Describe the location of the CSF.
Trace a drop of CSF from its origin to its absorption (Figure 13–1).
Draw a lateral projection of the ventricular system.
List the functions of the CSF.
Describe the changes in the total CSF protein level with age (Figure 13–3)
Describe the composition of normal CSF (Table 13–2).
Contrast the normal pressure of the CSF in infants and adults.
Describe the signs and symptoms of increased intracranial pressure in infants and older Pts.
Describe, in principle, the causes for increased CSF pressure.
Recite the usual sites of obstruction of the CSF and name some of the types of lesions that cause obstruction.
State Pascal's law of distribution of pressure in an enclosed container.
Describe the signs and symptoms and some causes of low CSF pressure.
List several common indications for an LP.
List and explain the most important contraindications for an LP.
Describe some situations in which the Ex may elect to do an LP despite increased pressure.
Describe the complications of an LP.
Describe the post-LP headache syndrome and its presumed cause.
Review the suggestions for prevention and management of the post-LP headache.
Describe the treatment for prolonged post-LP headache.
Discuss the Pt's apprehensions with regard to an LP.
Describe how to position a Pt for an LP and why that position is chosen (Figure 13–4).
Describe the levels of the vertebral column to choose for an LP.
Describe how to angle and align the bevel of the needle for an LP.
Describe how to measure the CSF pressure and state the normal range.
State the precautions the Ex takes in measuring the CSF pressure when the history or clinical examination raise the possibility of increased pressure.
State what causes the normal fluctuations in the level of the CSF meniscus in the manometer (Figure 13–5).
State, in principle, the relation between the CSF pressure and the pressure in the extracranial veins.
Describe the changes in CSF pressure with inspiration and expiration and explain why these changes occur.
State whether the intracranial and CSF pressure is most closely related to the arterial or capillary and venous pressure.
State the mechanism by which an anxious Pt's abdominal muscle tension may increase the opening CSF pressure.
Describe how to induce the anxious Pt to relax the abdominal muscles.
Explain how neck flexion may increase the CSF pressure.
Summarize the actions or instructions the Ex uses to exclude extrinsic causes for a high opening CSF pressure.
Describe how an LP can cause the death of a Pt with intrinsically increased intracranial pressure.
State what actions to take if the opening CSF pressure remains increased after having completed the usual maneuvers to exclude extrinsic causes for increased pressure.
Enumerate the causes and describe what to do if the flow of CSF stops or the manometer excursions cease (Table 13–3).
Describe the clinical signs of transforaminal herniation (Chapter 12).
Describe how to determine whether the CSF and manometer system is patent..
Explain why the Ex generally should not aspirate CSF with a syringe, if the flow suddenly stops.
Explain the rationale for collecting CSF in three different tubes.
Describe the gross appearance of normal CSF.
Describe the usual pathologic alterations in the gross appearance of the CSF.
Describe the proper way to inspect a sample of CSF for changes in gross appearance.
State how many RBCs or WBCs must be present to alter the gross appearance of the CSF.
State the usual cause for cloudiness of the CSF.
Explain how to interpret the situation if the Ex has seen a cloudy CSF and the laboratory reports a count of less than 200 WBCs/mm3.
Explain why the Ex cannot delegate the immediate inspection of the CSF to the laboratory.
Distinguish between erythrochromia of the CSF and xanthochromia.
Define what is meant by a traumatic or bloody tap.
Describe the methods for distinguishing a traumatic tap from preexisting blood in the CSF.
Explain the importance of centrifuging red or yellow CSF.
State the length of time required for xanthochromia to appear after hemorrhage into the CSF.
Describe how to correct the WBC count in the CSF when RBCs are also present.
Define erythrophagocytosis and discuss its meaning.
State the three most common causes of CSF xanthochromia and describe how to distinguish them.
Enumerate the widely available laboratory tests on the CSF and give normal values for the constituents of the CSF routinely tested. Use Figure 13–8 to remind you of the main headings and recite the tests under these headings. Also check Table 13–2 for values.
Give the normal cell count in the CSF for young infants and mature Pts and state the only types of cells normally present.
State the normal value for the CSF glucose concentration and how it relates to the blood glucose level.
State the normal value for the CSF protein and describe, in principle, the importance of fractionating the immunoglobulins.
State how to correct the CSF protein value to compensate for blood in the CSF.
Describe the methods for cytologic analysis of CSF.
List some of the types of neoplastic cells that invade the CSF and state, in principle, how they are identified.
Describe, in principle, the methods for identifying the various common bacteria and viruses that cause meningitis and encephalitis.
Contrast the typical CSF profiles in encephalitis and meningitis (Table 13–2).
Describe the CSF profiles for multiple sclerosis and intrinsic neoplasms (Table 13–2).
Summarize the differences in the CSF pressure, cell count, and protein content from early infancy to maturity.
Explain why the vast array of laboratory tests available for the identification of microorganisms, abnormal cells, and other constituents places even more value on the clinical findings than ever before.