Baunbæk Egelund Gertrud, Ertner Gideon, Langholz Kristensen Kristina, Vestergaard Jensen Andreas, Benfield Thomas L, Brandt Christian T
Department of Pulmonary and Infectious Diseases, Nordsjællands Hospital, University of Copenhagen, Hillerød Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.
Medicine (Baltimore). 2017 May;96(18):e6686. doi: 10.1097/MD.0000000000006686.
Cerebrospinal fluid (CSF) analysis is the most important tool for assessing central nervous system (CNS) disease. An elevated CSF leukocyte count rarely provides the final diagnosis, but is almost always an indicator of inflammation within the CNS.The present study investigated the variety of diseases associated with CSF pleocytosis.CSF analyses were identified through the biochemical database used in the capital region of Denmark in the period from 2003 to 2010. In patients >15 years, clinical diagnoses associated with the finding of a CSF leukocyte count >10 × 10 cells/L were obtained from discharge records and patient files.A total of 1058 CSF samples from 1054 patients were included in the analysis. The median age was 50 (interquartile range: 36-67) and 53% were male. Eighty-one different diagnoses were identified in 1058 cases with an elevated CSF leukocyte count, besides unknown causes. Infections were the most common cause of CSF pleocytosis (61.4%) followed by miscellaneous causes (12.7%), vascular (9.7%), neurodegenerative (7%), neoplastic (5%), and inflammatory conditions (4.2%). Only infections presented with leukocyte counts >10,000 × 10/L. Infections represented 82.6% of all cases with a leukocyte count >100 × 10/L whereas 56.3% of cases with at leukocyte counts <100 × 10/L were dominated by disease not related to infection.The present study may serve as a reminder to clinicians of what diseases and disease categories to suspect when patients present with CSF biochemistry indicating CNS inflammation.
脑脊液（CSF）分析是评估中枢神经系统（CNS）疾病最重要的工具。脑脊液白细胞计数升高很少能提供最终诊断，但几乎总是中枢神经系统内炎症的一个指标。本研究调查了与脑脊液细胞增多相关的各种疾病。通过丹麦首都地区2003年至2010年使用的生化数据库确定脑脊液分析情况。在15岁以上的患者中，从出院记录和患者档案中获取与脑脊液白细胞计数>10×10⁶细胞/L这一发现相关的临床诊断。共有来自1054名患者的1058份脑脊液样本纳入分析。中位年龄为50岁（四分位间距：36 - 67岁），53%为男性。在1058例脑脊液白细胞计数升高的病例中，除了不明原因外，确定了81种不同诊断。感染是脑脊液细胞增多最常见的原因（61.4%），其次是其他原因（12.7%）、血管性疾病（9.7%）、神经退行性疾病（7%）、肿瘤性疾病（5%）和炎症性疾病（4.2%）。只有感染患者的白细胞计数>10000×10⁶/L。白细胞计数>100×10⁶/L的所有病例中，感染占82.6%，而白细胞计数<100×10⁶/L的病例中，56.3%以非感染性疾病为主。本研究可能会提醒临床医生，当患者脑脊液生化指标显示中枢神经系统炎症时，应怀疑哪些疾病和疾病类别。
