Factitious hearing loss and otorrhea in an adolescent boy

Kelly, Robert L.; Kelly, Charlotte M; Busis, Sidney N.

doi:10.1016/s0009-8981(00)00279-5

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…Due to shortcomings of earlier methods (high resolution electrophoresis) [83,84] an isoelectric pH‐focusing method was developed followed by immunofixation and silver staining, for which as little as 5 μg total protein is necessary (class III). Various sources of error in use of beta‐2‐transferrin analysis for diagnosing cerebral spinal fluid leaks were described [85], such as transferrin isoforms especially in saliva with electrophoretic mobility similar to that of beta‐2‐transferrin (class IV) [86].…”

Section: Csf Markers Recommended For Use In Clinical Routinementioning

confidence: 99%

EFNS guidelines on disease‐specific CSF investigations

Deisenhammer

Egg

Giovannoni

et al. 2009

Euro J of Neurology

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We reviewed the literature for disease-specific markers in cerebrospinal fluid (CSF) and evaluated their diagnostic and prognostic relevance in neurological diseases. High tau protein in combination with low amyloid b levels has a high sensitivity (80%) and specificity (90%) for AlzheimerÕs disease (AD) against normal aging and can predict conversion of mild cognitive impairment to AD. The detection of 14-3-3 has a high sensitivity (80-90%) and specificity (90%) for the diagnosis of CJD. Low or undetectable CSF hypocretin-1 (orexin-1) levels constitute a diagnostic biomarker for narcolepsy with cataplexy. Detection of beta-2-transferrin indicates CSF contamination in oto-and rhinorrhoe with a sensitivity of >79% at a specificity of 95% similar to the beta-trace protein (sensitivity >90%, specificity 100%). However, beta-trace protein is faster and cheaper to perform. Possible future biomarkers are: elevated levels of vascular endothelial growth factor are relatively sensitive (51-100%) and specific (73-100%) for leptomeningeal metastases from solid tumors and are associated with a poor prognosis in this condition. Elevated CSF neurofilament (Nf) levels probably reflect acute neuronal degeneration. The prognostic value of CSF Nf levels is highest in acute conditions such as subarachnoid hemorrhage, acute optic neuritis and neuromyelitis optica.

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Section: Csf Markers Recommended For Use In Clinical Routinementioning

confidence: 99%

EFNS guidelines on disease‐specific CSF investigations

Deisenhammer

Egg

Giovannoni

et al. 2009

Euro J of Neurology

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“…Of these 71 studies, 18 were included for analysis. 13,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Table 1 shows study design and methodology details. The first report of potential false GE results was in 1978.…”

Section: Resultsmentioning

confidence: 99%

“…Since manuscripts for three studies could not be obtained, 71 full‐text articles were reviewed. Of these 71 studies, 18 were included for analysis 13,22–38 …”

Section: Resultsmentioning

confidence: 99%

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Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

Eide,

Mason,

Ray

et al. 2023

Int Forum Allergy Rhinol

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BackgroundBeta‐2 transferrin (B2‐Tf) gel electrophoresis (GE) is the preferred non‐invasive diagnostic modality for confirming cerebrospinal fluid (CSF) in body fluids. While B2‐Tf GE testing is highly sensitive and specific for CSF, false‐positive (FP) and false‐negative (FN) results can lead to diagnostic and therapeutic dilemmas. Several series have demonstrated potential causes of false B2‐Tf GE results, but few studies have reported reasons for these errors. The purpose of this systematic review was to describe sources of B2‐Tf GE errors.MethodsA systematic review was performed by searching OVID, EMBASE, and Web of Science databases for B2‐Tf GE studies. After applying exclusion criteria, original research studies directly addressing erroneous B2‐Tf GE results underwent qualitative analysis.ResultsOf the 243 abstracts screened, 71 underwent full‐text review and 18 studies reporting B2‐Tf GE errors were included for analysis. There were 15 potential FPs, 12 actual FPs, 12 potential FNs, 19 actual FNs, and 14 indeterminate results. There were also 246 potentially indeterminate results from in vitro studies. Reasons for B2‐Tf GE errors included serum transferrin alterations (n = 17; all potential), infection related (n = 13; 9 potential), orbital or salivary contamination (n = 2; 1 potential), and collection related (n = 255; 246 potential). There were 31 false or indeterminate results with unspecified reasons. There were no reported errors due to laboratory processing.ConclusionsMultiple potential or actual reasons for false or indeterminate results have been reported for B2‐Tf GE testing of rhinorrhea and otorrhea. Future studies should explore reasons for B2‐Tf testing errors and how these may affect clinical decision making.

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“…Potential pitfalls in interpreting electrophoresis and Western blots occur when other transferrin isoforms approximate the migratory behaviour of beta-2 transferrin. 6 Beta-trace protein may be quantified by nephelometric and immunoenzymatic assay.…”

mentioning

confidence: 99%

RE: Non-traumatic cerebrospinal fluid rhinorrhea: diagnosis and management

Dorta‐Contreras¹

2005

Annals of Saudi Medicine

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Factitious hearing loss and otorrhea in an adolescent boy

Cited by 4 publications

References 10 publications

EFNS guidelines on disease‐specific CSF investigations

EFNS guidelines on disease‐specific CSF investigations

Systematic review of errors on beta‐2 transferrin gel electrophoresis testing of rhinorrhea and otorrhea

RE: Non-traumatic cerebrospinal fluid rhinorrhea: diagnosis and management

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