Mononuclear cells are seen in viral infections meningoencephalitis, aseptic meningitis , syphilis, neuroborreliosis, tuberculous meningitis, multiple sclerosis, brain abscess and brain tumors. Tumor cells indicate dissemination of metastatic or primary brain tumors in the subarachnoid space. The most common among the latter is medulloblastoma. They can be best detected by cytological examination. A mononuclear inflammatory reaction is often seen in addition to the tumor cells. Oligoclonal bands are also seen occasionally in some chronic CNS infections.
The type of oligoclonal bands is constant for each MS patient throughout the course of the disease. Oligoclonal bands occur in the CSF only not in the serum.
These quantitative and qualitative CSF changes indicate that in MS, there is intrathecal immunoglobulin production. MBP can be detected by radioimmunoassay. MBP is not specific for MS. It can appear in any condition causing brain necrosis, including infarcts. Low glucose in CSF is seen in suppurative, tuberculous and fungal infections, sarcoidosis, and meningeal dissemination of tumors. Glucose is consumed by leukocytes and tumor cells. Alzheimer's disease AD. Total-tau t-tau and phosphorylated tau p-tau are both increased in AD.
Tau is an intracellular protein and p-tau is a component of neurofibrillary tangles NFTs. Their increase in AD is thought to reflect neuronal death with release of tau into the extracellular space. Creutzfeldt-Jacob disease. The proteins the name derives from their electrophoresis pattern are a group of proteins with diverse regulatory functions present in all cells.
Elevated CSF in a patient with progressive dementia of less than 2 years' duration is considered a strong indicator of CJD. A negative test does not rule out CJD. In the course of traumatic brain injury TBI , proteins from injured neurons and glial cells are released in the interstitial space and CSF and, because of damage of the BBB, make their way into the blood. Detection of these products in CSF or serum in the early phases of TBI would be very helpful, especially because imaging studies may be inconclusive.
Several such markers have been considered. Some of these are present in settings other than TBI. Other biomarkers such as neuron specific enolase and SB protein are elevated in TBI but are not specific because they are found in tissues outside the CNS. The rigid skull contains the brain, intravascular blood and CSF.
When the volume of one of these components increases, the other two adjust to this change up to a point. When intracranial pressure ICP exceeds cerebral perfusion pressure CPP , cerebral blood vessels are squeezed shut and cerebral ischemia ensues.
Such a situation occurs as a result of brain tumors and arises also following large ischemic strokes, traumatic brain injury, and cerebral and subarachnoid hemorrhage. Most cases of hydrocephalus are caused by obstruction of CSF flow-most frequently from brain tumors and aqueductal lesions. Elevated ICP with no other apparent pathology is also thought to be the cause of pseudotumor cerebri idiopathic intracranial hypertension. This condition is characterized by headache, papilledema, increased CSF pressure and normal size ventricles.
Obesity is a major risk factor. Acetazolamide, an inhibitor of carbonic anhydrase, is frequently used for treatment of pseudotumor cerebri. An illustrated interactive course for medical students and residents By Dimitri P.
Agamanolis, M. No Test Learning Objectives. Astrocytic processes around capillary Astrocytic processes around vessel. Glia limitans. Perivascular space. Leukemic cells in the CSF. The blood-brain barrier: an overview. The entire surface of central nervous system is bathed by a clear, colorless fluid called cerebrospinal fluid CSF.
The CSF is contained within a system of fluid-filled cavities called ventricles. The ventricles are shown in blue on the following midsagittal section of the brain. The Ventricles CSF is produced mainly by a structure called the choroid plexus in the lateral, third and fourth ventricles. CSF flows from the lateral ventricle to the third ventricle through the interventricular foramen also called the foramen of Monro. The third ventricle and fourth ventricle are connected to each other by the cerebral aqueduct also called the Aqueduct of Sylvius.
Abhaya V. Kulkarni, M. Shlomi Constantini, M. Rick Abbott, M. Bermans Iskandar, M. Iskandar, M. Deopujari, M. Muzumdar, M. Badami, B. Authors Andrew Jea, M.
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