Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry / Liquido cefalorraquidiano: compilação dos dados e interpretação avançada de doenças bacterianas, virais, parasitarias, oncológicas, inflamatórias cronicas e desmielinizantes. Padrões diagnósticos que não devem faltar em neurologia e psiquiatria

ABSTRACT The analysis of intrathecal IgG, IgA and IgM synthesis in cerebrospinal fluid (CSF) and evaluation in combined quotient diagrams provides disease-related patterns. The compilation with complementary parameters (barrier function, i.e., CSF flow rate, cytology, lactate, antibodies) in a cumulative CSF data report allows a knowledge-based interpretation and provides analytical and medical plausibility for the quality assessment in CSF laboratories. The diagnostic relevance is described for neurological and psychiatric diseases, for which CSF analysis can’t be replaced by other diagnostic methods without loss of information. Dominance of intrathecal IgM, IgA or three class immune responses give a systematic approach for Facial nerve palsy, Neurotrypanosomiasis, Opportunistic diseases, lymphoma, Neurotuberculosis, Adrenoleucodystrophy or tumor metastases. Particular applications consider the diagnostic power of the polyspecific antibody response (MRZ-antibodies) in multiple sclerosis, a CSF-related systematic view on differential diagnostic of psychiatric diseases and the dynamics of brain- derived compared to blood-derived molecules in CSF for localization of paracytes.

RESUMO A análise da síntese intratecal de IgG, IgA e IgM no liquido cefalorraquidiano (LCR) e a avaliação destas em diagramas com quocientes sugere padrões de diversas doenças. Estes dados, juntamente com outros parâmetros como a função de barreira, o fluxo liquórico, a citologia, o lactato e a pesquisa de anticorpos, integrados em uma ficha de paciente, permite uma interpretação baseada em conhecimento e permite também uma aferição da qualidade em laboratórios de LCR. A relevância diagnóstica é descrita para doenças neurológicas e psiquiátricas pois a análise do LCR não pode ser substituída por outros metódos diagnósticos sem perda de informação para o diagnóstico do paciente. O aumento da síntese intratecal de IgM, IgA ou das 3 classes de imunoglobulinas sugerem um diagnóstico sistemático de paralisia facial periférica, neurotripanosomiase, doenças oportunísticas, linfoma, neurotuberculose, adrenoleucodistrofia ou metástases de tumores cerebrais. A resposta poliespecífica de anticorpos contra sarampo, rubéola e varicela zoster (MRZ reação) é sugestiva de esclerose múltipla. Uma visão sistemática considera o diagnóstico diferencial de doenças psiquiátricas e doenças chrônicas. A dinâmica de moléculas derivadas do cérebro comparadas com aqueles derivadas do sangue é importante para a localização de parasitos em doenças parasitárias do sistema nervoso.

Membrane Na+ K+ ATPase inhibition related dyslipidemia and insulin resistance in neuropsychiatric disorders.

There are several reports in literature implicating cholesterol metabolism in the pathogenesis of neuronal degenerations, oncogenesis, functional neuropsychiatric disorders and multiple sclerosis. Biosynthesis of cholesterol takes place by the isoprenoid pathway, which also produces digoxin, an inhibitor of membrane Na(+)-K+ ATPase. Inhibition of this enzyme results in intracellular Mg++ deficiency which can influence cholesterol metabolism. Digoxin also influences transport of tryptophan and tyrosine which are precursors of various neurotransmitters. Alterations in digoxin, membrane Na(+)-K+ ATPase and also in neurotransmitters have been reported in the disorders mentioned above. In view of this, serum lipid profile, activity of plasma HMG CoA reductase (the major rate limiting step in the isoprenoid pathway), RBC membrane Na(+)-K+ ATPase activity, serum Mg++ concentration, concentration of digoxin and concentration of serum neurotransmitters were studied in some neuropsychiatric disorders. The serum serotonin level was increased while that of serum dopamine and noradrenaline was reduced. Serum digoxin levels were high and RBC membrane sodium-potasium ATPase activity and serum magnesium were reduced. There was a reduction in HDL cholesterol and increase in plasma triglycerides (pattern similar to insulin resistance and syndrome X) in most of the disorders studied. The HMG CoA reductase activity was high, the serum total cholesterol was increased while RBC membrane cholesterol was reduced in most of the cases. The significance of increased digoxin with consequent inhibition of membrane Na(+)-K+ ATPase in relation to changes in cholesterol metabolism and insulin resistance type of dyslipidemia is discussed in this paper.

Endogenous strychnine, nicotine, and morphine--description of hypo and hyper-strychninergic, nicotinergic and morphinergic state in relation to neuropsychiatric diseases.

Previous work from this laboratory had demonstrated the presence of endogenous morphine, strychnine and nicotine in the mammalian brain and human serum samples. Morphine is synthesised from tyrosine and strychnine and nicotine from tryptophan. This study examines the role of strychnine, nicotine and morphine in neuropsychiatric disorders. The blood levels of tyrosine, tryptophan, strychnine, nicotine and morphine were studied as also RBC membrane Na(+)-K+ ATPase activity. It was found that serum tyrosine levels were reduced and tryptophan levels elevated in all neuropsychiatric disorders studied with a reduction in RBC Na(+)-K+ ATPase activity. Nicotine was present in significant amounts in serum of patients with schizophrenia, CNS glioma and syndrome X with multiple lacunar state. Morphine was present in significant amounts only in the serum of patients with multiple sclerosis and MDP. Strychnine was present in significant amounts in the serum of patients with epilepsy, Parkinson's disease and MDP. The presence of nicotine and strychnine in significant amounts could be related to elevated tryptophan levels suggesting the synthesis of these alkaloids from tryptophan. Morphine was not detected in most of the disorders owing to low tyrosine levels noted in them. Na(+)-K+ ATPase inhibition noticed in most of the disorders could be related to decreased hyperpolarising morphinergic transmission and increased depolarising nicotinergic and strychinergic transmission. The role of morphine, strychnine and nicotine in the pathogenesis of these disorders in the setting of membrane Na(+)-K+ ATPase inhibition is discussed.

Serum cholesterol concentrations in parasuicide.

OBJECTIVE: To evaluate whether people who have committed parasuicide have low serum cholesterol concentrations. METHOD: All subjects admitted to the University Medical Unit, Ragama after parasuicide from 1.3.96 to 31.1.97 were matched for age, sex, presence of diabetes and arterial hypertension, substance abuse, body mass index and socioeconomic status with controls. Venous blood samples for cholesterol estimation were collected from parasuicides within 24 hours of admission. RESULTS: Analysis was done on 168 parasuicide patients [males 74; mean age for males 24 years (SD 6.2), females 19 years (SD 3.3)] and 168 matched controls. Of the parasuicide subjects, 33 had a psychiatric illness and 135 were considered to have impulsive personalities. The serum cholesterol level in parasuicide patients was not significantly different from that in controls. CONCLUSIONS: This study, the first from a developing country, did not show an association between low serum cholesterol concentrations and parasuicide.

Immunoglobulin profile in acute psychiatric disorders.

In a prospective study of 80 new female patients with acute psychiatric disorders (40 each with schizophrenia and major affective disorder), elevated (P less than 0.001) serum concentrations of IgG and IgA were found in comparison to healthy control groups matched for age and sex. In schizophrenic patients the mean levels of IgG (1682.76 mg/dl) and IgA (321.12 mg/dl) were found to be significantly more as compared to those in the control group (IgG-1213.18 mg/dl and IgA - 210.14 mg/dl). Patients with paranoid schizophrenia had significantly high mean serum levels of IgG (1896.86 mg/dl) and IgA (376.16 mg/dl) in comparison to other subtypes of schizophrenia (i.e., catatonic, disorganized and undifferentiated). Mean serum concentrations of IgG and IgA in major affective disorder - mania (IgG 1526.36 mg/dl and IgA 382.16 mg/dl) and major depressive episode (IgG 2008.12 mg/dl and IgA 536.72 mg/dl) were found to be significantly higher as compared to those in the control group (IgG-920.21 mg/dl and IgA - 232.12 mg/dl).