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Aim: To review the fundamental aspects of the theory of the molecular flow/ cerebrospinal flux described recently and it can explained a group of events in the physiology of the cerebrospinal fluid and the physiopathology of neurological diseases., Development: This theory was based on the postulate that a decrease of the flux rate of the cerebrospinal fluid was accompanied by an increment of the protein concentration in it and in the nervous system tissue. The increment of the protein transport from the blood to the cerebrospinal fluid not require structural changes or an increase of permeability. The reibergram or Reiber's quotient diagram, with the discriminatory hyperbolic function with its theoretical basis and its clinical relevance confirm the acceptance of the present theory. This theory was based on the first and second Fick's diffusion laws The increment of the molecular diffusion is the cause of the non-linear decrease of the cerebrospinal flux rate because of the blood-cerebrospinal fluid barrier dysfunction., Conclusions: This theory explain that an increase of the albumin quotient does not means a morphologic change on the barrier structures. The change in the cerebrospinal flux rate it has been considered the principal modulator of the protein concentration in cerebrospinal fluid in pathological conditions characterized by a blood-cerebrospinal fluid barrier dysfunction.

Introduction: Epidemics of meningoencephalitis due to echovirus 9 were commonly occurred when a children population become susceptible for the first time in front the virus., Objective: To present the intrathecal synthesis pattern of immunoglobulins of the epidemic that affected Cuba in 1999 and to probe the usefulness of reibergram and antibody index in the diagnostic and characterization of the outbreak., Patients and Methods: 23 pediatric patients suffering from viral meningoencephalitis due to echovirus 9 were studied in the income moment. Serum and cerebrospinal fluid IgA, IgM, IgG, albumin and glucose were quantified. Cerebrospinal fluid total protein content and lactate were quantified. Titles of antibodies against echo 9 and Coxsackie A9 and differential cell count were performed., Results: A mean of 555 cells/10 6 L mainly lymphocytes were obtained. Glucose in cerebrospinal fluid was over 50%, serum glucose and lactate levels below 2.1 mmol/L. In the reibergram an absence of intrathecal synthesis was predominant (15/23), IgM synthesis (6/23) and IgM+IgA (2/23). Blood cerebrospinal fluid dysfunction was observed in 15 patients. The mean antibody index was 1,8 for echo 9 and 0,9 for Coxsackie A9., Conclusions: The intrathecal synthesis pattern of immunoglobulins was different from other enterovirus and from echovirus 9 in non epidemic situations before this epidemic, probably with alteration of viral genome.

Introduction: During the third quarter of 2000, an outbreak of echovirus 16 meningoencephalitis was firstly occurred in Cuba and produced vomiting, headache, fever and exanthem that differentiate it from other enterovirus epidemies., Objective: To describe the intrathecal immunoglobulin synthesis pattern of the epidemie from the reibergram., Patients and Methods: Diagnostic serum and cerebrospinal fluid from 18 children during the acute phase by nephelometrie assay, besides cytochemical and virological study., Results: A predominant absence of intrathecal immunoglobulin synthesis and two patients with IgA and IgM synthesis was produced. 66% of cerebrospinal blood barrier dysfunction, 6.26 10 3 mean albumin ratio, lactate below 2.1 mmol/L and glucose concentration in cerebrospinal fluid was 50% over glucose blood content and 168 cells 10 6 L mainly lymphocytes were observed., Conclusions: The intratecal immunoglobulin synthesis pattern differs from other enterovirus outbreaks that have affected this population and it seems the one found for the diagnostic period in adults. This finding alerts the possibility of genetic changes in echovirus 16 strain, interesting from the neuroimmunoepidemiological point of view.

Introduction: The intrathecal response of IgG, is the most frequent neuropathological sign in multiple sclerosis (MS) patients beside the detection of oligoclonal IgG bands in cerebrospinal fluid. At the same time the observation of an intrathecal antibody synthesis (antibody index> 1.4) against neurotropic viruses like measles, rubella, varicella zoster or herpes simple shows a higher frequency in MS than any other chronic disease (MRZH reaction). We report the intrathecal, polyspecific and oligoclonal immune response in patients with definitive MS., Patients and Methods: CSF and serum were tested for Albumin, IgG, IgM and IgA by standard immunochemical nephelometry assay while virus specific antibodies in CSF and serum samples were evaluated by ELISA and calculated as antibody index., Results: Oligoclonal IgG by, isoelectric focusing was detectable in all patients. A differential pattern of combined antibody index against neurotropic virus was observed. The largest frequency of a single species in the oligoclonal immune response was for measles antibodies, while the antibody response was found as a combination with increased rubella antibody index and VZ antibody index, respectively., Conclusion: Our results although preliminary for our country, enrich the criteria about that MRZH reaction provide a major neuroimmunological support to MS diagnosis.

Introduction: Simultaneously with the origin and development of the Cuban epidemic neuropathy, cases of viral meningoencephalitis with particular characteristics due to Coxsackie were found. This virus and Inoue-Melnick virus were found too in patients suffering from Cuban epidemic neuropathy., Patients and Methods: 31 pediatric patients suffering from viral meningoencephalitis were studied. Albumin, IgA, IgM and IgG were quantified in serum and cerebrospinal fluid by nephelometry. Cytochemical studies and reibergrams were performed., Results: There was a lymphocyte predominance in cerebrospinal fluid. A dysfunction of blood-cerebrospinal fluid barrier was shown in 10 patients. Twenty patients have no immunoglobulins intrathecal synthesis. The synthesis patterns were: five patients with local IgM synthesis, two patients with local IgG synthesis and IgA + IgM. IgA + IgG and IgA + IgM pattern was synthesized in one patient respectively. Two patients with low IgG synthesis percentage or IgG intrathecal fractions were reported., Conclusions: The absence of immunoglobulins intrathecal synthesis and the immunoglobulins synthesis patterns differ from other pediatric patients with enterovirus meningoencephalitis. These patterns may have relationship with modified antigenic characteristics of the virus, also found in Cuban epidemic neuropathy.

Introduction: beta-trace protein or D2 prostaglandin synthase is a dual functional protein. Its role and clinical value in cerebrospinal fluid is under study., Material and Methods: Seventy four pediatric patients suffering from viral meningoencephalitis and 7 with bacterial meningoencephalitis were studied. Sera and cerebrospinal fluid samples were taken. Albumin and beta-trace protein were quantified by immunodiffusion and nephelometry respectively., Results: Increased cerebrospinal fluid beta-trace protein levels in comparison with normal value were observed. Nevertheless such expected increment was no possible seen in bacterial meningoencephalitis., Conclusions: beta-trace protein may contribute with the etiological diagnosis in meningoencephalitis.