The BLOOD-C.S.F. Barrier to Bromide in Diagnosis of Tuberculous Meningitis

Abnormalities of cerebrospinal fluid amino-acids in purulent meningitis

“…Animal experiments indicate that both the choroid plexus (Lorenzo andCutler, 1969: Franklin et al, 1975) and extrachoroidal sites (Levin et al, 1971;Dudzinski and Cutler, 1974) are involved in the active transport of amino-acids in order to maintain the normal CSF composition. It would, therefore, seem reasonable to suggest that inflammatory changes involving the meninges and choroid plexuses could cause disturbances of their transport mechanisms, in a manner similar to that previously described in relation to inorganic ions and protein in patients with meningitis (Nobecourt and Voisin, 1903;Cohen, 1927;Kabat et al, 1942;Tubiana et al, 1951;Rossi and Schneider, 1953;Taylor et al, 1954;Sambrook, 1974). Support for this view is provided in the present study by the significant increase in CSF proline and cystine concentrations in purulent meningitis, since both these amino-acids are excluded almost completely from CSF in normal individuals in spite of their high plasma concentrations (McGale et al, 1977).…”

“…In disease, alterations in the CSF amino-acid composition have been described in steady state chronic renal failure , in patients undergoing haemodialysis and in association with neurological disorders including epilepsy (Mutain et al, 1974), Parkinsonism (Lakke and Teelken, 1976), and Huntington's chorea (Perry et al, 1973). There is, however, relatively little information about the CSF amino-acid composition in meningitis, a disease in which the blood-CSF barrier to electrolytes and protein is known to change (Nobecourt and Voisin, 1903;Cohen, 1927;Kabat et al, 1942;Tubiana et al, 1951;Rossi and Schneider, 1953;Taylor et al, 1954;Bradbury et al, 1963;Sambrook, 1974).…”

The Blood-Cerebrospinal Fluid Barrier in Tuberculous Meningitis and Allied Conditions

“…The validity of the bromide test as a measure of the permeability of the blood-C.S.F. barrier has now been demonstrated (Hunter, Smith, and Taylor, 1954). Results of the test are expressed as the " bromide ratio ", that is to say, bromide per unit volume serum/bromide per unit volume C.S.F.…”

“…Results of the test are expressed as the " bromide ratio ", that is to say, bromide per unit volume serum/bromide per unit volume C.S.F. In subjects without overt disease of the nervous system the bromide ratio at equflibrium v4ries between 1-95 and 3*39, with a mean of 2-6 and a standard deviation of 0-30 (Taylor, Smith, and Hunter, 1954).…”

Mental Disturbances in Tuberculous Meningitis

“…Examination of smears of the cerebrospinal fluid showed fragments of acid-fast material which were thought to be tubercle bacilli. A bromide blood-cerebrospinal fluid permeability test was set up (Taylor, Smith, and Hunter, 1954). A provisional diagnosis of tuberculous meningitis was made and treatment begun with intrathecal and iritramuscular injections of streptomycin.…”