EXAMINATION OF CEREBROSPINAL FLUID (CSF)

SPECIFIC OBJECTIVES:

1. To discuss the physiology of the formation of CSF.

2. To discuss the procedure in the collection and preservation
of CSF.
3. To tabulate the normal & abnormal characteristics of CSF.
4. To compare the findings of the traumatic & sub-arachnoid
hemorrhage.
5. To explain the principles involved in the performance on the
various chemical tests for CSF.
6. To develop skill in performing chemical tests for CSF.
7. To appreciate the significance of cell counts in the
diagnosis of diseases involving brain damage.
8. To compare lab. findings of CSF examination w/ those of lab.
exams.
9. To identify the clinical sig. of abnormal results of CSF
analysis.

CHARACTERISTICS OF NORMAL SPINAL FLUID:

Total volume: 150 ml

Color: colorless, like H20
Transparency: clear, like water
Osmolality at 37°C: 281 mOsmol/L
Specific gr: 1.006-1.008
Acid-base balance:

pH 7.31
pCO2 47.9 mmHg
hCO3 22.9 mEq/L

Sodium (Na): 138-150 mEq/l

Potassium (K): 2.7-3.9 mEq/l
Chloride (Cl): 116-127 mEq/l
Calcium (Ca): 2.0-2.5 mEq/l
Magnesium (Mg): 2.0-2.5 mEq/l
Lactic acid: 1.1-2.8 mmole/l
Lactate dehydrogenase (LDH): absolute activity depends on method,
approx. 10% of serum value
Creatinine: 0.4-1.5 mg/dl
Glucose: 45-60 mg/dl
GOT: 0-19 units
Urea: 8-28 mg/dl
Uric acid: 0.07-2.8 mg/dl
Phosphorus, inorganic: 1.2-2.1 mg/dl
Proteins: 20-40 mg/dl
Lumbar 20-40 mg/dl
Cisternal 15-25 mg/dl
 Ventricular 5-10 mg/dl
Formal values in Children:
Up to 6 days of age = 70 mg/dl
Up to 4 years = 24.4 mg/dl
Electrophoresis separation of CSF proteins:
Prealbumin 2-7%
Albumin 56-76%
A1-Globulin 2-7%
A2-Globulin 3.5-12%
B- and gamma-globulin 8-18%
y-globulin 7-12%
IgG 1-4 mg/dl
IgM 0-0.6 mg/dl
IgA 0-0.2 mg/dl
Ratio 1.0
Erythrocyte count:
Newborns 0-675/mm3
Adults 0-10/mm3
Leukocyte count:
Less than 1 yr 0-30/mm3
1-4 years 0-20/mm3
5 yrs to puberty0-10/mm3
Adults 0-5/mm3

I. THE CSF: A. FORMATION & PHYSIOLOGY:

Cerebrospinal fluid (CSF) is an ultrafiltrate of plasma. It is

the product of continuous secretory activity of choroidal and
extracholoroidal sites of the brain. It fills the ventricles
and the subarachnoid space surrounding the brain and the
spinal cord. 50% of the fluid is formed in the choroid plexus,
the remainder escapes from the vessels lining the ventricles
(choloroidal & extrachoroidal origin of CSF). Each choloroidal
plexus is the result of the invagination of the ependymal (the
transparent delicate lining of the ventricles) by the blood
vessels of the pia matter. The choroid plexus of the 4th
ventricle protrudes through the foramina of Luschka and
Magendie into the subarachriod space, and be observed through
the arachnoid villi into the cerebral sinuses. The production
of CSF is the result of two separate processes: (l) filtration
across the choroidal capillary wall and (2) secretion by
choroidal opithelium.

* Formation happens in the ventricular choroid plexus

through active transport and ultrafiltration.

LOCATION: a. ventricles of the brain

b. cisterna & spinal cord canal
c. space between pia & arachnoid membrane
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