CSF laboratory
Neurochemical and neuro-immunological laboratory
Team:
PD Dr. H. Tumani
Senior physician and director of laboratory
Phone 0731 177-5204
Email: hayrettin.tumani@rku.de
Ms Dr. V. Lehmensiek/ Ms D. Vogel
Chief MTA
Phone: 0731 177-1519 or 0731 5023802
Analysing the cerebrospinal fluid (CSF) is an essential component of neurological diagnostic investigations. Apart from showing or excluding inflammatory processes caused by agents or autoimmune reactions, CSF investigations provides important information about neoplastic disorders of the meninges and the CNS (central nervous system) as well as about subarachnoid hemorrhage not found by CT. Selecting special therapeutic drugs and defining their dose for inflammatory or neoplastic neurological disorder treatment also greatly depend on CSF laboratory findings.
Material of examination:
- cerebrospinal fluid
- serum
- puncture specimens
Parameters of examination
Download form "CSF Laboratory Requirements" (Adobe Acrobat PDF)
Cytology:
- CSF cell count
- CSF cell sedimentation
- agent staining
Lactate Proteins:
- total protein, immunoglobulins (IgG, IgA, IgM), oligoclonal IgG bands
Agent-specific antibodies:
- Borrelia (IgG, IgM)
- spring-summer encephalitis (IgG, IgM)
- measles
- rubella
- zoster
- herpes
CNS-specific proteins:
- beta trace (prostaglandin-D synthesis)
- S-100b
- tau protein
- beta amyloid
CSF examination programme:
CSF diagnostics consist of a three-stage programme:
- emergency diagnostics (character, cell count, total protein, lactate)
- basic diagnosis (differentiated cell count, albumin, immunoglobulins (IgG, IgA, IgM))
- special diagnosis (oligoclonal bands, agent-specific antibodies, marker proteins for CNS-specific destruction and activity).
To be able to assess a possible autochthonous production of immunoglobulins or agent-specific antibodies, a parallel examination of both, CSF and blood is required because the largest CSF protein fractions originate from the blood. Computed CSF-to-blood ratios are then evaluated with reference to the patient's personal blood-CSF barrier function. Intrathecal synthesis of immunoglobulins is evaluated with reference to the quotient charts plotting the CSF-to-serum quotients for IgG, IgA and IgM vs the CSF-to-serum quotients for albumin (barrier function parameter). A graphical evaluation of these parameters leads to diagnostically highly specific findings of symptom constellations typical for a disease.
CNS-specific marker proteins:
Reliable quantification of the brain's own cell-specific marker proteins in the cerebrospinal fluid and serum started a new era of laboratory diagnostics of neurological disorders. Meningeal, glial and neuronal proteins can be found to derive information about acute or chronic CNS processes (e.g. neuronal damage, glia activation).
Significance of a specialised CSF laboratory:
German CSF diagnostics and clinical neurochemistry have a long track record of a high-level international standing. Introducing clinically relevant methods and evaluation procedures focussed on the actual disease took close collaboration of basic researchers and neurologists. Due to their neurological importance, the development of an integrated CSF findings report and the possibility of showing what findings are typical for a specific disease was widely heralded and promoted.
Experience from the last three decades has taught us that practicing integrated CSF diagnostics is the only way to satisfy the expectations of both, clinics and laboratory medicine. Essential factors are a deep knowledge of modern barrier concepts, the perfect handling of very sensitive techniques such as cytology and protein diagnostics, and close cooperation with neurologists.
The fact that, as opposed to blood or urine specimens, the cerebrospinal fluid needed for laboratory testing is drawn but once through lumbal puncture goes to show that the different branches of clinical neurochemical analytics (cytology, protein diagnosics etc.) right through to final findings should be handled by a single body. CSF thus qualifies as very precious material which results in the necessity of taking one analytical step at a time as dictated by clinical assumptions and previous findings, and in the necessity of keeping the sample for longer periods of time.
It takes years of experience and training just to analyse CSF cell preparations. This is followed by multiple protein analyses whose findings need to be more and more accurate and specific. Graphic charts plotting the CSF/serum concentration quotients as a quotient chart including barrier-related evaluations and showing the humoral immunity reactions has proved its worth for everyday clinical/neurological work where it is unquestionably and firmly established. Taking this as a basis, decisions need to be made on further and more sensitive (isoelectric focussing) or more specific (agent-specific findings) methods of analysis.
Download form "CSF Laboratory Requirements" (Adobe Acrobat PDF)
Scientific activities
Glial and neuronal proteins in blood as activity and progression markers in cases of inflammatory CNS disorders and neurodegenerative processes
CSF and serum specimen bank
Contact
PD Dr. H. Tumani
(senior physician and director of laboratory)
Phone: 0731 177-5204
Email: hayrettin.tumani@rku.de
Link to the site of Gesellschaft für Liquordiagnostik (CSF Diagnostics Association)