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Recommendations for cerebrospinal fluid analysis

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Abstract

Diseases of the central nervous system (CNS) mean for the human organism a potentially dangerous situation. An investigation of cerebrospinal fluid (CSF) provides important information about a character of CNS impairment in the decision-making diagnostic and therapeutic algorithm. The authors present a brief overview of available cerebrospinal fluid assays, shortened indication criteria, a recommended algorithm of CSF assessment in different suspected diseases, and a view of the external quality system. The whole portfolio of obtainable CSF methodology is further subdivided according to the adequate choice into the first and inevitable basic routine panel, and following complicated analyses of highly specialized character. The basic panel is considered for standard laboratories, the complete specialized assessment should be provided by a super-consulting laboratory.

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Abbreviations

AB:

β-amyloid

AIDP/CIDP:

Acute/chronic inflammatory demyelinating polyneuropathy

anti-AMPA:

Anti-glutamate receptor antibodies

anti-GAG:

Antiganglioside antibodies

anti-NMDAR:

Antibodies for detection of glutamate NMDA (N-methyl-D-aspartate) receptors

anti-VGKC:

Antibodies against Voltage-Gated Potassium (Kalium) channels

APP:

Acute phase proteins

BBR, BM:

Reaction for Berlin blue., i.e. cytological staining for iron detection using Prussian blue

CARS:

Compensatory anti-inflammatory response syndrome

CJD:

Creutzfeldt-Jakob disease

CMV:

Cytomegalovirus

CNS/PNS:

Central/peripheral nervous system

CSF:

Cerebrospinal fluid

EBV:

Epstein-Barr virus

EFNS:

European Federation of Neurological Societies

EQA:

External quality assessment

ELISA:

Enzyme-Linked Immuno-Sorbent Assay

HSV:

Herpes simplex virus

HZV:

Herpes zoster virus

GAD:

Acid decarboxylase of gamma aminobutyric acid

IL(s):

Interleukin(s)

JCV:

John Cunningham virus

LGI1:

Leucine-rich glioma inactivated protein 1

ME:

Viral meningoencephalitis

MRZH:

Antibodies against neurotropic viruses like measles, rubella, varicella zoster and herpes simplex

NMO:

Neuromyelitis optica

NMO-IgG:

IgG auto-antibodies against AQP-4 water channel

MS:

Multiple sclerosis

NSE:

Neuron-specific enolase

OCB:

Oligoclonal bands of immunoglobulins

ORO:

cytological staining for lipids (oil red O)

PACNS:

Primary angiitis of the CNS

PAP:

Papanicolaou cytological staining

PAS:

Cytological staining with periodic acid + Schiffs reagent on mucopolysaccharides

PCR:

Polymerase chain reaction

Pentraxins:

Pentagonal acute phase proteins, both of hepatic and extrahepatic (e.g. CNS, placenta) origin

PML:

Progressive multifocal leucoencephalopathy

RR MS:

Relapsing–remitting multiple sclerosis

SAH:

Subarachnoid haemorrhage

SERPIN(s):

Serin proteinase inhibitor(s)

SIRS:

Systemic inflammatory response syndrome

Tc:

CD8+ T cytotoxic cell

Th:

CD4+ T helper cell

Treg:

T regulatory cell

VZV:

Varicella zoster virus

WB:

Western blot

ᅟ:

All remaining abbreviations are explained in the text.

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Authors and Affiliations

  1. Institute of Laboratory Medicine Lab In, Bezručova 10, Carlsbad, Czech Republic

    D. Hepnar, P. Adam & H. Žáková

  2. Department of Laboratory Medicine, Golovinova 3, Kadaň, Czech Republic

    M. Krušina

  3. Department of Neurology, Medical School 3, Charles University, Šrobárova 50, Prague, Czech Republic

    P. Kalvach

  4. Central Military Hospital, U vojenské nemocnice 1200, Prague, Czech Republic

    J. Kasík

  5. Regional Carlsbad Hospital, Americká 2, Carlsbad, Czech Republic

    I. Karpowicz & J. Nasler

  6. Department of Neurology, Karla Čapka 589, Písek, Czech Republic

    K. Bechyně

  7. Pediatric Department, Radomyšlská 336, Strakonice, Czech Republic

    T. Fiala

  8. Department of Pediatric Neurology, Medical School 2, Charles University, V Úvalu 84, Prague, Czech Republic

    M. Mamiňák

  9. Institute of Clinical Chemistry and Laboratory Medicine, Medical School 1, Charles University, U Nemocnice 2, Prague, Czech Republic

    I. Malíková

  10. Department of Neurology, Palacký University, I.P. Pavlova 2, Olomouc, Czech Republic

    J. Mareš

  11. Department of Neurology, Regional Krnov Hospital, I.P. Pavlova 11, Krnov, Czech Republic

    V. Šigut

  12. Department of Clinical Chemistry, Radomyšlská 336, Strakonice, Czech Republic

    Z. Tokár

  13. Department of Medical Biophysics and Medical Informatics, 3rd Faculty of Medicine, Charles University, Ruská 87, 100 00, Prague 10, Czech Republic

    J. Vránová

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  1. D. Hepnar
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  2. P. Adam
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  3. H. Žáková
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Correspondence to P. Adam.

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Hepnar, D., Adam, P., Žáková, H. et al. Recommendations for cerebrospinal fluid analysis. Folia Microbiol 64, 443–452 (2019). https://doi.org/10.1007/s12223-018-0663-7

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