Cerebrospinal Fluid (CSF) | National Multiple Sclerosis Society ~ Lifestyle Blog

The 33 multiple choice questions about Cerebrospinal Fluid. 1. The functions of the CSF include all of the following except: A. Removal of metabolic wastes B. Producing an ultrafiltrate of plasma C. Supplying nutrients to the CNS D. Protection of the brain and spinal cord.Functions of cerebrospinal fluid. It acts as a shock absorber and protects the brain and spinal cord from injury. If facilities for estimation of CSF proteins are not available in the laboratory, then Pandy's test for globulins may be performed. In this test, CSF is added to saturated solution of...Cerebrospinal fluid (CSF) represents the fluid that is produced in the choroid plexuses of the ventricles of the brain. The CSF is contained within the The main functions of CSF are mechanical support for brain, transporter of different biochemical compounds, especially neuromodulators and...Share via. Share via... Twitter. LinkedIn. Facebook. Pinterest. Telegram. WhatsApp. Yammer. Reddit. Recent Changes. Send via e-Mail. Print. Permalink. ×. Table of Contents. Cerebrospinal fluid (CSF). Appearance. Pressure. Cells. Protein. Albumin. Immunoglobulin. Asialotransferrin. Myelin basic protein.Cerebrospinal fluid (CSF) shunts are used in the setting of hydrocephalus to divert CSF to another part of the body for absorption. The approach to management of shunt infections is discussed here.

Examination of Cerebrospinal Fluid (CSF) | Follow Us

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal cord. Also, anyone who experiences symptoms of a CSF leak following any of the following should seek medical The symptoms of a CSF leak include fluid drainage from the ears or nose and a headache that worsens...Cerebrospinal Fluid. CSF cushions your brain protecting it from injury. Examination of the cerebrospinal fluid helps to diagnose diseases, including infectious diseases of the central nervous system, causes of brain hemorrhages, immunological disorders, and cancer.I'm not sure what you mean by "midbrain only" but I do know that the answer is A. The Cerebrospinal fluid has nothing to do with brain weight.CSF or cerebrospinal fluid tests detect meningitis and multiple sclerosis. The function of the CSF includes cushioning and lubrication of the central nervous system, circulation of The changes which occur in CSF following hemorrhage include: Gross exam: 2 to12 hours; pink to orange xanthochromia.

Cerebrospinal Fluid Analysis: Reference Range, Interpretation...

Cerebrospinal fluid circulates within the ventricles of the brain and in the subarachnoid space outside the brain. Which of the following is not a function of the CSF? reduction of brain weight initiation of some nerve impulses protection from blows nourishment of the brain.Cerebrospinal fluid (CSF) analysis is a set of laboratory tests that examine a sample of the fluid surrounding the brain and spinal cord. This fluid is an ultrafiltrate of plasma. It is clear and colorless. It contains glucose, electrolytes, amino acids, and other small molecules found in plasma, but has very...30. Which is nota function of cerebrospinal fluid? 33. The amount of CSF within the brain at any given moment is approximately HAPS Topic: Module H08 Protective roles of the cranial bones, meninges, & cerebrospinal fluid.Learning Objective: 13.02.05 Trace the circulation of cerebrospinal...A cerebrospinal fluid (CSF) analysis is a group of tests that help diagnose diseases and conditions affecting the brain and spinal cord. Learn more. You may need a CSF analysis if you have symptoms of an infection of the brain or spinal cord, or of an autoimmune disorder, such as multiple sclerosis...Cerebrospinal fluid valves after reversal of CSF-to-blood pressure gradient. Although it has been shown that hydrocephalus may follow infection of the meninges, subarachnoid hemorrhage and infusion of FGF-2 (fibroblast growth factor) into the CSF, it is not clear whether the alterations in the...

Conditions associated with an odd CSF analysis come with (however not restricted) the following:

Conditions associated with changes in the look of CSF

Conditions associated with changes in the look of CSF come with the following:

Infections meningitis – Turbid, milky, cloudy CSF samples

Hemorrhage or tense tap – Xantochromic CSF samples with increased hemoglobin

Kernicterus - Xantochromic CSF samples with larger bilirubin

Meningeal melanosarcoma – Xantochromic CSF samples with greater melanin

Disorders affecting blood-brain barrier - Cloudy CSF samples with larger proteins (above one hundred fifty mg/dL) and albumin and IgG

Xantochromia is the term used for any kind of discoloration of CSF (purple, yellow, orange). Multiple stipulations are related to xantochromia: worrying faucet, presence of carotene, melanoma and increased bilirubin focus (bilirubin concentration may also be elevated in serum and sufferers are frequently jaundiced) due to liver illnesses, hemolytic diseases (also increased free hemoglobin concentration) and inborn mistakes of metabolism. [2, 3]

Note that standard CSF samples will have to be colorless, clear, like water. If CSF samples are centrifuged in an instant, xantochromia due to demanding faucet must not occur. However, if CSF samples are in moderation centrifuged immediately and the supernatant is still xantochromic, this means that bleeding may have occurred 2-Four hours ahead of pattern collection. Furthermore, in about 10% of sufferers with subarachnoid hemorrhage, the CSF samples may well be clear if the samples are gathered 12 hours after the hemorrhage passed off.

Conditions associated with adjustments in the biochemical composition of CSF

Conditions related to adjustments in glucose focus of CSF come with the following:

Note that ordinary concentration of glucose in CSF samples is 45-Eighty mg/dL or 60-80% of that during the plasma (for glucose plasma concentrations not up to 400 mg/dL). Absolute diminished CSF glucose stage and especially diminished CSF glucose stage in relation with serum are generally related to bacterial or fungal meningitis. However, in patient with a customary CSF glucose focus however with greater number of WBC, viral meningitis will have to be suspected. For accurate interpretation of CSF glucose concentration, serum glucose must be evaluated in serum samples amassed about 2 hours previous to spinal tapping (allow time for equilibrium) and all specimens (CSF and serum) will have to be tested in an instant to steer clear of glycolysis. [2, 3]

Conditions related to increased CSF lactate include any condition related to lowered blood float or hypoxia (eg, head trauma), akin to the following:

Evaluation of lactic acid focus in CSF is useful for the analysis and control of different types of meningitis. Generally, the following tips can be applied:

CSF lactate >35 mg/dL is seen in patients with bacterial meningitis

CSF lactate 25-35 mg/dL is observed in patients with tubercular and fungal meningitis

CSF lactate <25 mg/dL is seen in patients with viral meningitis

RBCs contain high concentration of lactate and LDH. Therefore, xantochromic CSF samples with increased hemoglobin and/or RBC can lead to falsely increased lactate and LDH effects. [3]

Conditions associated with increased CSF LDH include the following:

Intracranial hemorrhage

Bacterial meningitis

Conditions associated with elevated CSF glutamine come with the following:

Glutamine results from the amination of a-ketoglutarate with ammonia and it represents the main manner in which the poisonous metabolite ammonia is removed from the CNS. In the prerequisites in which ammonia accumulates, corresponding to in liver disease, inherited urea cycle issues, or Reye syndrome, glutamine concentration will carry as smartly. The standard glutamine concentration in CSF is 8-18 mg/dL. Increased concentration of glutamine in CSF is adopted impulsively by way of signed and signs, whilst at focus of 35 mg/dL or above, sturdy seizures and coma can occur. Evaluation of glutamine in CSF is a commonplace observe in the case of sufferers, particularly youngsters, with coma of unknown foundation. [2]

Conditions associated with cerebrospinal protein variation

The protein focus in CSF varies with age and level of tapping (eg, lumbar, ventricular, etc). It correlates well with the focus of general proteins and different fractions in serum, however they're significantly decrease. The important fraction in CSF is albumin, in a similar fashion as in serum. Decreased overall protein concentration in CSF is most often related to CSF leakage, while elevation of proteins in CSF will also be seen in a multitude of conditions.

In addition to medical stipulations, protein focus will also be falsely elevated in CSF due to nerve-racking faucet and greater RBC and hemoglobin. Therefore, corrections are often implemented: if CSF sample is xantochromic, for each 103 RBC counted, 1.1 mg/dL must be subtracted from the measured overall protein concentration of CSF. [2, 3] Online calculators, which calculate corrected protein focus in CSF bearing in mind the counted RBC, hematocrit and serum protein focus, also are available: http://reference.medscape.com/calculator/csf-protein-concentration-correction.

CSF protein fractions and CSF IgG

In sure conditions, reminiscent of in multiple sclerosis, analysis of general proteins in CSF is not enough. Evaluation of other protein fractions and more than a few immunoglobulins is important.

IgG immunoglobulins may also be produced by the plasma cells on each side of the blood-brain barrier: within CNS and in serum. When IgG fraction of CSF is elevated, the speedy question objectives the integrity of the blood-brain barrier. Therefore, opinions of serum albumin and serum IgG and normalization of IgG concentration of CSF, bearing in mind those serum concentrations, are important. [2, 3, 4]

Quotient of albumin

Albumin is synthetized in the liver and can succeed in CSF via diffusion. Normal albumin concentration in CSF is about 500 instances lower than that of serum. Abnormal focus of albumin in CSF is maximum often associated with disruption in the blood-brain barrier (eg, trauma, irritation). Quotient of albumin (Qalb) is a calculated parameter that normalizes the CSF focus of albumin to the concentration of albumin in serum:

Q-Alb=(AlbCSF/AlbSerum) X 1000

Normally, the Quotient of albumin is lower than 9 and reflects intact blood-brain barrier. However, the higher the quotient of albumin, the higher the blood-brain barrier harm and vice-versa. [2, 3, 4]

IgG Index

IgG index is a calculated parameter that normalizes the IgG focus in CSF, taking into consideration the focus of albumin (Qalb) and IgG in serum:

IgG index = (IgGCSF/IgGSerum) / Q-Alb

IgG index supplies a higher concept regarding IgG molecules coming into CSF by the use of damaged blood-brain barrier. Variations exist between laboratories relating to the normal value of IgG index (normally 0.25-0.7). However, generally if IgG index is more than 0.7, the patient is actively generating IgG within CSF, while the blood-brain barrier is intact. A lowered IgG index displays broken blood-brain barrier, which lets in IgG crossing (eg, stroke, tumors, some meningitis). [2, 3, 4]

CSF isoelectric focusing electrophoresis (IEF) and testing for a couple of sclerosis: oligoclonal banding

The CSF oligoclonal bands constitute a inhabitants of gamma-migrating globulins with similar electrophoretic mobility. IEF is considerably more delicate for optimum separation of CSF oligoclonal bands than the common CSF protein electrophoresis.

Detection of oligoclonal bands is associated with a couple of neurological stipulations. Up to 90% of sufferers with a couple of sclerosis present oligoclonal band upon CSF IEF evaluation, whilst the blood-brain barrier is intact (normal Qalb) and IgG index can also be inside customary range. [2, 3, 4]

For right kind interpretation of CSF IEF results, serum IEF should be run in parallel. Few patterns/medical eventualities will also be encountered:

Oligoclonal bands detected by the use of IEF in CSF indicate intrathecal immunoglobulins synthesis. If no bands or no matching bands are detected in serum integrity of blood-brain barrier is reflected. Detection of at minimum 2 unique oligoclonal bands particularly present most effective in CSF is most often enough for IEF test to be interpreted as certain for multiple sclerosis screening. Matching oligoclonal bands detected by the use of IEF in both CSF and serum indicates a systemic (nonintrathecal) immunoglobulin synthesis or immune response (eg, HIV an infection). Serum protein electrophoresis with immunofixation should be used to identify and quantitate the paraproteins present in serum. CSF IEF pattern could also be normal.

Although detection of oligoclonal bands is most often associated with more than one sclerosis, other reasons of oligoclonal banding must be excluded. Multiple myeloma and other monoclonal gammopathies, in addition to some viral infections, are characterised through the presence of immunoglobulin banding in serum. Upon disruption of the blood-brain barrier or after creation of blood into the CSF samples all through a nerve-racking tapping, banding can be detected in a matching trend in each CSF and serum. Integrity of the blood-brain barrier should be all the time evaluated (eg, Qalb). Therefore, for proper interpretation of CSF IEF effects, serum immunofixation will have to be thought to be for all positive cases with matching trend. In addition, some neurological problems, comparable to encephalitis, neurosyphilis, some forms of meningitis and Guillain-Barre syndrome can also produce CSF-specific banding. Clinical correlations must always be thought to be. Oligoclonal banding will stay sure all the way through multiple sclerosis remission, but it will disappear in different problems. [2, 3, 4]

CSF-specific transferrin and evaluation of CSF leakage

Transferrin is present in serum, in standard cases, only as a sialated isoform. However, CSF incorporates the specific, desialated isoform, also known as tau protein or tau transferrin. Normal serum transferrin (sialated isoform) migrates upon electrophoresis anodically and make up maximum of the beta-1 electrophoretic band. However, the CSF-specific desialated isoform (tau transferrin) is extra positive and, therefore, it migrates extra cathodically, as a distinct band, designated as "beta-2 transferrin." Note that this is a CSF-specific band/isoform and it is not detected in serum in standard circumstances. These electrophoretic homes of transferrin isoforms have diagnostic application in rhinorrhea or otorrhea (leakage of CSF into the nostril or ear canal, in most cases as a outcome of head trauma, tumor, congenital malformation, or surgical procedure). Beta-2 transferrin is used as an endogenous marker of CSF leakage.

Upon electrophoresis of ear or nostril fluid samples, not unusual transferrin migrates in the beta-1 electrophoretic fraction ("beta-1 transferrin"), whilst beta-2 transferrin, which is the CSF-specific variant of transferrin, if present in the ear or nose fluid samples, will migrate as an additional distinctive band. Detection of beta-2 transferrin in ear or nostril fluid samples is an indication of CSF leakage. [4]

Summary of chemistry analysis of CSF in numerous clinical stipulations

Chemistry evaluation of CSF in numerous scientific conditions is summarized beneath. [2]

Table. Changes in Analytes With Various CNS Disease (Open Table in a new window)

Disease

Glucose

Total Protein

IgG

IgG Index

Xanthochromia

Lactate

Stroke

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