CEREBRO SPINAL FLUID

1. LUMBAR PUNCTURE
&
CSF ANALYSIS
KEERTHI PRIYA, MPT NEURO
ASSISTANT PROFESSOR
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2. LUMBAR
PUNCTURE
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3. WHAT IS LUMBAR PUNCTURE?
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4. INTRODUCTION
A diagnostic procedure which is used to collect CSF to rule out infectious & non-infectious
neurological conditions.
It’s also a therapeutic procedure.
Uses :
Spinal anaesthesia
Administration of chemotherapy & antibiotics
To drain CSF
Introducing contrast medium for Myelography & Cisternography
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5. STEPS INVOLVED IN LUMBAR
PUNCTURE
 Persons
Equipment
Position
Site
Procedure
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6. Equipment
 Glove
 Iodine
 Sponge
 Drapes
 Lidocaine
 Syringe
 Needle
 3 way stop cock
 Manometer
 Collection tubes
 Adhesive bandage
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7. Position & Site
Site : L3-L4/L4-L5
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8. Procedure
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9. COMPLICATIONS
MAJOR
Herniation
Injury To Cord & Nerve Roots
Spinal Hematoma
Infection
Deterioration of conscious
MINOR
Back Ache
POST LP Pain
Radicular Pain/ Numbness
Neck stiffness
Dilated pupils
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10. CSF ANALYSIS
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11. CSF FORMATION & CIRCULATION
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12. FUNCTIONS
 Protection
Supplies nutrients
Removal of waste products
Transportation
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13. INDICATIONS
 Infection
Inflammatory Disease
Subarachnoid haemorrhage
Hepatic encephalopathy
Meningeal malignancies
Paraneoplastic abnormalities
ICP abnormalities
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14. CONTRA INDICATIONS
 Intracranial Mass Lesion
Local Infection
Coagulopathy
Spinal Cord Mass Lesion
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15. NORMAL VALUES
 5 Mononuclear Leukocytes
 NO Polymorphoneuclear cells
No Erythrocytes
Volume: 150 ml
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16. NORMAL PHYSICAL EXAMINATION
CONTENTS
COLOUR COLOUR LESS
VISCOCITY NON VISCOUS
APPEARANCE CLEAR
PH 7.28-7.32
SPECIFIC GRAVITY 1.006-1.007
PRESSURE 180-200mm of H2O
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17. NORMAL BIO CHEMICAL VALUES
CONTENTS VALUES
GLUCOSE 2.22-3.89 mmol/L
LACTATE 1-2 mmol/L
PROTIEN 6-50 mg/L
ALBUMIN 6.6-44.2 mg/L
IgG 0.9-5.7mg/L
CHOLESTEROL 0.2-0.6 mg/dL
AMONIA 25-80 micrograms/L
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18. NORMAL BIO CHEMICAL VALUES
CONTENTS VALUES
SODIUM 135-180mEq/L
POTASSIUM 2.6-3 mEq/L
CHLORINE 115-130 mEq/L
CSF GLUCOSE/PLASMA GLUCOSE 0.6-0.7
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19. ANALYSIS OF
RESULTS
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20. APPEARANCE
 Normal: Colour Less
Bilirubin: Yellow
Erythrocytes: Red
Melanin: Black
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21. CELL COUNT
Normal =5 Mononuclear leucocytes
Increases :
Meningitis
Infections
Seizures
Infarct
Degeneration & inflammatory conditions
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22. PROTIEN
 Meningitis
 Hemorrhage
 Endocrine
 Neurosyphilis
 Multiple Sclerosis
 CVD
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23. VISCOCITY
Increases :
Meningitis
Cryptococcal Meningitis
Adenocarcinoma
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24. CLOT FORMATION
Meningitis
Increased Proteins
T.B Meningitis
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28. THANK YOU
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