Use of cerebrospinal fluid CXCL13 concentration for diagnosis and monitoring of neurosyphilis: a three-case report

Introduction: Previous retrospective studies have demonstrated that the concentration of chemokine ligand CXCL13 in cerebrospinal fluid (CSF-CXCL13) is a promising biomarker in the diagnosis of neurosyphilis and, additionally, in the monitoring of therapeutic efficacy. Objective: To describe three cases of patients with neurosyphilis (NS) treated at Hospital Universitário Gaffrée e Guinle, in Rio de Janeiro, Brazil, with suspected active syphilis with neurological symptoms. Case report: Three patients from Rio de Janeiro, Brazil, were investigated for symptomatic NS. The concentration of CSF-CXCL13 was prospectively performed by enzyme-linked immunosorbent assay (ELISA) in all participants at baseline and in follow-up visits at 3 months after therapy. CSF-CXCL13 concentrations were significantly higher in all three patients with established NS. The CSF-CXCL13 concentrations decreased after 3 months of therapy compared to baseline in all cases reported. The added high concentration of CSF-CXCL13 plus CSF-TPHA reactivity above 1:40 titer agreed with the diagnosis of NS in 100% of the cases. Conclusion: In this case series, we present three cases of NS diagnosed using CXCL13 in CSF as a complementary test. These case series suggest that the clinical use of CSF-CXCL13 is useful as a supplementary biomarker for NS and for monitoring the effectiveness of NS therapy, especially in patients with nonreactive CSF-VDRL, excluding other neurologic diseases

Valores del análisis citoquímico de líquido cefalorraquídeo en pacientes con derivación ventrículo-peritoneal / Values of cerebrospinal fluid cytochemistry in pediatric patients with ventriculoperitoneal shunt

Resumen Introducción: La derivación ventrículo-peritoneal (DVP) es el tratamiento para la hidrocefalia. El líquido cefalorraquídeo (LCR) se evalúa para el manejo de sus complicaciones; sin embargo, la información de los valores del citoquímico en esta población es insuficiente. Objetivo: Describir las características del citoquímico del LCR de niños en manejo con DVP. Materiales y Métodos: Estudio de tipo observacional descriptivo, desarrollado en Bogotá (Colombia), entre el año 2008 y 2016. Se revisaron los registros de procedimientos de DVP y relacionados. Se incluyeron pacientes entre 6 meses y 18 años de edad. Resultados: Se revisaron 285 registros e ingresaron 31 muestras. Los valores de LCR fueron, respectivamente, para la mediana y al percentil 90%: leucocitos totales: 0 y 7 céls/mm3, neutrófilos: 0 y 6,8 céls/mm3, linfocitos: 0 y 2 céls/mm3, proteínas: 13,4 y 67,2 mg/dL, glucosa: 59 y 27,4 mg/dL. Discusión: Los valores de glucosa presentan un rango normal hacia el extremo inferior más amplio, con valores de proteínas mayores a los valores esperados. El rango de celularidad es la variable que presenta menor variación. Conclusiones: Los valores del citoquímico de LCR en paciente con DVP no son equiparables a los de la población sana y deben interpretarse según las características propias de esta población.

Background: The ventriculo-peritoneal shunt (VPS) is the treatment for hydrocephalus, the cerebrospinal fluid (CSF) is evaluated for the management of its complications; however, information on the values of the cytochemistry in this population is insufficient. Aim: To describe the characteristics of the CSF cytochemistry of children in VPS management. Methods: Descriptive observational study, developed in Bogotá (Colombia), from 2008 to 2016. VPS and related procedures records were reviewed. Patients between 6 months and 18 years were included. Results: A total of 285 records were reviewed, 31 samples were entered. The CSF values were, respectively, for the median and 90% percentile: total leukocytes: 0 and 7 cells/mm3, neutrophils: 0 and 6.8 cells/mm3, lymphocytes: 0 and 2 cells/mm3, proteins: 13.4 and 67.2 mg/dL, glucose: 59 and 27.4 mg/dL. Discussion: Glucose values evinced a normal rank towards the widest inferior limit with protein values exceeding the values expected. Cellularity is the variable with the lowest variation. Conclusions: The values of the CSF cytochemistry in patients with VPS are not comparable to those of the healthy population and should be interpreted according to the characteristics of this population.

Acute phase proteins in serum and cerebrospinal fluid in healthy cattle: possible use for assessment of neurological diseases / Proteínas de fase aguda no soro e no líquido cefalorraquidiano de bovinos hígidos: possíveis usos na avaliação de doenças neurológicas

Use of acute-phase proteins (APPs) for assessment of health and disease in animals has increased greatly within the last decade. The objective was to determine the normal concentration of APPs in the serum and cerebrospinal fluid (CSF) of healthy cattle by polyacrylamide gel electrophoresis. Fifty crossbred animals (350±70kg of BW and 18±1.2 months of age), 25 heifers and 25 steers were used. CSF samples were collected from atlanto-occipital (AO) site and blood samples were obtained from the jugular vein. CSF and serum protein electrophoresis were performed by means of sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Thirty-seven proteins with molecular weights ranging from 7 and 37kDa were identified in CSF of all animals. These eight were nominally identified with immunoglobulin A and G, celuloplasmin, transferrin, albumin, α1-antitripsin, acidic glycoprotein, and haptoglobin. All protein fractions in CSF did not differ between heifers and steers. In sera, 34 proteins with molecular weights between 7 and 244kDa were identified in heifers and steers. Similar proteins were nominally identified in the sera, but only the CSF presented α1-antitripsin. The serum values of acidic glycoprotein and immunoglobulin G were significantly higher in steers compared with heifers. In conclusion, measurement of CSF acute phase protein concentrations can be useful in diagnosing and monitoring the progression of bovine neurological diseases, perhaps even to guide therapeutic procedures. The CSF electrophoretic profile of healthy cattle does not change depending on gender.(AU)

O uso de proteínas de fase aguda (PFAs) para a avaliação da saúde e da doença em animais de produção tem aumentado consideravelmente na última década. O objetivo deste estudo foi determinar a concentração normal de PAFs no soro e no líquido cefalorraquidiano (LCR) de bovinos sadios por meio da eletroforese em gel de poliacrilamida. Foram avaliados cinquenta animais mestiços (350±70kg de PV e 18±1,2 meses de idade), 25 novilhas e 25 novilhos. As amostras de LCR foram colhidas no espaço atlanto-occipital (AO) e as amostras de sangue obtidas da veia jugular. As PAFs do soro e do LCR foram determinadas através da eletroforese em gel poliacrilamida. Trinta e sete proteínas com pesos moleculares que variaram entre 7 e 37kDa foram identificadas no LCR de todos os animais, independente do sexo. Estas oito proteínas foram nominalmente identificadas como imunoglobulina A e G, ceruloplasmina, transferrina, albumina, α1-antitripsina, glicoproteína ácida, e haptoglobina. As frações de proteínas presentes no LCR não diferiram entre novilhas e novilhos. No soro de machos e fêmeas, 34 proteínas com pesos moleculares entre 7 e 244 kDa foram identificadas. As proteínas do soro foram similarmente identificadas, entretanto a α1-antitripsina foi identificada somente no LCR. Os valores séricos de glicoproteína ácida e imunoglobulina G foram significativamente mais elevados nas novilhas em comparação aos novilhos. Em conclusão, a determinação das concentrações de proteínas de fase aguda presentes do LCR pode ser útil no diagnóstico e monitoramento da progressão de doenças neurológicas bovinas, talvez possa ainda direcionar procedimentos terapêuticos. O perfil eletroforético do LCR de bovinos hígidos não se altera em função do sexo.(AU)

Parâmetros citológicos e bioquímicos do líquido cefalorraquidiano coletado de bovinos sadios em dois momentos, com intervalo de 96 horas / Cerebrospinal fluid cytological and biochemical values of healthy cattle in two sampling times with an interval of 96 hours

A análise do líquido cefalorraquidiano (LCR) é uma importante ferramenta no diagnóstico das doenças neurológicas dos bovinos. A coleta do LCR em diferentes momentos facilita o monitoramento do quadro clínico e/ou a avaliação da eficácia de tratamentos estabelecidos. Todavia, os efeitos de coletas consecutivas sobre os parâmetros citológicos e bioquímicos do LCR de bovinos saudáveis ainda não foram analisados. Dessa forma, o objetivo do presente estudo foi avaliar potenciais diferenças citológicas e bioquímicas no LCR de bovinos sadios, obtidos em dois momentos, com intervalo de 96 horas. O LCR foi submetido à análise citológica e à determinação do teor de proteína total. Na segunda coleta, verificou-se aumento significativo da celularidade, porém ainda dentro do intervalo de referência para a espécie, diminuição de linfócitos e elevação de células mononucleares em relação à primeira coleta. No entanto, os números de hemácias (/µL), células nucleadas (/µL), neutrófilos (%), eosinófilos (%) e a concentração da proteína total (mg/dL) continuaram dentro dos valores de referência 96 horas após a realização da primeira punção. Conclui-se que os procedimentos de coleta de LCR consecutivos não provocaram inflamação local detectável 96 horas após a primeira punção, o que sugere que, quando necessário, coletas de LCR seriadas, por si só, não interfeririam nos resultados do exame.(AU)

The analysis of cerebrospinal fluid (CSF) is important for the diagnosis of neurological diseases in cattle. However, the effect of consecutive collections on the cytological and biochemical parameters of the CSF has not been evaluated yet. The objective of the present study was to evaluate potential differences on the cytological and biochemical analysis of CSF obtained from healthy cattle at two sampling times with 96 hours of interval in between. Total and differential cell counts, and total protein concentration were analyzed in the CSF. Increased cellularity and significant reduction of lymphocyte and elevated numbers of mononuclear cells were observed on the second collection. However, erythrocyte count (/µl), total leukocyte count (/µl), neutrophils (%), eosinophils (%) and total protein concentration (mg/dl) remained within the reference range 96 hours after the completion of the first puncture. In conclusion, consecutive CSF collections cause no detectable local inflammation 96 hours after the first puncture suggesting that repeated collections do not interfere in the CSF results.(AU)

Utilização de escore e dosagem de lactato no líquor para diagnóstico diferencial entre meningite bacteriana e meningite asséptica / Use of score and cerebrospinal fluid lactate dosage in differential diagnosis of bacterial and aseptic meningitis

RESUMO Objetivo: Avaliar o Escore para Meningite Bacteriana (EMB) isolado e associado ao valor do lactato no líquor para diferenciar meningite bacteriana (MB) e meningite asséptica (MA). Métodos: Foram selecionadas crianças com meningite atendidas em hospital terciário privado entre janeiro de 2011 e dezembro de 2014. Os dados foram obtidos na admissão. Utilizou-se o EMB com: coloração de Gram no líquor (2 pontos); neutrófilos no líquor ≥1.000 células/mm3 (1 ponto); proteína no líquor ≥80 mg/dL (1 ponto); neutrófilos no sangue periférico ≥10.000 células/mm3 (1 ponto); e convulsão durante/antes da chegada (1 ponto). Analisou-se também o lactato no líquor (elevado: ≥30 mg/dL). Avaliaram-se sensibilidade, especificidade e valor preditivo negativo de diversos valores de corte do EMB e do EMB associado ao lactato elevado para prever MB. Resultados: Dos 439 pacientes elegíveis, 94 não tinham todos os dados necessários para o escore, sendo 345 pacientes selecionados: 7 no grupo de MB e 338 no de MA. Como preditivos de MB, o EMB ≥1 mostrou sensibilidade de 100% (intervalo de confiança de 95% - IC95% 47,3-100), especificidade de 64,2% (58,8-100) e valor preditivo negativo de 100% (97,5-100), enquanto o EMB ≥2 ou EMB ≥1 associado a lactato liquórico ≥30 mg/dL mostrou sensibilidade de 100% (47,3-100), especificidade de 98,5% (96,6-99,5) e valor preditivo negativo de 100% (98,3-100). Conclusões: O EMB com 2 pontos associado à dosagem de lactato no líquor manteve a sensibilidade e o valor preditivo negativo, ao passo que aumentou a especificidade para identificar meningites bacterianas em relação à utilização do EMB com 1 ponto.

ABSTRACT Objective: To evaluate Bacterial Meningitis Score (BMS) on its own and in association with Cerebrospinal Fluid (CSF) lactate dosage in order to distinguish bacterial from aseptic meningitis. Methods: Children diagnosed with meningitis at a tertiary hospital between January/2011 and December/2014 were selected. All data were obtained upon admission. BMS was applied and included: CSF Gram staining (2 points); CSF neutrophil count ≥1,000 cells/mm3 (1 point); CSF protein ≥80 mg/dL (1 point); peripheral blood neutrophil count ≥10,000 cells/mm3 (1 point) and seizures upon/before arrival (1 point). Cutoff value for CSF lactate was ≥30 mg/dL. Sensitivity, specificity and negative predictive value of several BMS cutoffs and BMS associated with high CSF lactate were evaluated for prediction of bacterial meningitis. Results: Among 439 eligible patients, 94 did not have all data available to complete the score, and 345 patients were included: 7 in bacterial meningitis group and 338 in aseptic meningitis group. As predictive factors of bacterial meningitis, BMS ≥1 had 100% sensitivity (95%CI 47.3-100), 64.2% specificity (58.8-100) and 100% negative predictive value (97.5-100); BMS ≥2 or BMS ≥1 associated with high CSF lactate also showed 100% sensitivity (47.3-100); but 98.5% specificity (96.6-99.5) and 100% negative predictive value (98.3-100). Conclusions: 2 point BMS in association with CSF lactate dosage had the same sensitivity and negative predictive value, with increased specificity for diagnosis of bacterial meningitis when compared with 1-point BMS.

Polyspecific antibodies without persisting antigen in multiple sclerosis, neurolupus and Guillain-Barré syndrome: immune network connectivity in chronic diseases / Anticorpos poliespecíficos sem antígeno persistente em esclerose múltipla, neurolupus e síndrome de Guillain-Barré: conectividade imunológica em doenças crônicas

ABSTRACT The polyspecific antibody synthesis in multiple sclerosis (MS) gained diagnostic relevance with the frequent combination of measles-, rubella- and varicella zoster antibodies (MRZ-antibody reaction) but their pathophysiological role remains unknown. This review connects the data for intrathecal polyspecific antibody synthesis in MS and neurolupus with observations in the blood of patients with Guillain-Barré syndrome (GBS). Simultaneously increased antibody and autoantibody titers in GBS blood samples indicate that the polyspecific antibodies are based on a general property of an immune network, supported by the deterministic day-to-day concentration variation of antibodies in normal blood. Strongly correlated measles- and rubella- antibody variations point to a particular connectivity between the MRZ antibodies. The immune network, which provides serological memory in the absence of an antigen, implements the continuous change of the MRZ pattern in blood, not followed by the earlier immigrated B cells without corresponding connectivity in the brain. This may explain the different antibody patterns in cerebrospinal fluid, aqueous humor and blood of the individual MS patient. A complexity approach must implement a different view on causation in chronic diseases and causal therapies.

RESUMO A síntese de anticorpos poliespecíficos em esclerose múltipla (EM) ganhou relevância diagnóstica com a combinação frequente de anticorpos contra sarampo, rubéola e varicela-zoster (reação de anticorpos MRZ), mas seu papel fisiopatológico permanece desconhecido. Esta revisão relaciona os dados da síntese intratecal de anticorpos poliespecíficos em EM e Neurolupus com observações no sangue de pacientes com síndrome de Guillain Barré (SGB). Simultaneamente, os títulos aumentados de anticorpos e autoanticorpos em amostras de sangue de SGB indicam que os anticorpos poliespecíficos se baseiam numa propriedade geral de uma rede imunitária, suportada pela variação determinística da concentração diária de anticorpos no sangue normal. As variações fortemente correlacionadas de anticorpos contra sarampo e rubéola apontam para uma conectividade particular entre os anticorpos MRZ. A rede imunitária, que fornece memória sorológica na ausência de um antígeno, implementa a mudança contínua do padrão MRZ no sangue, não seguida pelas células B que imigraram anteriormente sem conectividade no cérebro. Isto pode explicar os diferentes padrões de anticorpos no LCR, humor aquoso e sangue do paciente individual de EM. Uma abordagem complexa deve implementar uma visão diferente sobre a causalidade em doenças crônicas e terapias causais.

Meningitis in Yemen

The Ministry of Health in Yemen, in collaboration with WHO, are closely monitoring the epidemiological pattern of the ongoing reported cases of menin-gitis in Yemen. Since the beginning of the year up to 8 July 2017 [Epidemiological week 27], a total of 2,146 suspected cases have been reported through the electronic early warning surveillance system [eDEWS] in the country

Chemical and cytological analysis of cerebral spinal fluid after intrathecal injection of hypodense fluorescein / Análise química e citológica do líquor após injeção intratecal de solução hipodensa de fluoresceína

ABSTRACT INTRODUCTION: Intrathecal fluorescein has been effective for topographic diagnosis of rhinoliquorrhea. Nonetheless, there are no reports on the study of cerebral spinal fluid (CSF) after use of intrathecal fluorescein. OBJECTIVE: A prospective study attempting to evaluate CSF through chemical and cytological analysis, after injection of fluorescein. METHODS: Prospective analysis of 24 samples of CSF after intrathecal injection of fluorescein for topographic diagnosis of CSF fistulae, collected at the time of puncture and after 24 and 48 h, divided by cellularity: Group 1, up to five cells, and Group 2, with more than five cells. RESULTS: The yellow-greenish color of CSF remained after 48 h in 36%, evidencing permanence of fluorescein. No changes in protein and glucose levels were observed between 0-24 h and 0-48 h. In group 2, an increase in cell count was observed between 24 h and 48 h (p = 0.019). In both groups, there was an increase of neutrophils between 0 and 48 h (p = 0.048) and a decrease between 24 and 48 h (p = 0.05). CONCLUSION: Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48 h and an increase of neutrophils at 24 h, with a subsequent decrease at 48 h with no correlation with symptomatology.

RESUMO Introdução: A fluoresceína intratecal tem sido efetiva no diagnóstico topográfico da rinoliquorréia. Entretanto, não há estudos no líquor após o uso de fluoresceína intratecal. Objetivo: Estudo prospectivo visando avaliar o líquor, através de análise química e citológica, após injeção de fluoresceína. Método: Análise prospectiva de 24 punções após injeção intratecal de fluoresceína para diagnóstico topográfico de fístula liquórica, coletado no momento da punção, 24 e 48 horas, divididos pela celularidade: grupo 1, com até 5 células e grupo 2 com mais de 5 células. Resultado: A coloração amarelo-esverdeada do líquor permaneceu após 48 horas em 36%, evidenciando permanência de fluoresceína. Observou-se ausência de mudanças no nível de proteína e glicose entre 0-24 horas e 0-48 horas. No grupo 2, um aumento na contagem celular foi observado entre 24 e 48 horas (p = 0,019). No dois grupos juntos, observou-se um aumento de neutrófilos entre 0 e 48 horas (p = 0,048) e uma diminuição entre 24 e 28 horas (p = 0,05). Conclusão: Fluoresceína intratecal provocou discretas reações meníngeas, como o aumento de células entre 24 e 48 horas e aumento dos dos neutrófilos em 24 horas com uma subsequente dimi nuição em 48 horas sem correlação com sintomas.

Role of cerebrospinal fluid il-8 as a marker for differentiation between acute bacterial and aseptic meningitis

No doubt, the distinguishing between bacterial and aseptic meningitis in the emergency department could help to limit unnecessary antibiotic use and hospital admissions. This study evaluated the role of cerebrospinal fluid IL-8 in differentiating acute bacterial meningitis [ABM] from aseptic meningitis [AM]. A total of 80 hospitalized patients with clinical presentations of suspected acute meningitis were subjected to estimation of IL-8 CSF concentrations. The results showed that CSF IL-8 levels were higher in acute bacterial meningitis than in aseptic ones [p <0.05]. The best cut-off value of CSF IL8 for early diagnosis of bacterial meningitis was 3.6ng/ml with a sensitivity of 82.5% and a specificity of 85.0%

Increased levels of glutamate in the central nervous system are associated with behavioral symptoms in experimental malaria

Cerebral malaria (CM) is a severe complication resulting from Plasmodium falciparum infection. This condition has been associated with cognitive, behavioral and motor dysfunctions, seizures and coma. The underlying mechanisms of CM are incompletely understood. Glutamate and other metabolites such as lactate have been implicated in its pathogenesis. In the present study, we investigated the involvement of glutamate in the behavioral symptoms of CM. Seventeen female C57BL/6 mice (20-25 g) aged 6-8 weeks were infected with P. berghei ANKA by the intraperitoneal route using a standardized inoculation of 10(6) parasitized red blood cells suspended in 0.2 mL PBS. Control animals (N = 17) received the same volume of PBS. Behavioral and neurological symptoms were analyzed by the SmithKline/Harwell/Imperial College/Royal Hospital/Phenotype Assessment (SHIRPA) battery. Glutamate release was measured in the cerebral cortex and cerebrospinal fluid of infected and control mice by fluorimetric assay. All functional categories of the SHIRPA battery were significantly altered in the infected mice at 6 days post-infection (dpi) (P ≤ 0.05). In parallel to CM symptoms, we found a significant increase in glutamate levels in the cerebral cortex (mean ± SEM; control: 11.62 ± 0.90 nmol/mg protein; infected at 3 dpi: 10.36 ± 1.17 nmol/mg protein; infected at 6 dpi: 26.65 ± 0.73 nmol/mg protein; with EGTA, control: 5.60 ± 1.92 nmol/mg protein; infected at 3 dpi: 6.24 ± 1.87 nmol/mg protein; infected at 6 dpi: 14.14 ± 0.84 nmol/mg protein) and in the cerebrospinal fluid (control: 128 ± 51.23 pmol/mg protein; infected: 301.4 ± 22.52 pmol/mg protein) of infected mice (P ≤ 0.05). These findings suggest a role of glutamate in the central nervous system dysfunction found in CM.

Predictors of bacterial meningitis in adult patients of South West Iran

To study the clinical and lab parameters in adult patients with suspected or confirmed bacterial meningitis [BM] to find out the usefull predictors. This was a retrospective study conducted in Razi hospital, a training center affiliated to Ahvaz Joundishapoor University of Medical Sciences in Iran. All patients with meningitis aged 18 years or more between 2003 and 2007, with CSF pleocytosis and who had not received antibiotic treatment before lumbar puncture were reviewed. Among 312 patients with CSF pleocytosis, two hundred fifteen [68.9%] had BM and ninety seven [31.1%] had aseptic meningitis [ASM]. The mean age for patients with BM was 34.7 +/- 17.7 years and for ASM was 32.2 +/- 15.5 years [P=0.22, NS]. Sixty percent of the cases of BM and 61.2% of the cases of ASM occurred in men [P=0.70, NS]. We identified the following predictors of BM: CSF-WBC count>100 per micro liter, CSF-glucose level<40 mg/dl, CSF-protein level>80 mg/dl. Sensitivity, specificity, PPV, NPV of these predictors, and LR for BM are 86.5%,52.6%,80.2%, 63.7% and 104.1 for CSF-WBC count and 72.1%, 83.5%, 90.6%,57.4% and 164.2% for CSF glucose, and 49.7%, 91.8%, 93.4%,45.2% and 104.5% for CSF protein. The CSF WBC count should not be used alone to rule out bacterial meningitis. When it is combined with other factors such as CSF glucose and protein it helps in decision making in patients suffering from bacterial meningitis

[Evaluation of epidemiological, clinical and laboratory findings of admitted patients with meningitis in infectious diseases ward of Razi hospital, Ahvaz]

Familiarity with the epidemiological, clinical and laboratory features of bacterial meningitis [BM] is important for rapid diagnosis and initiation of antibacterial therapy. This study aimed at evaluating these patients based on their epidemiological, clinical and laboratory findings and comparing these variables with patients with aseptic meningitis [ASM]. Admitted patients aged 18 years or more who were hospitalized because of meningitis, were studied between 2003 and 2007. Cases were grouped as BM and ASM and compared for their epidemiological, clinical and cerebrospinal fluid [CSF] laboratory aspects. Among 312 patients with meningitis, 215 [68.9%] had BM [42 definite, 156 probable and 17 partially treated] and 97 [31.1.%] had ASM. The mean age of patients with BM was 44.7 +/- 26.7 years and for ASM was 37.3 +/- 15.5 years [P>0.05]. Twelve percent of cases had triad of fever, neck stiffness and low level of consciousness. The means for CSF-WBC, CSF- glucose and CSF-protein in BM compared with ASM patients were 4021.6 +/- 1035.2 and 163.2 +/- 116.4 cell/microl of CSF; 27.5 +/- 17.3 and 68.7 +/- 16.lmg/dl and 689.8 +/- 476.8 and 132.6 +/- 107.7mg/dl, respectively [P<0.05]. The prevalence of BM was higher than that of ASM. Tuberculous meningitis had a considerable frequency among ASM patients. Confirmed BM based on CSF culture was lower than other studies. The number of performed LP procedures was not in accordance with the total meningitis cases. Similarly, WBC and glucose in CSF were helpful in differential diagnosis of BM vs. ASM

Childhood Guillain Barre syndrome

The Guillan-Barre syndrome [GBS] is characterized by the acute onset of rapidly progressive, symmetric muscle weakness with absent or decreased deep tendon reflexes. GBS is the most common cause of acute flaccid paralysis in childhood, with an incidence of 0.6-4 per 100000 Population per year. The clinical features are district and obtaining patient's history and conducting and examination generally lead to the diagnosis that can be confirmed by supportive laboratory tests and electrodiagnostic studies. The major considerations in differential diagnosis include transverse myelities, toxic neuropathy, tick paralysis, infantile butolism and myasthenia gravis. Although most, children with GBS have a relatively care monitoring. Immunomodulating treatment should be used for any child who loses the ability to walk

Exame do líquido cefalorraquidiano: influência da temperatura, tempo e preparo da amostra na estabilidade analítica / Cerebrospinal fluid exam: influence of sample preparation, temperature and time on analytical stability

O líquido cefalorraquidiano (LCR) é um fluido biológico que está em íntima relação com o sistema nervoso central (SNC). Por isso, o exame do LCR constitui um método de grande valia para o diagnóstico e o acompanhamento de diversas afecções neurológicas. Entretanto, existem poucos estudos sobre a estabilidade de seus analitos durante a etapa pré-analítica. OBJETIVO: Identificar dados existentes sobre a influência da temperatura e do tempo de estocagem, dos ciclos de congelamento/descongelamento e pré-tratamentos (centrifugação, desnaturação, adição de soro) na estabilidade dos analitos do LCR. MÉTODO: Foi realizada uma revisão sistemática de artigos da literatura, usando palavras-chave da língua inglesa como storage, cerebrospinal fluid, CSF, stability, temperature e period, com base nos serviços de dados de PubMed, Highwire Press, Lilacs e Amazonas Library, os quais permitem a pesquisa bibliográfica de citações e artigos científicos. RESULTADO: A busca encontrou nove artigos, resultado da escassez de trabalhos sobre o assunto. Os analitos do LCR estudados incluíram células (número e morfologia), proteínas totais, glicose, lactato, aminoácidos, creatina, creatinina, biomarcadores e enzimas. As metodologias se basearam em microscopia óptica, ensaio imunossorvente ligado à enzima (ELISA), Imunoblot/SDS-PAGE e fotometria. CONCLUSÃO: A revisão da literatura confirma que a estabilidade da amostra de LCR sofre influência da temperatura, do tempo de estocagem e das condições de preparo pré-analítico. Os achados desta revisão sistemática podem contribuir para a ampliação dos conhecimentos no exame do LCR, assim como o melhor entendimento sobre a estabilidade da amostra.

The cerebrospinal fluid (CSF) is a biological fluid that is in close relation with the central nervous system (CNS). Therefore, the CSF examination constitutes an invaluable method in the diagnosis and monitoring of countless neurological diseases. However, there are a few studies about the stability of its analytes during the pre-analytical stage. OBJECTIVE: To identify existing data about the influence of temperature and storage time, freezing/thawing cycles and pre-treatments (centrifugation, denaturation, serum addition) on the stability of CSF analytes. METHOD: A systematic review of articles in the literature was conducted by use of Key words: in English such as "storage", "cerebrospinal fluid", "CSF", "stability", "temperature" and "period", based on data from PubMed, Highwire Press, Lilacs and Amazonas Library, free digital archives of biomedical research articles. RESULTt: The search found nine articles, what results from the lack of studies about this subject. Different CSF constituents were analyzed: number of cells and their morphology, total protein, glucose, lactate, amino acids, creatine, creatinine, biomarkers and enzymes. The methodologies employed were: optical microscopy, enzyme linked immunosorbent assay (ELISA), Imunoblot/SDS-PAGE and spectrometry. CONCLUSION: The literature review confirms that the stability of CSF samples is influenced by temperature, storage time and conditions of pre-analytical preparation. The findings of this systematic review may contribute to improving the knowledge about CSF examination, as well as to better understanding the sample stability.

Vanishing white matter in Saudi Arabia

Vanishing white matter disease [VWMD] is an under-diagnosed condition that affects the brain's white matter at all ages, especially in the pediatric age group. It belongs to a clinically and genetically heterogeneous group of disorders, collectively known as eukaryotic initiation factor 2B-related disorders. The disorder has been described in different ethnic groups. Here, we describe a case of VWMD from Saudi Arabia

Laboratorial diagnosis of lymphocytic meningitis

Meningitis is the main infectious central nervous system (CNS) syndrome. Viruses or bacteria can cause acute meningitis of infectious etiology. The term "Aseptic Meningitis" denotes a clinical syndrome with a predominance of lymphocytes in the cerebrospinal fluid (CSF), with no common bacterial agents identified in the CSF. Viral meningitis is considered the main cause of lymphocyte meningitis. There are other etiologies of an infectious nature. CSF examination is essential to establish the diagnosis and to identify the etiological agent of lymphocytic meningitis. We examined CSF characteristics and the differential diagnosis of the main types of meningitis.

Cerebrospinal fluid cytological and biochemical characteristics in the presence of CNS neoplasia

Central nervous system (CNS) infiltration must be ruled out in patients with known neoplastic diseases and neurological symptoms. It was done a retrospective analysis of 1,948 CSF samples from patients with suspected malignant infiltration in the CNS, in order to evaluate the positivity rate of malignant cells in cerebrospinal fluid (CSF) samples and correlate with cytochemical characteristics. Sixty-two percent of subjects had acute lymphocytic leukemia. Malignant cells were found in 24 percent of all CSF samples. Subjects with positive malignant cells had predominance of increased levels of CSF total protein (TP), glucose and total cytology (p<0.05). Mean total cell count in this group was 232 (SD 933) cells/mm³, compared to 9 (SD 93) cells/mm³ in the group without neoplasic cells (p=0.029). CSF TP specificity was 87 percent and negative predictive value (NPV) 96 percent. CSF total cell count specificity 86 percent and NPV 97 percent. Although sensitivity and positive predictive value were low. The presence of inflammatory cells and elevated TP found in patients with malignant cells in the CSF can aid in diagnosing CNS neoplasms.

A infiltração neoplásica no SNC deve ser afastada em pacientes com neoplasia e sintomas neurológicos. Foi realizada uma análise retrospectiva de 1.948 amostras de LCR de pacientes com suspeita de infiltração neoplásica no SNC. Sessenta e dois por cento dos pacientes eram portadores de leucemia linfocitica aguda. Células neoplásicas foram encontradas em 24 por cento de todas as amostras. Houve níveis aumentados no LCR da proteína total (PT), glicose e de citologia global (p<0.05), no grupo com presença de células neoplásicas. A média da contagem global de células no LCR, neste grupo, foi 232±933 cels/mm³, contra 9±93 cells/mm³ no grupo sem células neoplásicas no LCR (p=0,029). O aumento de PT no LCR apresentou especificidade 87 por cento e valor preditivo negativo (VPN) 96 por cento. A contagem global de células no LCR apresentou especificidade 86 por cento e VPN 97 por cento. Porém sensibilidade e valores preditivos positivos foram baixos. A presença de células inflamatórias e PT no LCR elevada em pacientes com neoplasias pode ser um indicador do envolvimento no SNC.

Canine model of ischemic stroke with permanent middle cerebral artery occlusion: clinical and histopathological findings

The aim of the present study was to assess the clinical and histopathological findings in a canine model of ischemic stroke. Cerebral ischemic stroke was induced by middle cerebral artery occlusion in four healthy beagle dogs using silicone plugs. They showed neurological signs of forebrain dysfunction such as reduced responsiveness, head turning, circling, postural reaction deficits, perceptual deficits, and hemianopsia. These signs gradually regressed within 4 weeks without therapy. On magnetic resonance imaging, T2 hyperintensity and T1 hypointensity were found in the cerebral cortex and basal ganglia. These lesions were well-defined and sharply demarcated from adjacent brain parenchyma with a homogenous appearance. No abnormalities of the cerebrospinal fluid were observed. At necropsy, atrophic and necrotic lesions were observed in the cerebral cortex. The cerebral cortex, basal ganglia, and thalamus were partially unstained with triphenyl-tetrazolium chloride. Histopathologically, typical features of infarction were identified in cortical and thalamic lesions. This study demonstrates that our canine model resembles the conditions of real stroke patients.

CSF markers for diagnosis of bacterial meningitis in neurosurgical postoperative patients / Marcadores liquóricos para o diagnóstico de meningite bacteriana em pós-operatório neurocirúrgico

OBJECTIVE: To evaluate the diagnostic usefulness of cerebral spinal fluid (CSF) cellularity, protein, neutrophils, glucose and lactate for detection of postoperative bacterial meningitis. METHOD: This prospective study was conducted in 28 postoperative neurosurgical patients from 2002 to 2005 at University of São Paulo. The CSF markers were plotted in a receiver operating characteristic (ROC) curve to evaluate their accuracy. RESULTS: Based on the area under ROC curve CSF glucose, cellularity, and lactate were considered good tests. Polymorphonuclear and protein did not achieve enough accuracy to be used clinically. CONCLUSION: The CSF glucose, lactate, and cellularity can be used for the diagnosis of bacterial meningitis. Moreover, it can be helpful to differentiate bacterial from aseptic meningitis.

OBJETIVO: Para avaliar a utilidade diagnóstica dos marcadores liquóricos de celularidade, concentração de proteína, neutrofilia, concentração de glicose e lactato para a detecção da meningitie bacteriana no pós-operatório neurocirúrgico. MÉTODO: Esse estudo foi conduzido de maneira prospectiva na Universidade de São Paulo no período de 2002 a 2005 em 28 pacientes no pós-operatório neurocirúrgico. Os marcadores liquóricos foram colocados em uma curva ROC (receiver operating characteristic) para avalição da sua acurácia. RESULTADOS: Baseadas na área sob a curva ROC, glicorraquia, celularidade e concentração de lactato foram considerados bons testes. A contagem de polimorfonucleares e a proteínorraquia não atingiram acurácia suficiente para serem utilizadas clinicamente. CONCLUSÃO: A glicorraquia, a concentração de lactato e a celularidade podem ser utilizadas clinicamente para o diagnóstico da meningite bacteriana. Esses marcadores também podem ser úteis na diferenciação entre meningite bacteriana e asséptica.

Cerbrospinal fluid constituents in healthy female dromedary camels

The appropriate location for collecting cerebro-spinal fluid [CSF] from the dromedary camel was described and the reference range of cytological and biochemical constituents of CSF were determined in 25 clinically normal adult camels and compared with the corresponding serum. Camel CSF is colorless with similar viscosity to water. The maximum normal of RBCs and WBCs were 141 and 9 cells/ul, respectively. Significant differences were found in the biochemical values between the CSF and serum. These included total protein [TP], albumin, globulin, glucose, alkaline phosphatase [ALP] lactate dehydrogenase [LDH], creatine kinase [CK], glutamic pyruvic transaminase [GPT], and glutamic oxaloacetic transaminase [GOT]. In addition, there was significant difference between the CSF and serum in the levels of calcium