Cerebrospinal fluid diagnosis

Many enzyme activities have been proposed for diagnosis, in serum, urine, cerebrospinal fluid and other body fluids, and the proposed methods have been reviewed elsewhere (17). Here we will confine ourselves to the tried and most commonly used enzyme activities which yield useful information in ambulatory or hospital patients. 

The McDonald criteria allow the clinician to use the clinical exam in combination with magnetic resonance imaging (MRI) and cerebrospinal fluid data to make a diagnosis sooner, and thus begin treatment earlier. 

MS diagnostic criteria were revised in 2001 and are known as the McDonald criteria (Fig. 26-2).18-20 MS diagnosis requires that plaques be disseminated in time and space. Previously, diagnosis relied heavily on clinical examination. The McDonald criteria allow the clinician to use the clinical exam in combination with magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) data to make a diagnosis sooner, and thus begin treatment earlier (Table 26-1). 

Other diagnostic tests to consider for differential diagnosis erythrocyte sedimentation rate, urinalysis, toxicology, chest x-ray, heavy metal screen, HIV testing, cerebrospinal fluid (CSF) examination, electroencephalography, and neuropsychological tests such as the Folstein Mini Mental Status Exam. 

Flood,J., et al. (1997). Diagnosis of cytomegalovirus (CMV) polyradiculopathy and documentation of in vivo anti-CMV activity in cerebrospinal fluid by using branched DNA signal amplification and antigen assays. J. Infect. Dis. 176,348-352. 

Mase, M., et al. (2003). Lipocalin-type prostaglandin D synthase (beta-trace) in cerebrospinal fluid a useful marker for the diagnosis of normal pressure hydrocephalus. Neurosci. Res. 47, 455-9. 

Medical indications Chronic pulmonary disease (excluding asthma) chronic cardiovascular diseases, diabetes mellitus chronic liver diseases, including liver disease as a result of alcohol abuse (e.g., cirrhosis) chronic alcoholism, chronic renal failure or nephrotic syndrome functional or anatomic asplenia (e.g, sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]) immunosuppressive conditions and cochlear implants and cerebrospinal fluid leaks. Vaccinate as close to HIV diagnosis as possible. 

Clinical Diagnosis A presumptive diagnosis can be made from by Gram or Wayson stain of lymph node aspirates, sputum, or cerebrospinal fluid. Plague can also be cultured. As for treatment, early administration of antibiotics is very effective. Supportive therapy for pneumonic and septicemic forms is required. 

The measurement of enzyme activities in tissues other than blood can also be carried out, for example, in extracts of tissue obtained by biopsy, from red or white blood cells or from cerebrospinal fluid. Such measurements are valuable in diagnosis of genetic diseases in... 

Concentration of total protein in cerebrospinal fluid is an essential biochemical parameter. It is impossible to agree with the opinion of some clinicians (many of whom are fascinated by the latest examination methods) that this is an unnecessary parameter. It is tme that the concentration of total protein in cerebrospinal fluid varies with respect to the reference range. It is known that the concentration of total protein in cerebrospinal fluid exceeding 1 g represents a principal challenge to the diagnosis of some CNS diseases (e.g., multiple sclerosis). This is fully in accordance with the results of a study (A24) in which the highest detectable level of total protein was 0.92 g... 

Borreliosis is a disease that frequently and typically affects both the central and peripheral nervous systems (Table 13 for a historical overview, see Table 14). Owing to the frequent occurrence in our area, it is possible to observe highly variable clinical manifestations as well as different types of pathological appearances in cerebrospinal fluid. Current methods used in neuroborreliosis diagnosis include the evaluation of specific antibodies IgM, IgG detected by ELISA, Western blot, and PCR. 

We investigated 53 samples of cerebrospinal fluid (CSF) in patients with neuroborreliosis. The clinical diagnosis of neuroborreliosis was confirmed by positive antibody titers and intrathecal synthesis of immunoglobulins in CSF examined in the IgM and IgG classes by the EFISA method or Western blot or confirmed by direct detection by PCR. 

K9. Kleine, T. O., Damm, T, and Althaus, H., Quantification of /i-trace protein and detection of transferrin isoforms in mixtures of cerebrospinal fluid and blood serum as models of rhinorrhea and otorrhea diagnosis. Fresenius J. Anal. Cherrc 366,382-386 (2000). 

L2. Leib, S. L., Boscacci, R., Gratzl, O., and Zimmerli, W., Predictive value of cerebrospinal fluid (CSF) lactate level versus CSF/blood glucose ratio for the diagnosis of bacterial meningitis following neurosurgery. Clini. Infect. Dis. 29, 69-74 (1999). 

Itoh N, Arai H, Urakami K, et al. Large-scale, multicenter study of cerebrospinal fluid tau protein phosphorylated at serine 199 for the antemortem diagnosis of Alzheimer s disease. Ann Neurol 2001 50(2) 150—156. 

Hampel H, Buerger K, Zinkowski R, et al. Measurement of phosphorylated tau epitopes in the differential diagnosis of Alzheimer disease A comparative cerebrospinal fluid study. Arch Gen Psychiatry 2004 61(1) 95 102. 

Maddalena A, Papassotiropoulos A, Muller-Tillmanns B, Jung HH, Hegi T, Nitsch RM, Hock C. Biochemical diagnosis of Alzheimer disease by measuring the cerebrospinal fluid ratio of phosphorylated tau protein to beta-amyloid peptide42. Arch Neurol 2003 60(9) 1202-1206. 

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