Highly sensitive detection of beta-2 transferrin in rhinorrhea and otorrhea as a marker for cerebrospinal fluid (C.S.F.) leakage

Abstract

As beta-2 transferrin is almost specific to the cerebrospinal fluid, its detection in rhinorrhea or otorrhea fluids demonstrates the occurrence of CSF fistula. We describe a highly sensitive method based on immunoaffinity-mediated capillary blotting for the detection of this cathodic isoform of transferrin in minute amounts (3 microliters) of rhinorrhea or otorrhea fluids. Application of this method in a series of 10 patients with CSF fistula is reported.

The Management of Cerebrospinal Fluid Leaks in Patients at Risk for High-Pressure Hydrocephalus

“…Beta‐2 transferrin is a protein found in CSF, aqueous humor, and perilymph but not in blood or nasal secretions. Detection of β‐2 transferrin, based on standard, reproducible principles of protein electrophoresis and immunofixation, is a noninvasive, reliable chemical marker of CSF leakage 24–28 …”

“…Fluorescein is neurotoxic, and a low concentration–low volume injection is critical to avoid the neurological complications associated with higher concentrations. After intrathecal injection of the fluorescein solution, the CSF leak may be visualized using the nasal endoscope 24–29 . Under the Wood lamp (i.e., black light), fluorescein appears as bright yellow‐green; nonetheless, the yellowish color of fluorescein may be identified without the need for special lighting.…”

Skull base cerebrospinal fluid fistula: a novel detection method based on two‐dimensional electrophoresis

“…10 Among all these tests, determination of h-2 transferrin, a protein present in CSF but not in blood, nasal, or ear secretions, has been reported in the literature as one of the most useful tools in the diagnosis of suspected CSF leakage. 4,11,12 However, the specificity and sensitivity of h-2 transferrin analysis remain unknown. False-positive diagnoses of CSF fistula after h-2 transferrin analysis have been reported in patients suffering from alcoholism, severe liver disease, carbohydrate-deficient glycoprotein syndrome, allelic variant, or other transferrin anomalies.…”

Shunt failure in idiopathic intracranial hypertension presenting with spontaneous cerebrospinal fluid leak

“…31,32 If this test is unavailable, the presence of high glucose and low protein is somewhat reliable, although normal nasal discharge may be falsely positive in many cases. The most accurate study to confirm the presence of CSF is an assay for the presence of b-2 transferrin.…”