Spatial and temporal variation of routine parameters: pitfalls in the cerebrospinal fluid analysis in central nervous system infections
Open accessAbstract
The cerebrospinal fluid (CSF) space is convoluted. CSF flow oscillates with a net flow from the ventricles towards the cerebral and spinal subarachnoid space. This flow is influenced by heartbeats, breath, head or body movements as well as the activity of the ciliated epithelium of the plexus and ventricular ependyma. The shape of the CSF space and the CSF flow preclude rapid equilibration of cells, proteins and smaller compounds between the different parts of the compartment. In this review including reinterpretation of previously published data we illustrate, how anatomical and (patho)physiological conditions can influence routine CSF analysis. Equilibration of the components of the CSF depends on the size of the molecule or particle, e.g., lactate is distributed in the CSF more homogeneously than proteins or cells. The concentrations of blood-derived compounds usually increase from the ventricles to the lumbar CSF space, whereas the concentrations of brain-derived compounds usually decrease. Under special conditions, in particular when distribution is impaired, the rostro-caudal gradient of blood-derived compounds can be reversed. In the last century, several researchers attempted to define typical CSF findings for the diagnosis of several inflammatory diseases based on routine parameters. Because of the high spatial and temporal variations, findings considered typical of certain CNS diseases often are absent in parts of or even in the entire CSF compartment. In CNS infections, identification of the pathogen by culture, antigen detection or molecular methods is essential for diagnosis.
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Detection of enteroviral RNA in the CSF is a direct indicator of CNS involvement.
“The detection of enteroviral RNA in the CSF is therefore a direct indicator of CNS involvement (23–25).”
From Pathogen detection in acellular cerebrospinal fluid: diagnostic insights from a pediatric cohort in Colombia (2026) · cites this paper as [24]
The Conclusions (page not available) say that diagnosing CNS infection relies on identifying the causative pathogen by culture or molecular methods, supporting the general diagnostic point. The passages do not specifically address enteroviral RNA in CSF or state that its detection is a direct indicator of CNS involvement. (LLM, conf=0.78)
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- Authors
- Djukic, M., Lange, P., Erbguth, F., & Nau, R.
- Affiliations
- Universitätsmedizin Göttingen (DE)
- Paracelsus Medizinische Privatuniversität (DE)
- Corresponding author
- Nau, Roland
- Venue
- Journal of Neuroinflammation
- Published
- 2022-07-06
- Volume
- 19
- Issue
- 1
- Pages
- 174-174
- ISSN
- 1742-2094 (ISSN-L)
- PMC
- PMC9258096
- OpenAlex
- W4283838116
- Cited by
- 25
- References
- 112
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 5 · 2023: 7 · 2022: 1
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Neuroinflammation (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- Funders
- Deutsche Gesellschaft für Geriatrie
- Georg-August-Universität Göttingen
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Cerebrospinal fluid and hydrocephalus
- Life Sciences › Immunology and Microbiology › Microbiology › Bacterial Infections and Vaccines
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- cerebrospinal fluid, cerebrospinal fluid flow, rostrocaudal gradient, central nervous system infection, lactate, cerebrospinal fluid culture, antigen detection, molecular diagnosis
- MeSH terms
- Brain, Central Nervous System Infections, Cerebral Ventricles, Ependyma, Humans, Spinal Cord
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