Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry

Abstract

REVIEWCerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases. Diagnostic patterns not to be missed in neurology and psychiatry Liquido cefalorraquidiano: compilação dos dados e interpretação avançada de doenças bacterianas, virais, parasitarias, oncológicas, inflamatórias cronicas e desmielinizantes. Padrões diagnósticos que não devem faltar em neurologia e psiquiatria Hansotto ReiberGeorg August-University, Former Neurochemistry Laboratory, Goettingen, Germany. AbstrACtThe analysis of intrathecal IgG, IgA and IgM synthesis in cerebrospinal fluid (CSF) and evaluation in combined quotient diagrams provides disease-related patterns. The compilation with complementary parameters (barrier function, i.e., CSF flow rate, cytology, lactate, antibodies) in a cumulative CSF data report allows a knowledge-based interpretation and provides analytical and medical plausibility for the quality assessment in CSF laboratories. The diagnostic relevance is described for neurological and psychiatric diseases, for which CSF analysis can't be replaced by other diagnostic methods without loss of information. Dominance of intrathecal IgM, IgA or three class immune responses give a systematic approach for Facial nerve palsy, Neurotrypanosomiasis, Opportunistic diseases, lymphoma, Neurotuberculosis, Adrenoleucodystrophy or tumor metastases. Particular applications consider the diagnostic power of the polyspecific antibody response (MRZ-antibodies) in multiple sclerosis, a CSF-related systematic view on differential diagnostic of psychiatric diseases and the dynamics of brain-derived compared to blood-derived molecules in CSF for localization of paracytes.Keywords: cerebrospinal fluid; immunoglobulins; antibody; nervous system diseases; clinical record. resumo A análise da síntese intratecal de IgG, IgA e IgM no liquido cefalorraquidiano (LCR) e a avaliação destas em diagramas com quocientes sugere padrões de diversas doenças. Estes dados, juntamente com outros parâmetros como a função de barreira, o fluxo liquórico, a citologia, o lactato e a pesquisa de anticorpos, integrados em uma ficha de paciente, permite uma interpretação baseada em conhecimento e permite também uma aferição da qualidade em laboratórios de LCR. A relevância diagnóstica é descrita para doenças neurológicas e psiquiátricas pois a análise do LCR não pode ser substituída por outros metódos diagnósticos sem perda de informação para o diagnóstico do paciente. O aumento da síntese intratecal de IgM, IgA ou das 3 classes de imunoglobulinas sugerem um diagnóstico sistemático de paralisia facial periférica, neurotripanosomiase, doenças oportunísticas, linfoma, neurotuberculose, adrenoleucodistrofia ou metástases de tumores cerebrais. A resposta poliespecífica de anticorpos contra sarampo, rubéola e varicela zoster (MRZ reação) é sugestiva de esclerose múltipla. Uma visão sistemática considera o diagnóstico diferencial de doenças psiquiátricas e doenças chrônicas. A...

Knowledge-base for interpretation of cerebrospinal fluid data patterns. Essentials in neurology and psychiatry

“…Due to the particular relevance of IgM as part of the immunoglobulin synthesis pattern in CSF 1,4 its analysis deserves a particular consideration.…”

“…But the complete immunoglobulin class analysis (IgG, IgA, IgM) with disease-related patterns can provide an earlier and safer diagnosis 1 and it is also the base for a general quality assessment in the CSF laboratory. The knowledge about the different dynamics of blood-and brain-derived molecules or leptomeningeal proteins in CSF 8,9,10 supports basic research allowing to identify the source of molecules in CSF 11,12 or provides a new perspective for fast localization of the paracytes in tropical diseases 1 …”

“…For the construction of the diagrams as part of the individual CSF data report several professional solutions are available 1,19,20 . The solution for the individual personal computer is the free software of www.albaum.it…”

Liquordiagnostik in Deutschland nach 1950

“…Die Diskussion über Relevanz oder Spezifität eines neuen Markers ignoriert aber meist den Bezug auf eine hinreichende, komplette Liquoranalytik [11], was dann meist zu einer Überschätzung seiner Relevanz führte. Auch in der Entwicklung…”

Estimation of intrathecal IgG synthesis: simulation of the risk of underestimation

“…Changes in serum albumin level, in association with PLEX, poor physiological condition or chronic infection do not modify Q Alb. 12, 13 …”