lumbar puncture can be safely performed in the absence of raised intracranial napetosti.Igla is introduced between the third and fourth lumbar vertebrae. Fluic cerebrospinal (CSF) is collected in three bottles: cytology, biochemical and microbiological review of studies. Manometry during LP performed to measure the tension of cerebrospinal fluid. Queckenstedt test is done to detect a block in the spinal subarachnoid space. Compression of vessels Wein leads to an increase in lumbar CSF rapi tension and release of the vein results in rapid decline. It was abolished in the spinal block.
Normal CSF is a colorless, clear and watery. Xanthochromia (yellow) occurs in the subarachnoid hemorrhage and Froin's syndrome. Turbidity resulting from an increase in cells. Normally, the cell number below 5/cmm and all of them were lymphocytes. The increase in cells called pleocytosis. Lymphocytic pleocytosis occurs in viral, tuberculous meningitis and syphilitic. Neutrophil pleocytosis occurs in pyogenic meninigits, eg, meningococci, pneumococci. Mixed pleocytosis (lymphocytes and the neutrphils) occurs in leptospirosis, tuberculosis, or after subarachnoid hemorrhage. In neuroleukemia immature white cells can be seen in the cerebrospinal fluid.
Cerebrospical normal biochemical composition of the liquid are:
1 Protein: 30-40 mg / dl (much lower than serum levels)
Second Sugar: 60-80 mg / dl (50% serum level)
Third Phosphorus: 720 mg / dl (as well as serum levels).
Cytology, biochemical properties, and serology bolestima.Promjene change in the cerebrospinal fluid (CSF) in the disease are as follows:
First Normal condition: tension (normal), color (colorless) cells (0-5 LYM / cm), protein (30-40 mg / dl), sugar (80 mg / dl).
Second Bacterial meningitis: Tension (rose), color (opaque) cells (up to 2000 neutrophils), protein (significantly increased), sugar (very low).
Third Tuberculous meningitis: Tension (rose), color (cloudy), cells (up to 300-500 cell lymp), protein (200-300 mg / dl), sugar (very low).
4th Viral meningitis: Tension (rose), color (colorless) cells (10-100 cells of the lymph), protein (50-100 mg / dl), sugar (normal).
5th Syphilitic meningitis: Tension (rose), color (colorless) cells (20-500 cells to lymph), protein (200 mg / dl), sugar (normal).
6th General paralysis of the insane: the cells (up to 100 cells), protein (40-100 mg / dl), sugar (normal).
7th Drying dorsalis: color (clear) cells (100 cells), protein (30-60 mg / dl), sugar (normal ).
CSF should be examined after Gram staining the organisms. In meningitis, it is a great way to early bacteriological dijagnostike.Uzorak for microbiological examination should be cultured without delay in order to obtain a positive culture. In tuberculous meningitis, a fine clot (piston-web) forms when CSF was left at room temperature for 12-24 hours. It is coagulated fibrin and can demonstrate acid fast organisms in bojenje.Porast proteins in cerebrospinal fluid can be selectively and can be used for diagnosis. The selective increase in globulin fraction can be identified by appropriate tests. Before the colloidal gold test (Lange TEST0 to be done for this purpose. More modern and accurate method is to make immunoelectrophoresis. Determination of immunoglobulins in CSF and comparing them with the blood levels provide diagnostic information. For example, in multiple sclerosis, CSF oligoclonal IgG showed an increase.
complication of lumbar puncture include sudden Coning from the brainstem, severe headache, and the introduction of infection in the meninges, lumbar puncture is very risky in the presence of raised intracranial tension. The sudden release of lumbar CSF leads to Coning in the medulla in the foramen magnum resulting in fatal respiratory depression and other vital functions, if not released on time. Therefore, lumbar puncture is contraindicated in such situations, unless the neurological team is ready at hand. Under these conditions, CSF can be obtained ventricular puncture. Sometimes when the LP can not be performed or the lumbar subarachnoid space was destroyed, CSF can be obtained cisternal puncture.
