Cerebrospinal Fluid in Clinical Neurology
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Recognised positive and negative controls should be run with each set of samples. Because glucose is actively transported across the blood—brain barrier the CSF glucose levels are directly proportional to the plasma levels and therefore simultaneous measurement in CSF and blood is required.
The cerebrospinal fluid (CSF) is an invaluable diagnostic tool in clinical neurology, not only in the evaluation of inflammatory, degenerative, and malignant. PDF | The cerebrospinal fluid (CSF) is an invaluable diagnostic tool in clinical neurology, not only in the evaluation of inflammatory.
CSF glucose takes several hours to equilibrate with plasma glucose; therefore, in unusual circumstances levels of CSF glucose can actually be higher than plasma levels for several hours. During CSF storage glucose is degraded. Therefore, glucose determination must be performed immediately after CSF collection. A high CSF glucose concentration has no specific diagnostic importance and is related to an elevated blood glucose concentration, e. CSF lactate is independent of blood concentration [ 43 ] class IV.
An increased level can be detected earlier than the reduced glucose concentration. A cytocentrifuge cytospin , the Sayk sedimentation chamber, or membrane filtration can be used to obtain a sufficient number of cells for cytology [ 46 ].
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Lymphocytes and monocytes at the resting phase and occasionally ependymal cells are found in normal CSF. An increased number of neutrophilic granulocytes can be found in bacterial and acute viral CNS infections [ 48 , 49 ] class II. In the postacute phase a mononuclear transformation occurs. Upon activation lymphocytes can enlarge or become plasma cells indicating an unspecific inflammatory reaction [ 48 , 50 ] class IV. Resting monocytes enlarge and display vacuoles when activated. Macrophages are the most activated monocytes.
These cell forms can occur in a great variety of diseases. Lipophages indicate CNS tissue destruction. Eosinophils are not normally present in CSF. It can occur in malignancies and reactive to medication and ventriculoperitoneal shunts [ 52 ]. Malignant CSF cells indicate leptomeningeal metastases.
Factors increasing the detection rate of malignant cells include a volume of at least In conclusion, cell count is generally useful because most of the indications for CSF analysis include diseases which are associated with elevated numbers of various cells. Cytological staining can be helpful in distinguishing CNS diseases when the cell count is increased. Therefore, there are no valid data on the indication, sensitivity and specificity of microbiological procedures in general i.
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In neuroinfections specific antigen or antibody detection should be performed depending on the clinical presentation and the results of basic CSF analysis. The formula for the estimation of the relative intrathecal synthesis of specific antibodies in the CSF [Antibody Index AI ] is as follows:. Cerebrospinal fluid polymerase chain reaction PCR can be performed rapidly and inexpensively and has become an integral component of diagnostic medical practice. A negative PCR result can be used with moderate confidence to rule out a diagnosis of viral infection of the CNS the probability of a definite viral CNS infection was 0.
Cerebrospinal fluid should be immediately i.
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It is important that the CSF is not allowed to sediment before partitioning. Exact upper normal limits of protein concentration differ according to technique and examining laboratory. The Q alb should be preferred to total protein concentrations, partly because reference levels are more clearly defined and partly because it is not confounded by changes in other CSF proteins level B recommendation. The glucose concentration in CSF should be related to the blood concentration.
Pathological changes in this ratio or in lactate concentration support bacterial or fungal meningitis or leptomeningeal metastases level B recommendation.
Cerebrospinal Fluid in Clinical Neurology
Intrathecal IgG synthesis can be measured by various quantitative methods, but at least for the diagnosis of multiple sclerosis the detection of oligoclonal bands by appropriate methods is superior to any existing formula level A recommendation. Patients with other diseases associated with intrathecal inflammation, e. Cellular morphology cytological staining should be evaluated whenever pleocytosis is found or leptomeningeal metastases or pathological bleeding is suspected level B recommendation. Depending on clinical presentation incubation with bacterial and fungal culture media can be useful.
Anaerobic culture media are only recommended if there is suspicion of brain abscess. A viral culture is generally not recommended. The results of bacterial antigen detection have to be interpreted with respect to the microscopical CSF investigation and culture results. It is not routinely recommended in cases of negative microscopy. A diagnosis of bacterial nervous system infection based on antigen detection alone is not recommended risk of contamination.
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Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Abstract A great variety of neurological diseases require investigation of cerebrospinal fluid CSF to prove the diagnosis or to rule out relevant differential diagnoses. Introduction The cerebrospinal fluid CSF is a dynamic, metabolically active substance that has many important functions.
Quantitative analysis of total protein and albumin The blood—CSF barrier is a physical barrier, consisting of different anatomical structures, for the diffusion and filtration of macromolecules from blood to CSF. Qualitative oligoclonal intrathecal Ig synthesis The detection of intrathecal oligoclonal IgG in the CSF is useful diagnostically, particularly as it is one of the laboratory criteria supporting the clinical diagnosis of MS [ 35 ].
[Diagnosis in cerebrospinal fluid: possible applications in neurological practice].
Figure 1 Open in figure viewer PowerPoint. Recommendations and good practice points Cerebrospinal fluid should be immediately i. Conflicts of interest The authors reportedly have no conflicts of interest. European Journal of Neurology ; 11 : — Google Scholar.
There are some special considerations in CSF—serum sample pairs where the CSF but not the serum sample demonstrates a single band. Note that all the oligoclonal bands present are due to IgG. Reference Manager. Study Description. Rao, Aruna S, M.
CAS Google Scholar. Crossref PubMed Google Scholar. This demonstrates that in TBI, aquaporin upregulation can be attributed to hypoxia, and is relevant in other conditions of CNS injury, like ischemic stroke, in which hypoxia and oedema also occur. The result of increased vascular permeability associated with BBB disruption, or vasogenic oedema is the paracellular leakage of protein and ion rich fluid into the brain.
This can lead to a number of complications after TBI. Conversely, proteins normally sequestered in the brain will then have access to peripheral circulation and tissues [ , ]. There are some recent preclinical studies indicating that modulation of the BBB using small inhibitory RNA directed against claudin-5 may markedly improve the outcome of patients with cerebral oedema [ ]. Changes in osmotic balance between the intracellular compartment and the ECS occur as a result of this cytotoxic oedema.
This process leads to a net movement of water from the ECS to the intracellular compartment, and swelling of the brain may occur as a consequence of the ion gradient setup between the ECS and cerebral microvasculature. Williamson et al.
Additionally, ICP was more stable in drug-treated rats—a marker of improved intracranial compliance. In this example, although CSF was not the primary cause of the elevated pressure, it was still beneficial as a target in attenuating the effects of ICH [ ]. Neurological injury following SAH can be described as biphasic.
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