Lumbar puncture could be securely performed even without the elevated intracranial tension. The needle is introduced between your third and 4th lumbar vertebrae. The cerebrospinal fluic (CSF) is collected in three bottles for: cytology, biochemical examination and microbiological studies. Manometry during LP is conducted to determine the CSF tension. Queckenstedt’s test is performed to identify block within the spine subarachnoid space. Compression from the jugular wein results in rapi increase in lumbar CSF tension and discharge of the vein leads to its rapid fall. This really is abolished in spine block.
Normal CSF is without color, obvious and watery. Xanthochromia (yellow color) happens in subarachnoid hemorrhage as well as in Froin’s syndrome. Turbidity is a result of rise in cells. Normally, cells number below 5/cmm and all are lymphocytes. Increase in cells is known as pleocytosis. Lymphocytic pleocytosis happens in viral, tuberculous and syphilitic meningitis. Neutrophils pleocytosis happens in pyogenic meninigits, e.g meningococci, pneumococci. Mixed pleocytosis (both lymphocytes and neutrphils) happens in leptospirosis, t . b or following subarachnoid hemorrhage. In neuroleukemia immature white-colored cells show up in the CSF.
Biochemical composition of ordinary Cerebrospical fluid include:
1. Proteins: 30-40 mg/dL (reduced than serum level)
2. Sugar: 60-80 mg/dL (50% of serum level)
3. Chlorides: 720 mg/dL (just like serum level).
The cytology, biochemical characteristics, and serology alter in illnesses. Modifications in Cerebrospinal fluid (CSF) in illnesses are listed below:
1. Normal condition: Tension (normal) color (obvious) cells (-5 lym/cm) Protein (30-40 mg/dL) sugar (80 mg/dL).
2. Microbial meningitis: Tension (elevated) Color (Turbid) Cells (as much as 2000 neutrophils) proteins (elevated significantly) sugar (really low).
3. Tuberculous meningitis: Tension (elevated) Color (Cloudy) Cells (as much as 300-500 cells lymp) Protein (200-300 mg/dL) sugar (really low).
4. Viral meningitis: Tension (elevated) Color (obvious) Cells (10-100 cells lymph) Protein (50-100 mg/dL) sugar (normal).
5. Syphilitic meningitis: Tension (elevated) color (obvious) Cells (as much as 20-500 cells lymph) Protein (200 mg/dL) sugar (normal).
6. General paralysis from the insane: Cells (as much as 100 cells) Protein (40-100 mg/dL) sugar (normal).
7. Tabes dorsalis: Color (obvious) Cells (as much as 100 cells) Protein (30-60 mg/dL) Sugar (normal).
The CSF ought to be examined after Gram staining for microorganisms. In meningitis, this is a great way of early bacteriological diagnosis. The specimen for microbiological examination ought to be cultured immediately to obtain positive cultures. In tuberculous meningitis, an excellent coagulum (cob-web) forms once the CSF remains at 70 degrees for 12-24 hrs. This really is coagulated fibrin and it will show acidity fast microorganisms on staining. An upswing of proteins within the CSF might be selective which is employed for diagnosis. Selective increase in globulin fraction could be recognized by appropriate tests. Formerly the colloidal gold test (Lange’s test0 was once done for this function. A far more modern and accurate technique is to complete immunoelectrophoresis. Resolution of the immunoglobulins within the CSF and evaluating all of them with the bloodstream levels give diagnosis information. For instance, in ms, CSF shows increase in oligoclonal IgG.
The complications of lumbar puncture include sudden coning from the brain stem, severe headache and introduction of infection in to the meninges, Lumbar puncture is extremely dangerous in the existence of elevated intracranial tension. Sudden discharge of lumbar CSF results in coning from the medulla in to the foramen magnum leading to fatal depression of respiration along with other vital functions, otherwise released over time. Therefore, lumbar puncture is contraindicated such situations unless of course a nerve team is prepared at hands. During these conditions CSF could be acquired by ventricular puncture. On occasions when an LP can’t be performed or even the lumbar subarachnoid space is obliterated, CSF could be acquired by cisternal puncture.
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