课件：诊断学脑脊液.pptVIP

This principle is similar to the inflammation that occurred in other parts . * 结 核 性 脑 膜 炎 中性粒细胞、淋巴细胞同时存在 * 病 毒 性 脑 炎 以淋巴细胞为主，正中为大淋巴样细胞 * 常见中枢神经系统疾病的脑脊液检查特点 P337 压力 外观 蛋白 GLU Cl- 细胞 化脑 ↑↑↑ 混浊 ↑↑↑ ↓↓↓ ↓ Ne 结脑 ↑↑ 微混，毛玻璃 ↑ ↑ ↓↓ ↓↓ Ne /Ly 病脑 ↑ 多清 ↑ N N Ly 流脑 ↑ 多清 ↑ ↑ N N Ne→Ly 肿瘤 ↑ ↑ 多无色 ↑ N N 少Ly 出血 ↑ 血性 ↑ ↑ N RBC back * 微生物检查  阳性可确诊中枢神经系统微生物感染 1．直接镜检（显微镜检查） 革兰氏染色：化脑阳性率约为60-90% 抗酸染色：结脑取薄膜涂片 墨汁染色：用于新型隐球菌的观察，检有未染色的荚膜 2、微生物培养:厌氧培养 巧克力平板，CO2培养箱，有利于脑膜炎奈瑟菌、流感嗜血杆菌等生长. back * 免疫学检查 1、多发性硬化等：免疫球蛋白检测 2、梅毒性脑膜炎RPR：梅毒过筛试验 TPHA：梅毒确诊试验 3、 结核性脑膜炎的抗体检查： （1）?ELISA 法：测TB-Ab （2） PCR法： 测TB-DNA 敏感度高（10-20个）， 但假阳性也高。 下一页 * 脑脊液检查的临床应用 1、中枢神经系统感染性疾病的诊断与鉴别诊断 2、脑血管疾病的诊断与鉴别诊断 3、协助脑部肿瘤的诊断 4、中枢神经系统疾病的治疗及疗效观察 * 学习提纲 重点掌握常见中枢神经系统疾病脑脊液的检查特点？ 掌握CSF采集的三管及其用途。 如何鉴别穿刺出血和病理性出血？ 掌握CSF的一般性状检查，化学检查及显微镜检查。 THANK YOU SUCCESS * * 可编辑 It is produced by the choroid plexus that are formed by highly convoluted pia mater. Then enter the lateral ventricles through the choroid fissure, along the line of the fornix into the third ventricle, then via the cerebral aqueduct into the fourth ventricle. Through two lateral apertures and one median aperture, it is then allowed to flow into the venous system by the arachnoid granulations. It through the cerebromedullary cistern down the spinal cord and over the cerebral hemispheres * act as a buffer for the cortex, protecting the brain and spine?from injury exchange the matter, it can transport nutritions into brain,such an glucose ,glucose is a very important matter which can turn into ATP, to provide energy in brain. The CSF is produced by the choroid plexus , and the apithelium of the vessel can control the passage of substances. The small molecule substances such as kalium, natrium, chlorin, magnesium，can travelling into the CSF freely. And median molecule substances such as albumim , glucose and calcium can partly cross, while the larg