CSF biomarkers in posterior cortical atrophy.

OBJECTIVE: To describe CSF biomarker profiles in posterior cortical atrophy (PCA), which induces high-order visual deficits often associated with Alzheimer disease (AD) pathology, and relate these findings to clinical and neuropsychological assessment. METHODS: This prospective observational study included 22 patients with PCA who underwent CSF biomarker analysis of total tau (t-tau), phosphorylated tau on amino acid 181 (p-tau181), and amyloid ß (Aß(42)). At group level, the CSF profiles of patients with PCA were compared to those of patients with typical AD and patients with other dementia (OD). Individually, the clinical presentation of patients with PCA was correlated to their CSF profile to assess the predictability of clinical features for diagnosis of underlying AD pathology. RESULTS: At group level, the PCA biomarker profile was not different from that of the AD group, but very different from that of the OD group (p < 0.001). More than 90% of patients with PCA had CSF profiles consistent with AD. All patients with PCA with either isolated higher-order visual deficit (n = 8) or visual deficit associated with memory impairment (n = 11) had CSF profiles consistent with AD. Only one of the 3 patients with PCA with asymmetric motor signs fulfilled biological CSF criteria for AD. CONCLUSIONS: PCA syndrome is usually associated with CSF biomarkers suggestive of AD, as shown by previous neuropathologic studies. This does not apply in case of motor signs suggesting associated corticobasal syndrome. CSF biomarkers help to discriminate AD from non-AD processes associated with this condition.

[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]. / Contribution de l'analyse du LCR au diagnostic et au suivi évolutif d'une méningite tuberculeuse.

We report the case of a patient who was admitted to the hospital because of language and mental confusion. His initial lumbar puncture revealed 193 leukocytes per mm3 mostly lymphocytes (95%), no red blood cells, high protein content (1.20 g/L) and normal glucose level. The antibiotic therapy by amoxicilline and aciclovir during 6 days led to complete clinical recovery in a week. A CT scan of the cerebrum showed no abnormalities, nor did chest radiography. Twelve days after discharge, the patient was rehospitalized because of a meningitis syndrome. On lumbar puncture, the CSF analysis revealed 280 leukocytes/mm3, 56% lymphocytes, 10% monocytes and 34% polymorphonuclear cells. CSF chemistry showed a protein level of 3.54 g/L, and a glucose level depressed at 0.9 mmol/L. Because of the clinical symptoms and CSF abnormalities, the patient received aciclovir, amoxicilline vancomycine, isoniazide, rifampicine, pyrazinamide and ethambutol. Screening for infections gave negative results until the 37th day, when the diagnosis of tuberculous meningitis was confirmed by the isolation of Mycobacterium tuberculosis in the repetitive CSF. Antituberculous therapy was expanded. According the Reiber diagrams, intrathecal IgG synthesis was negative at day 25, day 37, month 4, month 9, month 17. Intrathecal IgM synthesis was elevated at day 12 and day 25 and intrathecal IgA synthesis at day 25. Improvement of the patient's conditions by tuberculosis treatment was obtained in 17 months. Cerebrospinal fluid analysis has been the basis for the diagnosis and follow-up of tuberculous meningitidis.

[CSF: diagnosis of neurosyphilis in a patient hospitalized for an acute brain stroke]. / LCR : diagnostic d'une neurosyphilis lors d'une hospitalisation pour un accident vasculaire cérébral.

We report the case of a sixty-eight years old patient, who was admitted to the emergency for paresthesis associated with dysarthra and speech complaints. Neuroimaging revealed the presence of stenosis caused by arteritis. The notion of history of syphilis infection led to diagnosis of neurosyphilis. Diagnosis is difficult due to its clinical polymorphism and requires using several tests in the cerebrospinal fluid (CSF) because infection involving the central nervous system. Neurosyphilis is diagnosed by finding elevated cell count (80 leukocytes/mm3), high protein level (1.07 g/L) and positive IgG oligoclonal bands. In addition CSF and blood should be titrated with the VDRL and TPHA tests which are difficult to interpret. The diagnosis of active neuro-syphilis requires positive, non specific and specific inflammatory tests.