CSF Testing Research Articles

Cerebrospinal fluid in acute optic neuritis: Experience of the Optic Neuritis Treatment Trial

The Optic Neuritis Treatment Trial (ONTT) is a prospective study of corticosteroid treatment of acute optic neuritis (ON), with subsequent longitudinal follow-up to determine development of clinically definite multiple sclerosis (CDMS). We analyzed the CSF of 83 patients with clinically isolated ON who underwent lumbar puncture within 24 hours of enrollment into the ONTT to determine the value of CSF changes in ON, especially regarding diagnostic utility, immunologic changes, MRI correlations, and progression to CDMS All patients had baseline MRI scans graded for changes typical of MS CSF measurements included immunoglobulin G (IgG) synthesis, IgG ratio, myelin basic protein, IgG kappa light chains, and oligoclonal banding. No patients had their diagnosis or management altered as a result of CSF findings. Except for oligoclonal bands, few patients showed any abnormalities on CSF tests, and no tests correlated with the 2-year development of CDMS. Oligoclonal banding, present at baseline in 11 of 13 patients who developed CDMS, did predict progression to CDMS, but this was not independent of MRI abnormalities. Two patients with oligoclonal bands and a normal MRI did progress to CDMS. We conclude that CSF analysis may not be necessary in the routine evaluation of patients presenting with a typical clinical profile of acute ON, and that most CSF tests add little additional information to MRI results for predicting the 2-year development of CDMS. However, the precise role of oligoclonal banding in the analysis of such patients awaits longer follow-up of this cohort. NEUROLOGY 1996,46 368-372

Diagnóstico da neurocisticercose através da tomografia axial computadorizada de crânio: análise de 2030 casos

Normal 0 21 false false false MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Tabela normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;} O diagnóstico da neurocisticercose através da tomografia axial computadorizada (TAC) de crânio é seguro, confiável e não invasivo, possuindo sensibilidade superior às reações imunológicas no LCR e identificando as várias fases de evolução da doença. Nosso objetivo foi estudar as características da população em que se diagnosticou neurocisticercose no Instituto de Tomografia Axial Computadorizada (I.T.A.C.) de Londrina, bem como os aspectos tomográficos encontrados. Foram revisadas todas as TAC de cránio realizadas no I. T.A.C. de Londrina entre setembro de 1986 e maio de 1994, sendo analisados os exames de pacientes em que se diagnosticou neurocisticercose. Estudou-se a presença de calcificações, cistos ou vesículas, granulomas e hidrocefalia. Analisou se também a idade, sexo e procedência de zona rural ou urbana. Houve diagn6stico de neurocisticercose em 2030 pacientes. A maioria (47,6%) possuía idade entre 20 e 40 anos; 886 (43,7%) eram do sexo masculino, e 1144 (56,3%) do sexo feminino. Apenas 85 pacientes procediam de zona rural. Dentre os achados tomográficos, houve 983 calcificações únicas (48,4%), 873 calcificações múltiplas (43,0%), 199 cistos ou vesículas (9,8%) e 121 granulomas (5,9%). O achado de hidrocefalia esteve presente em 135 casos (6,7%), e em 86 pacientes havia cisticercos em diferentes estágios de evolução. Os resultados são discutidos à luz da literatura disponível.

Evaluation of the polymerase chain reaction for the detection of Borrelia burgdorferi in cerebrospinal fluid of children with acute peripheral facial palsy.

Neuroborreliosis occasionally represents a diagnostic problem, especially in the early stage of the infection. The polymerase chain reaction (PCR) offers an attractive alternative to antibody testing. The aim of our study was to investigate the diagnostic potential of PCR in comparison to antibody tests in CSF of children with facial palsy. In contrast to other manifestations of neuroborreliosis, facial palsy is a well-defined clinical entity in which CSF findings allow an early distinction according to aetiology. The study included 17 children with neuroborreliosis, defined by the detection of specific IgM antibodies in CSF, and 20 children with facial palsy of unknown cause. Primers used for the nested PCR were generated from conserved sequences of the OspA-gene. Most of the cases in both subgroups have been examined within a few days after the onset of the paresis. Only in 2 out of 17 cases with neuroborreliosis could specific DNA be amplified. The PCR gave negative results in all cases of the control group. The IgM capture ELISA is superior to PCR to support the clinical diagnosis of neuroborreliosis.

Spinale Abszesse im Rahmen eitriger Meningitiden

Spinal abscesses are usually easily detected by clinical examination, CSF testing, and radiological imaging techniques. Diagnosis can be obscured in cases presenting with purulent meningitis, sepsis, and impaired consciousness. We describe 7 cases in which purulent meningitis initially dominated the clinical appearance. In 3 cases each, staphylococci or streptococci were cultured; one case was due to M. tuberculosis infection. Only after improvement of the obscured consciousness the paraparesis became more obvious, and the spinal abscesses were diagnosed. Four patients recovered favourably after decompression operations whereas 3 patients with rapid deterioration could not be operated on and died subsequently. In patients with purulent meningitis, any sign of ensuing paraparesis should prompt immediate magnetic resonance examination of the spinal canal to enable early detection of a spinal abscess. Immediate neurosurgical intervention determines the outcome.

Two cases of cerebral toxoplasmosis in AIDS patients mimicking HIV-related dementia

Two unusual cases of cerebral toxoplasmosis in AIDS patients are presented. Two homosexual males aged 33 and 52 years in CDC stage IV C1 complained of memory loss during the past 6 months, as well as weight loss and mild fever. They showed severe intellectual deterioration and discrete basal ganglia dysfunction. Motor performance and cognitive function as well as the conventional EEG findings were grossly abnormal. MRI was normal in the younger patient but showed signal-intensive zones in the basal ganglia and cortical atrophy in the older one. CSF and serological antibody tests were normal; immunological function was severely impaired. The patients were diagnosed as late "HIV-related dementia". Both deteriorated rapidly and died within a few weeks. Neuropathological examination revealed histologically severe Toxoplasma gondii encephalitis, involving the basal ganglia in particular. It is concluded that in AIDS patients with a severely impaired immune status cerebral opportunistic infection may present as dementia with mild basal ganglia impairment in the absence of other focal neurological signs or the characteristic radiological findings.

The Value of Somatosensory Evoked Potentials in the Assessment of Multiple Sclerosis

ABSTRACT.Somatosensory evoked potentials (SEPs) are widely used in the assessment of multiple sclerosis. Since other methods have been introduced recently, it is necessary to reevaluate the diagnostic power of the SEP method to allow for an easier selection of the set of tests used in the assessment of multiple sclerosis. It is worthwhile to emphasize that upper and lower limb SEPs are reliable, inexpensive, and not time consuming. Discomfort and risk for the patient are minimal. There are a few criteria that deserve special comment. 1) The sensitivity of SEPs in detecting a lesion in multiple sclerosis patients depends on the method applied and is in general lower than of magnetic resonance imaging, visual evoked potentials, and CSF tests, but higher than using brainstem auditory evoked potentials. 2) There is no specificity of SEPs. 3) In many instances it is possible to localize spinal and supraspinal subcortical lesions. 4) By proving normal sensory conduction or detecting clinically silent lesions, S...

Provas de aglutinação do látex no líquido cefalorraqueano em meningites bacterianas: análise de 333 casos

Foram estudadas 333 amostras de liqüido cefalorraqueano (LCR) de pacientes com suspeita clínica e/ou diagnóstico de meningite bacteriana aguda para avaliar o comportamento das provas do látex para os agentes etiológicos H. influenzae Upo b, N. mening tidis A e C, S. pneumoniae. Os resultados foram comparados aos do exame bacteriscópico direto pelo método de Gram e do exame bacteriológico feito a partir do isolamento bacteriano em culturas. Os resultados mostraram que as provas do látex, quando realizadas no LCR, são de grande auxílio diagnóstico imediato para a identificação do agente etiológico em meningite bacteriana aguda devido à sua rapidez e facilidade de execução. Das 106 amostras de LCR em que um desses três agentes etiológicos era o responsável pelo quadro de meningite bacteriana aguda, sua presença foi evidenciada pela prova do látex em: 98,2% para H. influenzas tipo b, 15,8% para N. meningitidis A ou C, 96,S% para S. pneumoniae. Discute-se o fato de estar iniciada a antibioticoterapia em grande número de casos de meningite bacteriana em nosso meio, antes que seja colhida a amostra de LCR que se destina a comprovar a infecção meníngea.

IgG synthesis rate in evaluation of multiple sclerosis in a community hospital.

We obtained CSF and serum from 21 patients with definite MS in a community hospital. Ninety percent of patients had an elevated IgG synthesis rate, comparable with the sensitivity of oligoclonal bands (0.95) or the IgG index (0.90) and better than the IgG% (0.47) in definite MS. We found that no area hospital routinely employs the IgG synthesis rate. The low-sensitivity IgG% and the dimensionless IgG index can be abandoned. The linear IgG synthesis rate and oligoclonal band scanning should be the CSF tests of choice.

Decreased somatostatin-like immunoreactivity in cerebral cortex and cerebrospinal fluid in Alzheimer's disease

To investigate changes in the somatostatinergic neurons of patients with Alzheimer's disease (AD), we determined the somatostatin-like immunoreactivity (SLI) in post-mortem brain tissue of histopathologically confirmed AD patients and in CSF of probable AD patients (according to DSM III). The CSF values were then correlated with psychological test scores. In 6 AD patients the SLI values were decreased 42% ( P<0.005) in the frontal cortex, 28% ( P<0.05) in the temporal cortex and 42% ( P<0.01) in the parietal cortex but not in the thalamus and putamen compared to 11 control patients. In some brain areas there were statistical correlations between SLI values and cholinergic markers, choline acetyltransferase and acetylcholine esterase activities, suggesting a relationship between these two neurotransmitter systems. In the CSF among 75 AD patients SLI was 35% lower ( P<0.001) than in controls. Severely demented patients showed lower SLI values than moderately demented individuals, but this difference was not significant. There was a weak but statistically significant correlation between SLI values in CSF and neuropsychological test scores. This study further confirms the involvement of somatostatinergic neurons in AD and suggests that this involvement may be related to the progression of dementia symptoms.

IUIS council meets

The identification of inborn errors of metabolism (IEM) in adults presenting with a wide range of neurological symptoms is a relatively new field in medicine. We sought to identify which treatable IEM have been diagnosed for the first time in adults and generate a protocol for metabolic screening targeting those treatable disorders.Medline/Pubmed searches of English language literature limited to the adult age group were performed. Diseases identified through this search were then compared to previously published lists of treatable IEM in both adults and children.85% of the treatable conditions known to cause global developmental delay or intellectual disability in children had reports where the diagnosis of that IEM was made in one or more adult patients with neurological symptoms. Screening tests in blood, urine, CSF and MRI can detect most of these treatable conditions but the diagnostic accuracy of these screening tests in adults is not clear.Treatable IEM need to be considered in the differential diagnosis of neurological symptoms in patients of any age.

Evaluation of the Phadebact CSF test for detection of the four most common causes of bacterial meningitis.

A five-center collaborative study was undertaken to determine the suitability of the Phadebact CSF test kit and the Phadebact group B Streptococcus reagent for routine use by clinical laboratories to detect antigens of common organisms causing bacterial meningitis. The kits employ staphylococcal protein A coagglutination to detect the antigens of Haemophilus influenzae types a, b, c, d, e, and f, Neisseria meningitidis groups A, B, C, Y, and W135, Streptococcus pneumoniae (83 serotypes), and group B Streptococcus. A total of 2,817 individual tests were performed on 577 cerebrospinal fluid specimens. The percent positive specimens detected by coagglutination was as follows: overall, 84%; H. influenzae, 97%; group B Streptococcus, 75%; S. pneumoniae, 71%; and N. meningitidis, 58%. Eighty-five of the specimens were also tested by counterimmunoelectrophoresis. Coagglutination was more sensitive than counterimmunoelectrophoresis because it detected 74% of the positive specimens, whereas counterimmunoelectrophoresis detected only 65%. No false-positive results were obtained with coagglutination. The Phadebact CSF test kit is recommended for routine use in screening cerebrospinal fluid samples for antigens of the common organisms causing bacterial meningitis along with the Gram stain and culture for delayed confirmation of the rapid results.

The Clinical Relevance of 'CSF Viral Culture'

The clinical relevance of CSF viral cultures was evaluated by reviewing the records of 390 patients whose CSF was cultured for virus during a two-year period. The diagnoses at hospital discharge were aseptic meningitis, meningoencephalitis, or both in 111 patients, and enterovirus was isolated from the CSF or other test specimens in 46 patients (41%). The diagnosis or management of nearly one half of the patients from whom enterovirus was isolated was directly influenced by this information. Hospitalization and the unnecessary use of antibiotics were shortened by at least 70 days. Enterovirus was the only virus isolated from the CSF during the study period. The CSF was more likely positive for an enterovirus if it was drawn from a young patient with aseptic meningitis during the summer of fall months. The clinical data obtained from this study are discussed and compared with national statistics.

False-Positive VDRL and FTA in Cerebrospinal Fluid

A VARIETY of CSF tests have been used in the diagnosis of neurosyphilis. Two of the most widely used are the nontreponemal VDRL and the FTA. Both tests have high specificity, and false-positive reactions are rare. A case of false-positive VDRL and FTA in the CSF occurred in a patient with meningeal carcinomatosis. Report of a Case A 65-year-old man was in good health until about three months before admission, when dizziness, tinnitis, and a tendency to fall developed. A few days before admission, he noted mild left-sided weakness, with subsequent episodes of confusion and urinary incontinence. He was a chronic alcoholic but gave no history of syphilis. On examination he was unkempt, dehydrated, and undernourished. His blood pressure was 120/70 mm Hg, his pulse rate was regular at 80 beats per minute, and his temperature was 36.4 °C. He was alert and oriented to place, time, and person, but