The CSF changes in the patients in our study (lymphocytic pleocytosis
, protein elevation, blood-brain barrier dysfunction, and local antibody production) are typical for a viral infection of the CNS.
Lead exposure reduces the tightness and augments the permeability of tight blood-CSF barrier; then, CSF analysis may show mild changes including pleocytosis
and high protein.
Changes in the cerebrospinal fluid are also present in Fabry patients and are defined as 'aseptic meningitis' or chronic meningitis with mild to moderate pleocytosis
(76 cells/[micro]L) and slightly elevated total protein levels (up to 800 mg/L) suggesting disturbed blood brain barrier function, mostly with lymphomonocytic response.
CSF analysis in TBM shows elevated proteins and low glucose with lymphocytic pleocytosis
but patients with Herpes encephalitis, cryptococcal meningitis, brucellosis and neurosyphilis also exhibit more or less same picture so there arise difficulty in differentiating TBM from these causes of meningitis.
Cerebrospinal fluid analysis may demonstrate pleocytosis
predominantly lymphocytes with moderate increase in CSF proteins but normal sugar.
 have shown that even with high CSF protein and a pleocytosis
, viscosity between CSF and saline are not very different and do not impact appreciably on CSF flow in the clinical setting.
Typical CSF picture for TBM was defined as lymphocytic pleocytosis
, elevated protein and low CSF glucose concentration.
The CSF profile in neuroinvasive disease may be characterized by a lymphocytic pleocytosis
in up to half of the cases, a neutrophil pleocytosis
in up to 45% of cases, or a noninflammatory profile in up to 5% of cases of neuroinvasive diseases , as was the case in our patient.
CSF features suggestive of neurosyphilis include lymphocytic pleocytosis
, low glucose, and raised protein , which may occur in HIV alone as well .
Given the patient's history of fever, myalgia, rash, and joint pain with CSF studies showing both a neutrophilic and lymphocytic pleocytosis
, there was concern for infectious etiologies, including both bacterial and viral infections, as well as autoimmune etiologies.
"We recommend that routine testing of CSF for enterovirus and parechovirus in febrile infants should be promoted, even in the absence of pleocytosis
," said Dr.
In the completed dose escalation portion (Part 1) of the study, the most common device-related adverse events (AEs) were ICV infection prior to first BMN 250 infusion, site erythema, CSF pleocytosis
and blood clot in CSF.