脑脊液浆膜腔积液检查.pptx

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1、OutlineCSF:colourless liquid that flows through the four cerebral ventricles,subarachnoid space and spinal canal surrounding the brain and spinal cord.CSF cirlulation communicate with blood circulationAdult:90150mlNewborn:10 60ml第1页/共24页blood brain barrier 第2页/共24页AIMS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

2、。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。第3页/共24页Contents of examinationGeneral Properties：pressure、color、Transparency、Clots and filmChemical Examination：protein、glucose、chloride Microscopy Bacteriological Examination 第4页/共24页Pressure General Properties Adult(lying):80180mmH2O，40-50 drips/min children：40-100mmH2

3、O。Increase：Intracranial Inflammation：meningitis,cephalitis,myelitiscerebral edema,cerebral hemorrhage,brain tumorsExtracranial：hypertension,congestive heart failureDecrease:CSF circulation obstruction,loss or impairment in secretion第5页/共24页Color changesColor of CSFConditions or causesClear,colorless

4、normalMilky With WBC increasePink to yellowWith bloodYellowHyperbilirubinemiaProtein1.5g/LGreen Purulent CSFBrown to BlackMeningeal melanoma第6页/共24页Transparency Normal:Clear,colorlessClear or Cloudy：Viral Meningitis、Epidemic Encephalitis B or Syphilis in CNSGround glass opacity：Tuberculous Meningiti

5、sMilky turbid：Purulent Meningitis 第7页/共24页Clots and filmNormal:No clots or film in 24 hoursPurulent Meningitis:clots observed in 1-2 hoursTuberculous Meningitis:thin film cover after 1224 hoursSubarachnoid obstruction:yellow jelly第8页/共24页Protein Qualitative：Pandy test：-/Quantitative：0.150.45g/L(adul

6、t,lumbar puncture)+Chemical examination第9页/共24页Clinical significanceinflammation：PM:TM:VM:Hemorrhage in cranial or subarachnoidintracranial mass lesions：tumor,hematomamultiple sclerosis,neurosyphilis第10页/共24页Glucose in CSFNormal value:Adult:2.54.5mmol/L Child:3.14.5mmol/L GCSF/GP：0.30.9 第11页/共24页Cli

7、nical significanceInflammation：PM:TM:VM：normalIntracranial tumor,neurosyphilisHypoglycemia 第12页/共24页Chloride in CSFAdult：120130mmol/L TM：，102mmol/LPM：102116mmol/L。Hypochloremia，such as severe vomit、diarrhea,dehydration第13页/共24页Normal ValueRBC：noneWBC:adult：08106/L child：015106/L Microscopic Examinat

8、ion第14页/共24页Clinical SignificanceInfectious Diseases in CNS第15页/共24页PURULENT MENINGITIS1000-20001000-2000 10106 6/L/L，segmented neutrocytesegmented neutrocyte 第16页/共24页Tuberculous Meningitis 500 106/L，segment neutrocytes in early stage,and lymphocytes increase afterward,plasmocyte also observed第17页/

9、共24页Viral Meningitis1000101000106 6/L/L，lymphocyteslymphocytes第18页/共24页Clinical SignificanceBrain tumor：lymphocytes and tumor cellsParasitic encephalopathy:eosinophile granulocyte Hemorrhage:RBC第19页/共24页NORMALNORMALPMPMTMTMVMVMSAHSAHPressure mmHPressure mmH2 2O O 70-180 70-180 或或 Appearance Appearan

10、ce 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/L2.5-4.52.5-4.5 Normal Normal Chloride Chl

11、oride 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 tubercle bacillusbacillusNo No no

12、no第20页/共24页General conceptsserous membrane fluid:pleural effussionperitoneum serouspericardial effusion Serous Membrane Fluid 第21页/共24页Classification Transudate:non-inflammatoryvExudate：inflammatory第22页/共24页differential diagnosis of transudate or exudateTransudateTransudateExudateExudatecausescauses

13、Increased capillary Increased capillary permeabilitypermeabilityInfection,malignant cancerInfection,malignant cancerAppearanceAppearanceLight yellow,clear or Light yellow,clear or cloudycloudyBloody,purulent,milky Bloody,purulent,milky turbidturbidgravitygravity1.0181.0181.018clottingclotting-+Cells

14、Cells1001010010100106 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 第23页/共24页感谢您的观看。第24页/共24页