脑脊液浆膜腔积液检查培训ppt课件

脑脑脊液脊液浆浆膜腔膜腔积积液液检检查查脑脊液浆膜腔积液检查1OutlinevCSF:colourless liquid that flows through the four cerebral ventricles,subarachnoid space and spinal canal surrounding the brain and spinal cord.vCSF cirlulation communicate with blood circulationvAdult:90150mlNewborn:10 60ml脑脊液浆膜腔积液检查2OutlineCSF:colourless liquid blood brain barrier 脑脊液浆膜腔积液检查3blood brain barrier 脑脊液浆膜腔积液检查AIMSv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4AIMS中枢神经感染性疾病的诊断与鉴别诊断。脑脊液浆膜腔积液Contents of examinationvGeneral Properties：pressure、color、Transparency、Clots and filmvChemical Examination：protein、glucose、chloride vMicroscopy vBacteriological Examination 脑脊液浆膜腔积液检查5Contents of examinationGeneralPressure vGeneral Propertiesv Adult(lying):80180mmH2O，40-50 drips/min children：40-100mmH2O。vIncrease：Intracranial Inflammation：meningitis,cephalitis,myelitiscerebral edema,cerebral hemorrhage,brain tumorsExtracranial：hypertension,congestive heart failurevDecrease:CSF circulation obstruction,loss or impairment in secretion脑脊液浆膜腔积液检查6Pressure General Properties脑脊液Color 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7Color changesColor of CSFCondiTransparencyTransparency vNormal:Clear,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8Transparency Normal:Clear,co脑脊液浆膜腔积液检查培训ppt课件9Protein vQualitative：Pandy testPandy test：-/-/vQuantitative：0.150.150.45g/L(adult,lumbar 0.45g/L(adult,lumbar puncture)puncture)+Chemical examination脑脊液浆膜腔积液检查10Protein Qualitative：Pandy tesClinical 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11Clinical significanceinflammatGlucose 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12Glucose in CSFNormal value:脑脊液Clinical significancevInflammation：PM:TM:VM：normalvIntracranial tumor,neurosyphilisvHypoglycemia 脑脊液浆膜腔积液检查13Clinical significanceInflammatChloride in CSFvAdult：120130mmol/L TM：，102mmol/LPM：102116mmol/L。Hypochloremia，such as severe vomit、diarrhea,dehydration脑脊液浆膜腔积液检查14Chloride in CSFAdult：120130mNormal ValuevRBC：nonevWBC:vadult：08106/L child：015106/L Microscopic Examination脑脊液浆膜腔积液检查15Normal ValueMicroscopic ExaminClinical SignificanceInfectious Diseases in CNS脑脊液浆膜腔积液检查16Clinical SignificanceInfectiouPURULENT MENINGITIS1000-20001000-2000 10106 6/L/L，segmented neutrocytesegmented neutrocyte 脑脊液浆膜腔积液检查17PURULENT MENINGITIS1000-2000 Tuberculous Meningitis 500 106/L，segment neutrocytes in early stage,and lymphocytes increase afterward,plasmocyte also observed脑脊液浆膜腔积液检查18Tuberculous Meningitis 500 1Viral Meningitis1000101000106 6/L/L，lymphocyteslymphocytes脑脊液浆膜腔积液检查19Viral Meningitis1000106/L，lyClinical SignificancevBrain tumor：lymphocytes and tumor cellsvParasitic encephalopathy:eosinophile granulocyte vHemorrhage:RBC脑脊液浆膜腔积液检查20Clinical SignificanceBrain tumNORMALNORMALPMPMTMTMVMVMSAHSAHPressure mmHPressure mmH2 2O O 70-180 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/L2.5-4.52.5-4.5 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 tubercle bacillusbacillusNo No nono脑脊液浆膜腔积液检查21NORMALPMTMVMSAHPressure mmH2O General conceptsvserous membrane fluid:pleural effussionperitoneum serouspericardial effusion Serous Membrane Fluid 脑脊液浆膜腔积液检查22General conceptsserous membraClassification vTransudate:non-inflammatoryvExudate：inflammatory脑脊液浆膜腔积液检查23Classification Transudate:nondifferential diagnosis of transudate or exudateTransudateTransudateExudateExudatecausescausesIncreased 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-+CellsCells1001010010100106 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24differential diagnosis of tran