Cerebrospinal fluid (CSF) lymphocytes from two patients with tuberculous meningitis proliferated stronger than the corresponding peripheral blood lymphocytes (PBL) when stimulated with tuberculin purified protein derivative (PPD) in the lymphocyte transformation test after 3 days of culture. This might indicate an accumulation of specifically primed lymphocytes within the central nervous system. CSF lymphocytes and PBL from nine of ten patients with acute aseptic meningitis investigated as controls showed no or low responses when stimulated with PPD, whereas the remaining patient displayed a significant proliferation of CSF lymphocytes, which was more pronounced than that of PBL. Stimulation with the mitogens phytohaemagglutinin, concanavalin A, and pokeweek mitogen gave lower proliferation of CSF lymphocytes compared with PBL in tuberculous and aseptic meningitis. Evaluation of the proliferative response of CSF lymphocytes compared with PBL on stimulation with PPD might be a useful complement in the diagnosis of tuberculous meningitis.

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Thin-layer polyacrylamide gel isoelectric focusing of cerebrospinal fluid (CSF) and serum obtained from one patient 48 and 65 days after the onset of tuberculous meningitis revealed five oligoclonal immunoglobulin zones in CSF without any counterpart in serum, indicating local immunoglobulin production. Subsequent immunofixation with specific antisera revealed that three of the zones consisted of immunoglobulin G lambda present simultaneously. Immunofixation with Mycobacterium tuberculosis and bacillus Calmette-Guérin (BCG) as antigens and autoradiography revealed zones of specific antibodies in the CSF which, regarding mobility, corresponded to oligoclonal and polyclonal CSF immunoglobulin G zones. No antibody activity was detectable in the corresponding serum, indicating that the antibodies present in CSF were synthesized within the central nervous system. In seven control patients (three with multiple sclerosis, four with chronic inflammatory central nervous system diseases of unknown cause) with oligoclonal CSF immunoglobulin, no evidence for local production of antibodies against M. tuberculosis or BCG was detectable. Immunofixation with M. tuberculosis or BCG as antigens and autoradiography may prove to be a useful diagnostic complement to conventional techniques in patients with suspected tuberculous meningitis.

A longitudinal study of multiple paired CSF and serum specimens from a patient with CNS sarcoidosis revealed high CSF IgM and IgG indices as well as oligoclonal IgM and IgG bands in CSF reflecting intrathecal IgM and IgG production. The antibody specificity of intrathecally-produced IgM and IgG remained undefined despite analysis for antibodies against mycobacterium tuberculosis and Kveim suspension. Steroid treatment induced rapid and complete clinical remission, and also decrease of CSF IgM and IgG antibodies, while oligoclonal IgM and IgG persisted in CSF. Repeated determinations of these CSF variables together with cell count and CSF/serum albumin ratio as a variable of blood-brain barrier function, might be useful in assessing effect of therapy in CNS sarcoidosis.

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