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Background: Cerebro Spinal Fluid (CSF) examination is very useful in patients of suspected CNS disease and the necessity of correlating it with the clinico-pathologic findings which will help in early diagnosis of CNS diseases and guide the further management of the disease. CSF examination with quantification of leukocytes and differential count of cellular subsets in the cerebrospinal fluid is a standard procedure in cases of suspected infectious conditions. Present study emphasises pleocytosis in the cerebrospinal fluid along with other laboratory parameters. Materials and Methods: The study is consisting of 295 CSF samples from patients with clinically suspected CNS infections. The CSF findings were evaluated in all age group patients in relation to cell counts and pleocytosis. Results: In Physical examination of CSF colour, appearance and received quantity were evaluated. Maximum specimen was received in 1 year to 18 year age group. CSF pleocytosis (>5cells/µl) was present maximum (48%) in 1 month to less than 1 year age. Pleocytosis >5 leucocytes/µl was found in 121 (41%) samples out of 295 samples. Conclusion: CSF cell count examination is very common and useful investigation done for suspected various CNS diseases. Infectious and non-infectious diseases of CNS can cause pleocytosis of the cerebrospinal fluid. The type of cells depends mainly on the clinical scenario. However it seems to vary with total cell count also, such as lymphocytes predominating at lower total cell counts while neutrophils are at higher total counts.

Postmortem interval is of interest to the forensic pathologist from time immemorial. Due to the number of variables affecting the range of physical, biochemical and molecular changes in the postmortem, the postmortem interval could be determined only as a range. The aim of this study is to analyse the number of cells in CSF in postmortem and their morphological changes, to determine the postmortem interval. 39 cases were studied in which 27 cases were male and 12 cases were female of age ranging from 6 – 65 years. The cerebrospinal fluid sample was collected by cisternal puncture. The cases are with known postmortem interval and are grouped into 5 intervals – 0-6 hours, 6 -12 hours, 12 – 18 hours, 18 – 24 hours and more than 24 hours. There is a raise in cell count in CSF up to 12 hours while there are no degenerative changes detected in the first 6 hours. In the first 6 hours, lymphocyte count is higher than the neutrophil count. In the next six hours, the cell count increases while the lymphocytes remain higher than the neutrophil count. After 20 hours, the cell morphology is unreliable. The changes in the CSF cell count and cytology can be used along with other parameters to estimate the range of postmortem interval.

Obiectivul studiului. Obiectivul acestui studiu a fost dozarea neurofilamentelor fosforilate (subunitatea pNF-H) în lichidul cefalorahidian al pacienţilor cu leziuni traumatice ale măduvei spinării şi stabilirea unei corelaţii intre valoarea pNF-H şi gravitatea leziunilor medulare. Material şi metode. Studiul a inclus 15 pacienţi cu leziuni traumatice acute medulare: opt pacienţi cu leziuni medulare complete şi şapte pacienţi cu leziuni medulare incomplete. Gravitatea leziunilor medulare a fost apreciată folosind scala ASIA (American Spinal Injury Association scale) şi la toti pacientii s-a aplicat tratamentul chirurgical în primele 24 de ore (decompresiune medulară şi stabilizare vertebrală). S-a facut determinarea zilnică a pNF-H din LCR folosind testul ELISA specific şi am corelat aceste valori cu evoluţia clinică. Rezultate. Subunitatea pNF-H a fost evidenţiată în LCR la toţi pacienţii cu traumatisme acute vertebro-medulare şi valorile au fost diferite în cazurile leziunilor medulare complete faţa de leziunile incomplete. Nivelul pNF-H din LCR a fost de zece până la o sută de ori mai mare în leziunile medulare complete fata de cazurile cu leziuni incomplete, unde nivelul acestui biomarker a fost aproape normal. Pacienţii cu o evoluţie neurologică favorabilă după tratament au avut un model specific al valorilor zilnice de pNF-H: o creştere bruscă până la o valoare maximă apoi o scădere progresivă până la normal. Valorile maxime au fost diferite în fiecare caz, de 10 ori până la 170 de ori mai mari faţă de normal. Concluzii. Forma fosforilată a subunităţii neurofilamentelor cu greutate moleculară mare pNF-H din lichidul cefalorahidian poate fi un biomarker specific pentru leziunile acute traumatice ale măduvei spinării corelat cu severitatea leziunilor medulare. pNF-H pare a fi un biomarker predictiv deoarece modelul evolutiv al valorilor sale arată reducerea sau blocarea leziunilor medulare secundare şi se corelează cu evoluţia favorabilă clinică

Central Nervous System (CNS) embryonal tumors are malignant neoplasms that share the predilection for the pediatric age, the tendency to early disseminate throughout the CNS via the cerebro spinal fluid, the high mortality and the significant long-term morbidity for survivors.

Hypereosinophilia has been detected in the CSF of 22 patients in a series of 81 cases of shunt infection. It was related with the evolution of the sepsis. Its persistence at the end of treatment appeared to predict later complications, septic or obstructive, and it could be the sign of latent infection. HE might be the result of a specific reaction directed against the infected material, but a non-specific process cannot be eliminated.

Leber's hereditary optic neuropathy (LHON) is a genetic disease leading to the loss of central vision and optic nerve atrophy. The existence of occasional cases of LHON patients developing a Multiple Sclerosis (MS)-like illness and the hypothesis that mtDNA variants may be involved in MS suggest the possibility of some common molecular mechanisms linking the two diseases. We have pursued a comparative proteomics approach on cerebrospinal fluid (CSF) samples from LHON and MS patients, as well as healthy donors by employing 2-DE gel separations coupled to MALDI-TOF-MS and nLC-MS/MS investigations. 7 protein spots showed significant differential distribution among the three groups. Both CSF of LHON or MS patients are characterized by lower level of transthyretin dimer adduct while a specific up regulation of Apo A-IV was detected in LHON CSF.

Central nervous system involvement is the most common neurological complication in the course of tuberculosis. Lack of rapid and sensitive test delays the early diagnosis. Cytological study was carried out in cerebrospinal fluid of patients which were clinically suspected patients of tubercular meningitis. Purpose of this study is to determine the cytomorphological patterns in cerebrospinal fluid which will help in making the diagnosis of tubercular meningitis by providing the additional supportive evidence in clinically suspected cases. Technical aspect of this cytological study is rapid and simple therefore it can be applied for early diagnosis of tubercular meningitis particularly in which bacteriological methods did not demonstrate the presence of mycobacterium bacteria in cerebrospinal fluid.

Leptomenigeal Carcinomatosis (LC) affects approximately 5% of patients with cancer, either as a presenting sign or as a late complication Improvements in neuro imaging and increased awareness of the condition have led to the condition being diagnosed with increasing frequency. LC is thought to result from the multifocal seeding of malignant cells via the cerebro spinal fluid (CSF).

In the very few previous investigations of the CSF-proteins in muscular dystrophies the results have generally been reported as normal. In spinal muscular atrophies a barrier-damage pattern of CSF-proteins has been found in amyotrophic lateral sclerosis (ALS). In the present investigation the CSF-proteins were examined by isoelectric focusing and quantitative paper electrophoresis in 13 patients with muscular dystrophies and in 11 patients with spinal muscular atrophies. On isoelectric focusing, CSF-protein abnormalities were found in 85% of the cases with muscular dystrophies and in all patients with spinal muscular atrophies. Differences in the CSF-protein patterns were observed within the group of muscular dystrophies and between these and the cases of spinal muscular atrophies. In ALS and in myotonic dystrophy, abnormal CSF-protein fractions occurred mainly in the alkaline pH-range, while in limb-girdle dystrophy and the patient with facioscapulohumeral dystrophy, aberrant fractions appeared mainly in the acidic region. CSF-protein abnormalities were found in both the alkaline and acidic regions in the case with Welander myopathy. Two pronounced, highly alkaline fractions (HAFs) with pI 9.2–9.6 and a fraction with pI 7.1 were found in half of the patients with myotonic dystrophy. The CSF electrophoresis in myotonic dystrophy showed increased levels of beta1-globulin in all cases examined. Signs of barrier-damage were commonly encountered in ALS in contrast to the muscular dystrophies, except for myotonic dystrophy. The results are discussed in terms of possible diagnostic value and with regard to pathogenetic significance, particularly in relation to the current hypothesis of a neural involvement in muscular disorders.

1. A positive Wassermann reaction was present (with the spinal fluid) in twenty-eight out of thirty cases of general paralysis; the spinal fluids of thirty cases of epilepsy and dementia praecox gave a negative reaction. 2. A quantitative estimation of the intensity of the reaction, in terms of haemolytic doses of complement, showed that great variation exists from case to case; speaking generally, the more advanced the case the greater the amount of complement absorbed. 3. Fresh cerebro-spinal fluid possesses no activating properties for cobra venom; certain fluids rich in cellular content were found to inhibit the activating power of alcoholic extract of liver; this inhibitory action disappeared when the cellular elements were centrifugalised. 4. Mixtures of cerebro-spinal fluid and alcohol present varying degrees of turbidity; as a rule the greatest degree of turbidity is seen in cases of general paralysis, but equally turbid mixtures were observed with fluids from cases of epilepsy and dementia praecox in their acute phases. 5. There is no relationship between the degree of turbidity and the amount of complement absorbed in the Wassermann reaction; a fluid which, with an equal volume of alcohol, gives rise to an opalescent mixture may deviate more haemolytic complement in the Wassermann test than a fluid which, with alcohol, gives rise to a markedly cloudy precipitate. 6. An alcoholic extract of cerebro-spinal fluid when heated and filtered is found to contain substances which produce lysis of ox-corpuscles sensitised with cobra venom. The precipitate does not possess inhibiting properties in a dilution equal to that in which the precipitable substances are present in the spinal fluid. 7. The strength of this lytic property bears no relation to the density of the precipitate in the mixture of alcohol and spinal fluid or to the amount of complement deviated by the fluid in a Wassermann test. 8. No difference between general paralytics and other cases of mental disease could be determined in respect of the content of the extract of spinal fluid in substances which activated cobra venom; it is thus questionable whether the Wassermann reaction is due to substances of a lipoid character in the fluid. 9. Examination of the protein content of the spinal fluid by precipitation with ammonia sulphate, and also by the Noguchi method, showed that there is a close correspondence between these methods of precipitation and the precipitation by alcohol. A few cases of dementia praecox were found with a high protein content, just as they sometimes show a considerable precipitate with alcohol. 10. There is, however, no relationship between the protein content of the spinal fluid and the intensity of the Wassermann reaction. Most cases of general paralysis show a high protein content in the spinal fluid, but a fluid with a low protein content may give a strong Wassermann reaction, and a fluid with a high protein may give a weak reaction. Cases of dementia praecox with a high protein content do not give a Wassermann reaction. 11. In filtering alcoholic or ethereal extracts allowance must be made for the fact that certain lytic substances in the filter-paper may be extracted.

Encephalitis lethargica, or epidemic encephalitis as it is now usually called, is becoming more generally recognized throughout the world, and while diagnosis is usually easy in those cases with a clear history, and who show the “encephalitic syndrome” to a marked degree, much confusion has arisen in the case of some patients who have shown clinical features which have led observers to arrive at a diagnosis of this disease when later investigations have shown that this conclusion has not been a correct one.

I. The results obtained by the French method appear to show a fairly consistent increase in cells throughout this study. 2. Seventy-six cases of dementia paralytica out of seventy-seven showed a lymphocytosis. Differential counts did not aid materially towards diagnosis. One case of clinical paresis was cytologically negative. Three cases of tabes dorsalis were cytologically positive. Two cases of cerebral syphilis showed a slight increase in cells. Ninty-three per cent of the cases of dementia paralytica gave a positive increase in globulin. One case of tabes dorsalis and one of cerebral syphilis gave a negative globulin reaction. 3. Korsakoff’s psychoses show practically no increase in lymphocytes of albumin. 4. Eighty-nine per cent of the epileptics showed abnormal increase in lymphocytes, at the same time no case of epilepsy gave an increase in globulin. 5. The diagnostic value of lymphocytosis in spinal fluids in cases of manic depressive insanity and dementia praecox still remains unexplained althoug...

Whilst it is an undisputed fact that under certain clinical and experimental conditions various antibodies (antitoxins, agglutinins, bacterio- and hæmolysins, complement-fixing antibodies) can be demonstrated in the cerebrospinal fluid, there is a divergency of opinion about their origin. Whereas some authors (Dujardin and Dumont, Ramon, Descombey and Bilal, Neufeld and Szyle, Nélis) ascribe their presence in the cerebro-spinal fluid to their passage from the blood through a damaged blood-cerebro-spinal fluid barrier, other investigators (Mutermilch, liiert, Grabow and Plaut, Friedemann and Elkeles) believe that the central nervous system or its membranes are able to produce antibodies on their own upon contact with an antigen. In the case of the Wassermann antibody in the cerebro-spinal fluid the question of its origin is of particular interest, because of the occasional occurrence of cases which show a positive Wassermann reaction in the cerebro-spinal fluid and a negative or weaker reaction in the blood. This divergence between blood and cerebro-spinal fluid is often quoted as an example of the independence of the cerebro-spinal fluid antibody.

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A procedure for determinations of both γ-globulin and total protein is described. Its application for the analysis of samples of cerebrospinal fluid from non-neurologic, multiple sclerosis, and other central nervous system disorders, revealed a characteristically high ratio of γ-globulin to total protein in multiple sclerosis. These findings suggest that this simple chemical test may be used routinely as an aid in the diagnosis of multiple sclerosis.

The fluid obtained by the easy and now frequent procedure of lumbar puncture affords, when subjected to simple tests, valuable aid in the diagnosis of mental disease.

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In the mass of conflicting evidence which has accumulated in recent years as to whether organisms are the exciting factor in the production of certain insanities, I have found it difficult to discriminate between cause and effect. Is the organism or group of organisms the specific pathogenesis of certain insanities or merely a bacteræmia secondary to the psychosis?

The Takata reaction (1) consists in the production of a flocculation or opacity in fluids on the addition of alkaline mercuric chloride solution. It has been modified and applied to the cerebro-spinal fluid (Takata-Ara (2)), and found to be positive mainly in cases of syphilis of the nervous system. Various modifications in the technique have been described, e.g., Jezler (3) and Ginkel (4), but in the following investigations on 177 specimens of cerebrospinal fluid Ucko's (5) modification of the reaction on serum, whereby the reaction time is reduced from 24 hours to 90 minutes, has been further modified by the author to permit of its application to the cerebro-spinal fluid.