Cellular Diagnostics of Csf

Table 1. Comparison of CSF and serum analytes: • Only few cells (12/3 cells or 4cells per μl): lymphocytes, monocytes (mesenchymal) • CSF is formed by the choroids plexus: 500 ml per day, total volume is replaced 2-3 times per day 4.3 Morphological diagnosis of the CSF: How to interpret the cell picture? We do CSF cytology on a cytospun specimen stained according May Giemsa Grünwald. • Inflammatory meningitis: the first common reaction invasion of the CSF by a microorganism is granulocytic pleocytosis. It mainly consists of neurotrophilic granulocytes and some monocytes (some of them are activated). But in viral infections the cell picture very quickly switches (within some hours) to a monocytic/ lymphocytic pleocytosis. Very similar changes are observed in Lyme disease with CSF involvement. TBC and fungal meningitis reveal a mixed-cell picture composed of granulocytes monocytes and lymphocytes with activation. Cell count is very high in bacterial infections (> 1000-10.000/3 cells). Viral infections resemble lower cell counts ranging from 300-1000/3 cells similar to fungal meningitis, whereas neuroborreliosis very often shows cell counts from 200-500/3cells. • Neoplastic meningitis: In CSF with carcinomatosis and also lymphoproliferative involvement, clusters of pleomorphic cells can sometimes be observed. The ratio between nucleus and cytoplasm is switched. Cytoplasm can be very dark blue. Some nuclei resemble an increased number of nucleoli. CSF cells show a reactive change. But not all cases are easily to diagnose as neoplastic involvement of the CSF. Carcinoma cells may be rare and not very pleomorphic. Lymphoproliferative CSF involvement sometimes resembles only a small rather monomorphic lymphocytic cell population with some reactive cells added. In such cases morphological diagnosis needs to be completed by some more accurate diagnostic tool. • Autoimmune diseases: Morphological changes in autoimmune diseases may be rather unspecific. A lympho-monocytic pleocytosis with a maximum of 100/3 cells, activation with activated How to Cite this article: 4. Cellular Diagnostics of CSF http://www.ifcc.org/ejifcc/vol15no3/150309200405.htm