Changes in cerebrospinal fluid in traumatic brain injury

For traumatic brain injury characterized by an admixture of blood in the cerebrospinal fluid, presence of protein in it and increase in cell number.

Blood cerebrospinal fluid imparts different colors - grayish to pink or red. Upon receipt of the cerebrospinal fluid portions of the second portion is generally the same color, as the first, and sometimes even more bloody. When injected into the spinal fluid of blood as a result of an unsuccessful puncture painted her first portion.

To differentiate abnormal blood in the cerebrospinal fluid of the recommended use of a random double-CSF protein test. Thus by lumbar puncture removed simultaneously for at least three portions of the cerebrospinal fluid (ml of 0,5-1-1,5). The first and last portions of the concentration of total protein.

In case of accidental admixture of blood a first portion of the cerebrospinal fluid protein concentration usually 1/3 better, than in the latter.

When abnormal blood impurities in the cerebrospinal fluid levels of the protein in the first and last portions remains unchanged. It speaks, that the accidental ingress of blood into the first portion of the cerebrospinal fluid lead to a significant increase in its content of protein, as its concentration in the blood greater, than in the cerebrospinal fluid. Blood, ranked in the cerebrospinal fluid in trauma, uniformly distributed, therefore the level of protein in the first and third portions is the same.

To quantify impurities blood count the number of red blood cells. To this liquid mixed with blood diluted in 10 once with isotonic sodium chloride solution (0,2 ml isotonic and 0,02 ml of liquid), mixed, fill the counting chamber and Goryaeva, according to the rules of counting the number of red blood cells, determine the number of red blood cells in the five large squares. The number of erythrocytes in 1 l<n> Cerebrospinal fluid is determined by the formula:

(X*4000*10)/80

where X - the number of red blood cells in five large (80 small) squares, 1/4000 - The volume of the small square, 10- Breeding of cerebrospinal fluid, 80 - The number of small squares.

Practically the number of erythrocytes, being told, five large squares, umnozhayut of 500 (the result of the reduction of numbers of permanent formula). In the presence of 1 l cerebrospinal fluid 680-700 erythrocytes its color varies macroscopically.

With traumatic brain injury erythrocytes can be detected in cerebrospinal fluid within 5 10 days, and while continuing bleeding and longer. In the first hours after the injury centrifuged liquid is colorless or pale yellow pigments due to the admixture of blood plasma. On the second day after the injury occurs xanthosis, which amplifies the third or fourth day, and further weakens. After 14-21 days after injury cerebrospinal fluid becomes colorless. When expressed xanthosis determine the content in the cerebrospinal fluid of bilirubin.

Where, where the removal of erythrocytes from the cerebrospinal fluid does not take place by disintegration, and their penetration through the arachnoid mater, within a few days post-traumatic period, fluid remains colorless after centrifugation.

Increasing the content of protein in the cerebrospinal fluid It observed in all cases of traumatic brain injury, even in the absence of bleeding in the subarachnoid space. In mild injuries in the early hours of the protein content may be normal, further it is increased to 0.4-0.8 g / l, and to the 15-20 th day of normal. In severe cases, the protein content reaches a high level (to 30 g / l).

Of great importance for the diagnosis of traumatic brain injury has protein ratio of cerebrospinal fluid and blood plasma. In the acute posttraumatic period the amount of albumin in cerebrospinal fluid increases significantly, and decreases in plasma. In the process of recovery of their content in the cerebrospinal fluid decreases, and in normal blood plasma. The normalization factor protein is slow, sometimes even a month after the injury, he remains elevated.

In the acute posttraumatic period in the cerebrospinal fluid increases the amount of glucose, lactic and pyruvic acids. When the concentration of 3-5 mmol / liter of lactic acid is usually unfavorable prognosis. The degree of elevation of AST, LDH and aldolase in acute trauma corresponds to the severity of the patient's condition.

The number of cells in the cerebrospinal fluid depends on the severity of the injury.

In the first hours after the injury with no admixture of blood cell number is normal or slightly increased. In hemorrhagic cerebrospinal fluid found blood cells (neutrophilic granulocytes, lymphocytes, monocytes, eosinophilic granulocytes) in proportions, roughly corresponding leukogram. Further (the second or third day after injury) cytosis increases - increases the number of neutrophils, there histiocytes, macrophages. At 10-14 days after injury dominated mononuclear cells - lymphocytes and histiocytes. The normalization of cellular composition of cerebrospinal fluid usually occurs after 3-5 weeks after injury.

Colloidal reaction at head- brain injury is not always indicative.

Responses Lange and Takata-Ara in the first days after injury normal, and in the future may be inflammatory or inflammatory degenerative.

When injected into the spinal fluid of blood lactate dehydrogenase enzyme activity, IS, ALT and alkaline phosphatase highly expressed, that can be used as an important diagnostic indicator, not only in traumatic brain injury, and stroke.