动态脑脊液细胞学检查在诊断中枢神经系统感染中的价值

【目的】探讨动态脑脊液细胞学检查在诊断中枢神经系统感染中的临床价值。【方法】将本院收治的中枢神经系统感染性疾病患者分别在入院时、1周、2周行脑脊液细胞学检查,对确诊的52例结核性脑膜炎,187例病毒性脑炎和21例化脓性脑膜炎患者的脑脊液细胞学检查进行对比,观察不同感染脑脊液细胞学变化的动态特征。【结果】结核性脑膜炎脑脊液细胞学表现主要是中性粒细胞、淋巴细胞、激活淋巴细胞、单细胞、激活单核细胞和浆细胞并存的混合型细胞反应,持续时间较长。病毒性脑炎的脑脊液细胞学主要表现为淋巴样细胞反应,短时间内恢复正常。化脓性脑膜炎患者的脑脊液细胞学,早期呈大量嗜中性粒细胞反应,细胞数明显增高,光镜下呈满视野中性粒细胞,可见杆状或分叶核粒细胞,治疗后中性粒细胞急剧下降,粒细胞历时短暂,转为淋巴细胞反应表现。【结论】动态脑脊液细胞学检查在诊断中枢神经系统感染中有重要的价值。     

469例患者异常脑脊液细胞学检查结果分析

目的探讨脑脊液细胞学检查在中枢神经系统感染性疾病的诊断、鉴别诊断及疗效判断的临床价值。方法回顾性分析469例患者异常脑脊液细胞学检查结果。结果 469例患者中,化脓性脑膜炎的患者84例,脑脊液细胞学呈中性粒细胞增多反应,最高可占97.5%;结核性脑膜炎的患者51例,呈中性粒细胞、淋巴细胞、单核细胞等混合细胞增多反应;病毒性脑膜炎的患者295例,呈淋巴细胞增多反应;新型隐球菌脑膜炎3例,脑脊液中检出隐球菌;脑寄生虫脑膜炎23例,以嗜酸性粒细胞增多为主;13例脑囊虫病,未见明显异常。结论脑脊液细胞学检查在中枢神经系统感染性疾病的诊断和鉴别诊断具有重要意义。     

脑脊液常规细胞学检查在患儿中枢神经系统的诊断意义

目的进一步了解中枢神经系统感染患儿脑脊液细胞学的特点及诊断意义。方法我们选择了96例病人标本均采用了常规的脑脊液离心玻片法完成细胞学检查。结果本组73例病毒性脑炎患儿急性期76%患儿脑脊液白细胞增高,而脑脊液细胞学异常为100%,且以淋巴细胞为主,淋巴细胞反应为94%。结论病毒性脑脊液细胞学检查异常率高于常规脑脊液白细胞检查,对病毒性脑膜炎的诊断有着重要意义,化脓性脑膜炎经临床治疗后脑脊液淋巴细胞仍生高的原因主要与感染后自身免疫反应有关。     

CT与磁共振联合诊断中枢神经系统感染的临床应用价值探讨

目的:探讨CT联合磁共振(MRI)诊断中枢神经系统感染的临床价值。方法:选取本院2018年10月至2019年10月收治的114例中枢神经系统感染患者为研究对象,给予CT联合MRI诊断,分别与单一方式诊断比较。以脑脊液病细胞学检查结果为金标准,比较不同检查方式的诊断符合率。结果:脑脊液病细胞学检查结果证实,114例中枢神经系统感染患者中有55例为病毒性脑炎,26例为结核性脑膜炎,15例为脑囊虫病,10例为化脓性脑膜炎,8例为隐球酵母菌脑膜炎。与脑脊液病细胞学检查结果相比,CT和MRI联合诊断符合率为(97.37%),明显高于单纯的CT诊断(77.19%)和MRI诊断(78.95%)(P<0.05)。结论:CT与MRI联合诊断中枢神经系统感染疾病的诊断符合率较高,可清晰显示颅脑各组织病理改变情况,对临床制定诊疗计划具有重要指导作用。     

玻片离心沉淀法脑脊液细胞学检查在小儿中枢神经系统感染性疾病中的诊断价值

目的探讨玻片离心沉淀法脑脊液细胞学检查在小儿中枢神经系统感染性疾病诊断中的应用价值。方法选择2015年5月—2019年5月于湖南省儿童医院住院治疗的185例中枢神经系统感染性疾病患儿作为研究对象,根据疾病类型分为化脓性脑膜炎组62例,病毒性脑膜炎组62例,结核性脑膜炎组61例。3组患儿入院后腰椎穿刺取1 mL脑脊液,各取0.5 mL分别采用玻片离心沉淀法及常规细胞计数法观察脑脊液中细胞形态并对异常细胞进行计数和比较,同时统计玻片离心沉淀法观察到的各组患儿脑脊液细胞学分类检查结果。另选60例经检查无中枢神经系统感染性疾病小儿的脑脊液细胞学分类检查结果进行比较。结果玻片离心沉淀法对3组中枢神经系统感染性疾病患儿脑脊液中异常细胞的检出率均明显高于常规细胞计数法〔化脓性脑膜炎组:100.0%(62/62)比72.6%(45/62),病毒性脑膜炎组:100%(62/62)比33.9%(21/62),结核性脑膜炎组:100%(61/61)比21.3%(13/61)〕,差异均有统计学意义(均P0.05)。化脓性脑膜炎患儿脑脊液中嗜中性粒细胞明显增多,而淋巴样细胞未见明显增多;病毒性脑膜炎患儿脑脊液中小淋巴细胞所占比例最高;结核性脑膜炎患儿脑脊液异常细胞特点是淋巴细胞为主的混合细胞学反应。结论玻片离心沉淀法检查脑脊液细胞成分可以更好地分辨出各类脑脊液异常细胞,对于感染类型的辨别具有重要的临床价值,对临床诊断小儿中枢神经系统感染性疾病具有指导意义。     

120例手足口病患者的脑脊液细胞学观察

目的探讨脑脊液细胞学检查对手足口病并发中枢神经系统感染的诊断价值。方法将脑脊液标本放入离心涂片机涂片后进行瑞氏染色和细胞学计数。结果送检的120例标本中83例有中枢神经系统感染,各个病程有不同的细胞学特点。结论脑脊液细胞学检查对手足口病并发中枢神经系统感染的诊断及治疗有重要价值。     

脑脊液淋巴样细胞与浆细胞检测在小儿中枢神经系统感染诊断中的应用

为了探讨脑脊液细胞学检查方法在中枢神经系统感染性疾病诊断中的价值。方法　用候氏脑脊液细胞学分类新概念对 3 2例结核性脑膜炎 ,85例化脓性脑膜炎 ,3 52例病毒性脑膜炎与 2 0例正常脑脊液的细胞学检查结果进行分析。结果　脑脊液细胞学检查发现淋巴样细胞和浆细胞在结核性脑膜炎和病毒性脑膜炎脑脊液中检出率均较高 ,淋巴样细胞检出率分别为 87 5%和 73 7% ,浆细胞检出率分别为 68 8%和 45 7%。结论　淋巴样细胞和浆细胞检出率较高可能是结核性脑膜炎和病毒性脑膜炎重要的脑脊液细胞学特征之一     

310例重症手足口病人的脑脊液细胞学观察

目的探讨脑脊液细胞学检查对手足口病并发中枢神经系统感染的诊断价值。方法将脑脊波标本放入离心涂片机涂片后进行瑞氏染色和细胞学计数。结果我们发现310例具有有中枢神经系统感染的病人,各个病程有不同的细胞学特点。结论脑脊液细胞学检查对手足口病并发中枢神经系统感染的诊断及治疗有重要价值。     

中枢神经系统感染160例临床分析

目的探讨各类中枢神经系统感染的临床特点及治疗方法。方法对我院收治的中枢神经系统感染160例的临床资料进行回顾性分析。结果本组诊断为病毒性脑炎(病脑)80例,化脓性脑膜炎(化脑)37例,结核性脑膜炎(结脑)35例,隐球菌性脑膜炎(隐脑)8例。全部予甘露醇、甘油果糖脱水降颅压及对症治疗,其中148例治疗有效,复查脑脊液示化脑、病脑患者脑脊液均恢复正常;结脑患者脑脊液明显好转,糖基本恢复正常;隐脑患者脑脊液3次墨汁涂片检查(-),糖、氯化物基本正常,脑脊液真菌培养(-),乳胶凝集试验效价明显下降(1∶8~1∶320)。148例病情好转出院,其中10例遗留颅神经损害和脑积水;12例死亡,病死率7.5%。结论中枢神经系统感染需结合临床表现、脑脊液检查和治疗效果综合进行诊断,对疑似中枢神经系统感染但不能确诊者,可予诊断性治疗,以免延误最佳治疗时机。     

急性病毒性脑炎和脑膜炎的脑脊液细胞学检查

脑脊液细胞学检查是中枢神经系统疾病检查手段之一,具有简易、快捷的特点.急性病毒性脑炎和脑膜炎患者的脑脊液中,早期可出现一过性中性粒细胞增多,以后主要以淋巴细胞为主,形成典型淋巴样细胞反应的脑脊液细胞学改变.淋巴细胞中又以激活型为主,可出现一些特殊形态学特征,如有丝分裂、双核细胞、Bussell小体及浆细胞中的桑椹体,具有一定的诊断价值.同时因应用玻片离心法收集脑脊液细胞,浓缩了脑脊液,对肿瘤细胞、抗酸杆菌及新型隐球菌等检出率大大提高,对于疾病早期诊断具有重要意义.现将52例急性病毒性脑炎、脑膜炎和18例脑脊液常规检查未见异常的结核性脑膜炎(结脑)患者的脑脊液细胞学检查结果分析如下.     

Lumbar puncture in the emergency department is useful and safe

A 12 month retrospective study was carried out by the Department of Emergency Medicine at Fremantle Hospital to evaluate lumbar puncture in the Emergency Department. Sixty-four patients underwent lumbar puncture in the study period. The main indication was suspicion of central nervous system (CNS) infection. Fifty-three percent of patients had an abnormal cerebrospinal fluid. Diagnoses in order of frequency were viral meningitis, subarachnoid haemorrhage, bacterial meningitis, and viral encephalitis, confirming the importance of this investigation in the diagnosis of CNS infection. No side effects were recorded. With appropriate selection criteria and supervision, lumbar puncture is a safe, simple and valuable investigation in the emergency department.     

Diplopia in a patient with carcinomatous meningitis: a case report and review of the literature

In a patient with a history of malignancy, an isolated neurologic sign or symptom may indicate metastasis to the central nervous system. To exclude this possibility, a lumbar puncture should still be performed after a nondiagnostic cranial computed tomography (CT) scan even in the absence of signs of infection. A case is presented of a 59 year-old man recently diagnosed with non-Hodgkin’s lymphoma that presented to the Emergency Department (ED) with the sole complaint of diplopia. Examination was unremarkable except for a left abducens nerve palsy. Cranial CT scan was normal but initial cerebrospinal fluid results were suggestive of carcinomatous meningitis, and cytology results later confirmed this diagnosis. A review of diplopia and carcinomatous meningitis is presented, along with a suggested conservative diagnostic algorithm for cancer patients presenting with neurologic signs or symptoms.     

Assay for beta-glucuronidase in cerebrospinal fluid: usefulness for the detection of neoplastic meningitis

The specificity and sensitivity of the assay for beta-glucuronidase in cerebrospinal fluid were evaluated to determine the usefulness of this test for the detection of neoplastic meningitis. The enzyme activity was first measured in cerebrospinal fluid from 131 patients with various disorders and was then prospectively measured in cerebrospinal fluid from 30 patients with cytologic results that were positive for or suggestive of malignant disease. Within the first group, elevated levels of beta-glucuronidase were found only among patients with neoplastic processes in the central nervous system, including neoplastic meningitis. Among 26 patients with neoplastic processes in the central nervous system, including neoplastic meningitis. Among 26 patients with positive cytologic results, 13 had elevated beta-glucuronidase activities. Elevated values were more frequent among patients with adenocarcinoma (75%) and myelogenous leukemia (60%). The patients with these two disorders also had the highest enzyme activities. The correlation of th beta-glucuronidase level with other cerebrospinal fluid values, including total protein, glucose content, and cell count, was not significant. The findings of this study indicate that measurement of beta-glucuronidase in cerebrospinal fluid can be used as an adjunctive diagnostic test for neoplastic meningitis. The results should be interpreted with caution, however, because of the possibility that the elevated enzyme levels may be due to acute or subacute bacterial or fungal meningitis.     

STUDIES ON MENINGOCOCCUS INFECTION : V. THE PRESENCE OF MENINGOCOCCUS PRECIPITINOGENS IN THE CEREBROSPINAL FLUID

Precipitin tests, carried out on the cerebrospinal fluid from cases of meningococcal meningitis with monovalent sera, demonstrate the presence in that fluid of type-specific precipitinogens of the meningococcus. Negative results are secured when the spinal fluid is obtained after the commencement of intrathecal serum treatment and also occasionally when the numbers of infecting organisms are very small. The reaction offers an easy and rapid method of ascertaining to which type of meningococcus a particular case of meningitis is due, and facilitates the immediate use of monovalent therapeutic antimeningococcal serum. Typing by means of the precipitin reaction can be confirmed by agglutination of the strain of organism responsible for the infection, if such strain be isolated. Confirmation by means of agglutination has been possible in all the cases discussed in this report. Spinal fluids from other diseases of the meninges and central nervous system fail to give any precipitin reaction with the monovalent sera.     

Pseudallescheria boydii infection of the central nervous system in a cardiac transplant recipient

We have described a cardiac transplant recipient with fatal Pseudallescheria boydii infection of the central nervous system. Unusual features included meningitis without brain abscess and noncommunicating hydrocephalus due to exuberant growth of the organism in the ventricular fluid. Long-term amphotericin B administration may have played a role in the development of this infection.     

Double infection with tick borne encephalitis virus and Borrelia burgdorferi sensu lato

The limited information on co-infection with Borrelia burgdorferi sensu lato and tick-borne encephalitis (TBE) virus was a stimulus for presentation of two patients with well-defined double infection of the central nervous system. TBE virus and B. burgdorferi sensu lato infections are searched for in all patients with lymphocytic meningitis and/or meningoencephalitis admitted to our department. During the last ten years we identified two patients who had ELISA IgM and IgG antibodies to TBE virus in serum and a positive PCR result for TBE virus in cerebrospinal fluid as well as B. burgdorferi sensu lato isolated from cerebrospinal fluid. Intrathecal production of borrelial antibodies was not proven in either of the two patients. These findings show that in patients with acute lymphocytic meningitis originating in regions endemic for Lyme borreliosis and TBE, the possibility of concomitant infection should be considered.     

Levels of three inflammation markers, C-reactive protein, serum amyloid A protein and procalcitonin, in the serum and cerebrospinal fluid of patients with meningitis.

The levels of C-reactive protein (CRP) and serum amyloid A protein (SAA) in blood are increased in patients with inflammatory diseases as acute phase proteins. Most of the presently used indicators of inflammation, such as body temperature, white cell count, erythrocyte sedimentation rate or CRP, are non-specific parameters. In contrast, procalcitonin (PCT) has been reported to be selectively induced by severe bacterial infection during the systemic inflammatory response syndrome (SIRS), and also in sepsis or multiorgan dysfunction syndrome. PCT expression is only slightly induced, if at all, by viral infections, autoimmune disorders, neoplastic diseases and trauma of surgical intervention. We measured the concentrations of CRP, SAA and PCT in the sera and cerebrospinal fluid (CSF) of 30 patients with bacterial, viral, or mycotic meningitis, and 12 patients with a noninflammatory central nervous system disease as controls. An extremely high CRP level in CSF of above 100 microg/L was seen in all seven bacterial meningitis patients and in only 10% of the viral meningitis patients. A high SAA level in CSF of greater than 10 microg/L was observed in all of the bacterial meningitis and mycotic meningitis patients, and in 95% of the viral meningitis patients. Among those with bacterial meningitis, the serum PCT level was more elevated in those with more serious bacterial meningitis. The PCT level in the CSF did not significantly differ among the patients with the three types of meningitis. However, the serum PCT level was very high above 0.1 microg/L in all seven bacterial meningitis patients, especially in the clinically serious cases.     

脑脊液寡克隆区带检测对中枢神经系统疾病的诊断价值

目的 探讨病人脑脊液中出现特异的IgG寡克隆区带对中枢神经系统体液免疫异常性疾病的诊断价值.方法 使用美国海伦娜公司Spife 3000型电泳仪及配套的相关试剂.同时采取517例神经系统疾病患者血清及脑脊液标本,进行等电聚焦加免疫印记金染色电泳.结果 多发性硬化组,脑脊液寡克隆区带阳性率为36.4%;中枢神经系统感染性疾病组,阳性率为43.8%;中枢神经系统非感染组,阳性率为7.1%.结论 进行脑脊液电泳,检查病人是否有典型的寡克隆区带的形成,是中枢神经系统体液免疫异常性疾病早期诊断重要的、必不可少的依据.     

隐球菌荚膜抗原胶体金免疫层析法在非HIV患者隐球菌脑膜炎诊断中的价值

目的探讨隐球菌荚膜抗原胶体金免疫层析法在非HIV患者隐球菌脑膜炎中的诊断价值。方法回顾性分析2013-2018年复旦大学附属华山医院3627例疑似中枢神经系统感染的住院患者的临床资料,收集符合隐球菌脑膜炎初诊的患者214例,分析各检验结果对隐球菌脑膜炎的诊断价值。结果隐球菌脑膜炎患者多数表现为脑脊液糖和氯化物水平显著下降,蛋白含量增高,白细胞增多且以单核细胞为主,脑脊液真菌镜检和培养的阳性率分别为75.23%和78.04%,脑脊液隐球菌胶体金免疫层析法检测阳性率高达100%。隐球菌脑膜炎患者随治疗时间的推移,脑脊液和血的隐球菌荚膜抗原滴度逐渐下降。结论胶体金免疫层析法适用于非HIV患者隐球菌脑膜炎的快速诊断,灵敏度高、特异性强,对隐球菌肺炎的患者能提前筛查是否有中枢神经系统感染,对荚膜抗原的动态监测有助于隐球菌病治疗疗效的观察。