By Dr. Hans Wolfgang Kölmel (auth.)
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Cerebral and Spinal Syphilis Syphilitic meningoencephalitis, tabes dorsalis, and progressive paralysis are not responsible for specific and characteristic cytologic findings in the eSF. However, cytologic monitoring of the eSF provides valuable information on the course of the illness and success of therapy. Pleocytosis of the eSF can exceed 3,OOO/mm 3 in rare cases of syphilitic meningoencephalitis, but values under 500/mm 3 are more usual. As in the case of other infectious disorders, granulocytosis is characteristic of the initial phase.
In the CSF, transformed lymphocytes and plasma cells predominate. The cell count can vary between normal values and more than 1,000/mm 3 . •• • • •• • • • •• •• b 35 5. Plasma Cells Plasma cells are present only in pathologically altered CSF. A number of researchers have suggested that some of them develop from leptomeningeal stem cells [55, 106, 138, 192]. A smaller fraction may emigrate from the blood. It is probable that they develop from small inactive lymphocytes which have emigrated from the blood to the CSF space.
CSF: 10000 cells/mm 3 • Demonstration of predominantly intracellular diplococci. Pure granulocytosis. b Enterococcal meningitis. Patient:female, 3years old. CSF: 700 cells/mm 3 • Masses of enterococci (primarily diplococci) in an inadequate granulocytic reaction. c Coli meningitis. Patient: male, 2 years old. CSF: 6000 cells/mm 3 • Demonstration of Escherichia coli bacteria in the subacute stage of meningitis. d Staphylococcal meningomyelitis. Patient: male, 24 years old. CSF: pus, 30000 cells/ mm 3 • Large clusters of micrococci.