Atlas of Cerebrospinal Fluid Cells by Dr. Hans Wolfgang Kölmel (auth.)

By Dr. Hans Wolfgang Kölmel (auth.)

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X 1,250. b Start of RBC phagocytosis. Macrophage shows similarities to monocyte. Interference phase microscopy. x 1,250. c Cytoplasm filled with phagocytized RBC's, which retain their normal color. Further proliferation of the mononuclear phagocytic system. Interference phase microscopy. x 1,250. d Phagocytized RBC's almost completely bleached. Stroma still in evidence. Interference phase microscopy. x 1,250. e First sign of pigment deposition. Large number offine vacuoles. Interference phase microscopy.

However, if the CSF is analyzed in the initial stage of viral meningitis, the observer may be surprised to find a pronounced granulocytosis in addition to a few transformed lymphocytes. This finding, common to all incipient infections, disappears abruptly, sometimes after I day, more often somewhat later, to be replaced by the typical lymphocytosis. The cell count can rise in the meantime. The cytogram shows a variety of transformed cells, primarily middle-sized and large lymphocytes. Plasma cells are also numerous, some polynuclear, others in the process Plate 17 Coxsackie meningitis.

Granulocytes predominate, accompanied by many lymphocytic-plasmocytic cell elements. Patient: female, 56 years old. CSF: 230 cells/mm 3 • 46 of the lymphocytes is rather limited. Although there are certain similarities between this form and tuberculous meningitis, differentiation is sometimes possible. The total number of cells is usually greater when the site of the abcess is near the eSF. In general, the total seldom exceeds I,OOO/mm 3 and is often under 300/mm 3 • b c 47 7. Lymphocytic Meningitis and Meningoencephalitis In cases in which lymphocytic meningitis takes the usual, relatively benign course, the cause is usually a member of the enterovirus group.

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