脑脊液浆膜腔积液检查培训课件.ppt

1、脑脊液浆膜腔积液检脑脊液浆膜腔积液检查查Outlinev CSF:colourless liquid that flows through the four cerebral ventricles,subarachnoid space and spinal canal surrounding the brain and spinal cord.v CSF cirlulation communicate with blood circulationv Adult:90150mlNewborn:10 60ml脑脊液浆膜腔积液检查2blood brain barrier 脑脊液浆膜腔积液检查3AIM

2、Sv中枢神经感染性疾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。脑脊液浆膜腔积液检查4Contents of examinationvGeneral Properties：pressure、color、Transparency、Clots and filmvChemical Examination：protein、glucose、chloride vMicroscopy vBacteriological Exami

3、nation 脑脊液浆膜腔积液检查5Pressure v General Propertiesv Adult(lying):80180mmH2O，40-50 drips/min children：40-100mmH2O。vIncrease：Intracranial Inflammation：meningitis,cephalitis,myelitis cerebral edema,cerebral hemorrhage,brain tumors Extracranial：hypertension,congestive heart failurevDecrease:CSF circulation

4、 obstruction,loss or impairment in secretion脑脊液浆膜腔积液检查6Color changesColor of CSFConditions or causesClear,colorlessnormalMilky With WBC increasePink to yellowWith bloodYellowHyperbilirubinemiaProtein1.5g/LGreen Purulent CSFBrown to BlackMeningeal melanoma脑脊液浆膜腔积液检查7TransparencyTransparency vNormal:C

5、lear,colorlessvClear or Cloudy：Viral Meningitis、Epidemic Encephalitis B or Syphilis in CNSvGround glass opacity：Tuberculous MeningitisvMilky turbid：Purulent Meningitis 脑脊液浆膜腔积液检查8Protein vQualitative：Pandy testPandy test：-/-/vQuantitative：0.150.150.45g/L(adult,lumbar 0.45g/L(adult,lumbar puncture)pu

6、ncture)+Chemical examination脑脊液浆膜腔积液检查10Clinical significancevinflammation：PM:TM:VM:vHemorrhage in cranial or subarachnoidvintracranial mass lesions：tumor,hematomavmultiple sclerosis,neurosyphilis脑脊液浆膜腔积液检查11Glucose in CSFNormal value:vAdult:2.54.5mmol/L Child:3.14.5mmol/L vGCSF/GP：0.30.9 脑脊液浆膜腔积液检查

7、12Clinical significancevInflammation：PM:TM:VM：normalvIntracranial tumor,neurosyphilisvHypoglycemia 脑脊液浆膜腔积液检查13Chloride in CSFvAdult：120130mmol/L TM：，102mmol/L PM：102116mmol/L。Hypochloremia，such as severe vomit、diarrhea,dehydration脑脊液浆膜腔积液检查14Normal Valuev RBC：nonev WBC:v adult：08106/L child：015106/

8、L Microscopic Examination脑脊液浆膜腔积液检查15Clinical SignificancevInfectious Diseases in CNS16PURULENT MENINGITIS1000-20001000-2000 10106 6/L/L，segmented neutrocytesegmented neutrocyte 脑脊液浆膜腔积液检查17Tuberculous Meningitis 500 106/L，segment neutrocytes in early stage,and lymphocytes increase afterward,plasmoc

9、yte also observed脑脊液浆膜腔积液检查18Viral Meningitis1000100010106 6/L/L，lymphocyteslymphocytes脑脊液浆膜腔积液检查19Clinical SignificancevBrain tumor：lymphocytes and tumor cellsvParasitic encephalopathy:eosinophile granulocyte vHemorrhage:RBC脑脊液浆膜腔积液检查20NORMALNORMALPMPMTMTMVMVMSAHSAHPressure Pressure mmHmmH2 2O O 70

10、-180 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 mmol/Lmmol/L2.5-4.5

11、2.5-4.5 Normal Normal Chloride Chloride mmol/L mmol/L 119-129119-129 NormalNormalNormalNormalCells Cells No No neutrocytes neutrocytes Neutrocytes,Neutrocytes,lymphocytes lymphocytes and plasma and plasma cellscellslymphocytlymphocytes es RBC RBC BACTERIALS BACTERIALS NO NO pyogenicpyogenic tubercle

12、 tubercle bacillusbacillusNo No nono脑脊液浆膜腔积液检查21General conceptsvserous membrane fluid:pleural effussion peritoneum serous pericardial effusion Serous Membrane Fluid 脑脊液浆膜腔积液检查22Classification vTransudate:non-inflammatoryvExudate：inflammatory脑脊液浆膜腔积液检查23differential diagnosis of transudate or exudat

13、eTransudateTransudateExudateExudatecausescausesIncreased capillary Increased capillary permeabilitypermeabilityInfection,malignant cancerInfection,malignant cancerAppearanceAppearanceLight yellow,clear or Light yellow,clear or cloudycloudyBloody,purulent,milky Bloody,purulent,milky turbidturbidgravi

14、tygravity1.0181.0181.018clottingclotting-+CellsCells10010010010106 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/serumTP fluid/serumTP 0.5 0.5 0.5 Pleural Pleural fluid/serumLDH fluid/serumLDH 0.6 0.6 0.6 LDH LDH 200IU 200IU 200IU 脑脊液浆膜腔积液检查24