Cerebrospinal-fluid lymphocyte populations and immune complexes in active multiple sclerosis

A specific subpopulation of mononuclear cells bearing a surface receptor for the Fc portion of IgG was considerably reduced in the cerebrospinal fluid (CSF) of multiple sclerosis (MS) patients during exacerbation, but returned toward normal levels as the patient entered remission. Low concentrations of immune complexes were found in the CSF in nearly 50% of MS patients during exacerbations but immune complexes were not found in patients with stable MS.

A diagnostic index of active demyelination: myelin basic protein in cerebrospinal fluid

We have developed a radioimmunoassay to measure a specific neurological component, the basic protein of myelin, and have used this test for assessing this component in spinal fluid. The levels of basic protein in spinal fluid correlate closely with the clinical activity of multiple sclerosis; therefore the test can be used for objective evaluation of disease activity in patients with that disorder. Moreover, it is a useful adjunct in the diagnosis of multiple sclerosis and evaluation of potential therapy. In addition, the test is helpful in diagnosing other diseases in which acute breakdown of myelin occurs, especially leukoencephalopathy resulting from irradiation and chemotherapy for treatment of leukemia in children.

Relationship between cerebrospinal fluid norepinephrine and blood pressure in neurologic patients

In 126 patients hospitalized for various diseases norepinephrine in cerebrospinal fluid correlated with blood pressure (r = 0.41, p < 0.0001). Plasma and cerebrospinal fluid norepinephrine levels correlated with heart rate. Central noradrenergic nerves help control blood pressure and may be involved in human hypertension.

Norepinephrine and gamma-aminobutyric acid in amyotrophic lateral sclerosis

Patients with amyotrophic lateral sclerosis have increased levels of the neutrotransmitter norepinephrine in blood and cerebrospinal fluid and depressed levels of the inhibitory neurotransmitter gamma-aminobutyric acid in cerebrospinal fluid. These neurochemical alterations are most marked in patients bedridden with advanced disease, appear interrelated, and lead to cardiovascular alterations in patients with amyotrophic lateral sclerosis.

CSF viral antibodies. Evaluation in amyotrophic lateral sclerosis and late-onset postpoliomyelitis progressive muscular atrophy

Serum and CSF from 48 patients with amyotrophic lateral sclerosis and six patients with late-onset postpoliomyelitis progressive muscular atrophy were investigated for the presence of antibody to poliovirus types 1, 2, and 3, coxsackie viruses B3 and B4, influenza A, measles, rubella, mumps, herpes simplex types 1 and 2, cytomegalovirus, varicella-zoster, and Toxoplasma gondii. These results were compared with those from 53 control patients with neuromuscular disease matched for age, sex, race, and poliovirus vaccine exposure. There was no difference either in distribution of serum or CSF antibody titers or the geometric-mean antibody titers. There was no evidence suggesting the presence of locally produced specific viral antibody within the CNS to any of the agents studied. In particular, there was no serological evidence to suggest an association between persistent infection with any poliovirus type and amyotrophic lateral sclerosis or late-onset postpoliomyelitis progressive muscular atrophy.

Murine neurotropic retrovirus spongiform polioencephalomyelopathy: acceleration of disease by virus inoculum concentration

A 10-fold reduction in the incubation period of murine neurotropic retrovirus spongiform polioencephalomyelopathy was effected by a 1,000-fold concentration of the cloned virus inoculum.

Decreased spinal cord cGMP in murine (wobbler) spontaneous lower motor neuron degeneration

Of the secondary messengers, cyclic quanosine monophosphate, but not cyclic adenosine monophosphate, was reduced by 80% in the cervical spinal cord and by 56% in the cerebellum of clinically affected homozygote "wobbler" mice compared to sex- and age-matched litter-mate clinically unaffected control mice. A neurotransmitter, gamma aminobutyric acid, and high-energy intermediates, adenosine triphosphate and phosphocreatine, were not significantly different in affected or unaffected mice.

Elevations in cerebrospinal fluid norepinephrine during unilateral and bilateral cerebellar stimulation in man

Lumbar cerebrospinal fluid (CSF) norepinephrine concentrations determined by radioenzymatic assay in four epileptic patients were significantly higher during either chronic unilateral or bilateral cerebellar stimulation than those determined after a 7-day period without stimulation. The mean CSF norepinephrine levels noted during these two modes of cerebellar stimulation were not significantly different. The percentage of increase in CSF norepinephrine in one patient receiving 200/sec stimulation was 3 times higher than those noted in the three patients undergoing 10/sec stimulation. These evoked alterations in norepinephrine metabolism may relate to the reported modulation of spasticity and cerebral neuronal excitability during chronic cerebellar stimulation. Lumbar CSF cyclic adenosine monophosphate levels determined by radioimmunoassay were not significantly altered by either mode or frequency of cerebellar stimulation.

Cerebrospinal fluid GABA reductions in seizure patients evoked by cerebellar surface stimulation

Lumbar cerebrospinal fluid (CSF) gamma-aminobutyric acid (GABA) levels determined by fluorometric assay in four seizure patients were found to be significantly lower during bilateral, continuous cerebellar stimulation than those determined after a 7-day period without stimulation. The CSF GABA concentrations during chronic unilateral, alternating cerebellar stimulation were reduced in three seizure patients but unchanged in a fourth patient. The percentage decrease in CSF GABA appeared to be independent of cerebellar stimulation frequency. These findings suggest that GABA-mediated neuronal transmission is depressed during cerebellar surface stimulation and this evoked reduction in GABA activity may compromise the efficacy of cerebellar stimulation in the treatment of epilepsy. Lumbar CSF cyclic guanosine monophosphate levels determined by radioimmunoassay were not significantly altered by either mode or frequency of cerebellar stimulation.

Blood-to-cerebrospinal fluid barrier for cyclic adenosine monophosphate in man

A definite blood to lumbar CSF barrier for cyclic adenosine monophosphate (cAMP) exists in man under physiologic conditions. Lumbar CSF cAMP level remained unchanged, while the CSF glucose level rose significantly after a glucagon hydrochloride infusion that caused a 40-fold increase in the plasma cAMP level.

Cerebrospinal fluid norepinephrine alterations during electrical stimulation of cerebellar, cerebral surfaces in epileptic patients

Lumbar cerebrospinal fluid norepinephrine concentrations were determined by radioenzymatic assay in five epileptic patients receiving double-blind cerebellar stimulation and in three epileptic patients with subdural cerebral surface electrodes. Mean CSF norepinephrine levels were significantly elevated by chronic cerebellar stimulation and significantly depressed after intermittent cerebral cortical stimulation. Lumbar CSF cyclic adenosine monophosphate levels determined by radioimmunoassay were not significantly altered by either cerebellar or cerebral surface stimulation. Our study suggests that (1) electrical stimulation of the anterodorsal cerebellum in man evokes alterations in noradrenergic metabolism. Cerebellar stimulation-induced elevations in norepinephrine may inhibit cerebellar, cerebral, and spinal neuronal activity. In addition, (2) noradrenergic responses to brain surface stimulation may exhibit regional specificity, and (3) noradrenergic alterations evoked by cerebral surface stimulation may not mimic those induced in isolated brain preparations.

Adult-onset acid maltase deficiency. Morphologic and biochemical abnormalities reproduced in in cultured muscle

We established muscle-tissue cultures from biopsy of a patient with adult-onset acid maltase deficiency. Morphologically and biochemically, the newly grown fibers of the cultured muscle showed the same abnormalities as those of the biopsied muscle. Light microscopy showed multiple vacuoles filled with acid-phosphatase-positive material; on ultrastructural examination there was abnormal accumulation of glycogen in membrane-bound sacs (secondary lysosomes), some of which also contained dark membranous of homogeneous material. Acid maltase (pH 4.0), a lysosomal enzyme, was undetectable in either cultured or biopsied muscle by maltose hydrolysis, whereas acid phosphatase, also a lysosomal enzyme, was increased in both sources of muscle cells. Cultured muscle fibers demonstrate the same morphologic and biochemical abnormalities characteristic of biopsied muscle, supporting the concept of a biochemically distinct primary myopathy in man.

Cerebrospinal fluid acid-base and lactate changes after seizures in unanesthetized man II. Alcohol withdrawal seizures

Acid-base changes in arterial blood and lumbar cerebrospinal fluid were correlated with simultaneously determined lactate levels in patients admitted after alcohol withdrawal seizures. Arterial and cerebrospinal fluid lactate was elevated in association with a marked respiratory alkalosis in 13 patients studied 5 to 12 hours after the seizure. Similar elevations of arterial and cerebrospinal fluid lactate were found in five patients during delirium tremens without antecedent withdrawal seizure. The cerebrospinal fluid lactate determined on admission appeared to correlate best with the length and severity of the alcohol withdrawal syndrome that developed in patients after a withdrawal seizure.

Cerebrospinal fluid acid-base and lactate changes after seizures in unanesthetized man. I. Idiopathic seizures

The natural course of acid-base changes in arterial blood and lumbar cerebrospinal fluid of patients admitted after major motor seizures was correlated with simultaneously determined lactate levels. In 10 patients with idopathic seizures studied less than 3 hours after the seizure, arterial lactate and cerebrospinal fluid lactate were elevated in association with a mild arterial metabolic acidosis. The elevated cerebrospinal fluid lactate persisted despite a return to normal of the arterial lactate in seven patients studied between 3 and 6 hours after the seizure. All values were normal in five patients studied more than 4 days after a major seizure.

Computerized axial tomography: clinicopathologic correlation

Between August 1973 and April 1974 more than 750 patients had computerized axial tomography (CT) scans at the Massachusetts General Hospital. Ten brains from previously CT-scanned patients in this group were sectioned in the plane of the scan. Nearly exact correlation was found between the anatomic location and extent of intracranial lesions demonstrated by CT scan and the findings on gross and microscopic pathologic examination in cases of primary intracranial tumors, obstructive hydrocephalus, intracerebral hemorrhage, ischemic and hemorrhagic infarctions, pineal tumor, and thermal-burn encephalopathy. Determination of absorption values (mu) of 47 pathologically verified processes showed that high-absorption intracerebral hemorrhage and calcium-containing tumors are readily separable from other processes on the basis of mu values alone. However, the abnormal mu values of primary brain tumor, edema, and infarction are difficult to distinguish from those of normal spinal fluid and white matter.