CSF CHARTS

1. A 28-year-old male presents with a 12-hour history of high fever, severe headache,
confusion, photophobia and neck stiffness. He has no significant past medical history
and takes no regular medication.

CSF findings
Appearance: cloudy

Opening pressure: 30 cm H₂O

WBC: 936 cells/µL (>95% PMN cells)

Glucose level: < 40% of serum glucose

Protein level: 3 g/L

1.What is the most likely diagnosis?

Ans:-Bacterial meningitis

2. Name the organisms causing the above condition in elderly?

Ans:-Streptococcus pneumoniae and Listeriamonocytogenes in the elderly

3. Name the organism causing the above condition in neonates?

Ans:-Escherichia coli and Group B Streptococci in neonates

4. Mention the gross appearance of CSF associated with the above condition?
Ans:- Cloudy

5. Name the common organism causing chronic meningitis?

Ans :Mycobacterium tuberculosis

6. Enumerate any 5 symptoms associated with this condition?

Ans:-Symptoms related to meningealirritation and neurologic impairment, including
headache, photophobia, irritability, clouding of consciousness, and neck stiffness.

7. List ( any 3) complications associated with this condition?

Ans : - Waterhouse-Frederichsen syndrome, Hydrocephalus,Leptomeningeal fibrosis ,
cerebritis; secondaryvasculitis and venous thrombosis may lead to hemorrhagic
cerebral infarction.

8. Define the term meningitis?

Meningitis is an inflammatory process of the leptomeninges
and CSF within the subarachnoid space, usually caused
by an infection
9. List down the broad classification of meningitis

Ans: Based on the etiology and clinical evolutionof the illness, infectious meningitis
is broadly classified into
acute pyogenic (usually bacterial), aseptic (usually acute or
subacute viral) and chronic (usually tuberculous, spirochetal,
orcryptococcal).

10. What is the choice of treatment for this condition?

Ans:Successful treatment relies on early initiation of appropriate antibiotic therapy,
accompanied by high dose corticosteroids to reduce brain swelling

CHART 2

A 38-year-old female presents with 24 hours of headache, photophobia and mild neck
stiffness, in addition to stuffy running nose and congestion.She had perianal
tenderness and rashes which on examination revealed herpetic lesions.

CSF findings
Appearance: clear

Opening pressure: 23 cm H₂O

WBC: 150 cells /µL (primarily lymphocytes)

Glucose level: normal

Protein level: 1.2g/dL

1. What is your diagnosis?

Ans :Viral meningitis ( HSV- Associated )

2. What are the common sites of infection in the brain?

Ans : Inferiorand medial regions of the temporal lobes and the orbital gyri ofthe
frontal lobes

3.Enumerate the histological findings of the above condition?

Ans:1. Necrotizing and hemorrhagic

2. Perivascularinflammatory infiltrates are usually present,
3. Cowdrytype Aintranuclear viral inclusions

4. Define Encephalomyelitis ?

Ans: Inflammationof the meninges and brain parenchyma with

simultaneousinvolvement of the spinal cord.

5. What are the other organisms (minimum 5) causing Viral meningitis?

Ans: Enteroviruses, Cytomegalovirus, Human immunodeficiencyVirus, JC

polyomavirus

6. What are the routes of spread of microbes to enter the nervous system?

Ans: Hematogenous spread, Direct implantation , Local extension,peripheralnervous

system,

7. List down the broad classification of meningitis

Ans :Based on the etiology and clinical evolutionof the illness, infectious meningitis
is broadly classified into
acute pyogenic (usually bacterial), aseptic (usually acute or
subacute viral), and chronic (usually tuberculous, spirochetal,
orcryptococcal).

8. Define Aseptic meningitis?

Ans: Aseptic meningitis is a clinical term used for absence

of organisms by bacterial culture in a patient with active clinical symptoms.

9. What is the definite investigation for identifying the causative organism?

Ans: Molecular methods – PCR

10. What is the choice of treatment for this condition?

Ans: Acyclovir, Corticosteroids

CSF CHART – 3

5 year old boy presented with fever,generalized body pain lasting for one month. On
physical examination multiple cervical and inguinal lymphadenopathy were found.

Complete blood count revealed 12x 109/L , Platelet : 24,000/mm3 and peripheral
smear showed 70% blast. Flow cytometry blasts showed CD10 : 89%, CD19 : 82%
TdT : 38%. Initial treatment was started .
One month later he had complaints of headache, vomiting, right hemiparesis. CSF
tapping was done,

CSF findings:

Appearance : Clear
Total count : 232 cells/mm3 – primarily (lymphocytes, monocytes)
Protein : 50 mg/dl
Glucose : 25 mg/dl
LDH : Increased

1. What is your diagnosis?

Ans: Relapse of B- ALL with CNS involvement

2. Name the prognostic factors associated with poor prognosis in this condition?
Ans:
a) Age younger than 2 years,
b) presentationin adolescence or adulthood
c) peripheralblood blast counts greater than 100,000, which probablyreflects a high
tumor burden.

3. What is the normal WBC count in a CSF ?

Ans: 0-5 Leukocytes/mm3

4. What is the appearance of blast in CSF cytology in the above condition ?

Ans: Lymphoblasts have more condensed chromatin, less conspicuous nucleoli, and
smaller amountsof cytoplasm that usually lacks granules

5. What are the Histochemical stain used to identify the blast?

Ans: Lymphoblasts aremyeloperoxidase-negative and often contain periodic acid–

Schiff–positive cytoplasmic material.

6. What are the other conditions (any 3) with malignant cells in CSF?

Ans: AML, CML, lymphoma, rarely other malignancies such as breast carcinoma,
lung carcinoma,gastric carcinoma, Melanoma

7.What are the indications (minimum 5) of lumbar puncture ?

Ans:
1. CNS infections
2. Autoimmune CNS diseases like GullainBarre syndrome
3. Malignant cells in metastasis
4. CT negative Subarachanoid hemorrhage
5. For therapeutic purposes and delivery of intrathecal drugs
8.How to assess the appearance of CSF ?
Ans:
1. Compare with water
2. Can read the paper through CSF in a test tube in normal condition.

9. Mention the site to perform lumbar puncture and why?

Ans: It is performed below the L2 level (usually between L3-4 or L4-5) in order not
to injure thespinal cord.

10. Mention any 3 contraindications of lumbar puncture ?

Ans:
1. Infected skin over the puncture site,
2. Increased intracranial pressure (ICP) from any space-occupying lesion
(mass, abscess),
3. Trauma
4. Uncorrected bleeding diathesis
5. Platelet count < 20,000/ cu.mm