Lumbar puncture can be safely in the absence of high intracranial tension. The needle is inserted between the third and fourth lumbar vertebrae. Spinal fluic (CSF) is collected in three bottles for: cytology, biochemical examination and Microbiological studies. Manometry during the LP is performed to measure the tension of the CSF. Queckenstedt test is performed to detect the block in the spinal subarachnoid space. Compression of the jugular wein leads to CSF lumbar rapidly rising tension and publication of the results of the vein in his rapidly falling. This is abolished in spinal block.
Normal CSF is colorless, clear and watery. Xanthochromia (yellow) occurs in bleeding subarachnoid and Froin syndrome. Results of the turbidity of increase in cells. The number of cells below 5/cmm and all of them are typically lymphocytes. Increase of cells called pleocytosis. Lymphocytic pleocytosis occurs in viral, tubercular and syphilitic meningitis. Neutrophil pleocytosis occurs in Pyogenic meninigits, e.g. meningococcus, pneumococci.Mixed pleocytosis (lymphocytes and neutrphils) occurs in leptospirosis, tuberculosis or subarachnoid siguiente.En neuroleukemia immature white cells can be seen in the CSF.
Biochemical composition of normal liquid Cerebrospical include:
1. Proteins: 30 - 40 mg/dL (much less than the level of serum)
2 Sugar: 60-80 mg/dL (50% of the level of serum)
3 Chlorides: 720 mg/dL (equal to the level of serum).
Cytology, biochemical characteristics and serology for altering the enfermedades.Las alterations in the cerebrospinal fluid (CSF) diseases are as follows:
1. Normal condition: Tension (normal); color (clara); cells (0-5 lym/cm); protein (30 - 40 mg/dL); sugar (80 mg/dL).
2. Bacterial meningitis: Tension (raised); (Unfiltered) color; cells (up to 2000 neutrophils); proteins (augmented considerably;) sugar (very low).
3. Tuberculous meningitis: Tension (raised); color (cloudy); Cells (up to 300-500 cells lymp); Protein (200 - 300 mg/dL);sugar (very low).
4. Viral meningitis: Tension (raised);Color (of course); Cells (lymph cells 10-100); protein (50 - 100 mg/dL); (normal) sugar.
5. Meningitis: Tension (raised); color (clara); Cells (up to 20-500 lymph cells); Protein (200 mg/dL) (normal) sugar.
6. General paralysis of the mentally ill: Cells (up to 100 cells);Protein (40 - 100 mg/dL);(normal) sugar.
7 Tabes dorsalis: color (of course);Cells (up to 100); protein (30 - 60 mg/dL);(Normal) sugar.
Community support framework should be examined after of Gram staining for agencies.In meningitis, this is an excellent method for the diagnosis early bacteriological. the specimen for microbiological examinations must be cultivation without delay to obtain positive cultures.Tuberculous meningitis, a clot fine (cob web) form when Cefalorraquideo liquid is left at room temperature for 12 to 24 hours.This is coagulated fibrin and can display acids fast agencies on the stain.The rise of protein in the cerebrospinal fluid can be selective and this can be used for diagnosis.Selective increase in the fraction globulin can be identified by appropriate tests.Previously the colloidal gold test (test0 its used to do for this purpose A more modern method and need is make immunoelectrophoresis. determination of immunoglobulins in cerebrospinal fluid and compare them with blood levels provides information diagnosis. for example, in MS, CSF shows increase in oligoclonal IgG.)
Lumbar puncture complications include sudden brain stem coning, headache, and the introduction of the infection of the meninges, lumbar puncture is very risky in the presence of high tension intracranial. sudden lumbar CSF's Liberation leads to the spinal cord in the foramen magnum, resulting in a fatal respiratory depression and other vital functions, if not released in the tiempo.Por therefore coning, lumbar puncture is contraindicated in such situations, unless a neurological team is ready to mano.En these conditions the CSF can be obtained by puncture ventricular.A times, when unable to perform an LP or erased the lumbar subarachnoid space, CSF can be obtained by cisternal puncture.
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