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Eine Entzündung des Gehirns, also eine Enzephalitis, kann zu einer Schädigung von Neuronen führen. Sie kann im Rahmen von Autoimmunerkrankungen auftreten und ist in der Frühphase und im weiteren Verlauf schwierig zu diagnostizieren und zu überwachen. Dank hochspezifischer Nachweistechnologie können Bestandteile des Stützskeletts von Neuronen wie das Neurofilament in Liquor, Serum oder Plasma quantifiziert werden. Aus diesem Grund gilt in der modernen Labordiagnostik das Neurofilament als das CRP der Neurologie. [ABSTRACT FROM AUTHOR]

Background: Infection with viruses, bacteria, or other pathogens can lead to inflammation of the meninges. Finding the pathogen and identifying the most common type is necessary for each country. Using multi-locus sequence typing (MLST), the aim of this study was to determine the genetic relationship among isolated from CSF in children with bacterial meningitis.Materials and methods: Fourteen isolates of from CSF in children with bacterial meningitis were included in this study. The seven housekeeping genes, primer, and analysis of the sequencing used in MLST were extracted from PubMLST.Results: The sequencing analysis showed four MLST types in the studied strains. The most frequent type is ST13649 and the least frequent are ST708 and ST285. Conclusion: Finding the bacterial sequence types (ST) enables comparing the ST in different, especially neighbouring, countries.

Detection of autoantibodies against neurons and glia cells has brought about the early and specific diagnosis of autoimmune encephalitis in patients with variable neurological and psychiatric symptoms. Growing knowledge not only resulted in profound changes in treatment algorithms including immunotherapy but also in the understanding of disease mechanisms and etiological factors. The still increasing numbers of new autoantibodies calls for continuous updates on the state of the art in antibody diagnostics, frequencies of associated tumors and the clinical spectrum linked to each antibody, which can range from mood changes, cognitive impairment and epileptic seizures to abnormal movements, autonomic dysfunction and impaired levels of consciousness. This article summarizes the recent developments in the predominant clinical presentations of autoimmune encephalitis patients in imaging and cerebrospinal fluid diagnostics and also in prognostic markers, in the establishment of innovative immunotherapies, in the use of diagnostic pathways even before the results of the antibody tests are available and the understanding of the autoimmune etiology. [ABSTRACT FROM AUTHOR]

Background: A rapid and reliable diagnosis of multiple sclerosis (MS) is crucial to initiate adapted disease-modifying treatment. The 2017 McDonald criteria were revised with the aim of further improving the diagnostic performance. Objective: In this article the published studies comparing the use of the 2017 and 2010 McDonald criteria were reviewed and analyzed in terms of diagnostic performance. Material and methods: A total of 20 studies and 1 review article with a total of 3006 evaluated patients were identified by means of a literature search in the PubMed database (search term: McDonald criteria 2010 and McDonald criteria 2017). Results: Using the 2017 McDonald criteria, a diagnosis of MS was made in more patients (2277/3006 patients, 76%) and in an earlier stage (3–10 months) compared with the 2010 revision (1562/3006 patients, 52%). Of the additional MS diagnoses, 193/715 were due to the adjustment of the imaging criteria of temporal dissemination and 536/715 were due to the introduction of oligoclonal bands as a diagnostic criterion. Conclusion: The revised McDonald criteria of 2017 have achieved their goal and enable the diagnosis of MS in a higher proportion of patients at the first clinical event. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Molecular cerebrospinal fluid (CSF) biomarkers of neurodegenerative diseases are now part of the established diagnostic tools for the clinical investigation of cognitive disorders in the elderly. Biomarkers allow for earlier and more accurate differential diagnosis, and are recommended by the Swiss Memory Clinics as an additional investigation based upon individual indication. Information and counselling are needed both before and after biomarker-supported diagnosis. The procedures for diagnostic lumbar punctures and pre-analytical sample handling should follow published recommendations. The results must be interpreted in the context of the other available history and assessment outcome. Thanks to recent research progress, blood-based biomarkers and other non-invasive markers are expected to become available for clinical practice in the near future. This trend will likely lead to a much broader utilisation of biomarkers and may accelerate the development of effective and individually tailored prevention and treatment approaches. This review article provides an overview over the current state of biomarkers and provides the recommendations of the Swiss Memory Clinics for their use in clinical practice. [ABSTRACT FROM AUTHOR]

Postdural puncture headache (PDPH) is one of the most important complications of peripartum neuraxial analgesia. Loss of cerebrospinal fluid volume and pressure as well as compensatory intracranial vasodilation are assumed to be responsible. Potentially severe long-term sequelae necessitate the correct diagnosis of PDPH, exclusion of relevant differential diagnoses (with atypical symptoms and when indicated via imaging techniques) and rapid initiation of effective treatment. Nonopioid analgesics, caffeine and occasionally theophylline, gabapentin and hydrocortisone are the cornerstones of pharmacological treatment, while the timely placement of an autologous epidural blood patch (EBP) represents the gold standard procedure when symptoms persist despite the use of analgesics. Procedures using neural treatment are promising alternatives, especially when an EBP is not desired by the patient or is contraindicated. Interdisciplinary and interprofessional consensus standard procedures can contribute to optimization of the clinical management of this relevant complication. [ABSTRACT FROM AUTHOR]

Hemispherotomies represent a major part of surgical interventions for epilepsy in childhood (16–21%). The anatomical resection has been replaced by minimally invasive disconnection techniques with lower perioperative mortality and fewer postoperative complications. Today the procedure is not only carried out from the lateral aspect via the Sylvian fissure/insula but also via a vertical parasagittal approach. Depending on the publication, hemispherotomy leads to freedom from postoperative seizures in 60–90% of patients. Despite changes in the surgical technique, disturbances of the cerebrospinal fluid circulation continue to be the main complication in 5–15% of cases. Hemispheric epileptogenic lesions usually lead to early onset and difficult to treat epilepsy in childhood. These epilepsies are characterized by a high frequency of seizures and propagation of epileptic discharges to the healthy hemisphere. The aim of a hemispherotomy is, in addition to postoperative freedom from seizures, the complete disconnection of the affected hemisphere. When deciding on a hemispherotomy, the expected functional consequences play a major role in addition to epileptological aspects. In the case of deficits already present preoperatively (hemianopia, hemiparesis) or reorganization of functions in the contralesional hemisphere (language), no new deficits are to be expected from the operation. In terms of cognition, a hemispherotomy can improve function by releasing the neuroplastic potential of the healthy hemisphere. In order to keep the negative and often irreversible effects of epilepsy as low as possible and to be able to use as much potential for neuroplasticity of the healthy hemisphere as possible, surgery should be considered as early as possible. [ABSTRACT FROM AUTHOR]

Infektiöse Enzephalitiden werden meist durch Viren, seltener aber auch durch Bakterien, Pilze oder Parasiten verursacht. Die Erreger können häufig mittels Nukleinsäureamplifikationstechniken im Liquor nachgewiesen werden, aber auch bewährte Verfahren wie die Kultur oder die Serologie haben weiterhin ihre Berechtigung. Aufgrund des Reiseverkehrs muss bei der Diagnostik in Europa auch an aus dem Ausland eingeschleppte Erreger gedacht werden. [ABSTRACT FROM AUTHOR]

The article reports that the product information on this double page makes it clear that inflammatory and degenerative diseases of the central nervous system can be well diagnosed and monitored thanks to numerous traditional and innovative biomarkers. Topics include considered that the "four compartment model" of the brain means that when interpreting measurements in blood and cerebrospinal fluid significantly more complex distribution models must be taken into account than in other organs.

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In accordance with the current German dementia guidelines, the dementia biomarkers amyloid beta 42, the tau peptides total tau and phosphorylated tau 181 are recommended for cerebrospinal fluid (CSF)-based diagnostics of dementia. Several studies have clearly shown that determination of the amyloid beta 42 to amyloid beta 40 peptide ratio is superior to the interpretation of amyloid beta 42 alone and should be implemented in the clinical work-up; however, in recent years different studies have presented many other innovative CSF and blood-based biomarkers. Besides CSF-based neurochemical diagnostics of dementia promising novel protocols for the detection of amyloid beta peptides in blood have meanwhile been published, which can currently be used in clinical studies for blood-based early diagnostics of Alzheimer's dementia. Following further validation and assay optimization these blood assays should be available for routine diagnostics in the near future. [ABSTRACT FROM AUTHOR]

Copyright of Rheuma Plus is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Zusammenfassung Studien zur Existenz regulärer Lymphgefäße in den duralen Sinus, zur Blut-Hirn-Schranke und zum Immunprivileg des ZNS führen zu neuen klinischen Konklusionen. Anhand der neuen Erkenntnisse zur Liquorforschung und zur Drainage des Gehirns werden mögliche osteopathische Zugänge dargestellt, zum Beispiel Techniken für die Halsvenen und den Plexus basilaris, Drainage der Zisternen, Pumptechnik am Kranium, Drainage der tiefen zervikalen Lymphknoten, Duratechniken, Lymphpumpe, OA-Release, osteopathische Lymphdrainage, Drainage der Nase, des Auges, des Ohres, der Hirnnerven und oberen Zervikalnerven. Studies about the regular existence of lymph channels in the dural sinus, about the blood-brain barrier and about the central nervous system immune privilege led to new clinic conclusions. On the basis of the results of the latest research in cerebrospinal fluids and brain drainage, possible osteopathic approaches are describes such as techniques for cervical venes and basilar plexus, drainage for the cisterns, cranial pumping, drainage of deep cervical lymphnodes, techniques for the dura, lymph pump, OA-release, osteopathic lymph drainage, drainage of the nose, eyes and ears, the cranial nerves and the upper cervical spinal nerves. [ABSTRACT FROM AUTHOR]

Zusammenfassung Studien zur Drainage des Gehirns und zur Liquorphysiologie haben in den letzten Jahren völlig neue Erkenntnisse ergeben mit bedeutsamen klinischen Konklusionen. Die Sichtweise zur Produktion und Resorption des Liquor cerebrospinalis (LCS) haben sich fundamental geändert. Auch konnten vorherige Untersuchungen zum Liquorfluss relativiert werden. Mittels ultraschneller Magnetresonanzenzephalographie (UF-MREG) konnten kardiovaskuläre, respiratorische und vasomotorische Einflüsse auf die Liquorpulsation differenziert werden. Es wurde außerdem eine Abschirmfunktion des LCS gegen innere und äußere elektrische Ladung postuliert. Mit dem glymphatischen System wurde ein Flüssigkeitsaustausch zwischen LCS und der interstitiellen Flüssigkeit beschrieben. Zudem konnte die Existenz regulärer Lymphgefäße in den duralen Sinus belegt werden. Dokumentationen der LCS-Ausströmung an lumbalen Nerven führen zur Hypothese der Wechselwirkung von LCS-Signalen und Nerven entlang der peripheren LCS-Ausstrombahn. Klinisch bedeutsam sind auch Studien zu Schlaf und LCS sowie zu möglichen Zusammenhängen zwischen peripherer LCS-Ausstrombahn und weitläufiger Berührungs-bzw. Schmerzüberempfindlichkeit. Studies on cerebral drainage und on physiology of cerebrospinal fluid (CSF) have produced completely new knowledge associated with an immense clinical value. The perception of liquor production and resorption have undergone a radical change. Furthermore, previous research on liquor flow could be relativised. By means of ultra-rapid magnet resonance encephalography (UF-MREG) it became possible to differentiate between cardiovascular, respiratory and vasomotor influence on an organism's liquor pulsation. Besides, a shielding function of the CSF against internal and external electric charge was postulated. An interchange of liquids between CSF and interstitial fluid via the glymphatic system was described. Furthermore, the existence of regular lymphatic vessels within the dural sinuses, could be demonstrated. Documentation of CSF-efflux along lumbal nerves leads to the hypothesis of an interaction between CSF-signals and nerves along the peripheral efflux channel. Investigations on the relation between sleep and CSF as well as a possible interrelation of peripheral efflux channel and an extensive touch and pain hypersensitivity are of clinical importance. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: A rapid and reliable diagnosis of multiple sclerosis (MS) is crucial to initiate adapted disease-modifying treatment. The 2017 McDonald criteria were revised with the aim of further improving the diagnostic performance., Objective: In this article the published studies comparing the use of the 2017 and 2010 McDonald criteria were reviewed and analyzed in terms of diagnostic performance., Material and Methods: A total of 20 studies and 1 review article with a total of 3006 evaluated patients were identified by means of a literature search in the PubMed database (search term: McDonald criteria 2010 and McDonald criteria 2017)., Results: Using the 2017 McDonald criteria, a diagnosis of MS was made in more patients (2277/3006 patients, 76%) and in an earlier stage (3-10 months) compared with the 2010 revision (1562/3006 patients, 52%). Of the additional MS diagnoses, 193/715 were due to the adjustment of the imaging criteria of temporal dissemination and 536/715 were due to the introduction of oligoclonal bands as a diagnostic criterion., Conclusion: The revised McDonald criteria of 2017 have achieved their goal and enable the diagnosis of MS in a higher proportion of patients at the first clinical event., (© 2022. The Author(s).)

Lyme borreliosis is the most frequent tick-borne infection in Europe. It is a multisystemic disease affecting the skin, joints, heart, in rare cases the eyes and regularly the nervous system. Taking current clinical and microbiological guidelines into account, neuroborreliosis can in general be diagnosed and treated successfully. An appropriate guideline-conform antibiotic treatment is effective and in most cases recovery from acute neuroborreliosis is complete. Nevertheless, the evidence base regarding pharmacological treatment needs reform and improvement. Contrary to this scientifically based medical opinion, divergent opinions presented in the media cause uncertainty and confusion among patients and also some physicians. The currently available scientific data on epidemiology, treatment and performance of microbiological testing reveals gaps and therefore a large scope for interpretation. In clinical practice, diagnostics and therapeutic methods that do not fulfill the criteria of evidence-based medicine are widely used due to the uncertain data situation. The Clinical Network Neuroborreliosis (KNN) is a publicly funded network of clinicians and clinical laboratory physicians with the goal to improve knowledge for disease-oriented evaluation of diagnostic and therapeutic methods. In addition, the Robert Koch Institute (RKI) and the KNN are performing an epidemiological study for collation and estimation of the number of neuroborreliosis cases in Germany (aNBorD study). [ABSTRACT FROM AUTHOR]

As a chronic inflammatory disease of the central nervous system (CNS), multiple sclerosis (MS) is associated with characteristic abnormalities in cerebrospinal fluid (CSF). Thus, in addition to magnetic resonance imaging, CSF examination is a central diagnostic procedure in patients with MS, which can corroborate a diagnosis of MS and may also help to discern differential diagnoses. The most important CSF finding in MS is the detection of persistent polyspecific intrathecal immunoglobulin synthesis. This review summarizes CSF findings of patients with MS and addresses issues of relevance for clinical practice, potential diagnostic pitfalls as well as new developments in CSF diagnostics of MS. [ABSTRACT FROM AUTHOR]

Progressive multifocal leukoencephalopathy (PML) is a disease of immunosuppressed patients caused by the JC polyomavirus (JCPyV). Due to the elevated risk in patients treated with natalizumab for multiple sclerosis (MS) and also treatment with other biologicals for different indications, the relevance of PML has increased in recent years. This article summarizes the published knowledge on the biology and pathogenesis of PML with a focus on the role of cerebrospinal fluid diagnostics in the work-up for PML and the current PML case definition. Current recommendations regarding risk management are discussed, as are possible therapies and prevention. [ABSTRACT FROM AUTHOR]

Cerebrospinal fluid-based neurochemical dementia diagnostics (CSF-NDD) support the early and differential diagnosis of dementia, most importantly the diagnosis of early or preclinical Alzheimer's dementia (AD). Meanwhile CSF-NDD are now recommended for improved exclusion and positive diagnostics of AD by the German national neuropsychiatry S3 dementia guidelines (). Meta-analyses of independent international multicenter studies have shown that a combined CSF analysis of amyloid-beta 1-42 (Aβ 1-42, decreased), total tau proteins (increased) and phospho-tau proteins (increased) offers a sensitivity and specificity of 80-90 % for the early and differential diagnosis of AD (AD versus all other). Generally, CSF-NDD should be combined with blood-based routine diagnostics and should be part of routine CSF diagnostics, e. g. cell count and cell differentiation (if applicable), intrathecal antibody synthesis and blood-CSF barrier analysis. The CSF-NDD are most valuable for the improved differentiation between reversible dementia syndromes and irreversible neurodegenerative dementia, e. g. cognitive deficits due to late onset depression (pseudodementia due to depression) or AD. Combined with extended psychometric neuropsychological evaluation and neuroimaging methods, such as magnetic resonance imaging (MRI), dopamine transporter scanning (DaTscan) by single photon emission computed tomography (SPECT), 18F-fluorodeoxyglucose positron emission tomography (glucose-PET) and amyloid-PET, CSF-NDD also significantly improve the differential diagnostics within the heterogeneous group of primary neurodegenerative dementias. Meanwhile, several independent studies have indicated that the Aβ 1-42:Aβ 1-40 ratio is superior to the determination of Aβ 1-42 alone. Currently, several international research initiatives have been launched to further harmonize and optimize preanalytical procedures and CSF-NDD biomarker assays. [ABSTRACT FROM AUTHOR]

Zusammenfassung Der folgende Artikel befasst sich mit der zerebrospinalen Flüssigkeit (Liquor) und erläutert die Grundzüge der alten und neuen Strömungstheorien sowie deren Implikationen für die manuelle und osteopathische Therapie. Im Jahr 2013 gelang es Wissenschaftlern, ein Leitungsnetz im Gehirn nachzuweisen, das glymphatische System. Es dient der Entwässerung und dem Abtransport von Stoffwechselendprodukten aus dem Hirn und arbeitet somit ähnliche wie das Lymphsystem im übrigen Körper. Im Jahr 2015 konnte ein weiteres Forscherteam Lymphgefäße im Gehirn nachweisen, deren Existenz bis dahin unbekannt war. Spezielle manuelle Techniken wirken direkt auf das glymphatische System, die zerebrale Zwischenzellflüssigkeit sowie die Lymphbahnen in den Hirnhäuten. Mithilfe der Lymphdrainagetherapie (LDT) können Orte im Körper, an denen sich Flüssigkeit staut oder Fibrosen vorliegen, aufgesucht und die für die Drainage am besten geeigneten Lymphbahnen bestimmt werden. Die LDT arbeitet mit sanften Techniken, die die Gewebeflüssigkeit und das Lymphsystem des Körpers ansprechen, um den Kreislauf und das Immunsystem zu aktivieren. The following article describes the traditional and new models of hydrodynamics of the cerebrospinal fluid (CSF) and their implications for osteopathic or manual therapy. Furthermore, it addresses new discoveries related to the brain and lymphatic system, including the newly depicted glymphatic system. This system was discovered in 2013 when scientists revealed the presence of a network of spaces within the brain that works as a functional waste clearance and drainage system for the brain, similar to the lymphatics in the periphery of the body. In 2015, lymphatic vessels in the central nervous system have been discovered by another team of researchers. Specific manual techniques can be used to address the glymphatic system, the cerebral interstitial fluid and intracranial lymphatic vessels in the meninges. Lymph Drainage Therapy (LDT) helps to identify areas of the body with fluid stagnation or fibrosis and detects the most appropriate pathways for drainage. LDT works with gentle techniques on the interstitial and lymphatic systems of the body to support fluid circulation and immune system. [ABSTRACT FROM AUTHOR]

Background: Some important knowledge has recently been gained on primary central nervous system lymphomas (PCNSL) despite its rarity. Goal: This article summarizes the most relevant progress in the diagnostics and therapy of PCNSL and discusses future directions. Material and methods: Reference articles in the English language literature were studied with respect to future approaches in PCNSL. Results: New diagnostic methods in cerebrospinal fluid have been developed to facilitate lymphoma diagnosis; however, their value still has to be validated. A better immunohistological and molecular characterization of PCNSL will probably result in identification of new therapeutic targets. The only phase III trial for PCNSL completed so far did not demonstrate a survival advantage with whole brain irradiation after high-dose methotrexate (HDMTX)-based chemotherapy as compared to chemotherapy alone. The optimal primary chemotherapy has not yet been established due to a lack of results from randomized trials. Non-comparative studies suggest a superiority of combined polychemotherapy over HDMTX monotherapy. Future therapeutic developments are directed towards consolidation of HDMTX-based induction chemotherapy with noncross-resistant conventional chemotherapy or high-dose chemotherapy with autologous stem cell transplantation. An important goal of all therapies for PCNSL is to avoid delayed neurotoxicity. Discussion: Further improvement of diagnostics and well-designed comparative studies, including new drugs when possible are still needed to define the optimal management of this still frequently prognostically unfavorable disease. [ABSTRACT FROM AUTHOR]

Novel diagnostic methods, such as cerebrospinal fluid-based neurochemical dementia diagnostics (CSF-NDD) and [18F] amyloid positron emission tomography (PET) are meanwhile recommended for specific indications by international guidelines for the improved early and differential diagnostics of multigenic (sporadic) Alzheimer's dementia (AD). In the case of CSF-NDD the German neuropsychiatric guidelines have already been validated on the S3 level of evidence (http://www.DGPPN.de) and the additional consideration of [18F] amyloid-PET in the current update of the guidelines is to be expected. By means of CSF-NDD and/or [18F] amyloid-PET a predictive diagnosis of incipient (preclinical) AD is also possible for patients at high risk for AD who are in prodromal stages, such as mild cognitive impairment (MCI). As accompanying (secondary) preventive therapy of AD cannot be offered a predictive molecular dementia diagnostics is not recommended by the German neuropsychiatric dementia guidelines (http://www.DGPPN.de). However, novel diagnostic approaches, which offer molecular positive diagnostics of AD have already gained high relevance in therapy research as they allow promising preventive treatment avenues to be validated directly in the clinical trial. Moreover, future blood-based dementia diagnostics by means of multiplex assays is becoming increasingly more feasible; however, so far corresponding proteomic or epigenetic assays could not be consistently validated in independent studies. [ABSTRACT FROM AUTHOR]

As cerebrospinal fluid-based neurochemical dementia diagnostics (CSF-NDD) has now been validated at the S3 evidence level, the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) and the German Society for Neurology (DGN) recommend CSF-NDD in the recent joint dementia guidelines for improved early and differential diagnostics of multigenic (sporadic) Alzheimer's dementia (AD). The CSF-NDD also provides a predictive diagnosis of incipient AD for high-risk patients when they are still in the prodromal stage of mild cognitive impairment (MCI) but as no (secondary) preventive therapy of AD is currently available, the use of CSF-NDD for the predictive molecular diagnosis of AD is not recommended in the neuropsychiatry guidelines (http://www.DGPPN.de). However, molecular diagnostics of preclinical AD by CSF-NDD and/or [18F]-amyloid positron emission tomography (PET) has meanwhile gained high clinical relevance for therapeutic clinical research, as this novel clinical model allows systematic screening for promising (secondary) preventive therapy options. Moreover, it has now become apparent that blood-based neurochemical diagnostics of preclinical and early AD will be possible by means of various formats of multiplex assays. However, so far promising blood assays have not been consistently validated by independent research groups and in contrast to CSF-NDD a blood-based diagnosis of AD is not yet available. [ABSTRACT FROM AUTHOR]

Background: The level of CXCL13 is a cerebrospinal fluid (CSF) biomarker for acute Lyme neuroborreliosis (LNB) with a high sensitivity. As the concentration rapidly declines during antibiotic therapy CXCL13 can also be used as a follow-up parameter. However, CXCL13 is not yet in use as a routine parameter due to concerns about the specificity. Objectives: The sensitivity, specificity and predictive value of CXCL13 in the clinical routine work-up of suspected LNB was analyzed. Material and methods: Since July 2010 the CSF of all patients (n = 204) with suspected acute LNB was not only analyzed for the routine parameters (i.e. pleocytosis and intrathecal production of Borrelia-specific antibodies, AI) but also for CXCL13. In cases of incongruent findings, a follow-up puncture after antibiotic therapy was carried out. The cut-off level for acute LNB was set at 250 pg/ml. Results: This study included 179 patients who were not pretreated with antibiotics. Of these patients 15 suffered from definite LNB, 3 had a probable LNB and all had a CXCL13 value above the cut-off level. Only 2 of the 161 patients with a non-LNB diagnosis (both with a lymphoma) had a CXCL13 value in the CSF higher than 250 pg/ml. Especially noteworthy were two patients without pleocytosis in the CSF but with CXCL13 levels above the cut-off level in whom LNB could be confirmed in the follow-up CSF analysis. Conclusions: The biomarker CXCL13 has a higher sensitivity (100 % vs. 87 %) with a specificity (99 %) comparable with the established diagnostic markers for LNB, e.g. CSF pleocytosis and Borrelia-AI in the investigated patient population. The negative predictive value of CXCL13 is 100 %. Therefore, a normal CXCL13 level virtually excludes LNB. In the clinical routine CXCL13 is a valuable and practical diagnostic marker for LNB and can even detect an acute LNB in patients without CSF pleocytosis. [ABSTRACT FROM AUTHOR]

Zusammenfassung: Die bisher geläufige Modellvorstellung vom Liquor cerebrospinalis (LCS) wird angesichts neuerer wissenschaftlicher Erkenntnisse zunehmend infrage gestellt. Diesem Modell zufolge bildet sich LCS vorrangig in den Plexus choroidei (PC), fließt dann aus den Ventrikeln in die Subarachnoidalräume und wird hauptsächlich in den Arachnoidalzotten (AV) reabsorbiert. Dieses Modell basiert offenkundig auf unzulänglichen Untersuchungen und auf Fehlinterpretationen. Aus der vorliegenden Literaturauswertung ergeben sich zahlreiche Belege für eine neue Hypothese zur Physiologie der LCS. Der Kernpunkt: LCS wird in der gesamten Funktionseinheit von LCS und interstitieller Flüssigkeit (IF) gebildet und reabsorbiert. IF und LCS werden in erster Linie in den Wänden der Kapillaren des ZNS gebildet und reabsorbiert. Plexus choroidei, Arachnoidalzotten und Lymphgefäße sind demnach für die LCS-Hydrodynamik eher nachrangig. Größere Bedeutung für die Absorption von LCS könnten die Lymphgefäße jedoch bei steigendem LCS-IF-Druck erhalten. Dieses von Grund auf neu formulierte Verständnis von der LCS-Hydrodynamik könnte sich in ihrer Konsequenz auf die Forschung, auf Publikationen und auch auf osteopathische Behandlungen auswirken. [Copyright &y& Elsevier]

Quantification is a major task in proteomics. Among the different analytical strategies to enable peptide and protein quantification, tagging with isotopic labels has emerged as a practical, versatile, and efficient alternative. In particular, isobaric labels, such as TMT or iTRAQ, are now widely employed to make relative comparison of the protein amounts in separate biological samples with tandem mass spectrometry (MS/MS). We used herein a shotgun proteomic approach based on labelling with tandem mass tags (TMTs) for the relative quantification of proteins, and the absolute quantification of their tryptic peptides in human cerebrospinal fluid (CSF). First, the comparison of ante- and post-mortem CSF samples was carried out for the discovery of protein marker candidates of brain-damage disorders. Second, tryptic peptides representative of these candidates were measured in CSF using reporter-ion calibration curves. These works highlighted the advantages and limitations of such strategies for quantification purposes in proteomics.

In primary and secondary brain diseases, increasing volumes of the three compartments of brain tissue, cerebrospinal fluid, or blood lead to a critical increase in intracranial pressure (ICP). A rising ICP is associated with typical clinical symptoms; however, during analgosedation it can only be detected by invasive ICP monitoring. Other neuromonitoring procedures are not as effective as ICP monitoring; they reflect the ICP changes and their complications by other metabolic and oxygenation parameters. The most relevant parameter for brain perfusion is cerebral perfusion pressure (CPP), which is calculated as the difference between the middle arterial pressure (MAP) and the ICP. A mixed body of evidence exists for the different ICP-reducing treatment measures, such as hyperventilation, hyperosmolar substances, hypothermia, glucocorticosteroids, CSF drainage, and decompressive surgery. [ABSTRACT FROM AUTHOR]

The clinical diagnosis of Parkinson's disease (PD) according to the UK Brain Bank criteria is based on the presence of motor symptoms and the response to dopaminergic medication. According to these criteria the clinical diagnosis is delineated too late when more than 50 % of the dopaminergic neurons are already degenerated. In recent years interest has shifted increasingly more towards non-motor symptoms (NMS), such as rapid eye movement (REM) sleep behavior disorder (RBD), constipation, hyposmia and neuropsychiatric as well as cognitive symptoms. It was shown that NMS can precede the motor symptoms by some years and may thus possibly enable support of an earlier clinical diagnosis. Furthermore, cerebrospinal fluid or blood biomarkers as well as brain imaging techniques can objectively support an earlier diagnosis of PD. This article reviews important NMSs (e.g. RBD, hyposmia and neuropsychiatric/cognitive symptoms) as well as the current status on biomarkers and brain imaging in early (premotor) phases of PD and their relevance for the early diagnosis. [ABSTRACT FROM AUTHOR]

Subdural hematoma may occur as rare, although intervention- specific complications of accidental dural puncture by neuroaxial block. Bleeding may be caused by rapid cerebrospinal fluid loss related to traction on fragile intracranial bridging veins. This article reports a case of postdural puncture headache in a 43-year-old woman after accidental dural puncture during attempted placement of an epidural catheter for induction of abortion. Bed rest, analgesics, theophylline and hydration were to no avail and only a blood patch improved the headaches. The patient presented 7 weeks later with headache and left-sided hemiplegia. Magnetic resonance imaging showed a right frontoparietal subdural intracranial hematoma which had to be surgically evacuated. The patient recovered completely. Intracranial hematoma is a rare but serious complication of central neuroaxial block. According to current German jurisdiction this risk must be addressed when informed consent is obtained. Intracranial hematoma should be considered in the differential diagnosis of atypical headache and neurological signs (e.g. focal motor and sensory deficits and seizures) following neuroaxial block and adequate image diagnostics should be carried out without delay. [ABSTRACT FROM AUTHOR]

Modern diagnostics for the determination of neurologically relevant autoantibodies are based on indirect immunofluorescence using tissue sections of the hippocampus, cerebellum and other tissues. For monospecific detection human embryonic kidney (HEK) cells transfected with different neurological antigens are used. Biochip mosaics are designed to give a quick overview and contain 20 or more substances positioned next to each other on a reaction field, which are incubated with the serum or cerebrospinal fluid (CSF) sample. Western blots based on cerebellum or hippocampus extracts or line blots containing defined recombinant antigens are used additionally. Initial investigations should always comprise the parallel analysis of all major antineural autoantibodies instead of performing only single parameter tests. Up until a few years ago autoantibodies against intracellular neuronal antigens were mainly investigated. Antibodies against structures of the neural cell surface, however, are much more frequently found, especially those against glutamate receptors (type NMDA). [ABSTRACT FROM AUTHOR]