脑脊液浆膜腔积液检查课件

CerebrospinalFluid(CSF)Examination脑脊液浆膜腔积液检查OutlineCSF:colourlessliquidthatflowsthroughthefourcerebralventricles,subarachnoidspaceandspinalcanalsurroundingthebrainandspinalcord.CSFcirlulationcommunicatewithbloodcirculationAdult:90—150mlNewborn:10—60mlbloodbrainbarrierAIMS中枢神经感染性疾病的诊断与鉴别诊断。脑血管疾病的诊断与鉴别诊断。协助脑部肿瘤的诊断。中枢神经系统疾病的治疗与疗效观察。ContentsofexaminationGeneralProperties：pressure、color、Transparency、ClotsandfilmChemicalExamination：protein、glucose、chlorideMicroscopyBacteriologicalExaminationPressureGeneralPropertiesAdult(lying):80—180mmH2O，40-50drips/minchildren：40-100mmH2O。Increase：IntracranialInflammation：meningitis,cephalitis,myelitiscerebraledema,cerebralhemorrhage,braintumorsExtracranial：hypertension,congestiveheartfailureDecrease:CSFcirculationobstruction,lossorimpairmentinsecretionColorchangesColorofCSFConditionsorcausesClear,colorlessnormalMilkyWithWBCincreasePinktoyellowWithbloodYellowHyperbilirubinemiaProtein≥1.5g/LGreenPurulentCSFBrowntoBlackMeningealmelanomaTransparency

Normal:Clear,colorlessClearorCloudy：ViralMeningitis、EpidemicEncephalitisBorSyphilisinCNSGroundglassopacity：TuberculousMeningitisMilkyturbid：PurulentMeningitis

ClotsandfilmNormal:Noclotsorfilmin24hoursPurulentMeningitis:clotsobservedin1-2hoursTuberculousMeningitis:thinfilmcoverafter12—24hoursSubarachnoidobstruction:yellowjellyProteinQualitative：Pandytest：-/±Quantitative：0.15～0.45g/L(adult,lumbarpuncture)++++++++++ChemicalexaminationClinicalsignificanceinflammation：PM:↑↑↑TM:↑↑VM:↑Hemorrhageincranialorsubarachnoidintracranialmasslesions：tumor,hematomamultiplesclerosis,neurosyphilisGlucoseinCSFNormalvalue:Adult:2.5—4.5mmol/LChild:3.1—4.5mmol/LGCSF/GP：0.3—0.9ClinicalsignificanceInflammation：PM:↓↓↓TM:↓VM：normalIntracranialtumor,neurosyphilisHypoglycemiaChlorideinCSFAdult：120—130mmol/LTM：↓↓↓，<102mmol/LPM：102—116mmol/L。Hypochloremia，suchasseverevomit、diarrhea,dehydrationNormalValueRBC：noneWBC:adult：0—8×106/Lchild：0—15×106/LMicroscopicExaminationClinicalSignificanceInfectiousDiseasesinCNS脑脊液浆膜腔积液检查PURULENTMENINGITIS1000-2000

×106/L，segmentedneutrocyte

TuberculousMeningitis<500

×106/L，segmentneutrocytesinearlystage,andlymphocytesincreaseafterward,plasmocytealsoobservedViralMeningitis<1000×106/L，lymphocytesClinicalSignificanceBraintumor：lymphocytesandtumorcellsParasiticencephalopathy:eosinophilegranulocyteHemorrhage:RBCNORMALPMTMVMSAHPressuremmH2O70-180↑↑↑或↑↑↑↑AppearanceClear,colorlessMilky、greenGroundGlassopacityclearbloodyClotsandfilmnoclotsThinfilmNojellyprotein0.2-0.4g↑↑↑↑↑↑Glucosemmol/L2.5-4.5↓↓Normal↓Chloridemmol/L119-129↓↓↓NormalNormalCellsNoneutrocytesNeutrocytes,lymphocytesandplasmacellslymphocytesRBCBACTERIALSNOpyogenic

tuberclebacillusNonoGeneralconceptsserousmembranefluid:pleuraleffussionperitoneumserouspericardialeffusion

SerousMembraneFluid

ClassificationTransudate:non-inflammatoryExudate：inflammatorydifferentialdiagnosisoftransudateorexudateTransudateExudatecausesIncreasedcapillarypermeabilityInfection,malignantcancerAppearanceLightyellow,clearorcloudyBloody,purulent,milkyturbidgravity<1.018>1.018clotting-+Cells<100×106/L,lymphocytes>100×106/L,differentcells