By Dr. Hans Wolfgang Kölmel (auth.)
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Extra info for Atlas of Cerebrospinal Fluid Cells
Cellular Reaction of Bloody Cerebrospinal Fluid An extraordinary leptomeningeal cell reaction takes place if blood infiltrates the CSF, as is the case after aneurysmal or hypertonal hemorrhage, after cerebral contusion or brain surgery . The presence of the blood as foreign material causes a meningitis whose first sign is the appearance of all the hematologic cell forms. In rare cases, the pleocytosis can attain levels of 1,500 cells/mm 3 , of which the majority are granulocytes. The phagocytic activity provoked by the red blood cells (RBC) is most impressive [99, 172].
Macrophages and plasma cells show only limited mitotic activity. All of the granulocytes possess degenerative stigmata, their nuclei become oversegmented and pyknotic, and the plasma becomes vacuolated and loses its sharp outline. The cellularity in the case of a cerebral abcess resembles that in chronic meningitis. The granulocytes are more numerous, and the macrophages are conspicuous, as some of them develop an enlarged signet ring shape. The activity of the lymphocytes is rather limited. Although there are certain similarities between this form and tuberculous meningitis, differentiation is sometimes possible.
A Early proliferative phase ol pneumococcal meningitis. Start of the monocytic reaction. Patient: male, 60 years old. CSF: 800 cells/ mm 3 , 120 mg% protein. b Late proliferative phase olpseudomonas meningitis. Granulocytes predominate, accompanied by many lymphocytic-plasmocytic cell elements. Patient: female, 56 years old. CSF: 230 cells/mm 3 . b 45 7. Lymphocytic Meningitides and Meningoencephalitides In cases in which the lymphocytic meningitides take the usual, relatively benign course, the cause is usually a member of the enterovirus group.
Atlas of Cerebrospinal Fluid Cells by Dr. Hans Wolfgang Kölmel (auth.)