p.16
Diagnostic Indicators of Meningitis Types
What type of leukemia is associated with leukemic involvement of the meninges?
Acute lymphoblastic leukemia.
p.3
Blood-Brain Barrier Structure and Function
What holds the blood-brain barrier together?
Intercellular tight junctions.
p.6
Specimen Collection Techniques for CSF
What is the purpose of Tube 1?
Chemistry and immunology.
p.6
Specimen Collection Techniques for CSF
Why should Tube 1 never be used for microbiology?
Due to contamination from the skin.
p.15
Differential Cell Count in CSF Analysis
What is the role of eosinophils in the inflammatory response?
They are mild contributors in general inflammatory responses.
p.14
Differential Cell Count in CSF Analysis
What change occurs in viral induced neutrophilia within 2-3 days?
Changes to lymphocytic predominance.
p.15
Differential Cell Count in CSF Analysis
What condition is associated with marked elevation of eosinophils?
Malfunctioning ventricular shunts.
p.19
Chemical Analysis of Cerebrospinal Fluid
What is B2-transferrin and its significance?
It is a protein resulting from cerebral neuraminidase digestion of sialic acid.
p.14
Differential Cell Count in CSF Analysis
What is the significance of increased neutrophils in CSF analysis?
Indicates early bacterial meningitis; may exceed 60%.
p.16
Diagnostic Indicators of Meningitis Types
What is the WBC count indicating CSF involvement in acute lymphoblastic leukemia?
Over 5 cells/µL with unequivocal lymphoblasts.
p.12
Differential Cell Count in CSF Analysis
Should red blood cells (RBCs) be present in normal CSF?
No, RBCs should not be present.
p.11
Differential Cell Count in CSF Analysis
What is a characteristic of a traumatic tap in CSF analysis?
Clears between the first and third tubes.
p.11
Differential Cell Count in CSF Analysis
What indicates the presence of erythrophagocytosis in CSF?
Evident erythrophagocytosis.
p.28
Chemical Analysis of Cerebrospinal Fluid
What causes decreased CSF glucose levels?
Increased anaerobic glycolysis and impaired transport into the CSF.
p.7
Specimen Collection Techniques for CSF
Why should glass tubes be avoided in specimen collection?
They can cause cell adhesion.
p.33
Tumor Markers in Cerebrospinal Fluid
What is the tumor marker associated with carcinomas and metastatic brain tumors?
Carcinoembryonic antigen.
p.36
Microbiological Examination of CSF
What is the purpose of a Gram stain?
To classify bacteria based on their cell wall properties.
p.36
Specimen Collection Techniques for CSF
What should be done to all specimens before Gram stain and culture?
They should be concentrated by centrifugation.
p.3
Blood-Brain Barrier Structure and Function
How do proteins cross the blood-brain barrier?
Via passive diffusion, dependent on the plasma-to-CSF concentration gradient.
p.40
Diagnostic Indicators of Meningitis Types
What is a hallmark characteristic of tuberculous meningitis?
Elevated protein and lymphocytic predominance.
p.35
Diagnostic Indicators of Meningitis Types
Which bacteria is associated with bacterial meningitis in individuals 3 months and older?
Streptococcus pneumoniae.
p.32
Chemical Analysis of Cerebrospinal Fluid
What is cerebral glutamine derived from?
Ammonia and glutamic acid.
p.37
Diagnostic Indicators of Meningitis Types
What does a nonreactive serum FTA - ABS indicate?
It rules out neurosyphilis.
p.32
Chemical Analysis of Cerebrospinal Fluid
What does the concentration of cerebral glutamine reflect?
The concentration of brain ammonia.
p.6
Specimen Collection Techniques for CSF
What type of analysis is Tube 2 used for?
Microbiological analysis.
p.6
Specimen Collection Techniques for CSF
What is the function of Tube 3?
Cell count and differential.
p.24
Tumor Markers in Cerebrospinal Fluid
What is myelin basic protein?
A component of the myelin nerve sheath.
p.27
Chemical Analysis of Cerebrospinal Fluid
What is Transferrin?
A protein that binds and transports iron in the blood.
p.22
Diagnostic Indicators of Meningitis Types
What is the most sensitive method for detecting oligoclonal bands?
Isoelectric focusing and IgG immunoblotting.
p.37
Diagnostic Indicators of Meningitis Types
What does a reactive serum FTA - ABS with a non-reactive CSF FTA - ABS indicate?
It rules out neurosyphilis.
p.24
Tumor Markers in Cerebrospinal Fluid
What causes marked elevation of alpha-2 macroglobulin?
Subdural hemorrhage or breakdown of the blood-brain barrier (bacterial meningitis).
p.10
Differential Cell Count in CSF Analysis
What is xanthochromia?
A pale pink to yellow color in cerebrospinal fluid (CSF).
p.13
Differential Cell Count in CSF Analysis
How can artifactual distortions be minimized?
By using fresh specimens.
p.15
Differential Cell Count in CSF Analysis
In which types of meningitis are monocytes commonly found?
Tuberculous, fungal, and chronic bacterial meningitis.
p.13
Differential Cell Count in CSF Analysis
What is the effect of adding albumin in the cytocentrifuge method?
It helps in preserving cell morphology.
p.3
Blood-Brain Barrier Structure and Function
What lines the choroid plexus?
Choroidal ependymal cells.
p.19
Chemical Analysis of Cerebrospinal Fluid
What can cause low total protein levels in CSF?
Removal of large CSF volumes, leakage by trauma or lumbar puncture, increased intracranial pressure, and hyperthyroidism.
p.19
Chemical Analysis of Cerebrospinal Fluid
What is transthyretin and where is it synthesized?
A protein synthesized in both the liver and choroid plexus.
p.2
Functions of Cerebrospinal Fluid
What is the physical support function of cerebrospinal fluid (CSF) for the brain?
It reduces the brain's weight from 1500 g to 50 g when suspended in CSF.
p.27
Tumor Markers in Cerebrospinal Fluid
What is Protein 14-3-3 associated with?
Creutzfeldt-Jakob disease.
p.11
Differential Cell Count in CSF Analysis
What is a key feature of xanthochromia in CSF analysis?
Remains uniform in all tubes.
p.2
Functions of Cerebrospinal Fluid
What excretory function does cerebrospinal fluid serve?
It helps in the excretion of waste products.
p.37
Diagnostic Indicators of Meningitis Types
What test is sensitive and specific for diagnosing neurosyphilis?
Treponemal antibody absorption (FTA - ABS).
p.2
Functions of Cerebrospinal Fluid
What role does cerebrospinal fluid play in transporting hypothalamic factors?
It transports hypothalamic releasing factors.
p.33
Tumor Markers in Cerebrospinal Fluid
Which tumor marker is linked to choriocarcinoma and germ cell tumors?
hCG (human chorionic gonadotropin).
p.39
Diagnostic Indicators of Meningitis Types
What method has higher sensitivity for detecting fungal meningitis antigens?
Latex agglutination from sera or CSF.
p.20
Chemical Analysis of Cerebrospinal Fluid
Which dyes are used in the colorimetric method?
Coomassie brilliant blue dye or Ponceau S.
p.27
Tumor Markers in Cerebrospinal Fluid
What disease is linked to the presence of Protein 14-3-3 in CSF?
Creutzfeldt-Jakob disease.
p.40
Diagnostic Indicators of Meningitis Types
What diagnostic method is used for rapid and accurate diagnosis of tuberculous meningitis?
PCR nucleic acid amplification.
p.9
Gross Examination of Cerebrospinal Fluid
What is the normal appearance of cerebrospinal fluid (CSF) during gross examination?
Crystal clear and colorless.
p.38
Diagnostic Indicators of Meningitis Types
What is the gold standard for diagnosing viral meningitis?
RT - PCR, as it is more sensitive than cell culture.
p.5
Diagnostic Indicators of Meningitis Types
What syndrome is associated with increased pressure in the CSF?
SVC syndrome (Superior Vena Cava syndrome).
p.34
Microbiological Examination of CSF
Which organisms are commonly detected in microbiological examination of CSF?
Bacteria, viruses, fungi, and parasites.
p.23
Tumor Markers in Cerebrospinal Fluid
What do immunoglobulin free light chains indicate?
B-cell activity; found in multiple sclerosis (MS).
p.32
Chemical Analysis of Cerebrospinal Fluid
What is homovanillic acid related to in the context of schizophrenia?
The severity of schizophrenic psychosis.
p.5
Diagnostic Indicators of Meningitis Types
What can lead to hypoosmolality in the CSF?
Conditions inhibiting CSF absorption.
p.10
Differential Cell Count in CSF Analysis
When does yellow xanthochromia peak after a subarachnoid bleed?
12 hours post-bleed, peaks at 2-4 days, and persists for 2-4 weeks.
p.31
Chemical Analysis of Cerebrospinal Fluid
What other conditions can lead to increased lysozyme levels?
Cerebral atrophy, multiple sclerosis (MS), intracranial hemorrhage, and epilepsy.
p.2
Functions of Cerebrospinal Fluid
How does cerebrospinal fluid protect the brain?
It provides protection against venous, arterial, and impact pressure.
p.28
Diagnostic Indicators of Meningitis Types
What condition is indicated by CSF glucose levels <40 mg/dL?
Hypoglycorrachia, which can suggest bacterial, tuberculous, and fungal meningitis.
p.22
Diagnostic Indicators of Meningitis Types
What methods are used for detecting oligoclonal bands?
Isoelectric focusing and IgG immunoblotting.
p.17
Chemical Analysis of Cerebrospinal Fluid
What is the primary focus of chemical analysis in the context of cerebrospinal fluid (CSF)?
To determine the concentration of various substances and identify abnormalities.
p.13
Differential Cell Count in CSF Analysis
What are the advantages of using the cytocentrifuge method?
Better cell yield and preservation.
p.28
Chemical Analysis of Cerebrospinal Fluid
What is the clinical significance of increased CSF glucose levels?
It is of NO clinical significance.
p.30
Chemical Analysis of Cerebrospinal Fluid
What does adenosine deaminase catalyze?
The irreversible hydrolytic deamination of adenosine to inosine.
p.17
Chemical Analysis of Cerebrospinal Fluid
What does an elevated protein level in CSF indicate?
Possible infection, inflammation, or central nervous system disorders.
p.31
Chemical Analysis of Cerebrospinal Fluid
What conditions lead to increased total CSF LD?
CNS leukemia, lymphoma, metastases, bacterial meningitis, and subarachnoid hemorrhage.
p.9
Gross Examination of Cerebrospinal Fluid
What turbidity level indicates abnormal CSF?
WBC >200 cells/µL or RBC >400/µL.
p.25
Chemical Analysis of Cerebrospinal Fluid
What does an increased level of CRP indicate?
Bacterial infection; higher in gram-negative bacteria.
p.5
Specimen Collection Techniques for CSF
What should be done if there is a significant pressure drop after removing 1 to 2 mL of CSF?
Stop the procedure to prevent herniation or spinal block.
p.9
Gross Examination of Cerebrospinal Fluid
What does pink-red CSF indicate?
Presence of blood; RBCs >6000/µL; hemorrhage.
p.23
Tumor Markers in Cerebrospinal Fluid
What do neurofilaments indicate in the context of MS?
They are released following neuron and axon injury and serve as a prognostic marker.
p.29
Chemical Analysis of Cerebrospinal Fluid
How is the accuracy of F2 - Isoprostanes enhanced?
In conjunction with B-amyloid and Tau proteins.
p.20
Chemical Analysis of Cerebrospinal Fluid
What is a key characteristic of the Coomassie brilliant blue method?
It is rapid and highly sensitive.
p.25
Tumor Markers in Cerebrospinal Fluid
What is B2-microglobulin a part of?
HLA class I molecule on surfaces of all nucleated cells.
p.26
Functions of Cerebrospinal Fluid
What is fibronectin?
A protein present in all tissues and body fluids.
p.5
Diagnostic Indicators of Meningitis Types
What can cause straining and increased pressure in the CSF?
Congestive heart failure.
p.34
Microbiological Examination of CSF
What is the primary purpose of microbiological examination in CSF analysis?
To identify the presence of pathogens causing infections.
p.9
Gross Examination of Cerebrospinal Fluid
What indicates abnormal CSF appearance?
Cloudy, purulent, or pigment-tinged.
p.25
Chemical Analysis of Cerebrospinal Fluid
What does C-reactive protein (CRP) help differentiate?
Viral from bacterial infections.
p.17
Chemical Analysis of Cerebrospinal Fluid
How can lactate levels in CSF be useful?
Elevated lactate levels can indicate anaerobic metabolism, often seen in infections or ischemia.
p.23
Tumor Markers in Cerebrospinal Fluid
What do oligoclonal IgM bands indicate in MS?
They are markers for more severe and aggressive MS.
p.34
Microbiological Examination of CSF
What staining techniques are used in microbiological examination of CSF?
Gram staining and acid-fast staining.
p.4
Specimen Collection Techniques for CSF
What does an opening pressure above 250 mmH2O indicate?
Intracranial hypertension (meningitis, hemorrhage, or tumors).
p.8
Gross Examination of Cerebrospinal Fluid
What does a cloudy appearance in CSF indicate during gross examination?
Possible infection or the presence of cells or proteins.
p.27
Chemical Analysis of Cerebrospinal Fluid
What does increased B2-transferrin indicate in CSF?
It is associated with rhinorrhea and otorrhea.
p.20
Chemical Analysis of Cerebrospinal Fluid
What advantage does the colorimetric method have regarding sample size?
It can be used in small sample sizes.
p.24
Tumor Markers in Cerebrospinal Fluid
What is alpha-2 macroglobulin associated with?
Seen in polyneuropathies.
p.26
Functions of Cerebrospinal Fluid
What are the functions of fibronectin?
Cell adhesion and phagocytosis.
p.14
Differential Cell Count in CSF Analysis
What are plasma cells associated with in CSF analysis?
Acute viral infections; Guillain-Barre; Multiple sclerosis.
p.15
Differential Cell Count in CSF Analysis
What is a characteristic of monocytes in meningitis?
They lack diagnostic specificity.
p.4
Specimen Collection Techniques for CSF
What are the methods for specimen collection of cerebrospinal fluid?
Lumbar, cisternal or lateral cervical puncture, or ventricular shunts.
p.10
Differential Cell Count in CSF Analysis
What causes xanthochromia in CSF?
Due to RBC lysis and hemoglobin breakdown.
p.32
Chemical Analysis of Cerebrospinal Fluid
In which type of headache is GABA detected?
Migraine attacks, but not tension headaches.
p.10
Differential Cell Count in CSF Analysis
What are some other causes of xanthochromia?
Artifactual RBC lysis, bilirubin in jaundice, CSF protein >150 mg/dL, disinfectant contamination, carotenoids, melanin, rifampin therapy.
p.10
Differential Cell Count in CSF Analysis
How is xanthochromia assessed in CSF?
By centrifuging CSF and comparing the supernatant fluid with distilled water.
p.21
Blood-Brain Barrier Structure and Function
How is the permeability of the Blood-Brain Barrier (BBB) assessed?
By the CSF/serum albumin index.
p.17
Chemical Analysis of Cerebrospinal Fluid
Which substances are commonly analyzed in cerebrospinal fluid chemical analysis?
Glucose, protein, lactate, and electrolytes.
p.31
Chemical Analysis of Cerebrospinal Fluid
What is lactate dehydrogenase (LD) useful for in CSF analysis?
Differentiating traumatic taps from intracranial hemorrhage due to RBC lysis.
p.7
Diagnostic Indicators of Meningitis Types
What type of malignancy can indicate the need for a lumbar puncture?
Primary or metastatic malignancy.
p.31
Chemical Analysis of Cerebrospinal Fluid
In which types of meningitis is lysozyme increased?
Bacterial and tuberculous meningitis.
p.34
Microbiological Examination of CSF
What role does PCR play in microbiological examination of CSF?
PCR is used for rapid detection of specific pathogens' DNA.
p.8
Gross Examination of Cerebrospinal Fluid
What is the primary purpose of gross examination in cerebrospinal fluid (CSF) analysis?
To assess the physical characteristics of the CSF, such as color, clarity, and volume.
p.24
Tumor Markers in Cerebrospinal Fluid
In which conditions is myelin basic protein also increased?
Guillain-Barré Syndrome (GBS), Systemic Lupus Erythematosus (SLE), and Subacute Sclerosing Panencephalitis.
p.1
Cerebrospinal Fluid Production and Composition
How is cerebrospinal fluid derived?
By ultrafiltration and secretion through the choroid plexus.
p.18
Chemical Analysis of Cerebrospinal Fluid
What is the most common abnormality found in CSF?
Elevated total protein levels.
p.37
Diagnostic Indicators of Meningitis Types
What does a reactive CSF VDRL suggest?
It makes a diagnosis of neurosyphilis likely.
p.17
Chemical Analysis of Cerebrospinal Fluid
What is the significance of glucose levels in CSF analysis?
Low glucose levels can indicate bacterial meningitis or other infections.
p.37
Diagnostic Indicators of Meningitis Types
What can a reactive CSF FTA - ABS indicate?
It may indicate active neurosyphilis, asymptomatic neurosyphilis, treated neurosyphilis, or a false-positive reaction.
p.30
Chemical Analysis of Cerebrospinal Fluid
What does creatine kinase correlate with?
The severity of concussion.
p.23
Tumor Markers in Cerebrospinal Fluid
What is the target of oligoclonal IgM bands in MS?
Myelin lipid (phosphatidylcholine).
p.34
Microbiological Examination of CSF
How can the presence of white blood cells in CSF indicate infection?
An increased white blood cell count suggests an immune response to infection.
p.41
Diagnostic Indicators of Meningitis Types
What is the significance of the presence of erythrocytes in CSF analysis?
Indicates potential hemorrhage or trauma.
p.26
Tumor Markers in Cerebrospinal Fluid
What is the relationship between Tau protein and B-amyloid in Alzheimer disease?
Increased Tau protein and decreased B-amyloid indicate Alzheimer disease.
p.30
Chemical Analysis of Cerebrospinal Fluid
What CK level indicates a poor outcome in subarachnoid hemorrhage?
Increased levels of >40 U/L.
p.25
Tumor Markers in Cerebrospinal Fluid
Which conditions are associated with B2-microglobulin?
Leptomeningeal leukemia and lymphoma.
p.2
Functions of Cerebrospinal Fluid
How does cerebrospinal fluid maintain ionic balance in the CNS?
It maintains CNS ionic homeostasis.
p.14
Differential Cell Count in CSF Analysis
What does increased lymphocytes in CSF indicate?
Reactive: viral meningoencephalitis.
p.7
Specimen Collection Techniques for CSF
Why is refrigeration contraindicated for certain tests?
It is contraindicated for culture and flow cytometry.
p.18
Chemical Analysis of Cerebrospinal Fluid
What can cause elevations in total protein levels in CSF?
Increased permeability of the blood-brain barrier, decreased resorption, mechanical obstruction, and increased intrathecal immunoglobulin.
p.41
Diagnostic Indicators of Meningitis Types
What are the primary organisms associated with primary amebic meningoencephalitis?
Naegleria and Balamuthia.
p.41
Diagnostic Indicators of Meningitis Types
What type of inflammatory response is observed in primary amebic meningoencephalitis?
Acute inflammatory response with neutrophilic pleocytosis.
p.34
Microbiological Examination of CSF
What is the significance of culturing CSF samples?
It helps in isolating and identifying specific microorganisms.
p.15
Differential Cell Count in CSF Analysis
What does a mixed cell pattern without neutrophils indicate?
Viral and syphilitic meningoencephalitis.
p.9
Gross Examination of Cerebrospinal Fluid
What does viscous CSF indicate?
Metastatic mucin-producing tumors or cryptococcal meningitis.
p.5
Diagnostic Indicators of Meningitis Types
What are mass lesions in relation to CSF pressure?
Abnormal growths that can increase pressure in the CSF.
p.29
Chemical Analysis of Cerebrospinal Fluid
What does elevated lactate levels reflect in the CNS?
Anaerobic metabolism due to hypoxia.
p.8
Gross Examination of Cerebrospinal Fluid
What does a yellowish tint in CSF suggest during gross examination?
Possible presence of bilirubin, indicating a hemorrhage.
p.38
Diagnostic Indicators of Meningitis Types
Which echoviruses are commonly associated with viral meningitis?
Echoviruses 9 (E9) and 30 (E30).
p.26
Functions of Cerebrospinal Fluid
What role does fibronectin play in leukocyte transmigration?
It facilitates the process.
p.31
Chemical Analysis of Cerebrospinal Fluid
What is lysozyme rich in?
Neutrophil and macrophage lysosomes.
p.9
Gross Examination of Cerebrospinal Fluid
What can cause clot formation in CSF?
Traumatic taps, complete spinal block, tuberculous meningitis.
p.41
Diagnostic Indicators of Meningitis Types
What is the protein concentration status in primary amebic meningoencephalitis?
Increased protein concentration.
p.26
Tumor Markers in Cerebrospinal Fluid
What are neurofibrillary tangles and amyloid plaques?
Pathological features seen in Alzheimer disease.
p.29
Chemical Analysis of Cerebrospinal Fluid
What do F2 - Isoprostanes indicate in advanced age and latent Alzheimer?
Marker of free radical brain injury.
p.26
Tumor Markers in Cerebrospinal Fluid
What proteins are associated with Alzheimer disease?
B-amyloid protein and Tau protein.
p.23
Tumor Markers in Cerebrospinal Fluid
What is the significance of the measles-rubella-zoster reaction in MS?
It is highly specific for MS in oligoclonal band (OCB) negative cases.
p.29
Chemical Analysis of Cerebrospinal Fluid
What are F2 - Isoprostanes associated with in the brain?
Increased in diseased regions in Alzheimer’s.
p.8
Gross Examination of Cerebrospinal Fluid
What is the significance of measuring the volume of CSF during gross examination?
To determine if there is an abnormal increase or decrease in CSF volume, which can indicate various conditions.
