose in sepsis without elevated csf cell count and with negative csf culture andor pcr is different from csf in patients without a systemic inflammatory response and different from the normal values of csf biochemistry as reported in the literature reference range for neonates and to. Csv to pdf convert file now view other document file formats technical details in computers, a csv file contains the different values in a table as a series of ascii american standard code for information interchange text lines which are then organised so that each column value is separated by a comma from the next columns value and each. Analysis of differences between respective mean values of csf flow has shown that csf flow characteristics have greatest values in the sylvian aqueduct and on the. The csf pressure, measured at lumbar puncture lp, is 100180 mm of h2o 815 mm hg with the patient lying on the side and 200300 mm with the patient sitting up. There is about 125ml of csf at any one time, and about 500 ml is generated every day. Increased csf protein may be due to blood in the csf, diabetes, polyneuritis, tumor, injury, or any inflammatory or infectious condition.
Csf files are used for achieving color consistency between images and prints. Cerebrospinal fluid csf is collected by performing a lumbar puncture on your patient. Csf acts as a cushion or buffer, providing basic mechanical and immunological protection. Cerebrospinal fluid csf is secreted by the choroid plexuses, around the cerebral vessels, and along the walls of the ventricles of the brain, filling the ventricles and cisternae and bathing the spinal cord. Csf glucose levels may be decreased due to consumption by. A csf cerebrospinal fluid flow study is a test used to see the flow patterns of fluid in your brain and around your spinal cord. Elevated cerebrospinal fluid csf protein concentration measured during diagnostic lumbar puncture lp can indicate a pathologic central nervous system process. Cerebrospinal fluid protein in diabetes mellitus jama. Normal values are given and discussed for 1 the resting pressure, 2 the conductance of the csf outflow pathways, 3 the formation rate of csf, 4 the pressure difference across the csf outflow pathways, and 5 the sagittal sinus pressure. Knowledge of the normal physiology and pathophysiology of csf production and flow is useful in interpreting such test results. Cerebrospinal fluid cell count 05l 05 x 106l glucose 4080 mgdl 2. Elevated total protein concentration with normal csf cell count albuminocytological dissociation is. Interpretation of cerebrospinal fluid parameters in.
Several studies have found increased csf tau 9,10 and reduced csf a 42 11 levels in ad to be a pathological csf biomarker signature that is diag nostic of ad heralding the onset of ad before it be comes clinically manifest 7,1416. Meningitis can occur in children with normal csf microscopy. A lumbar puncture procedure is performed to allow a radioactive substance to be injected into the fluid around the spinal cord in your. Csf analysis includes measurement of normal csf compounds eg, proteins, glucose, as well as examining for abnormal elements eg, cells, pathogens, abnormal proteins, serology. Above the age of 4 years a gradual increase in the csf glucose 95 th percentile was seen from 4. Normal values are given and discussed for 1 the resting pressure.
For exampl e, healthy neonates may have leukocytes in the csf in the absence of infection or neuropathology. The reference values provided in these tables should be used as guidelines only. Table referring to normal values of csf has been updated to include a wider population. Csf glucose levels can be useful in distinguishing among causes of meningitis as more than 50% of patients with bacterial meningitis have decreased csf glucose levels while patients with viral meningitis usually have normal csf glucose levels.
Csf is reabsorbed into the blood through the arachnoid villi. Investigation of reference values of components of. Elevations of the cerebrospinal fluid total protein have been reported in patients with diabetes mellitus. In order to obtain reference values, random samples of csf from 70 women and 69. Laboratory values see inside back cover for continuation. Critical values are called to the clinician responsible for the patient. It is recommended that csf should be analysed immediately after collection. Lumbar puncture spinal tap merck manuals professional edition. Csf turnover is rapid, exchanging about 4 times per day. Uk standards for microbiology investigations issued by the standards unit, public health england acknowledgments uk standards for microbiology investigations smis are developed under the.
See page 1039 for definitions of strength ofevidence levels. While these results are readily available to ucsf providers through the apex emr, the ucsf clinical labs. Cerebrospinal fluid in critical illness college of intensive care. Rheumatoid meningitis and lupus myelopathy may cause low csf glucose. Examination of the cerebrospinal fluid csf may provide critically important diagnostic information in a number of infectious and noninfectious medical conditions. Normal values of ventricular volume and cerebrospinal fluid. In recommending the csf flow study the doctor believes the benefits to you from having this procedure exceed the risks involved. Although normal values are wellestablished for csf cell counts and protein and glucose contents in children and adults, this is not the case for neonates. Dec 18, 2018 a csf file is a color management settings file used by adobe photoshop, indesign, and illustrator. For the procedure, the patient is typically in the left lateral decubitus position. The total of csf in the brain and spinal cord is about 140 ml.
An overview of cerebrospinal fluid interpretation csf interpretation, including some worked examples to put your knowledge to the test. Page 4 of 7 results using qflow technique the normal values of csf flow through the sylvian aqueduct, the fourth ventricle and the magendies foramen were defined fig. Several authors have pointed out that there is an acceptable variability in the csf profile, especially csf wbc count, in neonates1,35,815. These values and curves can be used to interpret the results of lumbar puncture in infants. Normal laboratory values msd manual professional edition.
Peripheral blood in the csf after a traumatic tap will result in an artificial increase in wbcs by one wbc for every 500 to 1,000 rbcs in the csf. Cerebrospinal fluid reference values for young infants undergoing. Csf flow quantification through the fourth ventricle by data. Proper eval uation of csf depends on knowing which tests to order, normal ranges for the patients age, and the tests limitations. The resulting clinical reference values obtained were discussed in light of the published normal values for csf from horses, other animals, and man. In the following table, you can find a list of programs that can open files with.
Interpretation of csf protein concentration requires established reference values. Proper evaluation of csf depends on knowing which tests to order, normal ranges for the patients age, and the tests limitations. The test is also used to measure pressure in the spinal fluid. Using the results of quantitative csf and serum albumin assays, a csf in mgdlserum in gdl albumin index can be calculated.
Protein level, opening pressure, and csftoserum glucose ratio vary. The increase of cells in the cerebrospinal fluid may be either in the number of mononuclear lymphocytes or polymorphonuclear leukocytes and is invariably an indication of a pathological process. Agespecific reference values for cerebrospinal fluid. Decreased csf pressure may be due to spinal block, dehydration, fainting, or csf leakage. The rationale for in cluding these biomarkers in the diagnostic criteria of probable ad is that it increases the certainty that the basis of the clinical dementia syndrome is the ad patho.
Oct 26, 2010 other tests if indicated ie more specific viral or fungal tests. Normal csf values table amended to include the ages and the supporting text underneath has been strengthened. The tests may look for proteins, sugar glucose, and other substances. This table lists reference values for the most common laboratory tests and is intended for interpretation of the results as they are provided in the examination. If storage is needed 12 ml of csf should be partitioned into three to four sterile tubes. If you continue browsing the site, you agree to the use of cookies on this website. This list is created by collecting extension information reported by users through the send report option of filetypesman utility. Reference values intervals for blood, urine, csf, stool, and other fluids eg, gastric acid and commonly used panels are included. Reference values vary based on several factors, including the demographics of. The proper interpretation of csf results depends on knowledge of normal values in the group of patients being evaluated 3,4,15,16.
1489 598 1281 183 1338 878 1372 365 880 1405 913 1350 1231 1524 553 1423 1115 695 801 814 1346 1234 468 1352 385 894 1408 132 588 238 1277 49 203 497 25 972 347 34 360 1177 829 797 1163 1099