Palpate intervertebral space and move one

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Palpate intervertebral space and move one intervertebral space above, this is place for puncture. Anesthesia- local Angle of the needle not 90 degrees but angle of processus spinosus. Neddel passes along ligament between processes. 2 points of resistance: -yellow ligament -dura matter Slowly remove needle and observe if there is any dropping of fluid (normally 1 drop/ 5 sec- higher indicates hypertension) CSF is collected to 3 tubes, 5 ml each: 1 st - cellular assessment 2 nd - biochemical assessment 3 rd - immunological assessment Tubes are also useful to differentiate blood in CSF Apply aseptic bandage, patient should lay face down for 2 hours. 47. CSF – normal physical and biochemical parameters and their changes in the different neurological disorders. Normal parameters: absolutely transparent and clear Only lymphocytes, up to 5/ microscopic field Protein 0,12-0,32g/L No immunoglobulins Glucose -40-50% of glucose blood level. 2-3 micromol/dL Chlorides 120-130 micromol/mL Intracranial pressure, not higher than 250 mm H2O CSF changes: stroke: ischemic- slightly incr. level of proteins Hemorrhage (especialy SAH) -Red colour
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- incr. level of protein - high incr. in RBC - xantochromia- whle LP is performed after several days Neural infection for differential diagnosis between viral and bacterial infection Viral: (encephalitis, meningitis) -Colour: normal or cloudy -Inr proteins - pleocytosis- inc number of cells up to several hundreds/mm3, 80-90% are leukocytes Bacterial: (purulent meningitis) -butter-like texture - not transparent grey/green/brown depending on causative factor - inc protein - pleocytosis- neutrophils up to several thousands/mm3 Tuberculosis; (tuberculous meningitis) - Cludy, yellowish -after pting ito thermostate for 24 h formation of fibrin layers on the surface - opalescence -inc protein -pleocytosis- 2000- 3000 cells mixed 40% lymphocytes, 60% neutrophils -decr. Glucose and chloride Neuroimmune disease: -mild pleocytosis up to 50 cells/ micr. Field (lymphocytes) -incr of protein 1-2 g/L -presence of immunoglobulins Tumors -slightly inc protein SPECIAL NEUROLOGY
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1.Classification of cerebro-vascular diseases 1. Atherosclerotic thrombosis 2. Transient ischemic attacks 3. Embolism 4. Hypertensive hemorrhage 5. Ruptured or unruptured saccular aneurysm or AVM 6. Arteritis a. Meningovascular syphilis, arteritis secondary to pyogenic and tuberculous meningitis, rare infective types (typhus, schistosomiasis, malaria, mucormycosis, etc.) b. Connective tissue diseases (polyarteritis nodosa, lupus erythematosus), necrotizing arteritis. Wegener arteritis, temporal arteritis, Takayasu disease, granulomatous or giantcell arteritis of the aorta, and giant-cell granulomatous angiitis of cerebral arteries 7. Cerebral thrombophlebitis: secondary to infection of ear, paranasal sinus, face, etc.; with meningitis and subdural empyema; debilitating states, postpartum, postoperative, cardiac failure, hematologic disease (polycythemia, sickle cell disease), and of undetermined cause 8. Hematologic disorders: anticoagulants and thrombolytics, clotting factor disorders, polycythemia, sickle cell disease,
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  • Winter '18
  • Jane doe

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