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Running Out of Protein!

Topic: Physiology

Created on Monday, October 27 2008 by rednucleus

Last modified on Monday, October 27 2008.

After performing a lumbar puncture for an inpatient, the lab calls you to tell you that the protein content of the CSF sample is 13 mg/dl. Your intern is astonished and asks why? All, but one, of the following can result in this CSF protein value?

A) Pseudotumor cerebri

B) Removal of large volume of CSF

C) CSF fistulae

D) Leukemias

E) Hyperparathyroidism

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This question was created on October 27, 2008 by rednucleus.
This question was last modified on October 27, 2008.

ANSWERS AND EXPLANATIONS

A) Pseudotumor cerebri

This answer is incorrect.

About 30% of patients with idiopathic pseudotumor cerebri have low CSF protein because of unknown mechanism. (See References)

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B) Removal of large volume of CSF

This answer is incorrect.

For example for cytological studies. (See References)

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C) CSF fistulae

This answer is incorrect.

Note that the commonest 2 causes of low CSF protein are CSF leaks and removal of large volume of CSF. (See References)

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D) Leukemias

This answer is incorrect.

Although leukemias can produce carcinomatous meningitis with raised CSF protein, some cases produce low CSF protein without involving the CNS by an unknown mechanism! Other causes of low CSF protein are acute water intoxication and age between 6 months and 2 years. (See References)

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E) Hyperparathyroidism

This answer is correct.

Hyperthyroidism can result in low CSF protein, that usually normalizes when the patient is rendered euthyroid. Note that the definition of low CSF protein is a protein value between 3-20 mg/dl. (See References)

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References:

1. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973)

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physiology
Running Out of Protein!
Question ID: 102708090
Question written by rednucleus. (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 10/27/2008
Modified: 10/27/2008
Estimated Permutations: 120