Skip to main content
SpringerLink
Log in

Liquordiagnostik

  • Living reference work entry
  • First Online:
Book cover Klinische Neurologie

Part of the book series: Springer Reference Medizin ((SRM))

  • 1187 Accesses

Zusammenfassung

In einer kurzen Einführung werden die Besonderheiten der Physiologie und Neuroimmunologie des ZNS kurz dargestellt. Das analytische Programm der Liquoranalytik und die Bedeutung der zusammenfassenden Darstellung der Ergebnisse mit krankheitsbezogener Interpretation im integrierten Gesamtbefund werden aufgezeigt. Präanalytische Faktoren wie Punktionsdurchführung, Zeitpunkt, Blutbeimengung etc. haben bedeutenden Einfluss auf die sich ergebende Befundkonstellation. Die Verfahren der Liquordiagnostik beinhalten u. a. Zellzahl- und Erythrozytenzahlbestimmung, Differenzialzellbild (Liquorzytologie), Laktatbestimmung, Ferritinbestimmung, die Verfahren zum Nachweis von intrathekal gebildeten Immunglobulinen als Nachweis einer ZNS-Infektion (Quotientendiagramm, oligoklonale Banden), Antikörperindices, Demenz und Destruktionsmarker (β-Amyloid, Tau, S100, NSE etc.), PCR. Methodische Aspekte, die wichtig für die Interpretation im integrierten Gesamtbefund sind, werden dargestellt. Die diagnostische Bedeutung der Liquoranalytik auf unterschiedliche Erkrankungsbilder wird im Detail erläutert. Dazu gehören u. a. akute und entzündliche ZNS-Erkrankungen (Meningitis, Hirnabszess, Neuroborreliose, Neurotuberkulose, Neurosyphilis, Herpes und Zoster-bedingte ZNS-Erkrankungen, HIV und opportunistische Erkrankungen), multiple Sklerose, Autoimmunerkrankungen, Parasitosen, Tumorerkrankungen, Hypoxien, Blutungen, neurodegenerative und psychiatrische Erkrankungen. Es wird besonderer Wert auf die Zusammenführung aller Liquordaten und der Interpretation und Erkennung von krankheitsspezifischen Mustern gelegt.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Literatur

  • Andersson M, Alvarez-Cermeno J, Bernardi G et al (1994) Cerebrospinal fluid in the diagnosis of multiple sclerosis: a consensus report. J Neurol Neurosurg Psychiatry 57:897–902

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bechter K, Reiber H, Herzog S, Fuchs D, Tumani H, Maxeiner HG (2010) Cerebrospinal fluid analysis in affective and schizophrenic spectrum disorders. Identification of subgroups with immune responses and blood-CSF barrier dysfunction. J Psychiatr Res 44:321–330

    Article  CAS  PubMed  Google Scholar 

  • Bridel C, Courvoisier DS, Vuilleumier N, Lalive PH (2015) Cerebrospinal fluid angiotensin-converting enzyme for diagnosis of neurosarcoidosis. J Neuroimmunol 285:1–3

    Article  CAS  PubMed  Google Scholar 

  • Burkhardt D, Schipper HI, Kaboth U, Felgenhauer K (1992) IgA producing primary intracerebral lymphoma. J Neurol Neurosurg Psychiatry 55:623–625

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Carpio A, Campoverde A, Romo ML, García L, Piedra LM, Pacurucu M, López N, Aguilar J, López S, Vintimilla LC, Toral AM, Peña-Tapia P (2017) Validity of a PCR assay in CSF for the diagnosis of neurocysticercosis. Neurol Neuroimmunol Neuroinflamm 4(2):e324

    Article  PubMed  PubMed Central  Google Scholar 

  • Cinque P, Cleator GM, Weber T, Monteyne P, Sindic CJ, Van Coon AM (1996) The role of laboratory investigation in the diagnosis and management of patients with suspected herpes simplex encephalitis: a consensus report. J Neurol Neurosurg Psychiatry 61:339–345

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Cinque P, Scarpellini P, Vago L et al (1997) Diagnosis of central nervous system complications in HIV-infected patients: cerebrospinal fluid analysis by the polymerase chain reaction. AIDS 11:1–17

    Article  CAS  PubMed  Google Scholar 

  • Conrad AJ, Chiang EY, Andeen LE et al (1994) Quantitation of intrathecal measles virus IgG antibody synthesis rate: subacute sclerosing panencephalitis and multiple sclerosis. J Neuroimmunol 54:99–108

    Article  CAS  PubMed  Google Scholar 

  • Dorta AJ, Reiber H (1998) Intrathecal synthesis of immunoglobulins in eosinophilic meningoencephalitis due to Angiostrongylus cantonensis. Clin Diagn Lab Immunol 5:452–455

    Google Scholar 

  • Ebinger M, Grauer MT, Uhr M (2005) Intrathecal IgA synthesis in neurosyphilis. J Neurol Sci 228:21–25

    Article  CAS  PubMed  Google Scholar 

  • Felgenhauer K (1988) Prozesslokalisation, Krankheitsphase und Liquorzusammensetzung. In: Holzgraefe M, Reiber H, Felgenhauer K (Hrsg) Labordiagnostik von Erkrankungen des Nervensystems. Perimed, Erlangen, S 84–92

    Google Scholar 

  • Felgenhauer K, Reiber H (1992) The diagnostic relevance of antibody specificity indices in multiple sclerosis and herpes virus induced diseases of the nervous system. Clin Investig 70:28–37

    Article  CAS  PubMed  Google Scholar 

  • Graef I, Henze T, Reiber H (1994) Polyspezifische Immunreaktion im ZNS bei Autoimmunerkrankungen mit ZNS Beteiligung. Z Arztl Fortbild 88:587–691

    CAS  Google Scholar 

  • Harrer A, Tumani H, Niendorf S, Lauda F, Geis C, Weishaupt A, Kleinschnitz C, Rauer S, Kuhle J, Stangel M, Weber F, Uhr M, Linnebank M, Wildemann B, Jarius S, Guger M, Ayzenberg I, Chan A, Zettl U, Wiendl H, Pilz G, Hitzl W, Weber JR, Kraus J (2013) Cerebrospinal fluid parameters of B cell-related activity in patients with active disease during natalizumab therapy. Mult Scler 19(9):1209–1212

    Article  CAS  PubMed  Google Scholar 

  • Jacobi C, Reiber H (1988) Clinical relevance of increased neuron-specific enolase concentration in cerebrospinal fluid. Clin Chim Acta 177:49–54

    Article  CAS  PubMed  Google Scholar 

  • Jacobi C, Lange P, Reiber H (2007) Quantitation of intrathecal antibodies in cerebrospinal fluid of subacute sclerosing panencephalitis, herpes simplex encephalitis and multiple sclerosis: discrimination between microorganism-driven and polyspecific immune response. J Neuroimmunol 187:139–146

    Article  CAS  PubMed  Google Scholar 

  • Jesse S, Steinacker P, Lehnert S, Gillardon F, Hengerer B, Otto M (2009) Neurochemical approaches in the laboratory diagnosis of Parkinson’s and Parkinson’s dementia syndromes: a review. CNS Neurosci Ther 15(2):157–182

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kluge H, Wieczorek V, Linke E, Zimmermann K, Witte OW (2005) Atlas der praktischen Liquorzytologie. Thieme, Stuttgart

    Book  Google Scholar 

  • Korenke GC, Reiber H, Hunnemann DH, Hanefeld F (1997) Intrathecal IgA synthesis in X-linked cerebral adrenoleukodystrophy. J Child Neurol 12(5):314–320

    Article  CAS  PubMed  Google Scholar 

  • Kuehne LK, Reiber H, Bechter K, Hagberg L, Fuchs D (2013) Cerebrospinal fluid neopterin is brain-derived and not associated with blood-CSF barrier dysfunction in non-inflammatory affective and schizophrenic spectrum disorders. J Psychiatr Res 47(10):1417–1422

    Google Scholar 

  • Kuhle J, Barro C, Disanto G, Mathias A, Soneson C, Bonnier G, Yaldizli Ö, Regeniter A, Derfuss T, Canales M, Schluep M, Du Pasquier R, Krueger G, Granziera C (2016) Serum neurofilament light chain in early relapsing remitting MS is increased and correlates with CSF levels and with MRI measures of disease severity. Mult Scler 22(12):1550–1559

    Article  CAS  PubMed  Google Scholar 

  • Lejon V, Reiber H, Legros D et al (2003) Intrathecal immune response pattern for improved diagnosis of central nervous system involvement in trypanosomiasis. J Infect Dis 187:1475–1483

    Article  PubMed  Google Scholar 

  • Lewerenz J, Jarius S, Wildemann B, Wandinger KP, Leypoldt F (2016) Autoantibody-associated autoimmune encephalitis and cerebellitis: clinical presentation, diagnostic work-up and treatment. Nervenarzt 87(12):1293–1299

    Article  CAS  PubMed  Google Scholar 

  • Llorens F, Schmitz M, Ferrer I, Zerr I (2016) CSF biomarkers in neurodegenerative and vascular dementias. Prog Neurobiol 138–140:36–53

    Article  PubMed  CAS  Google Scholar 

  • McDonald WI, Compston A, Edan G et al (2001) Recommended diagnostic criteria for multiple sclerosis: guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    Article  CAS  PubMed  Google Scholar 

  • Monteyne PH, Sindic CJM (1995) The diagnosis of tuberculous meningitis. Acta Neurol Belg 95:80–87

    CAS  PubMed  Google Scholar 

  • Nielsen PR, Kragstrup TW, Deleuran BW, Benros ME (2016) Infections as risk factors for autoimmune diseases – a nationwide study. J Autoimmun 74:176–181. https://doi.org/10.1016/j.jaut.2016.05.013

    Article  PubMed  Google Scholar 

  • Oeckl P, Jardel C, Salachas F et al (2016) Multicenter validation of CSF neurofilaments as diagnostic biomarkers for ALS. Amyotroph Lateral Scler Frontotemporal Degener 17(5-6):404–413

    Article  CAS  PubMed  Google Scholar 

  • Otto M, Wiltfang J (2003) Differential diagnosis of neurodegenerative diseases with special emphasis on Creutzfeldt-Jakob disease. Restor Neurol Neurosci 21:191–209

    CAS  PubMed  Google Scholar 

  • Otto M, Wiltfang J, Cepek L et al (2002) Tau protein and 14-3-3 protein in the differential diagnosis of Creutzfeldt-Jakob disease. Neurology 58:192–197

    Article  CAS  PubMed  Google Scholar 

  • Passerini G, Dalla Costa G, Sangalli F, Moiola L, Colombo B, Locatelli M, Comi G, Furlan R, Martinelli V (2016) Free light chains and intrathecal B cells activity in multiple sclerosis: a prospective study and meta-analysis. Mult Scler Int 2016:2303857 (online)

    Google Scholar 

  • Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Filippi M, Fujihara K, Havrdova E, Hutchinson M, Kappos L, Lublin FD, Montalban X, O’Connor P, Sandberg-Wollheim M, Thompson AJ, Waubant E, Weinshenker B, Wolinsky JS (2010) Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 69(2):292–302

    Article  Google Scholar 

  • Prange HW, Aue G, Frauendorf H, Reiber H (1995) Die neuronenspezifische Enolase als Prognosemarker bei zerebraler Hypoxie. Intensivmed 32:17–22

    Google Scholar 

  • Presslauer S, Milosavljevic D, Huebl W, Aboulenein-Djamshidian F, Krugluger W, Deisenhammer F, Senel M, Tumani H, Hegen H (2016) Validation of kappa free light chains as a diagnostic biomarker in multiple sclerosis and clinically isolated syndrome: a multicenter study. Mult Scler 22(4):502–510

    Article  CAS  PubMed  Google Scholar 

  • Quentin CD, Reiber H (2004) Fuchs’ heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor. Am J Ophthalmol 138(1):46–54

    Article  PubMed  Google Scholar 

  • Reiber H (1994) Flow rate of cerebrospinal fluid (CSF) – a concept common to normal blood-CSF barrier function and to dysfunction in neurological diseases. J Neurol Sci 122(2):189–203

    Article  CAS  PubMed  Google Scholar 

  • Reiber H (2001) Dynamics of brain-derived proteins in cerebrospinal fluid. Clin Chim Acta 310:173–186

    Article  CAS  PubMed  Google Scholar 

  • Reiber H (2003) Proteins in cerebrospinal fluid and blood: barriers, CSF flow rate and source-related dynamics. Restor Neurol Neurosci 21:79–96

    CAS  PubMed  Google Scholar 

  • Reiber H (2008) Neurologische Untersuchungen/Liquoranalytik. In: Sinha P (Hrsg) Laborbefunde und ihre klinischen Interpretationen, Methoden der Laboruntersuchung, Diagnosestrategien, Differentialdiagnose. Spitta, Balingen

    Google Scholar 

  • Reiber H (2016a) Knowledge-base for interpretation of Cerebrospinal fluid data patterns – essentials in neurology and psychiatry. Arq Neuropsiquiatr 74(6):501–512

    Article  PubMed  Google Scholar 

  • Reiber H (2016b) Cerebrospinal fluid data compilation and knowledge-based interpretation of bacterial, viral, parasitic, oncological, chronic inflammatory and demyelinating diseases: diagnostic patterns not to be missed in neurology and psychiatry. Arq Neuropsiquiatr 74(4):337–350

    Article  PubMed  Google Scholar 

  • Reiber H (2016c) Liquordiagnostik in Deutschland nach 1950. Entwicklungen im Kontext von Wissenschaft und Gesellschaft in DDR und BRD. Nervenarzt 87:1261–1270. https://doi.org/10.1007/s00115-016-0241-7

    Article  CAS  PubMed  Google Scholar 

  • Reiber H (2017a) Physiological and biophysical data of proteins in CSF: facts and interpretations by the molecular flux/CSF flow theory for barrier functions (im Druck)

    Google Scholar 

  • Reiber H (2017b) Chronic diseases with delayed onset after infections and vaccinations: Gulf war illness, autoimmune diseases, post lyme syndrome and chronic fatigue. J Arch Mil Med (review submitted)

    Google Scholar 

  • Reiber H (2017c) Polyspecific antibodies without persisting antigen in multiple sclerosis, neurolupus and Guillain-Barré syndrome: immune network connectivity in chronic diseases. Arq Neuropsiquiatr 75(8):580–588. https://doi.org/10.1590/0004-282X20170081

    Article  PubMed  Google Scholar 

  • Reiber H, Albaum W (2008) Statistical evaluation of intrathecal protein synthesis in CSF/Serum quotient diagrams. Acta Neuropsychiatrica 20(supplement 1):48–49, Free software at www.albaum.it

    Google Scholar 

  • Reiber H, Davey B (1996) Desert-storm-syndrome and immunization. Arch Intern Med 156:217

    Article  CAS  PubMed  Google Scholar 

  • Reiber H, Felgenhauer K (1987) Protein transfer at the blood cerebrospinal fluid barrier and the quantitation of the humoral immune response within the central nervous system. Clin Chim Acta 163:319–328

    Article  CAS  PubMed  Google Scholar 

  • Reiber H, Peter JB (2001) Cerebrospinal fluid analysis – disease-related data patterns and evaluation programs. J Neurol Sci 184:101–122

    Article  CAS  PubMed  Google Scholar 

  • Reiber H, Ungefehr St, Jacobi C (1998) The intrathecal, polyspecific and oligoclonal immune response in multiple sclerosis. Mult Scler 4:111–117

    Article  CAS  PubMed  Google Scholar 

  • Reiber H, Otto M, Trendelenburg C, Wormek A (2001) Reporting cerebrospinal fluid data – knowledge base and interpretation software. Clin Chem Lab Med 39:324–332

    Google Scholar 

  • Reiber H, Walther K, Althaus H (2003) Beta-trace protein as sensitive marker for CSF Rhinorhea and CSF Otorhea. Acta Neurol Scand 108:1–4

    Article  Google Scholar 

  • Reiber H, Teut M, Pohl D, Rostasy KM, Hanefeld F (2009) Paediatric and adult multiple sclerosis: age-related differences and time course of the neuroimmunological response in cerebrospinal fluid. Mult Scler 15:1466–1480

    Article  CAS  PubMed  Google Scholar 

  • Reiber H, Ressel Chr, Spreer A (2013) Diagnosis of neuroborreliosis-improved knowledge base for qualified antibody analysis and cerebrospinal fluid data pattern related interpretations. Neurol Psychiatry Brain Res 19:159–169

    Article  Google Scholar 

  • Reiber H, Lange P, Zerr I (2014) Neurochemical dementia diagnostics – interlaboratory variation of analysis, reference ranges and interpretations. J Alzheimers Dis Parkinsonism 4:147–151

    Google Scholar 

  • Reiber H, Kruse-Sauter H, Quentin CD (2015) Different B cell repertoires in brain and eye of the individual multiple sclerosis patient. Patterns of antibodies, oligoclonal IgG and isotypes in cerebrospinal fluid and aqueous humor. J Neuroimmunol 278:247–254

    Article  CAS  PubMed  Google Scholar 

  • Robinson-Agramonte M, Reiber H, Cabrera-Gomez JA, Galvizu R (2007) Intrathecal polyspecific immune response to neurotropic viruses in multiple sclerosis: a comparative report from Cuban patients. Acta Neurol Scand 115:312–318

    Article  CAS  PubMed  Google Scholar 

  • Schaarschmidt H, Prange H, Reiber H (1994) Neuron-specific enolase concentrations in blood as a prognostic parameter in cerebrovascular diseases. Stroke 24:558–565

    Article  Google Scholar 

  • Schmutzhard E (2005) Mikrobiologische Diagnostik im Liquor bei Parasitosen. In: Zettl UK, Lehmitz R, Mix E (Hrsg) Klinische Liquordiagnostik, 2. Aufl. De Gruyter, Berlin

    Google Scholar 

  • Shoji H, Honda Y, Murai I, Sato Y, Oizumik K, Hondo R (1992) Detection of VZV-DNA by polymerase chain reaction in CSF of patients with herpes zoster meningitis. J Neurol 239:69–70

    Article  CAS  PubMed  Google Scholar 

  • Sindic CJM, Monteyne PH, Laterre EC (1994) The intrathecal synthesis of virus-specific oligoclonal IgG in multiple sclerosis. J Neuroimmunol 54:75–80

    Article  CAS  PubMed  Google Scholar 

  • Stauch C, Reiber H, Rauchenzauner M, Pohl D, Hanefeld F, Gärtner J, Rostásy KM (2011) Intrathecal IgM synthesis in pediatric MS is not a negative prognostic marker of disease progression: quantitative versus qualitative IgM analysis. Mult Scler 17:327–334

    Article  CAS  PubMed  Google Scholar 

  • Terryberry JW, Shoenfeld Y, Gilburd B et al (1995) Myelin- and microbe-specific antibodies in Guillain-Barré Syndrome. J Clin Lab Anal 9(5):308–319

    Article  CAS  PubMed  Google Scholar 

  • Thompson EJ (2005) The CSF proteins: a biochemical approach, 2. Aufl. Elsevier, Amsterdam

    Google Scholar 

  • Tumani H, Petzold A, Wick M, Kühn HJ, Uhr M, Otto M, Regeniter A, Brettschneider J (2010) Cerebrospinal fluid-based diagnostics of CT-negative subarachnoid haemorrhage. Nervenarzt 81(8):973–979

    Article  CAS  PubMed  Google Scholar 

  • Uhr M (2001) Neurologische Tropenkrankheiten. In: Prange H, Bitsch A (Hrsg) Infektionserkrankungen des Zentralnervensystems. Wissenschaftliche Verlagsgesellschaft, Stuttgart

    Google Scholar 

  • Uhr M (2010) Psychiatrische Erkrankungen. In: Wildemann B, Oschmann P, Reiber H (Hrsg) Laboratory diagnosis in neurology. Thieme Verlag, Stuttgart

    Google Scholar 

  • Uhr M, Tumani H, Lange P (2016) Strategien der Liquorbefundung – integrierter Befundbericht. Nervenarzt 87(12):1271–1275

    Article  CAS  PubMed  Google Scholar 

  • Vaughan K, Peters B, O’Connor KC, Martin R, Sette A (2014) A molecular view of multiple sclerosis and experimental autoimmune encephalitis: what can we learn from the epitope data? J Neuroimmunol 267:73–85

    Article  CAS  PubMed  Google Scholar 

  • Voltz R (2002) Paraneoplastic neurological syndroms: an update on diagnosis, pathogenesis and therapy. Lancet Neurol 1:294–304

    Article  PubMed  Google Scholar 

  • Weber T, Jürgens S, Lüer W (1987) Cerebrospinal fluid immunoglobulins and virus-specific antibodies in disorders affecting the facial nerve. J Neurol 234:308–314

    Article  CAS  PubMed  Google Scholar 

  • Wick M, Gross CC, Isenmann S, Strik H (2016) Cytology of cerebrospinal fluid: standards, importance and modern methods. Nervenarzt 87(12):1271–1275

    Article  Google Scholar 

  • Wildemann B, Oschmann P, Reiber H (Hrsg) (2010) Laboratory diagnosis in neurology. Thieme Verlag, Stuttgart

    Google Scholar 

  • Wiltfang J, Lewczuk P, Otto M (2016) Biomarkers for dementia and other neurodegenerative diseases: current developments. Nervenarzt 87(12):1305–1309

    Article  CAS  PubMed  Google Scholar 

  • Wurster U (2010) Antineuronale Antikörper. In: Wildemann B, Oschmann P, Reiber H (Hrsg) Neurologische Labordiagnostik. Thieme, Stuttgart

    Google Scholar 

  • Zettl UK, Lehmitz R, Mix E (Hrsg) (2005) Klinische Liquordiagnostik, 2. Aufl. Berlin, De Gruyter

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Max-Planck-Institut für Psychiatrie, München, Deutschland

    Manfred Uhr

  2. Kooperationsstelle Hochschulen und Gewerkschaften Göttingen, Göttingen, Deutschland

    Hansotto Reiber

Authors
  1. Manfred Uhr
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hansotto Reiber
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Manfred Uhr .

Editor information

Editors and Affiliations

  1. Essen, Germany

    Peter Berlit

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer-Verlag GmbH Deutschland

About this entry

Cite this entry

Uhr, M., Reiber, H. (2017). Liquordiagnostik. In: Berlit, P. (eds) Klinische Neurologie. Springer Reference Medizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44768-0_22-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-44768-0_22-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44768-0

  • Online ISBN: 978-3-662-44768-0

  • eBook Packages: Springer Referenz Medizin

Publish with us

Policies and ethics

Search

Navigation