The prognostic value of the lactate concentration and lactate/pyruvate ratio in cerebrospinal fluid following acute cerebral circulatory disorders

The study was conducted in 80 patients with ischaemic and 29 with haemorrhagic cerebral stroke. Lactate, pyruvate, the lactate/pyruvate ratio and glucose were determined in the arterial blood and lumbar CSF. A high prognostic value of the CSF lactate content was found in cases of ischaemic stroke. According to the data obtained, an elevation of the CSF lactate concentration above 4.0 mEq/l should be considered life-threatening. Haemorrhagic stroked was found to be accompanied by a reduced CSF glucose level and an elevated lactate content, as well as by a significant proportional elevation of the lactate and red blood cells count in the CSF. The conducted calculations demonstrated that 1/4 to 1/3 of the CSF lactate is formed at the expense of the glycolytic metabolism in the CSF erythrocytes. This constitutes the main reason of the discordance between the CSF lactate content in haemorrhagic stroke and the routine criteria of prognosis in ischaemic stroke. The lactate/pyruvate ratio in the CSF is of no prognostic importance in both forms of cerebral stroke.     

Diagnostic value of atypical lymphocytes in cerebrospinal fluid from adults with enteroviral meningitis

We have noted two morphologically distinct types of atypical lymphocytes (AL) in the cerebrospinal fluid (CSF) of adult patients with meningitis: one, which we designate type-I AL, with multilobulated nuclei resembling those of the abnormal cells in adult T-cell leukaemia (ATL); and another, type-II AL, characterized by large lymphocytes with basophilic cytoplasm and nuclei containing coarse chromatin. Type-I AL were detected in 25 of 39 patients (64%) with enteroviral and in 11 of 109 (11%) with aseptic meningitis presumed to be caused by other viruses, but not in meningitis resulting from Cryptococcus neofirmans (n = 14), Mycobacterium tuberculosis (n = 19) or acute bacterial infection (n = 49). Type-I AL were not seen in herpes zoster (n = 15) aseptic meningeal reactions (n = 15), or in leptomeningeal carcinomatosis (n = 14). Type-II AL were often present in meningitis of various aetiologies and in aseptic meningeal reactions, but not in leptomeningeal carcinomatosis. The presence of type-I AL in the CSF was found to be indicative of enteroviral meningitis with the highest predictive value (69%), while type-II AL had a lower diagnostic positive predictive value in meningitis of the five aetiologies above. Type-I AL immunostained for CD4, while type-II AL were stained for CD8. The presence of type-I AL in CSF strongly suggests enteroviral meningitis, which warrants careful follow-up without antifungal, antituberculous or antibacterial agents. However, type-I AL, which are likely to be virally transformed lymphocytes, must be distinguished from ATL cells, which frequently involve the meninges.     

Diagnostic value of cerebrospinal fluid oxyhemoglobin and bilirubin determination in cerebrovascular diseases]

The levels of oxyhaemoglobin and bilirubin were determined in the cerebrospinal fluid in 46 cases of subarachnoideal haemorrhage and cerebromeningeal haemorrhage, 18 cases of haemorrhagic infarction. Autopsy confirmation was available in 18 cases of haemorrhages and 18 cases of infarction. Determination of oxyhaemoglobin and bilirubin levels in the cerebrospinal fluid is not sufficient as a reliable basis for differentiating between cerebral haemorrhage and haemorrhagic infarction. High values of oxyhaemoglobin and bilirubin seem to indicate bleeding into the cerebrospinal fluid spaces. Assessment of oxyhaemoglobin level and cerebrospinal fluid sediment suggests in some cases the diagnosis.     

Sanguineous cerebrospinal fluid in recanalized cerebral infarction

To clarify the causal relationship between spontaneous recanalization of the occluded cerebral artery and development of hemorrhagic infarction, 15 patients with internal carotid or middle cerebral arterial axis occlusion were submitted to consecutive lumbar punctures and follow-up cerebral angiography. Consequently, six of seven recanalized patients had sanguineous cerebrospinal fluid (CSF) on the second or third day after ictus, while only one of eight non-recanalized patients had bloody CSF. It was strongly suggested that recanalization might have an initimate relationship with the development of hemorrhagic infarction.     

Diagnostic studies of cerebrospinal fluid in patients with multiple sclerosis

The diagnostic criteria postulated by Poser necessitate clinical and laboratory CSF analysis for establishment of the diagnosis of definitive multiple sclerosis. The present paper reports methods for CSF examinations relating to multiple sclerosis with regard to the examinations suggested by the Charcot Foundation. In the course of CSF analysis, it is important to discriminate between the immunoglobulins present in normal amounts, those synthesized locally in pathological quantities and those penetrating across the damaged blood-CSF barrier. Normally, a parallel assay of CSF and serum specimens is carried out in the course of quantitative and qualitative protein analysis. In 37 patients with clinical multiple sclerosis, we determined the albumin and the immunoglobulin classes IgG, IgA and IgM, using laser nephelometry. An elevated IgG index was found in 76% of the cases, which points to local IgG snythesis and might be proof of the humoral immune response. The albumin quotient, which is suitable for examination of the integrity of the blood-CSF barrier, was within the reference range. Qualitative protein analysis was performed by means of electrophoresis on agarose-gel and isoelectric focusing. Agarose-gel electrophoresis revealed oligoclonal gammopathy in 68%, in contrast with the 91% demonstrated by isoelectric focusing. Comparison of the two kids of qualitative protein analyses indicated that isoelectric focusing was more sensitive for the detection of oligoclonal bands, in support of the literature finding.     

Gangliosides in cerebrospinal fluid in children with autism spectrum disorders

Gangliosides are sialic acid-containing glycolipids found in all cells, especially abundant in nerve cells and mainly situated on outer-membrane surfaces. The aim of this study was to provide data on the concentration of gangliosides in the CSF of children and adolescents with autism spectrum disorders (ASD) - 66 with autistic disorder, and 19 with other autism spectrum disorders. The comparison group consisted of 29 children and adolescents, whose CSF had been sampled to exclude acute infectious CNS disorder. The concentrations of the gangliosides GM1, GD1a, GD1b, and GT1b were determined using a microimmunoaffinity technique. The ASD group had a significantly higher concentration of ganglioside GM1 compared with the comparison group. The GM1 increase could not be explained as secondary to other clinical factors. Mean ganglioside levels did not differentiate subgroups with autistic disorder and those with a more atypical clinical picture, nor subgroups with known medical disorders and those with idiopathic autism. Altered patterns of gangliosides in the CNS might reflect important correlates of pathogenesis in autism.     

Age and features of adrenal cortical function in cerebral circulatory disorders

The indices of glucocorticoid and androgen activity in the adrenal cortex (the level of circulating eosinophils, the daily urine excretion of 17 OCS and 17 CS) and the functional reserve after an ACTH loading was studied in 2 groups of patients with disorders of cerebral circulation under 45 years of age (247 cases) and over 55 (234 cases). In the acute period of a cerebral stroke there was an increase of the glucocorticoid activity which was more definitely expressed in the younger group and a certain inhibition of the androgen function seen mainly in the older group. In transient disorders of cerebral circulation significant age difference in the functioning of the adrenal cortex was not established. In the period following a stroke the established and potential reserves of the adrenocortical glands were distinctly decreased in patients above 55 years and practically unchanged in the younger group.     

The value of cerebrospinal fluid immunoglobulin analysis in clincial neurology

The IgG index (formula: see text) corrects for the influence of serum protein abnormalities as well as a bloodbrain barrier damage and is, therefore, a better measure for the presence of an IgG elevation in CSF due to IgG synthesis, when compared with other IgG quotients commonly used. Agar gel electrophoresis of CSF for demonstration of oligoclonal IgG is probably superior to the determination of the IgG index when a diagnosis of MS is suspected. Determination of kappa and lambda light chain antigenic determinants in CSF, and calculation of the kappa/lambda ratio may also be used to demonstrate the occurrence of oligoclonal CSF immunoglobulins. An abnormal ratio can, however, be demonstrated only in 50% of MS patients and has, therefore, at present no place as a routine diagnostic method when MS is suspected.     

Lysozyme activity in cerebrospinal fluid. Studies in inflammatory and non-inflammatory CNS disorders

Lysozyme activity was measured in cerebrospinal fluid (CSF) from 114 patients with inflammatory (bacterial and serous meningitis, polyradiculitis, encephalitis) and non-inflammatory (multiple sclerosis, CNS tumors, cerebral vascular diseases) CNS diseases. Highly elevated values were found consistently in patients with bacterial meningitis. Elevated values were found also in patients with encephalitis, polyradiculitis, multiple sclerosis and CNS tumors, but a considerable overlapping between these groups and normal controls precludes the use of CSF lysozyme measurements as a diagnostic aid in the latter disease groups. Simultaneous measurements of lysozyme, albumin and IgG in CSF and serum suggested that the mechanism for increased CSF lysozyme values in bacterial meningitis is mainly a breakdown of the blood/brain barrier, whereas the increased CSF lysozyme values in the remaining groups of patients are more likely caused by production of lysozyme by cells within the meninges (neutrophilic granulocytes, monocytes?).     

Lumbar cerebrospinal fluid drainage for prevention of cerebrospinal fluid fistulas

Leakage of cerebrospinal fluid may complicate surgical procedures of the temporal bone and skull base. This presentation details experience utilizing 7 days lumbar drainage in an attempt to prevent the occurrence of a postoperative CSF fistula. Thirty-nine patients underwent surgery for various intracranial pathologies and were felt to be at high risk for the development of postoperative CSF fistulae. None of the patients was given prophylactic antibiotics. Ten patients developed clinical and laboratory findings consistent with early meningitis and were treated with appropriate antibiotics. Three patients eventually developed a CSF fistula, with two resolving spontaneously and the third requiring a second surgical procedure to repair the dura (again using lumbar drainage postoperatively). Our conclusions suggest that prophylactic placement of a lumbar catheter in high risk patients increases the likelihood of successful dural closure with an acceptable morbidity. Is these patients routine antibiotic coverage is not indicated.     

Regional cerebral blood flow and cerebrospinal fluid amino acid analysis in elderly dementia

Regional cerebral blood flow and amino acid concentration in the cerebrospinal fluid were studied in 12 cases of vascular dementia, 12 cases of Alzheimer's disease, 12 cases of chronic alcoholism, and 12 age-matched healthy controls. In vascular dementia, blood flows were decreased in the cerebral cortex, frontal white matter, thalamus, caudate nucleus, and putamen and alpha-aminobutyric acid and glutamic acid concentrations were increased in the cerebrospinal fluid. In Alzheimer's disease, blood flows were decreased in the frontal cortex, parietal cortex, temporal cortex, and frontal white matter and alanine concentration was increased in the cerebrospinal fluid. In chronic alcoholism, blood flows were decreased in the cerebral cortex, thalamus, and putamen and urea, alanine, and glycine concentrations were increased in the cerebrospinal fluid.     

Prostaglandin D synthase concentration in cerebrospinal fluid and serum of patients with neurological disorders

Prostaglandin D synthase (PGD synthase) or beta-trace protein is a major constituent of human cerebrospinal fluid (CSF) representing-3% of the total CSF protein. We have recently developed a highly specific immunofluorometric assay for PGD synthase, which enabled us to quantify the presence of PGD synthase in fluids and tissues not associated with the CNS. In this report we provide quantitative data of the presence of PGD synthase in CSF and serum from 302 subjects with various neurological diseases and symptoms. PGD synthase levels in CSF are approximately 35-fold higher than those of serum, with a median concentration of 11,299 micrograms/L. A statistically significant association of PGD synthase concentration in CSF was observed with both patient age and gender. There was no correlation between PGD synthase concentration in serum and patient age or gender. To evaluate the clinical utility of PGD synthase in diagnosing neurological diseases, the distribution pattern of PGD synthase in CSF and serum was examined for each neuropathology of 268 patients whose diagnosis was known. No statistical difference was observed between PGD synthase concentration in the CSF (129 cases) or the serum (94 cases) of multiple sclerosis afflicted subjects in comparison to all other patients studied. The distribution pattern was also not different for PGD synthase levels in CSF of patients with HIV/AIDS related neuropathies, viral meningitis and fibromyalgia. We conclude that PGD synthase measurement presents no clinical utility in diagnosing neurological disorders in adulthood. PGD synthase may have a physiological and/or pathological role in the developing brain and in neurodegenerative diseases.     

Experimental model of transient cerebral circulatory disorders by way of embolization of cerebral arteries with fresh blood clots

A total of 85 experimental animals received through the blood flux of the carotid arteries clots of autogenic blood of 1 hour age. A histomorphological study after 40 minutes following an embolism there were revealed clots in the cerebral arteries in 13 out of 14 animals. After 1.5 hours in 1 of 17, and after 24 hours in none of the 10 animals. Directly following the administration of clots in all the 20 animals of this series, there were symptoms of focal brain lesions: hemipareses, ptosis and myosis, a "trot around circles", etc. In all 20 animals there was a complete regress of the symptom at different times (from 10 min to 18 hours). In all cases there was an increased amount of lactic acid in the cerebral blood outflow while subsequently was reduced, correlating with the time of clot lysis. The morphological control did not depict brain infarctions. It is assumed that the reason of brain dysfunctions is an obturation by blood clots of cerebral arteries, while their normalization is due to a spontaneous lysis of the embols which obturated the cerebral arteries.     

Role of genotypic and environmental factors in the origin of cerebral circulatory disorders in young persons

The paper is concerned with the results of a comparative analysis of clinical signs in cerebral crises, strokes and other symptoms seen in 2 groups of patients younger than 45 years of age, and differing only in the presence (104 cases) or absence (108 cases) of hereditary-familial aggravation by a cardio-vascular pathology. Although in the first group of patients there was a certain tendency towards a more severe disorder of cerebral circulation, it was not possible to mark any statistically significant differences in the clinico-biochemical indices. At the same time different negative environmental influences (alcohol abuse, brain injuries, severe acute and chronic mental traumatization, frequent exacerbations of focal chronic infections of the ENT and the lungs, etc.) and a combination of 2 or 3 of them were significantly more frequently seen in patients without hereditary aggravation (34.8%) rather then with it (10.7%). A conclusion is being made that genotypical factors do not play a decisive role in the etiology of cerebral vascular disorders in young people. They only condition a lesser stability of the organism to unfavourable environmental factors and their different combinations.     

Proinflammatory cytokine levels in cerebrospinal fluid from children with acute encephalitis]

Pediatric liver transplant recipients constitute a population characterized by a particularly unpredictable and poor bioavailability of cyclosporin (CyA). Even though several adult studies show that the new oral formulation of CyA, Neoral (NEO), produces better bioavailability and blood level predictability, few data describe its pharmacokinetics in children. We performed a complete analysis of the pharmacokinetics of NEO in ten small children after primary liver transplantation. Three pharmacokinetic profiles were set up with data obtained from tests taken during i.v. administration of CyA, after the first oral NEO dose, and after the last NEO dose before discharge from the hospital. The mean half-lives obtained were 8.1, 7.7, and 6.9 h, respectively, and the bioavailabilities were 22% and 21% for the first and last NEO doses. A large interpatient variability was observed. This was due, in part, to episodes of diarrhea that interfered with the pharmacokinetic evaluation and, in part, to the variability of post-transplant hepatic function. There was a good correlation between CyA trough levels and their related AUCs for both NEO profiles (r = 0.93 and r = 0.74, respectively). We conclude that, even though the pediatric OLT population remains more unpredictable than that of adults, NEO has a relatively rapid half-life and a remarkably improved bioavailability.