Der blutige Liquor

Zusammenfassung

Der sanguinolente Liquor hat nicht nur diagnostische Aspekte; seine häufigste Ursache — die Subarachnoidalblutung — ermöglicht es uns außerdem, die morphologischen und humoralen Reaktionen des Liquorsystems als Antwort auf eine schwerwiegende physikomechanische Veränderung der Homöostase im Liquorsystem zu studieren.

Unseren Untersuchungen liegen 6000 Liquorpräparate und -befunde zugrunde, von denen 140 von spontanen Subarachnoidalblutungen stammen. Es zeigt sich in Übereinstimmung mit anderen Untersuchern, daß die Mehrzahl der entnommenen Liquorproben — um 90% — mikroskopische Beimengungen von Blut beinhalten. Es werden aus der Korrelation Erythrozytenzahl/Aussehen/Gesamteiweiß die diagnostischen Abgrenzungsmöglichkeiten einer artifiziellen akzidentellen Blutung von einer echten autochthonen pathologischen Subarachnoidalblutung besprochen. Eine wesentliche Bedeutung kommt bei der Verifizierung einer echten autochthonen Subarachnoidalblutung derproteinokolorimetrischen, Dissoziation zu.

Summary

Blood stained cerebrospinal fluid (c.s.f.) has not only a diagnostic significance; its commonest cause—subarachnoid haemorrhage—makes it additionally possible for us to study the morphological and humoral reactions of the c.s.f. system to a serious physicomechanical change of the homeostasis of that system.

Our researches are based on the analyses of 6,000 c.s.f. specimens of which 140 were taken from patients with spontaneous subarachnoid haemorrhage. In agreement with other investigations, it appeared that the majority (about 90%) of the c.s.f. specimens withdrawn contained microscopical contamination with blood. A possible correlation is discussed between the erythrocyte count, the appearance of the fluid, and the total protein content as a means of differentiating between an accidental artefactual haemorrhage and a true subarachnoid haemorrhage of pathological origin. A real importance belongs to the protein—colorimetric dissociation in the verification of a true pathologically caused subarachnoid haemorrhage.

In the field of the morphological defence reaction an acute inflow of blood into the c.s.f. leads, via the mobilization of the reticulohistiocytic stem-cells with a positive haemotaxis, to differentiation of macrophages with eurythrocyte—haemosiderin—and haematoidin storage. The meningeal defence reaction is set in motion immediately after the occurrence of the insult. From the type of dominant storage cells conclusions could be drawn as to the time of the subarachnoid haemorrhage and certain laws concerning its course could be established.

Moreover, the blood-phagocytes are a certain sign that the subarachnoid haemorrhage is at least a few hours old and they are never identified in an artificially blood stained c.s.f. Free haemosiderin crystals can still be in the c.s.f. months after the last diagnostic verification of an established subarachnoid haemorrhage.

An especial significance attaches to the c.s.f. protein spectrum in subarachnoid haemorrhage. The red-brown staining after centrifuging of the supernatant fluid by haemoglobin and methaemoglobin, which travel with the ß-globulins and usually are recognisable even in small amounts in the native electrophoretic bands, confirm a true subarachnoid haemorrhage. After staining with Amido-schwarz the hight of the ß-globulins depends on the portion of the haemoglobin respectively methaemoglobin in the ß-globulin fraction, and it can exceed the albumen in the first week after the haemorrhage. A rise in ß-globulin up to over 50% of the c.s.f. protein spectrum can for practical purposes be considered as pathognomic of a spontaneous subarachnoid haemorrhage.