By Dr. Hans Wolfgang Kölmel (auth.)
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Patient: female, 2 years old. CSF: 420 cells/mm 3 • (b) Meningoencephalitis in tuberculosis. Patient: male, 26 years old. CSF: 260 cells/mm 3 • (c, d) First symptoms in multiple sclerosis. (e) Anaphase in the mitosis of a cell similar to a plasma cell (chronic meningitis, etiology unknown). (f) Unusual plasma cell with 6 nuclei. (Aseptic, eosinophilic meningitis after bleeding angioma, Patient 9 years old). 38 disputed [209], it seems to have special diagnostic value in cases in which the total cell count in the CSF remains normal.
No therapy as yet. Patient: male, 22 years old. CSF: 430 cells/mm 3 , 95 mg% protein. a Large cluster of predominantly multinuclear macrophages. b Many transformed monocytes in loose clusters as well as some granulocytes. Phagocytized material in the cytoplasm. c Fluorescent stain with acridine orange. Strong red fluorescence indicates activity of monocytic and lymphocytic cytoplasm. 54 difficult to draw clear lines of distinction among these cell types. One can divide the lymphoid cells into dark-cytoplasmic and light-cytoplasmic types, but further differentiation (as Wieczorek proposed, for example [228]) is not easy.
Lymphoid cells can appear in all forms of infectious pleocytosis of the CSF [69] and occasionally appear in reaction to foreign elements, as in the case of myelography or subarachnoid hemorrhage. They are always present in the cytograms of tuberculous CSF, often in the early stage, and deserve special attention. a b c 55 9. Cerebral and Spinal Syphilis Syphilitic meningoencephalitis, tabes dorsalis, and progressive paralysis are not responsible for specific and characteristic cytologic findings in the eSF.