CSF transparency

Normal cerebrospinal fluid is clear and transparent. When the meninges have pathological changes, the cerebrospinal fluid will show varying degrees of turbidity due to the presence of bacteria or cells. The degree of turbidity varies with the type and severity of the disease. For example, in purulent meningitis, white blood cells increase in a large amount, which may be pus-like milky white turbidity; in tuberculous meningitis, the white blood cells in the cerebrospinal fluid are moderately increased, and may be mildly ground glass-like opacity. Normal cerebrospinal fluid can also cause mild turbidity by entering red blood cells into the cerebrospinal fluid during puncture. Basic Information Specialist classification: examination classification: cerebrospinal fluid examination Applicable gender: whether men and women apply fasting: fasting Reminder: specimens should be sent immediately after collection, generally should not exceed 1h, so as not to be placed for too long to cause cell destruction, glucose decomposition or clots affect the inspection results. Normal value Clear and transparent. Clinical significance (1) Micro-mixed Japanese encephalitis, polio, and brain abscess (not ruptured). (2) rice soup-like (purulent) suppurative meningitis. (3) ground-glass sporadic viral encephalitis, viral meningitis, epidemic encephalitis, fungal meningitis, tuberculous meningitis (cerebrospinal fluid is allowed to stand for 24 h, white floc film is formed on the liquid surface, taken out Smear, acid-fast staining after drying and fixing, can be found in acid-fast bacilli. (4) clot paralytic dementia, poliomyelitis, purulent meningitis, tuberculous meningitis. (5) Late stage of yellow clot spinal cord tumor. (6) Coagulation subarachnoid obstruction (tumor, vertebrae abscess, inflammatory adhesion). Precautions Specimens should be sent immediately after collection, generally should not exceed 1h, so as not to be placed for too long to destroy the cells, glucose decomposition or clots affect the test results. Inspection process 1. The patient lies on the hard board bed, the back is perpendicular to the table top, the head is bent as far as possible to the chest, the knees are tightly attached to the abdomen with both hands, so that the trunk is as arched as possible; or the assistant is used to hold the patient's head opposite the surgeon. The other hand pulls the lower limbs of the armpits and holds them tightly, so that the spine is as convex as possible to widen the intervertebral space, which is convenient for needle insertion. 2, determine the puncture point, usually the junction point of the highest point of the bilateral iliac spine and the posterior median line as the puncture point, here is equivalent to the third to fourth lumbar spine process, sometimes in the upper or lower lumbar spine The gap is carried out. 3, routine disinfection of the skin after wearing sterile gloves, cover the hole towel, with 2% lidocaine from the skin to the interspinous ligament for layer-by-layer local anesthesia. 4, the surgeon uses the left hand to fix the puncture point skin, the right hand holding puncture needle to the vertical back, the needle tip slightly obliquely to the direction of the head, the adult needle depth is about 4 ~ 6cm, children about 2 ~ 4cm. When the needle passes through the ligament and the dura mater, there is a sudden loss of resistance. At this point, the needle core can be slowly withdrawn (to prevent the cerebrospinal fluid from flowing out quickly, causing cerebral palsy), and the cerebrospinal fluid can be seen to flow out. 5. Connect the pressure measuring tube to measure the pressure before draining. The cerebrospinal fluid pressure in the normal lateral position is 70-180 mmH2O (0.098 Kpa=10 mmH2O) or 40-50 d/min. If you continue to do the queckstedt test, you can see if there is any obstruction in the subarachnoid space. That is, after the initial pressure is measured, the assistant first compresses one side of the carotid artery for about 10 s, then presses the other side, and finally presses both sides of the carotid artery. When the carotid artery is compressed at normal time, the pressure of the cerebrospinal fluid immediately increases by about one time, and after 10 to 20 seconds after the pressure is released, it rapidly drops to the original level, which is called negative in the obstruction test, indicating that the subarachnoid space is unobstructed; if the carotid artery is compressed, it cannot be When the pressure of the cerebrospinal fluid is raised, the obstruction test is positive, indicating that the subarachnoid space is completely blocked. If it rises slowly after applying pressure, it will slowly fall after relaxation, indicating incomplete obstruction. but. Those with increased intracranial pressure are forbidden to do this test. 6. Remove the pressure measuring tube and collect 2~5ml of cerebrospinal fluid for examination. If it is needed for cultivation, use sterile tube to keep the specimen. 7. After the operation, insert the needle core and pull out the puncture needle together, cover the sterile gauze, and fix it with tape. 8, go to the pillow for 4 to 6 hours, so as not to cause postoperative low intracranial pressure headache. The same science test. Not suitable for the crowd 1. If there is obvious papilledema or cerebral palsy, contraindications are contraindicated. 2. Patients who are in shock, exhaustion or endangered state and local skin inflammation, and lesions in the posterior cranial fossa are contraindicated. Adverse reactions and risks If the patient has symptoms such as breathing, pulse, or abnormal color during puncture, stop the operation immediately and deal with it accordingly.

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