Cerebrospinal fluid , examination

Cerebrospinal fluid examination and electroencephalography are not required routinely in the investigation of dementia. Lumbar puncture is indicated in suspected Creutzfeldt-Jakob disease or other forms of rapidly progressive dementia. Electroencephalography should be considered if delirium, frontotemporal dementia or Creutzfeldt-Jakob disease are possibilities. Electroencephalography may also be required in the assessment of associated seizure disorder in those with dementia. 

Apolipoprotein E4 Caloric study Cerebral angiography Cerebrospinal fluid examination Computed tomography of brain C-reactive protein Digital subtraction angiography Electroencephalography... 

Lumbar puncture and cerebrospinal fluid examination Paracentesis Pericardiocentesis Secretin-pancreozymin Semen analysis Sims-Huhner test Sweat electrolytes test Tau protein... 

She was treated with oxamniquine and transported to the USA, where evaluation showed flaccid paralysis and decreased sensation of touch and of temperature over the skin of the legs. Cerebrospinal fluid examination showed pleocytosis and protein elevation. Serologic tests for mycoplasma and viral pathogens were negative. A myelogram. showed no masses amenable to surgical removal. 

The causative oiganophosphate was identified in nine patients four fenthion, two dimethoate. two monocrotophos, and one mclhamidophos. Standard biochemistry and cerebrospinal fluid examination were normal. Cholinesterase (ChE) assays were not available. Electromyography (EMG) showed normal motor and sensory nerve conduction velocities and normal needle myography. Tetanic stimulafion of the abductor pollicis brevis muscle 24-48 hr after the onset of IMS showed a marked fade at 20 and 50 Hz. A train of four stimuli applied at 2 Hz produced no changes in the amplitude of the compound muscle action potential (CMAP). CMAPs are the motor responses recorded with surface electrodes over a muscle after stimulation of its motor nerve. 

A 34-year-old woman developed a severe headache and a high fever soon after cesarean section under spinal anesthesia with bupivacaine. Cerebrospinal fluid examination showed an increase in cell count but no organisms were found. 

Filtering cells and cell fractions from fluid media. These particles, after concentration by filtration, may be examined through subsequent quantitative or qualitative analysis. The filtration techniques also have applications in fields related to immunology and implantation of tissues as well as in cytological evaluation of cerebrospinal, fluid. 

This chapter will review some recently completed studies on the long-term effects of MDMA in nonhuman primates. The goals of these studies were to (1) determine if the neurotoxic effects of MDMA, which have been well documented in the rodent (see below), generalize to the primate (2) compare the relative sensitivity of primates and rodents to the neurotoxic effects of MDMA (3) ascertain if the toxic effects of MDMA in the monkey are restricted to nerve fibers (as they are in the rat), or if they involve cell bodies as well (4) evaluate how closely toxic doses of MDMA in the monkey approximate those used by humans and (5) examine whether 5-hydroxyindoleacetic acid (5-HIAA) in the cerebrospinal fluid (CSF) can be used to detect MDMA-induced serotonergic damage in the CNS of primates. Before presenting the results of these studies, previous results in the... 

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. 

Ideally, lumbar puncture to obtain cerebrospinal fluid (CSF) for direct examination and laboratory analysis, as well as blood cultures and other relevant cultures, should be obtained before initiation of antimicrobial therapy. However, initiation of antimicrobial therapy should not be delayed if a pretreatment lumbar puncture cannot be performed. 

T. pallidum rapidly penetrates intact mucous membranes or microscopic dermal abrasions, and within a few hours, enters the lymphatics and blood to produce systemic illness. During the secondary stage, examinations commonly demonstrate abnormal findings in the cerebrospinal fluid (CSF). As the infection progresses, the parenchyma of the brain and spinal cord may subsequently be damaged. 

Fluids such as tissue aspirates, cyst fluid, bronchial washings, cerebrospinal fluid, pleural fluid, and peritoneal fluid can be examined directly, or they can be centrifuged and the sediment examined by wet mounts or stains (or both), depending on the parasite suspected, as described above for abscesses or tissue. 

Examination of cerebrospinal fluid (CSF) in patients with cryptococcal meningitis generally reveals an elevated opening pressure, CSF pleocytosis (usually lymphocytes), leukocytosis, a decreased CSF glucose, an elevated CSF protein, and a positive cryptococcal antigen. 

The calculated intrathecal synthesis of IgG based on Reiber s formula is more precise in its latest version (see the recommended literature) and is recommended for the examination of cerebrospinal fluid in many countries. Physiological values for this formula are negative or equal to zero (software used for this purpose is able to recognize this). Negative values are considered to be equal to zero. Positive values indicate evidence of intrathecal synthesis of immunoglobulins (F3, R7). 

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... 

Although the examination of total protein in cerebrospinal fluid is quite valuable, it is necessary to mention that this parameter does not provide exact information on the function of the blood-CSF barrier. This is easy to understand. The increased concentration of total protein in cerebrospinal fluid can be based both on the failure of the barrier with a subsequent increase in the concentration of albumin and of other proteins originating from serum and on a more significant intrathecal synthesis of immunoglobulins, especially in levels of IgG. 

In patients with multiple sclerosis, a qualitative cytological examination should always be carried out. Besides the finding of plasmocytic forms, which are considered to be one of the proofs of intrathecal synthesis of immunoglobulins, this examination also provides invaluable information concerning the reaction of the monocyte-macrophage system in the CSF compartment. It should be noted on the scope of biochemical examinations of cerebrospinal fluid in multiple sclerosis that it is most important to return to the simple and inexpensive method. 

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. 

Patient 1. This 24-year-old male university student was brought to the emergency department at 1600 h by his roommate. He was delirious and had a depressed level of consciousness. Although he had been well the previous day, that morning he had complained of a fever, severe headache, severe neck and back stiffness, nausea, and vomiting. He had become progressively unwell over 7-8 hours. On physical examination he was acutely ill with a temperature of 40°C. He was delirious and had neck rigidity with severe resistance to any attempt to passively flex his neck. A CT scan of his brain was normal. A spinal tap was performed and cerebrospinal fluid (CSF) was removed it was cloudy. 

Burger B, Zimmermann M, Mann G et al. Diagnostic cerebrospinal fluid (CSF) examination in children with acute lymphoblastic leukemia (ALL) significance of low leukocyte counts with blasts or traumatic lumbar puncture. J Clin Oncol 2003 21 184-188. 

Examination of stained specimens by microscopy or simple examination of an uncentrifuged sample of urine for white blood cells and bacteria may provide important etiologic clues in a very short time. Cultures of selected anatomic sites (blood, sputum, urine, cerebrospinal fluid, and stool) and nonculture methods (antigen testing, polymerase chain reaction, and serology) may also confirm specific etiologic agents. 

---