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Keywords: central nervous system infections, central nervous system pleocytosis, diagnostics. Introduction Any means which will facilitate the difficult diagnosis of diseases of the central nervous system is of value, and the cerebrospinal fluid, which bathes its deepest recesses and washes the very nerve cells and fibers themselves, is in truth a mirror which reflects every change taking place in that system.
Methods and materials 2. Design, setting, and population This retrospective study is based on the collection of all CSF cell counts and additional biochemistry from 2 hospitals from to and from an additional 3 hospitals from to Exclusion criteria CSF samples with an elevated CSF count due to blood contamination; resampling in the same patient within 90 days of the primary sample; samples related to a neurosurgical procedure; and samples where patient records are missing were excluded from the study.
Diagnosis categories The diagnoses were a priori divided into 6 groups based on the proposed pathogenesis of the disease: infectious, inflammatory, neurodegenerative, neoplastic, vascular, and miscellaneous. Statistics Descriptive data are reported as counts and percentage, and as medians and range.
Results A total of CSF analyses were reviewed. Table 1 Causes of cerebrospinal fluid pleocytosis and associated cell counts. Open in a separate window. Table 2 Cerebrospinal fluid analysis characteristics according to disease categories. Table 3 Distribution leukocyte count levels in cerebrospinal fluid according to disease categories. Infections Infectious causes of CSF pleocytosis were further divided into the following groups: acute bacterial, chronic bacterial, fungal, and viral CNS infections and inflammation secondary to an infectious focus outside the CNS extra-CNS.
Table 4 Cerebrospinal fluid analysis characteristics according to infectious categories. Figure 1. Figure 2. Table 5 Probability of bacterial meningitis. Discussion The presented data illustrate the variety of diseases that may be associated with an inflammatory process within the CNS.
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We wanted to assess the diagnostic diversity of unselected adult patients with pleocytosis in the cerebrospinal fluid. The study is based on data from cerebrospinal fluid CSF analyses of all adult patients 15 years or older admitted to a large university hospital in Denmark during a two-year period — Data from the local patient administrative system supplied with data from patient charts were combined with laboratory data.
A total of cerebrospinal fluid samples from patients were included. CNS infection, non-infectious neurological disease, malignancy, and infection outside CNS can cause pleocytosis of the cerebrospinal fluid. These conditions are most commonly caused by non-infectious neurological diseases including seizures. Migration of leukocytes to the cerebrospinal fluid CSF is a cardinal symptom of an infectious condition affecting the meninges or the cerebral parenchyma.
Bacterial and viral meningitis cannot reliably be differentiated clinically and requires lumbar puncture to analyse the CSF [ 1 , 2 ]. However, pleocytosis in the CSF may also occur in other medical conditions, e. Apart from the issue of a large overlap in leukocyte concentrations caused by viral and bacterial infections, the relative distributions of the non-infectious diagnoses are not well described.
One reason for this is the fact that these patients are dealt with by different clinical specialities. This study aimed at obtaining an overview of the relative contribution of the causes of cerebrospinal pleocytosis by a comprehensive method including all adult patients regardless indication for lumbar puncture, requesting department, and symptomatology of the patient admitted to a large university hospital in Denmark during a two-year period.
Pleocytosis is defined as increased cell count. The study was performed at Odense University Hospital, a large regional hospital in Denmark with beds serving as referral hospital for 1. In addition, we obtained data from the electronic patient records on hospital admissions and CSF sample reports.
Exclusion criteria were: not the first CSF sample in the time period, wrong social security number, if the sample was not cerebrospinal fluid, if the erythrocytes were in layers or too numerous to quantify, if a sample was collected by a method different from lumbar puncture, or if the patient was transferred to another hospital with an uncertain diagnosis.
If a sample was analysed more than once, the report given to the clinician was used Fig. Discharge diagnoses ICD were used to categorise the cause of pleocytosis. The category CNS infection was further divided into 2 groups: verified and probable. A discharge diagnosis was considered verified if the diagnosis was verified by MRI, CT, microbiological analyses, or autopsy. Charlson index score [ 7 ] was used to describe patients comorbidity. Charlson score estimating risk of death from comorbid disease in longitudinal studies by scoring each comorbid disease a score of 1, 2, 3, or 6.
Calculation was based on registered diagnoses in the patient administration system from years to All p -values were comparisons between the marked category and the other categories. Out of unselected cerebrospinal fluid samples, met the inclusion criteria Fig. The neurological department CNS infection amounted to Infection outside CNS to 7.
Significantly lower mean age was found in the Non-infectious neurological diseases category mean age Mean Charlson score in the patients was 0.
Mean Charlson score was significantly lower in the Non-infectious neurological diseases category mean 0. In general, there was a tendency of high mean Charlson score in the categories with high mean age. In the category CNS infection no distinction between viral and bacterial neuroinfection was made.
Eighty seven point three percent of the patients with more than leukocytes were diagnosed with CNS infection. Distribution of diagnose category per cell count. CNS infection is the only category present in all intervals. CNS infection was the only category present in all intervals. Distribution of diagnose category as a percentage per cell count. The mean CSF protein concentration in all patients was 1.
CSF protein was normal 0. CNS protein is known to be increased in meningitis, but also to be one of the least specific parameters in CSF [ 4 ]. Of the patients with CNS infection 59 For the categories of malignancy 20 For six patients, seizures, epilepsy or status epilepticus was the cause of pleocytosis.
Pleocytosis has previosly been found in patientes after seizures [ 8 ]. Higher concentrations of CSF leukocytes were found in Other neurological diseases. No distinction between viral and bacterial meningitis was made.
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