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Summary of cerebrospinal fluid routine parameters in neurodegenerative diseases.

Jesse S, Brettschneider J, Süssmuth SD, Landwehrmeyer BG, von Arnim CA, Ludolph AC, Tumani H, Otto M - J. Neurol. (2010)

Bottom Line: Mildly elevated Q (alb) were found in a small percentage of nearly all subgroups and in a higher proportion of patients with PSP, MSA, VD, PDD, and MND.With the exception of 1 MND patient, no intrathecal Ig synthesis was observed.Extensive elevation of routine parameters is not characteristic and should encourage a re-evaluation of the clinical diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Ulm, Steinhövelstr. 1, 89075, Ulm, Germany. sarah.jesse@uni-ulm.de

ABSTRACT
In neurodegenerative diseases, cerebrospinal fluid analysis (CSF) is predominantly performed to exclude inflammatory diseases and to perform a risk assessment in dementive disorders by measurement of tau proteins and amyloid beta peptides. However, large scale data on basic findings of CSF routine parameters are generally lacking. The objective of the study was to define a normal reference spectrum of routine CSF parameters in neurodegenerative diseases. Routine CSF parameters (white cell count, lactate and albumin concentrations, CSF/serum quotients of albumin (Q (alb)), IgG, IgA, IgM, and oligoclonal IgG bands (OCB)) were retrospectively analyzed in an academic research setting. A total of 765 patients (Alzheimer's disease (AD), Parkinson's disease (PD), Parkinson's disease dementia (PDD), vascular dementia (VD), frontotemporal lobar degeneration (FTLD), progressive supranuclear palsy (PSP), multisystem atrophy (MSA), motor neuron diseases (MND), spinocerebellar ataxia (SCA), Huntington's disease (HD)) and non-demented control groups including a group of patients with muscular disorders (MD). The main outcome measures included statistical analyses of routine CSF parameters. Mildly elevated Q (alb) were found in a small percentage of nearly all subgroups and in a higher proportion of patients with PSP, MSA, VD, PDD, and MND. With the exception of 1 MND patient, no intrathecal Ig synthesis was observed. Isolated OCBs in CSF were sometimes found in patients with neurodegenerative diseases without elevated cell counts; lactate levels were always normal. A slightly elevated Q (alb) was observed in a subgroup of patients with neurodegenerative diseases and does not exclude the diagnosis. Extensive elevation of routine parameters is not characteristic and should encourage a re-evaluation of the clinical diagnosis.

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Related in: MedlinePlus

Illustration of age-related Qalb. CSF–blood barrier (dys-) function of all groups are indicated on the basis of Qdiff that represents the age-dependant CSF–blood barrier function according to Qdiff = Qalb − Qalb* (with Qalb* = (4 + age in years)/15) × 10−3). The box represents the 25th to 75th quartile, whiskers represent the range, the vertical line in the boxes shows the median and circles depict outliers. The numbers of patients correspond to the numbers given in Table 1
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Fig2: Illustration of age-related Qalb. CSF–blood barrier (dys-) function of all groups are indicated on the basis of Qdiff that represents the age-dependant CSF–blood barrier function according to Qdiff = Qalb − Qalb* (with Qalb* = (4 + age in years)/15) × 10−3). The box represents the 25th to 75th quartile, whiskers represent the range, the vertical line in the boxes shows the median and circles depict outliers. The numbers of patients correspond to the numbers given in Table 1

Mentions: Concerning dysfunction of the CSF–blood barrier, reasons for all outliers were detected. Here, osteodegenerative diseases with stenosis of the spinal canal could often traced back to the herniation of a lumbar intervertebral disk or to a scoliosis as a frequent cause for elevated Qalb values (as seen in 1 PD patient, 1 patient among the persons with MSA-P, 2 patients in the MSA-C group, 2 AD patients as well as in 1 PDD patient, 1 HD diseased person, 1 MD patient, and 1 patient of the CON group). Besides degenerative processes of the spine, metabolic dysfunctions related to insufficiently treated diabetes with severe diabetic vasculo- and neuropathy were additional causes for the elevated QAlbvalues as detected in 1 FTLD patient. For detailed information, see Fig. 2 and Online Resource Table 2.Fig. 2


Summary of cerebrospinal fluid routine parameters in neurodegenerative diseases.

Jesse S, Brettschneider J, Süssmuth SD, Landwehrmeyer BG, von Arnim CA, Ludolph AC, Tumani H, Otto M - J. Neurol. (2010)

Illustration of age-related Qalb. CSF–blood barrier (dys-) function of all groups are indicated on the basis of Qdiff that represents the age-dependant CSF–blood barrier function according to Qdiff = Qalb − Qalb* (with Qalb* = (4 + age in years)/15) × 10−3). The box represents the 25th to 75th quartile, whiskers represent the range, the vertical line in the boxes shows the median and circles depict outliers. The numbers of patients correspond to the numbers given in Table 1
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3101362&req=5

Fig2: Illustration of age-related Qalb. CSF–blood barrier (dys-) function of all groups are indicated on the basis of Qdiff that represents the age-dependant CSF–blood barrier function according to Qdiff = Qalb − Qalb* (with Qalb* = (4 + age in years)/15) × 10−3). The box represents the 25th to 75th quartile, whiskers represent the range, the vertical line in the boxes shows the median and circles depict outliers. The numbers of patients correspond to the numbers given in Table 1
Mentions: Concerning dysfunction of the CSF–blood barrier, reasons for all outliers were detected. Here, osteodegenerative diseases with stenosis of the spinal canal could often traced back to the herniation of a lumbar intervertebral disk or to a scoliosis as a frequent cause for elevated Qalb values (as seen in 1 PD patient, 1 patient among the persons with MSA-P, 2 patients in the MSA-C group, 2 AD patients as well as in 1 PDD patient, 1 HD diseased person, 1 MD patient, and 1 patient of the CON group). Besides degenerative processes of the spine, metabolic dysfunctions related to insufficiently treated diabetes with severe diabetic vasculo- and neuropathy were additional causes for the elevated QAlbvalues as detected in 1 FTLD patient. For detailed information, see Fig. 2 and Online Resource Table 2.Fig. 2

Bottom Line: Mildly elevated Q (alb) were found in a small percentage of nearly all subgroups and in a higher proportion of patients with PSP, MSA, VD, PDD, and MND.With the exception of 1 MND patient, no intrathecal Ig synthesis was observed.Extensive elevation of routine parameters is not characteristic and should encourage a re-evaluation of the clinical diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, University of Ulm, Steinhövelstr. 1, 89075, Ulm, Germany. sarah.jesse@uni-ulm.de

ABSTRACT
In neurodegenerative diseases, cerebrospinal fluid analysis (CSF) is predominantly performed to exclude inflammatory diseases and to perform a risk assessment in dementive disorders by measurement of tau proteins and amyloid beta peptides. However, large scale data on basic findings of CSF routine parameters are generally lacking. The objective of the study was to define a normal reference spectrum of routine CSF parameters in neurodegenerative diseases. Routine CSF parameters (white cell count, lactate and albumin concentrations, CSF/serum quotients of albumin (Q (alb)), IgG, IgA, IgM, and oligoclonal IgG bands (OCB)) were retrospectively analyzed in an academic research setting. A total of 765 patients (Alzheimer's disease (AD), Parkinson's disease (PD), Parkinson's disease dementia (PDD), vascular dementia (VD), frontotemporal lobar degeneration (FTLD), progressive supranuclear palsy (PSP), multisystem atrophy (MSA), motor neuron diseases (MND), spinocerebellar ataxia (SCA), Huntington's disease (HD)) and non-demented control groups including a group of patients with muscular disorders (MD). The main outcome measures included statistical analyses of routine CSF parameters. Mildly elevated Q (alb) were found in a small percentage of nearly all subgroups and in a higher proportion of patients with PSP, MSA, VD, PDD, and MND. With the exception of 1 MND patient, no intrathecal Ig synthesis was observed. Isolated OCBs in CSF were sometimes found in patients with neurodegenerative diseases without elevated cell counts; lactate levels were always normal. A slightly elevated Q (alb) was observed in a subgroup of patients with neurodegenerative diseases and does not exclude the diagnosis. Extensive elevation of routine parameters is not characteristic and should encourage a re-evaluation of the clinical diagnosis.

Show MeSH
Related in: MedlinePlus