CSF

The CNS is covered by the meninges ,three

layers referred as : pia, arachnoid and
meninges dura mater .
CSF is found between the pia and
aracchnoid mater .

Its secreted from choriod plexuses, a

vascular structure lying within the ventricles
of the brain, and reabsorbed by the
arachnoid villi.

 The total volume of the CSF is about 130 ml.

CSF is clear and colorless .

Presence of blood in the CSF may be

due to trauma or sub arachnoid
hemorrage .

This can be differentiated by

collecting 3 ml of CSF in 3 test tube .
If blood is due to trauma of spinal puncture
,the fluid becomes clear and less bloody
from first to the third tube .if blood is due
to subarachnoid hemorrhage ,it is mixed
with csf in the 3 test tubes and all the
tubed contain an equal amount of blood
and show no color changes.
 Turbidity is seen when there is an excess
of the white cells ( pus) and so is found in
meningitis . Slight turbidity will occur after
hemorrhage .

Spontaneous clotting occurs when there is

an excess of fibrinogen in the specimen
usually associated with high total protein .
 Total cell content in CSF normally is 0-4
× 10 6 \ L present as mononuclear or
lymphocyte .

Total protein
Normal 0.15-0.45 g\ L .
An increase in CSF protein is the
commonest of all type of meningitis
especially pyogenic and tuberculous
meningitis .
This because increase in the cell content
and as a cosequance of the inflamation .
In blokage of spinal canal when stasis
result in fluid reabsorbtion protein conc. Is
very high .
 Procedure
Method used is turbidometric using 3 %
trichloroacetic acide TCA .

 ml TCA 4 mL CSF 1 TEST

ml TCA 4 ml working 1 STANDARD

standard

ml TCA 4 ml DW 1 BLANK

After 10 mint read at 450 nm .

CSF glucose
Glu. conc. In CSF is normally 60-70 % of that of blood
.
Normal FPG 55-110 mg\dl .
CSf glucose normally = 40-75 mgL\dl.
 the most important pathologic changes seen in CSF
finding is the decrease in glucose which is due to
(INFECTION). Bacterial meningitis and TB meningitis
while in viral meningitis CSF glucose is often normal.
During hyperglycemia CSF glucose will be high but
remain lower than that of blood.
CSF protein gm\l = A T – A B\ A St –A B ×
protein standard conc.

Urinary protein
Quantitative tests for urinary protein are
generally carried out on 24 hour urine collection
.normally small amount of protein is excreted in
the urine ranging between 0.1-0.2 gm/24 h.
Proteinuria is said to be present whenever the
urinary protein output is greater than that
reflected in these normal values. However not all
proteinuria is clinically significant ,but persistent
abnormal levels of protein in the urine are an
indicator of kidney or urinary tract disease.

Proteinuria which is mainly glomerular in origin is
often a manifestation of primary renal diseases
although transient proteinuria may occur with fever
,thyroid disorders, and in heart diseases, in the
absence of renal diseases ,exercise or work,after
exposure to cold, orthorstatic protienuria protien
excretion is normal when the patient is lying down
but is elevated when the patient stands for any
peroid of time …proteinuria may be evident very early
in the course of various renal diseases states. with
such condition as pyelonephritis and acute
glomerulonephritis.often associsted with recent
strptococcal infection

Persistent proteinuria:
Indicate renal disease
1- acute glomerulus's nephritis ,often associated with
recent streptococcal infections, the degree of proteinuria
is slight ,usually amounting to less than >2 gm/day
2- chronic glomerulus's nephritis (nephrotic syndrome),
protein loss may vary from a few grams to as much as 30
gm/day.