脑膜癌病

目的分析脑脊液细胞学检查对脑膜癌病的诊断价值。方法描述了12例脑膜癌病患者的临床表现,辅助检查及确诊依据。结果12例脑膜癌病临床表现多样,主要表现为颅内高压和脑膜刺激征。颅脑CT和MRI多正常。脑脊液细胞学检查发现肿瘤细胞,异常细胞成簇排列,其胞体形态多变,核浆比例增大,胞浆呈嗜碱性,胞核形态不规则,核仁增多,核染色质浓染。常见有丝分裂等恶性肿瘤细胞固有特点。结论脑脊液细胞学检查发现癌细胞是脑膜癌病唯一生前确诊的依据。     

肺癌转移致脑膜癌病12例临床分析

目的 分析12例肺癌致脑膜癌病患者的临床特征.方法 对12例经脑脊液细胞学证实的肺癌致脑膜癌病患者的临床资料进行分析.结果 首发症状多为头痛、呕吐,头颅CT或MRI检查多无异常发现,脑脊液检查颅内压均有不同程度增高,脑脊液生化检查蛋白升高者多见,细胞学检查均见癌细胞,形态与原发肿瘤相似,经治疗后25%的患者获得缓解.结论 对以头痛、呕吐发病,伴颅内压增高及脑膜刺激征,且CT及MRI检查无明显异常者,应高度警惕脑膜癌病的可能,鞘内注射加全身化疗是有效的治疗手段.     

脑膜癌病59例临床分析

目的 探讨脑膜癌病（MC）的临床和脑脊液（CSF）细胞学特征。方法 回顾性分析59例确诊为MC患者的临床资料。结果 本组中老年患者占91．5％（54例）;呈亚急性或急性起病,病情进展较快;疾病早期多不发热（55例,93．2％）;头痛（57例）、呕吐（45例）及视盘水肿（21例）等颅内压增高症状为突出表现;32例（54．2％）出现脑神经受累,以视神经、展神经受累多见,其次为动眼神经、面神经及前庭蜗神经等;59例均有脑膜刺激征,其中31例（52．5％）较明显;59例CSF细胞学检查均找到癌细胞。结论 MC的临床表现具有一定的特征,确诊依赖于CSF细胞学检查找到癌细胞。     

脑膜癌病的临床和脑脊液细胞学特征

目的探讨脑膜癌病的临床和脑脊液细胞学特征。方法回顾性分析44例确诊为脑膜癌病患者的临床、影像学及脑脊液资料。结果本组临床表现为头痛、背痛31例,脑神经损害18例,脑膜刺激征25例。头颅MRI增强扫描显示软脑膜弥漫性异常增强3例：脑脊液压力增高32例,细胞数增多41例,以激活型单核细胞和淋巴细胞为主;44例脑脊液细胞学检查均发现肿瘤细胞,5例为颅内原发肿瘤,其余39例颅外转移肿瘤细胞学分类为腺癌33例、恶性淋巴瘤3例、小细胞未分化癌2例及鳞癌1例：结论脑膜癌病的临床表现及影像学检查缺乏特异性,脑脊液细胞学检查是诊断脑膜癌病的可靠依据。     

脑膜癌病（附12例报告）

目的：分析脑脊液细胞学检查对脑膜癌病的诊断价值。方法：描述了１２例脑膜癌病患者的临床表现,辅助检查及确诊依据。结果：１２例脑膜癌病临床表现多样,主要表现为颅内高压和脑膜刺激征。颅脑ＣＴ和ＭＲＩ多正常。脑脊液细胞学检查发现肿瘤细胞,异常细胞成簇排列,其胞体形态多变,核浆比例增大,胞浆呈嗜碱性,胞核形态不规则,核仁增多,核染色质浓染。常见有丝分裂等恶性肿瘤细胞固有特点。结论：脑脊液细胞学检查发现癌细胞     

脑膜癌病68例脑脊液细胞学分析

目的探讨脑脊液检查对诊断脑膜癌病的重要意义。方法对68例确证的脑膜癌病患者临床资料进行回顾性分析。结果本组患者主要临床表现为头痛、恶心呕吐,脑膜刺激征等;仅15例患者的头部MRI增强扫描显示脑膜异常强化;脑脊液压力均增高,细胞数增多45例,常呈中-重度增加,并以激活型单核细胞增加为主,68例患者在脑脊液中均发现肿瘤细胞。结论脑膜癌病的临床表现及影像学缺乏特异性,脑脊液检查尤其是细胞学检查是诊断该病的可靠依据,而进行多次脑脊液细胞学检查可提高诊断准确率。     

脑膜癌病（附45例分析）

报告３４例脑脊液细胞学和１１例尸解确诊的脑膜癌病，转移性４２例，原发性３例。主要病变累及软脑膜、颅神经及脊神经根。主要表现为逐渐加重的头痛、呕吐、脑膜刺激征持续存在，颅神经麻痹及双下肢无力，腱反射减弱或消失。无脑实质病变的局灶定位体征。脑普液学以压力进行性升高和找到大量癌细胞为特点，并提出了本病的诊断要点及需注意的问题。     

脑膜癌病20例临床分析

目的:探讨脑膜癌病的临床特点及脑脊液细胞学改变。方法:对1998年9月到2004年12月收治的20例 经脑脊液细胞学证实的脑膜癌病患者的临床资料进行回顾性分析。结果:首发症状多以头痛、呕吐为主,可伴脑神经和 脊神经损害及脑膜刺激征;脑脊液检查颅内压均不同程度增高,另外还可表现细胞数、蛋白升高,糖、氯化物下降;细胞学 检查均发现癌细胞,其中有四例经丫啶橙荧光染色结果阳性。结论:脑脊液细胞学检查发现癌细胞是诊断脑膜癌病的重 要依据。     

脑膜癌病的临床观察

目的探讨脑膜癌病的临床特点及诊断方法。方法回顾性分析13例确诊为脑膜癌病的患者的临床资料,结合文献进行分析讨论。结果13例脑脊液中均查到癌细胞。结论脑膜癌病是中枢神经系统恶性转移肿瘤,临床多以进行性加重的高颅压表现为首发症状,多累及脑膜、颅神经,头颅MRI增强扫描对早期诊断有重要作用,反复的脑脊液细胞学检查是确诊的重要手段。     

脑膜癌病的临床特点及脑脊液检查对其诊断的重要意义

目的探讨脑脊液检查对诊断脑膜癌病的重要意义。方法对22例脑膜癌病患者临床资料进行回顾性分析。结果22例脑膜癌病患者中男15例,女7例,45岁以下6例,平均年龄(53.21±8.67)岁,临术及病理学诊断11例为肺癌,3例为胃癌,2例乳腺癌,1例为恶性淋巴瘤,5例来源未明。结论脑膜癌病为恶性肿瘤颅内转移的特殊形式,多以头痛为首发症状,脑脊液细胞学检查找到癌细胞是诊断脑膜癌病的金标准,多次复查细胞学有助于早期确诊。     

结核性脑膜脑炎脑脊液细胞学动态分析及其诊断价值

目的探讨脑脊液细胞学特点在结核性脑膜脑炎临床诊断中的价值。方法运用玻片细胞沉淀（粟秀初教授研制）细胞学方法,对72例结核性脑膜脑炎患者的脑脊液细胞学分类特点进行动态观察与分析,以评估治疗效果。结果结核性脑膜脑炎患者脑脊液白细胞总数升高。早期嗜中性粒细胞增高,随后呈混合型细胞反应,随着病情的好转,嗜中性粒细胞逐渐消失,以淋巴、单核细胞为主。结论脑脊液细胞学检查操作简便,结果确切,有一定特异性,对结核性脑膜脑炎的临床诊断具有辅助价值。     

37例培养阳性结核性脑膜脑炎脑脊液细胞学动态分析

目的探讨脑脊液结核分枝杆菌培养阳性结核性脑膜炎脑脊液细胞学特点。方法运用玻片细胞沉淀(粟秀初教授研制)细胞学方法,对37例使用Bactec MGIT 960培养阳性结核性脑膜炎患者的脑脊液细胞学分类特点进行动态观察与分析。结果结核性脑膜脑炎患者脑脊液白细胞总数升高,但有4例患者脑脊液白细胞数小于50×106/L。多数确诊结核性脑膜炎患者脑脊液呈混合型细胞反应,有33例(89.2%)患者脑脊液中检测到中性粒细胞,25例(67.6%)患者脑脊液中检测到浆细胞。但多数患者脑脊液(60%)以淋巴细胞为主,少量(1/3)以中性粒细胞为主。且几乎所有患者脑脊液内均可以检测到浆细胞的存在。结论确诊结核性脑膜炎患者的脑脊液白细胞数明显增高,脑脊液细胞分类主要表现为淋巴细胞为主型,少部分为中性粒细胞为主型。     

脑脊液中免疫球蛋白及腺苷脱氨酶测定对三种脑膜炎的诊断价值

目的 对不同病因的脑膜炎患者的脑脊液(CSF)中的免疫球蛋白(Ig)各组及腺苷脱氨酶(ADA)含量进行分析。方法 选取3组脑膜炎患者的CSF标本32份,对其中的Ig成分及ADA的含量进行测定。结果 结脑患者的CGF中ADA含量显著升高,IgG显著增高(P<0.01);化脑患者CGF中IgG显著增高(P<0.01),ADA无显著性变化;病脑患者CSF中Ig、ADA均没有显著性变化。结论 对脑膜炎患者CSF中Ig各组分及ADA含量的联合测定对病因的鉴别诊断具有很高的应用价值。     

Spinal arachnoiditis due to aspergillus meningitis in a previously healthy patient

Summary A 30-year-old, previously healthy, non-addicted man presented with a chronic spinal meningitis complicated by arachnoiditis and spinal cord compression. Biopsy showed a chronic granulomatous leptomeningitis, in which some cells contained branching septate organisms that were immunostained with an antiserum to Aspergillus fumigatus. Precipitins to A. fumigatus were detected in cerebrospinal fluid (CSF), but not in blood, and aspergillus infection was apparently restricted to the leptomeninges. Clinically successful treatment led to the disappearance of CSF precipitins and oligoclonal bands.     

真菌性脑膜炎继发癫临床研究

对10例真菌性脑膜炎继发癫患者的临床表现,以及脑脊液、影像学和脑电图特点进行回顾分析,提示真菌性脑膜炎累及大脑皮质者易继发癫,尤其是影像学检查发现额颞叶病灶、脑电图呈中至重度异常的患者更易诱发癫发作。真菌性脑膜炎患者脑脊液内毒素和(1-3)-β-D葡聚糖水平均升高,是否与继发癫相关尚待进一步观察。     

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 neoformans (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. Received: 29 May 1997 Received in revised: 1 November 1997 Accepted: 20 March 1998     

Increased intrathecal synthesis of fibronectin in bacterial and carcinomatous meningitis

Immunoreactive fibronectin (Fn) was quantified in paired cerebrospinal fluid (CSF) and serum samples from patients with bacterial meningitis (n = 46), tick-borne encephalitis (TBE) (n = 6), HIV infection (n = 6), Guillain-Barré syndrome (n = 5), carcinomatous meningitis (n = 11), multiple sclerosis (n = 15), disk disease (n = 11), and controls (n = 28). A highly significant elevation of CSF Fn was found in bacterial meningitis, TBE, and carcinomatous meningitis. There were no significant differences in serum Fn between any of the groups. An Fn index to estimate the rate of intrathecal Fn synthesis reached the highest value in bacterial meningitis. Our findings suggest that CSF Fn may be an indicator of adequate host reaction and tissue repair. For diagnostic purposes, the determination of CSF Fn probably does not add much to routine CSF laboratory tests.     

Clinical utility of the FilmArray meningitis/encephalitis panel in children at a tertiary center in South Korea

BackgroundWe retrospectively evaluated the pathogens in the cerebrospinal fluid (CSF) of pediatric meningitis/encephalitis (M/E) by FilmArray meningitis/encephalitis panel (FA-MEP), and the characteristics of children showing positive and negative FA-MEP results.MethodFA-MEP along with conventional tests (bacterial/viral cultures, and polymerase chain reaction tests) was performed in children who presented symptoms of M/E. Clinical and laboratory data were reviewed to evaluate the characteristics of children with pathogens detected by FA-MEP.ResultsThe CSF specimens from 110 pediatric M/E patients were enrolled. Mean age of the patients was 5.9 ± 5.2 years. Overall positive rate of FA-MEP was 46.4% (51/110). The pathogens detected in the patients were enterovirus (23/51, 45.1%), parechovirus (10/51, 19.6%), S. pneumoniae (7/51, 13.7%), human herpesvirus type 6 (6/51, 11.8%), S. agalactiae (3/51, 5.9%), herpes simplex virus type 2 (1/51, 2.0%), and E. coli (1/51, 2.0%). Aseptic meningitis (OR, 3.24, 95% CI, 1.18–12.73) and a duration of <2 days from onset of symptoms to CSF test (OR, 3.56, 95% CI, 0.1–0.91) significantly contributed to detection of pathogens by the FA-MEP. Among the 14 children who were administered empiric antibiotics before the CSF test, the detection rate was significantly higher in the FA-MEP than in the conventional test (28.6 vs. 0.0%, p = 0.031).ConclusionsFA-MEP had a higher detection rate in children with M/E compared with conventional tests, particularly aseptic meningitis, and in case of shorter duration of time-to-test. This test was more effective than the conventional test in pediatric M/E patients that had been administered empiric antibiotics.     

Activin A concentrations in human cerebrospinal fluid are age-dependent and elevated in meningitis

OBJECTIVE: Activin A, and its binding protein, follistatin (FS), are expressed in the central nervous system (CNS). We have previously shown elevated concentrations of FS in the cerebrospinal fluid (CSF) of patients with meningitis and increased concentrations of activin A in the CSF of rabbits with bacterial meningitis. METHODS: We measured CSF and serum concentrations of activin A and FS in normal subjects and in patients with various neurological diseases using previously validated immunoassays specific for activin A or FS. RESULTS: In healthy persons, serum concentrations of both activin A and FS were age-dependent. In CSF, concentrations of activin A ranged from 0.03 to 0.33 ng/ml and were strongly correlated with age in both sexes, whereas FS CSF concentrations were below the assay detection limit in most of the patients. Activin A concentrations in CSF of patients with various neurological diseases, including meningitis, chronic inflammatory CNS diseases, neurodegenerative diseases, tumors in the CNS, cerebral ischemia, intracerebral/subarachnoid hemorrhages, subdural hemorrhages and epileptic seizures, were compared with age- and sex-matched control patients. The comparisons revealed significantly elevated concentrations of activin A in patients with meningitis (P=0.017). Serum concentrations of activin A or FS were not affected by any of the neurological diseases examined. CONCLUSIONS: Our results show for the first time that in normal subjects concentrations of activin A in CSF are correlated with age, and furthermore, that activin A CSF concentrations are elevated in patients with meningitis. The latter underlines a role for activin A in acute inflammatory processes within the CNS.     

DNA single cell cytometry in lymphocytic pleocytosis of the cerebrospinal fluid

The value of DNA single-cell cytometry for the detection of neoplasia in Feulgen-stained cerebrospinal fluid cytological specimens was tested on 34 cases of Non-Hodgkin's lymphoma or leukemia and on 66 cases of viral or bacterial meningitis as a disease control group. The DNA content of 200 randomly chosen nuclei was measured on one pre-existing, cytologically representative slide per case, using a TV-image analysis system TAS-plus (Leitz, Germany). Neoplasia was diagnosed, if at least three nuclei with a DNA content above 5c (5cEE3) were found. The sensitivity investigating only one slide per case was 79.4% (27/34), the specificity 78.8% (52/66). Three lymphomas and 7 inflammatory cases were classified as suspicious (0<5cEE<3). In 4 lymphoma cases (11.8%) a false-negative diagnosis and in 7 cases (10.6%) of viral meningitis a false-positive diagnosis were made. No false-positive diagnosis occurred in bacterial meningitis. While the false-negative diagnoses may be due to the only slightly increased number of cells in cerebrospinal fluid, no final explanation for increased DNA values after viral infection can be given. Therefore, before using DNA single-cell cytometry to proove the malignant character of lymphocytic pleocytosis in cerebrospinal fluid, viral meningitis has to be clinically excluded.