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The authors investigated the frequency and quantity of intrathecal antibody synthesis against Chlamydia pneumoniaeand the presence of C pneumoniaeantigen in 25 children with MS. C pneumoniaegenome was present in two children. In seven children an intrathecal synthesis of C pneumoniaeantibodies was detected, representing only a small part of the total intrathecal immunoglobulin G, suggesting that this intrathecal synthesis is part of a polyspecific, oligoclonal immune response.

Prothrombin, known to be expressed in brain and to possess growth modulating properties, has been suggested to be involved in the pathogenesis of Alzheimer's disease (AD). We studied prothrombin concentration in lumbar CSF (L-CSF) in patients with AD (n = 25), neurologic disease controls (NDC; n = 33) covering a wide range of neurologic disorders, and subjects with Guillain-Barré syndrome (GBS; n = 4) as well as in samples of non-pathological ventricular CSF (V-CSF; n = 4). The results were evaluated with respect to CSF flow rate, as indicated by the albumin quotient (QAlb). The concentrations of prothrombin in L-CSF in NDC (mean: 0.46 mg/l, range: 0.21–0.96), and AD (mean: 0.6 mg/l, range: 0.19–1.2) were in the normal range reported previously. Expectedly, prothrombin concentration in L-CSF of GBS was increased (mean: 6.3 mg/l, range: 2.3–9.7) corresponding to the increased QAlbin this group (mean 54.6 × 10−3, range: 17–88.1). The concentrations of both prothrombin and albumin were 5.5-fold higher in L-CSF than in V-CSF (mean QAlb: 1.1 × 10−3, mean concentration of prothrombin: 0.088 mg/l). In conclusion, CSF prothrombin in all conditions evaluated here is exclusively derived from blood.

Both young and adult strain 13 guinea pigs have been treated with complete Freund's adjuvant (CFA). In young animals CFA induced an increase in the lymphocyte cell count in blood and a reversible blood CSF barrier impairment. Both these effects could be suppressed by the immunosuppressant drug Cyclosporin A. In contrast to the young animals treatment with CFA in adult strain 13 guinea pigs influenced neither the lymphocyte cell count nor blood CSF barrier function. In young and adult CFA-treated animals the number of polymorphonuclear cells in blood were increased and this increase was not reversed by Cyclosporin A. We discuss the influence of a systemic immune stimulation and suppression on blood CSF barrier function for proteins and its relevance to the pathogenesis of inflammatory diseases of the central nervous system.

In spite of the fact that prothrombin is produced by cells within the central nervous system, its presence in the cerebrospinal fluid (CSF) has not been investigated. We determined the concentration of prothrombin in CSF with reference to the concentration in plasma in paired samples from 18 “normal” control patients and 4 patients with relapsing-remitting type of multiple sclerosis (MS). The newly developed ELISA was very specific (no cross-reactivity with thrombin) and sensitive (detection limit—0.7 ng/ml) with an imprecision of CV = 8.3% (intraseries) and 7.0% (interassay). The mean prothrombin concentration in normal CSF was 0.55 mg/l (CV ± 33%, range: 0.28–0.93 mg/l), in normal plasma 121.8 mg/l ± 21%, resulting in a mean CSF/plasma concentration quotient (QProth)—4.5 · 10−3(CV ± 35%, range: 2.1–8.3 · 10−3) corresponding to a mean albumin quotient in this group of subjects of QAlb= 5.8 · 10−3. Due to the QProthand the molecular weight of prothrombin (72 kDa)—similar to that of albumin—we conclude that prothrombin in normal human CSF originates predominantly (>95%) from blood. The enzymatic activity in CSF is conserved. Comparable results obtained in MS patients with only few small MRI lesions suggest that local chronic inflammatory disease of the central nervous system does not influence prothrombin concentration in the CSF if the blood-CSF barrier function is normal.

The antibody specificity index (ASI) indicates the cerebrospinal fluid (CSF)/serum difference of antibody amounts per weight unit IgG (normal < 1.5). It has proven to be the most sensitive inflammation parameter in CSF analysis so far, more sensitive than the Western blot, the “oligoclonal” response, and the empirical differentiation of CSF immunoglobulins. By this diagnostic criterion, several benign viral meningitis cases were found to be caused by the varicella/zoster virus. The diagnostic relevance of local zoster antibody synthesis was greatest in ganglionitis cases, e.g., in zoster oticus sine herpete (facial paresis) and acute radicular syndromes of the elderly. The diagnostic significance of the local immune response against measles, rubella, and zoster antigens (MRZ response) was ascertained further. Together with oligoclonal gamma-globulin fractionation, there is now only 1 out of 100 multiple sclerosis (MS) patients left who has been found to have a normal CSF.

A graph for the evaluation of the CSF-protein profile is presented as a basic program for the clinical-neurochemical laboratory.

Cerebrospinal fluid (CSF) was removed from guineapigs by puncture of the cisterna magna and the total sample volume of 200-360 µl divided into 40 µl aliquots. After determination of albumin and IgG in these CSF aliquots it was found that successive samples gave different results. In general, up to 100 µl CSF could be removed before the protein concentration began to increase. In animals with chronic relapsing experimental allergic encephalomyelitis (CR-EAE) the rise in albumin concentration was accompanied by a corresponding fall in the number of white cells in later samples.

Eosinophilic meningoencephalitis due to the nematode Angiostrongylus cantonensis, which is endemic to Cuba, occurs in children and is due to accidental contact with soil snails. The course is less often fatal than in adult patients in southeastern Asia. Cerebrospinal fluid (CSF) and serum samples from 24 pediatric patients were analyzed and evaluated in CSF/serum quotient diagrams (Reiber graphs) to characterize the neuroimmunological response and the blood-CSF barrier dysfunction that occur in the course of the disease. At the time of the first diagnostic lumbar puncture, together with eosinophilic pleocytosis (1,920 +/- 400 cells/microl), intermediate blood-CSF barrier dysfunction (i.e., an increased CSF/serum albumin quotient) with no intrathecal immunoglobulin G (IgG), IgA, and IgM class response was observed in all cases. Seven days later, at the time of early clinical recovery, the blood-CSF barrier dysfunction was normalized in 75% of the patients, but meanwhile, intrathecal immunoglobulin synthesis emerged in all cases, as either a two-class response (IgG and IgA in 85% of the patients) or a three-class response (IgG, IgA, and IgM; 30%). The fraction of eosinophilic cells (40%) remained large despite a decreasing total cell count. The neuroimmunological pattern of this inflammatory response to the parasite and its toxins is discussed with regard to the CSF patterns of other infectious diseases caused by bacteria or viruses.

Sixteen out of eighteen meningeal carcinomas (89%) secreted carcinoembryonic antigen (CEA) into the cerebrospinal fluid, where it could be quantified separately from the portion originating from the circulating blood. The discrimination of both fractions was performed according to an empirical approach analogous to the immunoglobulins. Only 47% of the intraparenchymal carcinomas released CEA into the CSF compartment and it is possible that the extracellular space of these tumour sites does not communicate with the free CSF space. Extradural metastases may cause an impairment of the blood-CSF barrier via restrictions of the CSF fluid turnover, but the dura remains impermeable for the tumour marker. Seven out of 54 primary brain tumours (13%) released carcinoembryonic antigen into the cerebrospinal fluid.

Cisternal cerebrospinal fluid (CSF) was tapped from anaesthetized guineapigs by an improved technique. This method allowed repeated weekly punctures of the same animal without any cellular or neurochemical changes in CSF or changes in behaviour. About 60% of the punctures produced enough CSF (30-330 μl) with no or a sufficiently low blood contamination for neurochemical analysis. The CSF space in the spinal canal, cisterna magna and basal cisterns was demonstrated by myelography.

The authors studied CSF characteristics in 136 patients with multiple sclerosis (MS) with a disease onset before age 16. In the initial diagnostic lumbar puncture, CSF-pleocytosis was observed in 66%, blood–CSF barrier dysfunction in 13%, and oligoclonal IgG in 92% of the early-onset MS (EOMS) patients. CSF oligoclonal IgG supports the early diagnosis of MS in childhood with a sensitivity similar to adult-onset MS.