Meningitis, cerebrospinal fluid protein

Brettschneider, J., el al. (2004). Meningeal derived cerebrospinal fluid proteins in different forms of dementia is a meningopathy involved in normal pressure hydrocephalus J. Neurot Neurosurg. Psychiatry 75, 1614-16. 

Glucocorticoids given intrathecally can cause a rise in cerebrospinal fluid protein and carry the risk of arachnoiditis (SED-8, 820). Chemical meningitis has been reported after two intrathecal injections of methylpredni-solone acetate (450) and after lumbar facet joint block (SEDA-17, 450). Intraspinal injections of hydrocortisone for multiple sclerosis apparently led in one case to a cauda equina syndrome, with subsequent ulceromutilating acro-pathy (SEDA-17, 450). Intra-discal injections of triamcinolone acetonide in a number of French cases led to disk or epidural calcification, sometimes symptomless (SEDA-17, 450). 

Kastenbauer S, Angele B, Sporer B, Pfister HW, Koedel U (2005) Patterns of protein expression in infectious meningitis A cerebrospinal fluid protein ai ray analysis. J Neuroimmunol 164(1-2) 134-139. 

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. 

Distribution - The therapeutic range for total serum chloramphenicol concentration is Peak, 10 to 20 mcg/mL trough, 5 to 10 mcg/mL. The drug is 60% bound to plasma proteins. Chloramphenicol enters the cerebrospinal fluid (CSF), even in the absence of meningeal inflammation. 

Isoniazid does not bind to serum proteins it diffuses readily into all body fluids and cells, including the caseous tuberculous lesions. The drug is detectable in significant quantities in pleural and ascitic fluids, as well as in saliva and skin. The concentrations in the central nervous system (CNS) and cerebrospinal fluid are generally about 20% of plasma levels but may reach close to 100% in the presence of meningeal inflammation. 

It then undergoes enterohepatic recirculation, with the bulk excreted as a deacylated metabolite in feces and a small amount in the urine. Dosage adjustment for renal insufficiency is not necessary. Usual doses result in serum levels of 5-7 g/mL. Rifampin is distributed widely in body fluids and tissues. Rifampin is relatively highly protein-bound, but adequate cerebrospinal fluid concentrations are achieved only in the presence of meningeal inflammation. 

Cerebrospinal fluid is often abnormal in cerebral venous thrombosis the pressure is usually raised and there may be elevated protein and pleocytosis, especially in patients with focal signs. Lumbar puncture may be indicated in patients with isolated intracranial hypertension in order to lower cerebrospinal fluid pressure when vision is threatened and to exclude meningeal infection. 

A 53-year-old man with severe rheumatoid arthritis and mixed type III cryoglobulinemia received his first four injections of infliximab uneventfully, but 4 hours after the fifth injection had severe muscle pain in the lower limbs, which required morphine and abated within 3 days. Similar symptoms were observed after the sixth injection. There were no signs of meningitis, the cerebrospinal fluid contained lymphocytes and increased concentrations of protein and IgG. Cultures were negative and MRI scans of the brain and the spine were normal. The CSF was normal 1 month later. 

Lumbar puncture (LP) is used to obtain cerebrospinal fluid (CSF). It is used most often as an evaluation of CNS infections such as meningitis and encephalitis, but it is also useful in subarachnoid hemorrhage, multiple sclerosis, and dementia. Opening pressure, cell count and differential, glucose concentration, total protein... 

Nafcillin is absorbed erratically from the GI tract and distributes poorly into cerebrospinal fluid, but this passage is enhanced by meningeal inflammation. Nafcillin, which is bound to plasma protein to the extent of 90%, crosses the placenta and is found in breast milk. 

Lahrtz, F., Piali, L., Nadal, D., Pfister, H. W., Spanaus, K. S., Baggiolini, M., and Fontana, A. (1997). Chemotaetic activity on mononuclear cells in the cerebrospinal fluid of patients with viral meningitis is mediated by interferon-gamma inducible protein-10 and monocyte chemotaetic protein-1. Eur. J. Immunol. 27, 2484-2489. 

A case of severe neurologic disease with symptoms of facial diplegia, tetraplegia and areflexia was observed a few days after the fourth monthly infusion of ipilimumab. Cerebrospinal fluid showed elevated protein and lymphocytic meningitis. Symptoms did not improve after steroids but slow recovery occurred following venoglobulins [163 ]. 

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