[Infrared spectroscopy of the dry residue of liquor crystallograms in various diseases]

The article presents the results of an examination of the dry residue of liquor crystallograms (DRLC) using infrared spectroscopy technique. 36 spectrograms were studied. Elements of similarity and difference were revealed in the spectrograms of organic substance (antifreeze, sodium cyclamate and fatty tissue), of DRLC of the crystal-forming matter CuCl(2)x2H(2)0, of DRLC of a live person and cadaveric liquor (with no brain injury in respective case histories), of DRLC of liquor of live persons with a brain injury, of DRLC of liquor of persons who died of a brain injury and of persons who died of other causes.

Micrometer-sized particles in cerebrospinal fluid (CSF) in patients with schizophrenia

The etiology of schizophrenia is unknown, but the pathogenetic process involves organic changes in brain tissue, which may alter the composition of cerebrospinal fluid (CSF). For the present study, CSF was obtained by lumbar puncture from 22 schizophrenic patients and 38 control patients. We have used scanning electron microscopy combined with filtration techniques to search for pathogenic correlates and diagnostic biomarkers in the nano-micrometer range. Micrometer-sized spherical particles were isolated from CSF in 20 of the 22 patients with schizophrenia compared to only two of the 38 controls (P < 0.001). Reverse transcription-polymerase chain reaction analysis did not reveal bacterial DNA material in the particles. The particles have not replicated in culture. The micrometer-sized particles may serve as biological disease markers in schizophrenia. Hypothetically, they may be involved in development of the disease or may result from the disease process in brains of schizophrenic patients.

Does lumbar cerebrospinal fluid reflect ventricular cerebrospinal fluid? A prospective study in patients with external ventricular drainage

Ventriculitis may sometimes occur after an external ventricular drain has been removed, and diagnosis has to be made by lumbar puncture. But are the lumbar findings comparable to previously obtained ventricular results? In a prospective study, sample pairs of ventricular and lumbar cerebrospinal fluid (CSF) were obtained at an interval of <30 min in 25 patients with increased intracranial pressure suffering from cerebral hemorrhage (n = 15), meningitis/encephalitis (n = 6), cerebral infarction (n = 3), and meningeosis carcinomatosa (n = 1). CSF was analyzed for protein, albumin, IgG, IgA, IgM, glucose, lactate, and leukocytes including cytological differentiation. A significant ventriculo-lumbar increase was observed for protein, albumin, and the immunoglobulins. Lactate was distributed equally in ventricular and lumbar CSF, as well as glucose in the cerebral hemorrhage subgroup (n = 15). Cell count failed to show a clear ventriculo-lumbar ratio. Cytological distribution was comparable in lumbar and ventricular CSF, except for macrophages showing a significant rostrocaudal decrease. In conclusion, in cases of clinically suspected bacterial central nervous system infection after removal of an external ventricular drain, lumbar CSF lactate, glucose, and cytology are comparable to previously determined ventricular values, and thus may help physicians to choose the best treatment.

Ketogenic diet: does acetone stop seizures?

BACKGROUND

The mechanism of action of the ketogenic diet, a therapy for refractory epilepsy, is unknown. Our hypothesis is that acetone, one of three ketones elevated by the ketogenic diet, is directly responsible for the diet's anticonvulsant effects. This study examined the basic concepts of this hypothesis.

MATERIAL/METHODS

Rats were acutely injected with acetone intraperitoneally at doses of 1 or 10 mmol/kg, or received acetone chronically in drinking water (1% v/v) for 10 days before being injected with a 1 mmol/kg dose of acetone. Controls consumed regular water and were injected with vehicle. A pentylenetetrazole seizure test was administered 15 min after the injections. Following the test, acetone was measured in the cerebrospinal fluid.

RESULTS

A 10 mmol/kg injection of acetone suppressed seizures in 60% of rats (P<0.05). A chronic administration of acetone followed by a 1 mmol/kg injection suppressed seizures in 47% of rats (P<0.05). The acetone concentrations in these rats were 10.3I2.3 and 1.0I0.2 mmol/L, respectively. The effect of the acute 1 mmol/kg injection (without acetone pretreatment) was not statistically significant. This dose elevated acetone to 1.1I0.1 mmol/L in the cerebrospinal fluid.

CONCLUSIONS

Our findings suggest that acetone is an anticonvulsant and that chronic administration may enhance its action. Linking acetone to the effects of the ketogenic diet requires further research. In particular, it will be important to confirm that the ketogenic diet generates relevant concentrations of acetone.

Rapid analysis of tryptically digested cerebrospinal fluid using capillary electrophoresis-electrospray ionization-Fourier transform ion cyclotron resonance-mass spectrometry

Mass spectrometry has in recent years been established as the method of choice for protein identification and characterization in proteomics. Capillary electrophoresis (CE) is a fast and efficient method for the separation of peptides and proteins. The on-line combination of CE with Fourier transform ion cyclotron resonance (FTICR) mass spectrometry (MS) has been shown to be a powerful tool in the analysis of complex mixtures of proteins. This paper presents the first results from a proteomic analysis of human cerebrospinal fluid proteins by tryptic digestion and CE-FTICR-MS, where 30 proteins could be identified on a 95% confidence level with mass measurement errors less than 5 ppm.

Oxidative damage increases with age in a canine model of human brain aging

We assayed levels of lipid peroxidation, protein carbonyl formation, glutamine synthetase (GS) activity and both oxidized and reduced glutathione to study the link between oxidative damage, aging and beta-amyloid (Abeta) in the canine brain. The aged canine brain, a model of human brain aging, naturally develops extensive diffuse deposits of human-type Abeta. Abeta was measured in immunostained prefrontal cortex from 19 beagle dogs (4-15 years). Increased malondialdehyde (MDA), which indicates increased lipid peroxidation, was observed in the prefrontal cortex and serum but not in cerebrospinal fluid (CSF). Oxidative damage to proteins (carbonyl formation) also increased in brain. An age-dependent decline in GS activity, an enzyme vulnerable to oxidative damage, and in the level of glutathione (GSH) was observed in the prefrontal cortex. MDA level in serum correlated with MDA accumulation in the prefrontal cortex. Although 11/19 animals exhibited Abeta, the extent of deposition did not correlate with any of the oxidative damage measures, suggesting that each form of neuropathology accumulates in parallel with age. This evidence of widespread oxidative damage and Abeta deposition is further justification for using the canine model for studying human brain aging and neurodegenerative diseases.

Markers for different glial cell responses in multiple sclerosis: clinical and pathological correlations

Disease progression in multiple sclerosis occurs within the interface of glial activation and gliosis. This study aimed to investigate the relationship between biomarkers of different glial cell responses: (i) to disease dynamics and the clinical subtypes of multiple sclerosis; (ii) to disability; and (iii) to cross-validate these findings in a post-mortem study. To address the first goal, 51 patients with multiple sclerosis [20 relapsing remitting (RR), 21 secondary progressive (SP) and 10 primary progressive (PP)] and 51 neurological control patients were included. Disability was assessed using the ambulation index (AI), the Expanded Disability Status Scale score (EDSS) and the 9-hole PEG test (9HPT). Patients underwent lumbar puncture within 7 days of clinical assessment. Post-mortem brain tissue (12 multiple sclerosis and eight control patients) was classified histologically and adjacent sites were homogenized for protein analysis. S100B, ferritin and glial-fibrillary acidic protein (GFAP) were quantified in CSF and brain-tissue homogenate by ELISA (enzyme-linked immunosorbent assay) techniques developed in-house. There was a significant trend for increasing S100B levels from PP to SP to RR multiple sclerosis (P < 0.05). S100B was significantly higher in RR multiple sclerosis than in control patients (P < 0.01), whilst ferritin levels were significantly higher in SP multiple sclerosis than in control patients (P < 0.01). The S100B : ferritin ratio discriminated patients with RR multiple sclerosis from SP, PP or control patients (P < 0.05, P < 0.01 and P < 0.01, respectively). Multiple sclerosis patients with poor ambulation (AI > or =7) or severe disability (EDSS >6.5) had significantly higher CSF GFAP levels than less disabled multiple sclerosis or control patients (P < 0.01 and P < 0.001, respectively). There was a correlation between GFAP levels and ambulation in SP multiple sclerosis (r = 0.57, P < 0.01), and between S100B level and the 9HPT in PP multiple sclerosis patients (r = -0.85, P < 0.01). The post-mortem study showed significantly higher S100B levels in the acute than in the subacute plaques (P < 0.01), whilst ferritin levels were elevated in all multiple sclerosis lesion stages. Both GFAP and S100B levels were significantly higher in the cortex of multiple sclerosis than in control brain homogenate (P < 0.001 and P < 0.05, respectively). We found that S100B is a good marker for the relapsing phase of the disease (confirmed by post-mortem observation) as opposed to ferritin, which is elevated throughout the entire course. GFAP correlated with disability scales and may therefore be a marker for irreversible damage. The results of this study have broad implications for finding new and sensitive outcome measures for treatment trials that aim to delay the development of disability. They may also be considered in future classifications of multiple sclerosis patients.

Carbon monoxide as a novel central pyrogenic mediator

Carbon monoxide (CO) are produced by heme oxygenase (HO), and HO was detected in hypothalamus. However, the roles of CO produced in hypothalamus was not fully elucidated. So, we tested the effects of CO on body temperature because preoptic-anterior hypothalamus was known as the presumptive primary fever-producing site. CO-saturated aCSF (4 microl, i.c.v.) and hemin (10 microg, i.c.v.) elicited marked febrile response. Pretreatment with indomethacin completely inhibited CO- and hemin-induced fever. Zinc protoporphyrin-IX (10 microg, i.c.v.) or ODQ (50 microg, i.c.v.) partially reduced hemin-induced febrile response. Dibutyryl-cGMP (100 microg, i.c.v.) produced profound febrile response and this febrile response was attenuated by indomethacin. These results indicate that endogenous CO may have a role as a pyrogenic mediator in CNS and CO-mediated pyresis is dependent on prostaglandin production and partially on activation of soluble guanylate cyclase.

Cerebrospinal fluid density influences extent of plain bupivacaine spinal anesthesia

BACKGROUND

The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine. The ancillary endpoints were search of factors explaining the interindividual differences in cerebrospinal fluid density values reported and determination of the relation between upper extent and regression of spinal anesthesia.

METHODS

Sixty-four consecutive patients undergoing peripheral orthopedic surgery with spinal block were enrolled. Spinal anesthesia was performed in the lateral decubitus position with the operated side upward. Two milliliters of cerebrospinal fluid was sampled before injection of 3 ml plain bupivacaine 0.5%. The patient was immediately turned supine and remained in the horizontal position until the end of the study. Maximal sensory block level and time to sensory regression to L4 were determined for each patient enrolled. Cerebrospinal fluid and bupivacaine densities as well as cerebrospinal proteins, glucose, sodium, and chloride concentrations were measured.

RESULTS

A highly significant correlation between cerebrospinal fluid density and maximal sensory block level was found (P = 0.0004). However, this correlation was poorly predictive (R(2) = 0.37). Cerebrospinal fluid density, proteins, and glucose concentrations were significantly higher in men than in women: 1.000567 +/- 0.000091 versus 1.000501 +/- 0.000109 g/ml (P = 0.014), 0.46 +/- 0.18 versus 0.32 +/- 0.13 g/l (P = 0.001), and 3.27 +/- 0.7 versus 2.93 +/- 0.5 mM (P = 0.023), respectively. A highly significant (P = 0.0004) and predictive (R(2) = 0.73) inverse correlation was found between maximal upper sensory extent and sensory regression to L4.

CONCLUSION

These findings indicate an influence of cerebrospinal fluid density on subarachnoid distribution of 3 ml plain bupivacaine 0.5% and show that with higher cerebrospinal fluid densities, a higher spinal block level can be expected.

[Reference values in the cerebrospinal fluid of calves between four and eight weeks of age]

Reference values for the following parameters were established in the cerebrospinal fluid of 27 calves between four and eight weeks of age: specific weight, protein concentration, erythrocyte count, total leucocyte count with cell differentiation, creatin kinase activity, glucose and sodium. If possible, the findings were compared with those of other authors in calves and adult bovines. With 24.3 cells per microliter the 90% quantile of the total leucocyte count was seated significantly above comparable values for adult bovines. Hence, in individual cases markedly higher leucocyte counts can be expected in the cerebrospinal fluid of calves. In agreement with other authors, the protein concentration in calves was lower than in adult bovines. The reference range for creatin kinase activity was increased whereas the one for sodium was only slightly increased compared to earlier investigations in calves and in adult bovines.

[Low grade astroblastoma: pathological and magnetic resonance findings]

INTRODUCTION

The astroblastoma is an uncommon type of glial tumour. It accounts for less than 1% of all tumours of the central nervous system. It originates in the tanicytes, ependymal cells present in the embryo and usually seen in adolescents and young adults. Radiologically it presents as a well delimited, heterogeneous tumour with a solid component which takes up contrast and is cystic, giving the same signal as cerebrospinal fluid (CSF). The pathological characteristics are of the formation of radial astroblastic pseudorosettes with perivascular hyalinization.

CASE REPORT

An 18 year old woman presented with a 15 month history of motor deficit of her right limbs with occasional left frontal headache and horizontal diplopia on looking towards the left. On examination there was minimal claudication of the right limbs and bilateral papilloedema. Magnetic resonance showed a very well circumscribed left prefrontal neoplasm of heterogeneous aspect, with areas of solid and cystic appearance in the different sequences. The area of cystic appearance did not show the CSF signal in all sequences of the pulse. The tumour was totally excised. On histological study there were radial astroblastic pseudorosettes with perivascular hyalinization, with two mitoses per 10 fields of great magnification and the final diagnosis was of low grade astroblastoma. The apparently cystic portion was composed of friable gelatinous tissue. Fifteen months after her operation the patient is still asymptomatic.

CONCLUSION

We report the radiological and pathological findings of a low grade astroblastoma.

Calpain inhibition by cerebrospinal fluid and effects of calpain on intrathecal nerve tissue

STUDY DESIGN

The effects of calpain on intrathecal nerve tissue in the rabbit were investigated.

OBJECTIVE

To evaluate the chemonucleolytic side effect of calpain on nerve tissue in the event of accidental intrathecal calpain injection.

SUMMARY OF BACKGROUND DATA

Calpain has a degradative effect on proteoglycans, and as previously shown, it is associated with chemonucleolytic action in the rabbit. However, its effect on nerve tissue in the event of accidental intrathecal injection is not clear.

METHODS

The inhibitory activity of cerebrospinal fluid against calpain was measured in human cerebrospinal fluid using mu-calpain, and in different cerebrospinal fluid fractions separated by molecular filtration. The presence of the endogenous calpain inhibitor, calpastatin, in human cerebrospinal fluid was examined by Western blotting with anticalpastatin antibody. After intrathecal application of calpain in rabbits, the spinal cord nerve tissue was examined by light microscopy.

RESULTS

Cerebrospinal fluid inhibited the enzyme reaction of calpain at its normal concentration. Immunoblotting with anticalpastatin antibody did not yield positive staining. After the intrathecal application of calpain, there was no evidence of degeneration in the nerve tissue of the spinal cord.

CONCLUSIONS

This study suggests that in the event of accidental intrathecal injection of calpain for chemonucleolysis, the enzyme activity of calpain will be neutralized by cerebrospinal fluid, and the calpain should not cause unwanted side effects in chemonucleolysis.

Towards a high resolution separation of human cerebrospinal fluid

Human cerebrospinal fluid is an ultrafiltrate of plasma that is largely produced by the choroid plexus. It consists of a mixture of anorganic salts, various sugars, lipids and proteins from the surrounding brain tissues. The predominant proteins in cerebrospinal fluid are isoforms of serum albumin, transferrin and immunoglobulins, representing more than 70% of the total protein amount. A rough overview of the protein compounds of human cerebrospinal fluid including their respective concentrations is given by Blennow et al. [Eur. Neurol. 33 (1993) 129]. In contrast, the aim of this work is to display the detailed protein composition of CSF by two-dimensional gel electrophoresis and to identify both high and low concentrated proteins using different mass spectrometry techniques. This extensive overview of proteins in human cerebrospinal fluid will be highly relevant for clinical research. Furthermore, the comparison of 2D gels will help to analyze the standard protein variability in CSF of healthy persons and detect specific protein variations of patients with various neurological diseases (e.g., Alzheimer's disease, Huntington's chorea). Sample preparation for two-dimensional gel electrophoresis must include concentration and desalting steps such as precipitation and ultrafiltration due to the high amount of salts, sugars and lipids and the low total amount of protein of 0.3-0.7 microg/microl present in human CSF. Up to now we were able to identify more than 480 spots from suchlike generated 2D gels using MALDI- and ESI-mass spectrometry.

Metabolic profiling of rodent biological fluids via 1H NMR spectroscopy using a 1 mm microlitre probe

The application of a 1 mm TXI (1H/13C/15N) microlitre NMR probe with z-gradient for metabolic profiling of biofluids is described. The probe was used to provide spectral profiles for rat blood plasma using only approximately 2 microl of fluid with a range of solvent suppression techniques. Using a similar amount of fluid, spectra were obtained from rat and mouse cerebrospinal fluid, demonstrating that the probe could be used to profile rodents metabolically via biofluids previously inaccessible to NMR analysis without the need for termination.

[Effect of intraventricular infusion of Licvorin on general convulsive activity of rats]

It was studiet anticonvulsive action of the biopreparation licvorin had been made from a cerebrospinal fluid (CSF) of a cattle on the epiliptic activity provoking by korasol. The preparation was infused intraventriculary. Research showed preparation had the antiepileptic effect. It was manifested by decreasing expressiveness of convulsions, averting of general epileptic fit and mortality. Anticonvulsive action of the biopreparation licvorin was registrated in 2 hours and was achieved maximum effect 24 hours after injection. Anticonvulsive properties of the biopreparation licvorin realized by influence his active factors on structures of a brain, specifically on the GABAdependent systems.

Plaque-associated disruption of CSF and plasma amyloid-beta (Abeta) equilibrium in a mouse model of Alzheimer's disease

To better understand amyloid-beta (Abeta) metabolism in vivo, we assessed the concentration of Abeta in the CSF and plasma of APP(V717F) (PDAPP) transgenic mice, a model that develops age-dependent Alzheimer's disease (AD)-like pathology. In 3-month-old mice, prior to the development of Abeta deposition in the brain, there was a highly significant correlation between Abeta levels in CSF and plasma. In 9-month-old-mice, an age at which some but not all mice have developed Abeta deposition, there was also a significant correlation between CSF and plasma Abeta; however, the correlation was not as strong as that present in young mice. In further exploring CSF and plasma Abeta levels in 9-month-old mice, levels of CSF Abeta were found to correlate highly with Abeta burden. Analysis of the CSF: plasma Abeta ratio revealed a selective two-fold increase in plaque versus non-plaque bearing mice, strongly suggesting a plaque-mediated sequestration of soluble Abeta in brain. Interestingly, in 9-month-old mice, a significant correlation between CNS and plasma Abeta was limited to mice lacking Abeta deposition. These findings suggest that there is a dynamic equilibrium between CNS and plasma Abeta, and that plaques create a new equilibrium because soluble CNS Abeta not only enters the plasma but also deposits onto amyloid plaques in the CNS.

Analysis of the human lumbar cerebrospinal fluid proteome

Idiopathic low back pain has no known cause, and the molecular basis is unknown. Neuropeptidergic systems have been previously studied, and proteomics methods have been applied in this present study. Proteomics combines high-resolution two-dimensional (2-D) gel electrophoresis, high-sensitivity mass spectrometry, and continuously expanding protein databases. Proteomics offers a comprehensive, bird's-eye view to analyze, at a systems level, all of the proteins in cerebrospinal fluid (CSF) that might contribute to idiopathic low back pain. CSF contains a high salt concentration and low protein concentration. In order to obtain a high-quality 2-D pattern, several sample preparation methods were tested to remove salts - protein precipitation with either acetone or trichloroacetic acid/acetone, or sample treatment with a Bio-Spin column. More spots were visualized on the 2-D gel of human CSF, and a relatively high protein recovery was obtained when a Bio-Spin column was used to process a human CSF sample. Sixty-one protein spots, obtained from 2-D gels with a pH range of either 3-10 or 4-7, were identified by matrix assisted laser desorption/ionization-mass spectrometry (MALDI-MS) and MALDI-post-source decay (PSD)-MS. These 61 protein spots represent 22 proteins; six of those proteins were not annotated in any previously published 2-D maps. Those six proteins are PRO2619, pigment epithelium-derived factor, albumin homolog, kallikrein-6 precursor, DJ717I23.1, and AMBP protein precursor. These protein-mapping data will contribute to the database that will be used in the future to compare the proteomes obtained from the CSF of controls and low back pain patients, to characterize differentially expressed proteins, and to elucidate the biological markers for idiopathic low back pain.

Results of cerebrospinal fluid analysis, neurologic examination findings, and age at the onset of seizures as predictors for results of magnetic resonance imaging of the brain in dogs examined because of seizures: 115 cases (1992-2000)

OBJECTIVE

To determine whether neurologic examination findings, results of CSF analysis, or age at the onset of seizures could be used to predict whether results of magnetic resonance imaging (MRI) would be normal or abnormal in dogs with seizures.

DESIGN

Retrospective study.

ANIMALS

115 dogs.

PROCEDURE

Information on results of neurologic examination, results of CSF analysis, age at the onset of seizures, and results of MRI was obtained from the medical records.

RESULTS

Results of MRI were abnormal in 61 dogs and normal in 54. Sensitivity and specificity of neurologic examination alone were 77 (47/61) and 91% (49/54), respectively. Sensitivity and specificity of CSF analysis alone were 79 (48/61) and 69% (37/54), respectively. Results of MRI were abnormal for 12 of 28 (43%) dogs with abnormal CSF analysis results and normal neurologic examination results but for only 2 of 35 (6%) dogs with normal CSF analysis and normal neurologic examination results. Similarly, results of MRI were abnormal for 36 of 37 (97%) dogs with abnormal CSF analysis and abnormal neurologic examination results but for only 11 of 15 (73%) dogs with normal CSF analysis results and abnormal neurologic examination results. Age at the onset of seizures (< 6 vs > or = 6 years old) was not significantly associated with results of MRI.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that neurologic examination findings and results of CSF analysis are useful in predicting whether results of MRI will be abnormal in dogs examined because of seizures, but age at the onset of seizures is not.

Magendie and the chemists: the earliest chemical analyses of the cerebrospinal fluid

Having described the spinal fluid, François Magendie (1783-1855) called upon a number of chemists in Paris to analyze the material, in the effort to decide if it was a special secretion of the nervous system or simply a filtrate of the blood. J.L. Lassaigne (1800-1859) and J.P. Couerbe (1805-1867) responded. Their results, and those of some earlier investigators, are described. In the ensuing years of the nineteenth century, other investigators similarly conducted analyses of spinal fluid, but these were usually of single constituents in poorly defined diagnostic conditions. In 1909-1912, William Mestrezat (1883-1928) took advantage of the recently introduced technique of lumbar puncture, which by now had become hospital routine, and introduced the modern era of systematic analysis of many components of the spinal fluid, correlated with specific disease states.

[Corticoliberin protects the olfactory cortex slices against the negative effect of "dysfunctins"]

Corticoliberin may induce protective effects via its specific receptors or unspecifically by means of the glutamate receptors. A combined action of these mechanisms is also possible.

Tuberculous meningoencephalitis in Baghdad, 1993-99: a clinical study of 224 cases

This study examined all cases of tuberculous meningoencephalitis admitted to Ibn El-Khateeb Hospital for Infectious Diseases in Baghdad from 1993 to 1999. The diagnosis was based on the patient's history, clinical findings, cerebrospinal fluid analysis, microbial isolation and response to antitubercular drug therapy. The findings for cases diagnosed with tuberculous meningoencephalitis were compared with other types of meningitis. There were 224 cases comprising 5% of the total number of meningitis cases admitted during this period. The male to female ratio was 1.4:1. The age range was from 6 months to 72 years and the overall case fatality rate was 21%.

What I have learned about infectious diseases with my sleeves rolled up

The questions most often asked of my residents and myself are the following: (1) How do you interpret the cerebrospinal fluid white blood cell count and polymerase chain reaction results when the lumbar puncture has been traumatic? (2) Does the older adult with a serum sample that tests positive by the Venereal Disease Research Laboratory test need spinal fluid analysis for neurosyphilis, and which of those syphilis tests can become nonreactive even though the patient is never treated? (3) Do you give steroids to patients with bacterial meningitis? (4) What do you do for the patient with cryptococcal meningitis who develops a spastic gait? (5) Are all cases of transverse myelitis "idiopathic"? and (6) When does the patient who has had a stroke need spinal fluid analysis to rule out an infectious etiology? This is how we answer these questions.

Correlations between the cerebrospinal fluid surface tension value and 1. Concentration of total proteins 2. Number of cell elements

The contribution gives a survey about the problematics of surface tension in biomedical sciences. The paper presents results of a study devoted to the cerebrospinal fluid. The distribution of the surface tension values of this liquid in healthy individuals is presented (n = 33), and further, statistically significant correlations between the cerebrospinal fluid surface tension value and 1. concentration of total proteins expressed by Spearman's coefficient p(s) = (-0.995) and 2. number of cell elements expressed through Spearman's coefficient p(s) = (-0.965) in cerebrospinal fluid are described.