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1、Cerebrospinal Fluid(CSF)ExaminationOutlinevCSF:colourless liquid that flows through the four cerebral ventricles,subarachnoid space and spinal canal surrounding the brain and spinal cord.vCSF cirlulation communicate with blood circulationvAdult:90150mlNewborn:10 60mlblood brain barrier AIMSv中枢神经感染性疾
2、病的诊断与鉴别诊断。中枢神经感染性疾病的诊断与鉴别诊断。v脑血管疾病的诊断与鉴别诊断。脑血管疾病的诊断与鉴别诊断。v协助脑部肿瘤的诊断。协助脑部肿瘤的诊断。v中枢神经系统疾病的治疗与疗效观察。中枢神经系统疾病的治疗与疗效观察。Contents of examinationvGeneral Properties：pressure、color、Transparency、Clots and filmvChemical Examination：protein、glucose、chloride vMicroscopy vBacteriological Examination Pressure Gener
3、al Properties Adult(lying):80180mmH2O，40-50 drips/min children：40-100mmH2O。vIncrease：Intracranial Inflammation：meningitis,cephalitis,myelitiscerebral edema,cerebral hemorrhage,brain tumorsExtracranial：hypertension,congestive heart failurevDecrease:CSF circulation obstruction,loss or impairment in se
4、cretionColor changesColor of CSFConditions or causesClear,colorlessnormalMilky With WBC increasePink to yellowWith bloodYellowHyperbilirubinemiaProtein1.5g/LGreen Purulent CSFBrown to BlackMeningeal melanomaT Transparencyransparency vNormal:Clear,colorlessvClear or Cloudy：Viral Meningitis、Epidemic E
5、ncephalitis B or Syphilis in CNSvGround glass opacity：Tuberculous MeningitisvMilky turbid：Purulent Meningitis Clots and filmvNormal:No clots or film in 24 hoursvPurulent Meningitis:clots observed in 1-2 hoursvTuberculous Meningitis:thin film cover after 1224 hoursvSubarachnoid obstruction:yellow jel
6、lyProtein vQualitative：PandyPandy test test：-/-/vQuantitative：0.150.150.45g/L(0.45g/L(adult,lumbaradult,lumbar puncture)puncture)+Chemical examinationClinical significancevinflammation：PM:TM:VM:vHemorrhage in cranial or subarachnoidvintracranial mass lesions：tumor,hematomavmultiple sclerosis,neurosy
7、philisGlucose in CSFNormal value:vAdult:2.54.5mmol/L Child:3.14.5mmol/L vGCSF/GP：0.30.9 Clinical significancevInflammation：PM:TM:VM：normalvIntracranial tumor,neurosyphilisvHypoglycemia Chloride in CSFvAdult：120130mmol/L TM：，102mmol/LPM：102116mmol/L。Hypochloremia，such as severe vomit、diarrhea,dehydra
8、tionNormal ValuevRBC：nonevWBC:vadult：08106/L child：015106/L Microscopic ExaminationClinical SignificanceInfectious Diseases in CNSPURULENT MENINGITIS1000-20001000-2000 10106 6/L/L，segmented segmented neutrocyteneutrocyte Tuberculous Meningitis 500 106/L，segment neutrocytes in early stage,and lymphoc
9、ytes increase afterward,plasmocyte also observedViral Meningitis1000100010106 6/L/L，lymphocyteslymphocytesClinical SignificancevBrain tumor：lymphocytes and tumor cellsvParasitic encephalopathy:eosinophile granulocyte vHemorrhage:RBCNORMALNORMALPMPMTMTMVMVMSAHSAHPressure mmHPressure mmH2 2O O 70-180
10、70-180 或或 Appearance Appearance Clear,Clear,colorless colorless Milky Milky、greengreenGround Glass Ground Glass opacityopacityclearclearbloodybloodyClots and Clots and filmfilmnonoclotsclotsThin film Thin film No No jellyjellyprotein protein 0.2-0.4g 0.2-0.4g Glucose Glucose mmolmmol/L/L2.5-4.52.5-4
11、.5 Normal Normal Chloride Chloride mmolmmol/L/L 119-129119-129 NormalNormalNormalNormalCells Cells No No neutrocytesneutrocytes NeutrocytesNeutrocytes,lymphocytes lymphocytes and plasma and plasma cellscellslymphocytlymphocytes es RBC RBC BACTERIALS BACTERIALS NO NO pyogenicpyogenic tubercle tubercl
12、e bacillusbacillusNo No nonoGeneral conceptsvserous membrane fluid:pleural effussionperitoneum serouspericardial effusion Serous Membrane Fluid Classification vTransudate:non-inflammatoryvExudate：inflammatorydifferential diagnosis of transudate or exudateTransudateTransudateExudateExudatecausescause
13、sIncreased capillary Increased capillary permeabilitypermeabilityInfection,malignant cancerInfection,malignant cancerAppearanceAppearanceLight yellow,clear or Light yellow,clear or cloudycloudyBloody,purulent,milky Bloody,purulent,milky turbidturbidgravitygravity1.0181.0181.018clottingclotting-+Cell
14、sCells10010010010106 6/L,different cells/L,different cells bacteriology bacteriology-+Total proteinTotal protein25g/L30g/L30g/LRivaltaRivalta-+Glucose Glucose 3.3mmol/L3.3mmol/L3.3mmol/L3.3mmol/LPleural Pleural fluid/fluid/serumTPserumTP 0.5 0.5 0.5 Pleural Pleural fluid/fluid/serumLDHserumLDH 0.6 0.6 0.6 LDH LDH 200IU 200IU 200IU