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. 2011 Jun;258(6):1034-41.
doi: 10.1007/s00415-010-5876-x. Epub 2010 Dec 25.

Summary of cerebrospinal fluid routine parameters in neurodegenerative diseases

Sarah Jesse  1 , Johannes Brettschneider, Sigurd D Süssmuth, Bernhard G Landwehrmeyer, Christine A F von Arnim, Albert C Ludolph, Hayrettin Tumani, Markus Otto
Affiliations

Summary of cerebrospinal fluid routine parameters in neurodegenerative diseases

Sarah Jesse et al. J Neurol. 2011 Jun.

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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Figures

Fig. 1
Fig. 1
CSF–serum quotient diagram for IgG with hyperbolic reference range according to Reiber [24]. On the abscissa, a Q alb of 1 represents a normal blood–CSF barrier function; 2 demonstrated a blood–CSF barrier dysfunction. The ordinate demonstrates Q IgG with the upper limit for Q lim, Q mean, and Q low, whereby values below Q lim can discriminate the blood-derived IgG fraction from an intrathecal Ig synthesis either represented by 4 as intrathecally IgG synthesis only or as 3 demonstrating a combined blood–CSF barrier function together with an intrathecal IgG-synthesis. 5 is not possible and indicates a methodological error in the measurement
Fig. 2
Fig. 2
Illustration of age-related Q alb. CSF–blood barrier (dys-) function of all groups are indicated on the basis of Q diff that represents the age-dependant CSF–blood barrier function according to Q diff = Q alb − Q alb* (with Q alb* = (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
Fig. 3
Fig. 3
Illustration of Reibergrams for all patient groups. Q–IgG, Q–IgA, and Q–IgM are indicated in relation to the CSF–blood barrier function, represented by Q alb. For interpretation of the Reibergrams, see Fig. 1
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