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We report the case of a 40-year-old male HIV-negative renal transplant patient with allograft rejection and immunosuppressive therapy who presented with acute cytomegalovirus (CMV) encephalitis. CT and MRI of the brain were normal but EEG showed diffuse slowing and dysrhythmia. In cerebrospinal fluid (CSF) initially 81 cells/microliters were found and immunocytochemistry showed a decreased CD4/CD8 ratio and increased values of activated lymphocytes, natural killer cells and immunoglobulin-containing cells. CMV-specific IgM antibodies in CSF and serum, immunostaining of CMV antigen in CSF cells and virus culture from CSF and urine were negative. During the first 3 weeks of illness no intrathecal production of immunoglobulins could be detected. Early diagnosis of CMV encephalitis was made by in situ hybridization (ISH) on CSF cell preparations and the polymerase chain reaction (PCR) which was positive in CSF and blood. On day 26 diagnosis was confirmed by detection of CMV-specific intrathecal IgG production. The patient was treated with ganciclovir, anti-CMV immunoglobulins and intrathecal beta interferon. He recovered completely after 2 months. Our data demonstrate the usefulness of ISH and PCR in the early diagnosis of CMV encephalitis and perhaps may encourage the use of intrathecal beta interferon in other patients with this disease.

Mononuclear cell subsets in cerebrospinal fluid (CSF) and peripheral blood (PB) were monitored during the clinical course in 23 patients with acute meningitis using 6 monoclonal antibodies. Significant differences between aseptic and bacterial meningitis mainly consisted of a higher percentage of OKT4-positive cells in PB in the acute phase of bacterial meningitis. Significant differences between CSF and PB are found in the amount of most cell subtypes at all times except the acute phase of bacterial meningitis. The OKT4/OKT8 ratio was always significantly higher in CSF and correlated with the acuity of inflammation in bacterial meningitis.

Patients with dementia of the Alzheimer type (DAT) have been studied with many brain imaging procedures. The results demonstrated the superiority of Positron Emission Tomography (PET) over structural imaging in the separation of DAT patients and controls. The P 300 being another functional parameter is also reported to be highly specific and sensitive in dementia.We present the preliminary results of an ongoing 2-year-prospective study. The first 17 consecutive patients (13 females, 4 males; mean age 66, range 52-76 years) with probable Alzheimer's disease using NINCDS-ADRDA criteria were examined. Based upon the 7-point Global Deterioration Scale (GDS), the severity ranged from mild to moderate (GDS 3-6). The regional cerebral glucose metabolism (rCMRGlu) was studied with 18 F-2-fluoro-2-deoxyglucose and PET. Standardized regional quantitation was achieved using an interactive mapping program. The P 300 was elicited within a two-tone auditory "oddball" paradigm according to Maurer et al. using a Biologic Brain Atlas System III. Two identical runs were presented. Amplitude, latency and spatial distribution of P 300 were analyzed in comparison with an age matched control group.16 patients showed a pattern of rCMRGlu which is supposed to be typical for Alzheimer's disease: a predominantly regional hypometabolism in the posterior parietal and temporal cortex. In one patient there was the main decrease of glucose utilization in the frontal association area. The overall reduction of global metabolism was 9%. The P 300 showed a considerable variability of all parameters not only inter-but also intraindividually regardless of the severity of the dementia. A possible explanation for the discrepancy of PET and P 300 might be the influence of the affective state of the patients (anxiety, tension, uneasiness) on the P 300 component.

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