scholarly journals Role and Relevance of Cerebrospinal Fluid Cells in Diagnostics and Research: State-of-the-Art and Underutilized Opportunities

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 79
Author(s):  
Ferdinand Otto ◽  
Christine Harrer ◽  
Georg Pilz ◽  
Peter Wipfler ◽  
Andrea Harrer
Keyword(s):  
Cerebrospinal Fluid ◽  
State Of The Art ◽  
Csf Analysis ◽  
Immune Mediated ◽  
Csf Cells ◽  
Immune Phenotyping ◽  
Technical Issues ◽  
Csf Pleocytosis ◽  
Cns Immunity

Cerebrospinal fluid (CSF) has recently experienced a revival in diagnostics and research. However, little progress has been made regarding CSF cell analysis. For almost a century, CSF cell count and cytomorphological examination have been central diagnostic parameters, with CSF pleocytosis as a hallmark finding of neuroinflammation and cytology offering valuable clues regarding infectious, autoimmune, and malignant aetiologies. A great deal of information, however, remains unattended as modern immune phenotyping technologies have not yet been broadly incorporated into routine CSF analysis. This is a serious deficit considering the central role of CSF cells as effectors in central nervous system (CNS) immune defence and autoimmune CNS processes, and the diagnostic challenges posed by clinically overlapping infectious and immune-mediated CNS diseases. Here, we summarize historical, specimen-intrinsic, methodological, and technical issues determining the state-of-the-art diagnostics of CSF cells and outline future perspectives for this underutilized window into meningeal and CNS immunity.

Diagnostic challenges in neoplastic meningitis presenting as intracranial hypertension

2021 ◽  
Vol 14 (3) ◽  
pp. e238808
Author(s):  
Santosh Sriram Andugulapati ◽  
Akash Chheda ◽  
Karan Desai ◽  
Sangeeta Hasmukh Ravat
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Neoplastic Meningitis ◽  
Whole Body ◽  
Csf Cytology ◽  
Csf Analysis ◽  
Pet Ct ◽  
Pet Ct Scan ◽  
Systemic Malignancy

A diagnosis of idiopathic intracranial hypertension should be considered only after careful exclusion of all possible aetiologies. We report a case of neoplastic meningitis presenting as intracranial hypertension with inconclusive repeated cerebrospinal fluid (CSF) cytology and MRI of brain, emphasising the importance of meticulous CSF analysis and role of early whole-body PET–CT scan for diagnosis of systemic malignancy.

scholarly journals Bacterial Meningitis in the Absence of Cerebrospinal Fluid Pleocytosis: A Case Report and Review of the Literature

2014 ◽  
Vol 25 (5) ◽  
pp. 249-251 ◽  
Author(s):  
Ryota Hase ◽  
Naoto Hosokawa ◽  
Makito Yaegashi ◽  
Kiyoharu Muranaka
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Lumbar Puncture ◽  
Early Stage ◽  
Review Of The Literature ◽  
Csf Analysis ◽  
Cell Counts ◽  
Csf Pleocytosis ◽  
Cerebrospinal Fluid Pleocytosis ◽  
Rule Out

Elevation of cerebrospinal fluid (CSF) cell count is a key sign in the diagnosis of bacterial meningitis. However, there have been reports of bacterial meningitis with no abnormalities in initial CSF testing. This type of presentation is extremely rare in adult patients. Here, a case involving an 83-year-old woman who was later diagnosed with bacterial meningitis caused byNeisseria meningitidisis described, in whom CSF at initial and second lumbar puncture did not show elevation of cell counts. Twenty-six non-neutropenic adult cases of bacterial meningitis in the absence of CSF pleocytosis were reviewed. The frequent causative organisms wereStreptococcus pneumoniaeandN meningitidis. Nineteen cases had bacteremia and seven died. The authors conclude that normal CSF at lumbar puncture at an early stage cannot rule out bacterial meningitis. Therefore, repeat CSF analysis should be considered, and antimicrobial therapy must be started immediately if there are any signs of sepsis or meningitis.

Cardiovascular Risk in Psoriasis: Current State of the Art

2018 ◽  
Vol 17 (1) ◽  
pp. 85-91 ◽  
Author(s):  
Giuseppe Dattilo ◽  
Francesco Borgia ◽  
Claudio Guarneri ◽  
Matteo Casale ◽  
Roberto Bitto ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cardiovascular Risk ◽  
Skin Disease ◽  
Independent Risk Factor ◽  
Clinical Laboratory ◽  
State Of The Art ◽  
Mortality And Morbidity ◽  
Current State ◽  
Immune Mediated

Psoriasis (Pso) is a chronic inflammatory immune-mediated skin disease associated with several comorbidities. Despite the growing number of studies providing evidence for the link between Pso and Cardiovascular (CV) disorders, there are still many unsolved questions, dealing with the role of the skin disease as an independent risk factor for CV events, the influence of Pso severity and duration on CV damage, the presence of Psoriatic Arthritis (PsA) as a predictor of increased CV mortality and morbidity and the detection of reliable clinical, laboratory and/or instrumental parameters to stratify CV risk in psoriatic patients. Moreover, it remains to clarify if the early treatment of the dermatosis may lower CV risk. In this paper we will try to provide answers to these queries in the light of the updated data of the literature.

Cerebrospinal fluid - physiology, analysis and interpretation of protein patterns for diagnosis of neurological diseases

1998 ◽  
Vol 4 (3) ◽  
pp. 99-107 ◽  
Author(s):  
Hansotto Reiber
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
State Of The Art ◽  
Neurological Diseases ◽  
Antibody Index ◽  
Csf Flow ◽  
Protein Patterns ◽  
Antibody Synthesis ◽  
Csf Analysis ◽  
Marker Proteins

The state of the art in routine CSF analysis is reviewed with particular reference to multiple sclerosis regarding: (1) The physiology and pathophysiology of blood-CSF barrier function and dysfunction with the CSF flow rate as main modulator of blood- and brain-derived protein concentrations in CSF; (2) The neuroimmunological aspects regarding (a) patterns of disease-related immunoglobulin class response (IgG, lgA, IgM) in actual Reiber graphs with reference to specific parameters and optional tests, and (b) the oligoclonal, polyspecific antibody synthesis in brain; (3) Particular marker proteins in CSF and blood for differential diagnosis of neurological diseases; (4) Mathematical base for evaluations of CSF data with an example of a multiple sclerosis patient for calculation of intrathecal immunoglobulin and antibody synthesis as well as Antibody Index.

Increased prevalence of lymphoid tissue inducer cells in the cerebrospinal fluid of patients with early multiple sclerosis

2015 ◽  
Vol 22 (8) ◽  
pp. 1013-1020 ◽  
Author(s):  
Matilda Degn ◽  
Signe Modvig ◽  
Beatrice Dyring-Andersen ◽  
Charlotte M Bonefeld ◽  
Jette L Frederiksen ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cerebrospinal Fluid ◽  
Lymphoid Cells ◽  
Early Stages ◽  
Wide Range ◽  
Lymphoid Tissue Inducer Cells ◽  
Csf Pleocytosis ◽  
Ms Pathogenesis ◽  
Lymphoid Tissue Inducer

Background: Inflammatory cytokines produced by cells of the immune system are believed to play a central role in the pathogenesis of multiple sclerosis (MS). Innate lymphoid cells (ILCs) have been shown to produce and secrete a wide range of the cytokines involved in MS pathogenesis; however, a possible implication of ILCs in MS development and disease progression has not been investigated. Objective: With this study, we aimed to clarify a potential role of ILCs in the early stages of MS. Methods and Results: Using flow cytometry, we analysed the prevalence and phenotype of ILCs in the cerebrospinal fluid (CSF) of patients experiencing their first or second demyelinating event. We found a substantial increase in both frequency and number of ILCs, in particular the LTi subset, as compared to healthy controls. We also found an association between CSF pleocytosis and an increased frequency of LTi cells in the CSF, suggesting a favoured recruitment of blood derived LTi cells. Conclusion: Our data suggests a role for ILCs, and in particular the LTi subset, in the early stages of MS. This finding represents an important contribution to the understanding of early inflammation in MS, and adds new knowledge beneficial for future MS therapies.

scholarly journals Cytological Analysis of CSF in Patients with Acute Schizophrenia

2021 ◽  
Vol 57 (2) ◽  
pp. 191-198
Author(s):  
Sanda Moslavac ◽  
Mislav Škrobo ◽  
Elvira Lazić Mosler ◽  
Dalibor Karlović
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Cytological Analysis ◽  
Cns Diseases ◽  
Acute Schizophrenia ◽  
Csf Analysis ◽  
Pathological Conditions ◽  
Immune Mediated

Cerebrospinal fluid (CSF) analysis is one of the most important tests in the diagnosis of central nervous system (CNS) diseases. Although CSF analysis is most commonly used in neurological pathological conditions, it also has its place in psychiatry. Studies to date have described several valuable specific cytomorphological phenomena in the cerebrospinal fluid of patients with acute schizophrenia, which indicate inflammatory or immune-mediated etiopathogenesis of the disease. Additional and long-term research is needed to confirm and standardize the importance of cytological analysis of cerebrospinal fluid in the diagnosis and etiopathogenesis of acute schizophrenia.

Abstract TP214: Low Diagnostic Yield of Routine Cerebrospinal Fluid Analysis in Patients with Juvenile Stroke

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Alexandra Prakapenia ◽  
Volker Puetz ◽  
Kristian Barlinn ◽  
Jessica Barlinn ◽  
Timo Siepmann ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Diagnostic Yield ◽  
Cerebral Vasculitis ◽  
Secondary Stroke Prevention ◽  
Stroke Patients ◽  
Csf Analysis ◽  
Csf Pleocytosis ◽  
Ischemic Attack ◽  
Work Up ◽  
Csf Findings

Background: The diagnostic value of cerebrospinal fluid (CSF) analysis in identification of stroke etiology in patients with juvenile stroke remains not well studied. We sought to determine the frequency and underlying causes of pathological CSF-findings in juvenile stroke patients who underwent CSF-analysis as part of their diagnostic work-up. Methods: We retrospectively abstracted data from consecutive (01/2008 to 12/2015) patients aged 18 to 45 years with acute ischemic stroke or transient ischemic attack. Routine work-up included MRI with dissection-sensitive sequences, Holter-ECG, transthoracic and transesophageal echocardiography, duplex ultrasound of extra- and intracranial arteries and screening for coagulopathies, vasculitis and Fabry disease. CSF-analysis was routinely performed in patients with hitherto cryptogenic stroke. We assessed frequency and causes of pathological CSF-findings including microbiological and virological abnormalities, and their impact on the choice of specific therapy for secondary stroke prevention. Results: Among 379 juvenile patients with acute ischemic stroke or transient ischemic attack, CSF analysis was performed in 201 patients (53%). Of these, 26 patients (13%) had CSF pleocytosis (leucocyte cell count ≥5 Mpt/l). CSF-pleocytosis was rated false positive (e.g. traumatic lumbar puncture, reactive pleocytosis due to acute stroke) after exclusion of specific conditions in 23 of these patients. Only 2 patients with CSF-pleocytosis (1% of patients who underwent CSF analysis) had specific CSF-findings (Lyme disease and neurosyphilis with consecutive cerebral vasculitis) as a cause of stroke and subsequent impact on secondary stroke prevention therapy. One patient had serological evidence of chronic infection with Mycoplasma pneumoniae that was rated as a contributing factor to stroke pathophysiology. Conclusions: The diagnostic yield of routine CSF-analysis in juvenile stroke patients was remarkably low in our study. Our data suggest that CSF-analysis should only be performed if further findings raise the suspicion of cerebral vasculitis.

scholarly journals Cognitive impairment in syphilis: Does treatment based on cerebrospinal fluid analysis improve outcome?

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254518
Author(s):  
Arielle P. Davis ◽  
Clare L. Maxwell ◽  
Haley Mendoza ◽  
Abby Crooks ◽  
Shelia B. Dunaway ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cognitive Impairment ◽  
High Risk ◽  
Cognitive Decline ◽  
Cognitively Impaired ◽  
Cognitive Complaints ◽  
Fluid Analysis ◽  
Csf Analysis ◽  
Persons Living With Hiv ◽  
Csf Pleocytosis

Background Individuals with previous syphilis may experience cognitive impairment. The goal of this study was to determine if those at high risk for laboratory-defined neurosyphilis are cognitively impaired, and whether treatment based on cerebrospinal fluid (CSF) findings results in better outcomes. Methods Participants had a new syphilis diagnosis, serum RPR titer ≥ 1:32 or peripheral blood CD4+ T cells ≤ 350/ul (in persons living with HIV) and did not endorse neurological symptoms. They underwent computerized cognitive assessment with the CogState. Thirty-two were randomized to either undergo lumbar puncture (LP) or to not undergo LP and 14 underwent LP; 64 were not randomized and 48 opted to undergo LP. Results Demographics, cognitive complaints and cognitive impairment did not differ between randomized and nonrandomized participants. Two-thirds were cognitively impaired, and impairment was not more common in those with cognitive complaints. The adjusted odds of increased severity of impairment were 3.8 times greater in those with CSF pleocytosis compared to those without. Time to cognitive normalization, improvement or decline did not differ between those who did not undergo LP and those who underwent LP and whose treatment was based on CSF analysis. Taking into account pre-treatment cognitive impairment, the risk of cognitive decline was lower in those with CSF pleocytosis treated for neurosyphilis compared to those without CSF pleocytosis not treated for neurosyphilis, (HR 0.24 (95% CI 0.07–0.88], p = 0.03). Conclusion In individuals at high risk for laboratory-defined neurosyphilis, cognitive complaints are not a good indicator of cognitive impairment. Severity of cognitive impairment was greater in those with CSF pleocytosis. Identification and treatment of those with neurosyphilis may mitigate subsequent cognitive decline.

scholarly journals A Rare case of recurrent Guillain-Barré syndrome without albuminocytological dissociation

2018 ◽  
pp. bcr-2018-226572
Author(s):  
Anudeep Yelam ◽  
Elanagan Nagarajan ◽  
Raghav Govindarajan ◽  
Pradeep C Bollu
Keyword(s):  
Cerebrospinal Fluid ◽  
Rare Case ◽  
Guillain Barre Syndrome ◽  
Csf Analysis ◽  
Immune Mediated ◽  
Guillain Barré Syndrome ◽  
Sensory Disturbances ◽  
Guillain Barré ◽  
Csf Findings

Guillain-Barré syndrome (GBS) is an immune-mediated polyneuropathy, often preceded by an illness. It is a self-limiting illness in most of the cases, but recurrence is rare and can be seen in about 1%–6% of patients. GBS is characterised by progressive, symmetrical, proximal and distal weakness. Areflexia and sensory disturbances are also common. Patients with GBS usually have albuminocytological dissociation on cerebrospinal fluid (CSF) analysis. This is a case of a 69-year-old woman with recurrent GBS and normal CSF findings.

scholarly journals Clinical, cerebrospinal fluid and neuroimaging findings in COVID-19 encephalopathy: a case series

2020 ◽  
Author(s):  
Raphael Tuma ◽  
Bruno Guedes ◽  
Rafael Carra ◽  
Bruno Iepsen ◽  
Julia Rodrigues ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Series ◽  
Oligoclonal Bands ◽  
Consecutive Series ◽  
Cns Inflammation ◽  
Csf Analysis ◽  
Probability Of Death ◽  
Cns Demyelination ◽  
Csf Findings

Objective - To describe the clinical, neurological, neuroimaging and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. Methods - We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020. Results - Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2) or severe (3), p<0.001). Conclusion - In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.

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