Findings in Cerebrospinal Fluid among Children with Paretic Involvements

Authors: L. Krbková 1;  K. Holečková 2;  Z. Blechová 3;  V. Marešová 3;  K. Labská 3;  H. Štroblová 4;  J. Bednářová 4
Authors‘ workplace: Klinika dětských infekčních nemocí LF MU a FN Brno 1;  Klinika infektológie a geografickej medicíny LF SZU, LF UK a UN Bratislava 2;  I. infekční klinika 2. LF UK a Nemocnice Na Bulovce, Praha 3;  Oddělení klinické mikrobiologie, FN Brno 4
Published in: Cesk Slov Neurol N 2014; 77/110(4): 496-500
Category: Short Communication


To evaluate cerebrospinal fluid (CSF) findings in children with paretic involvements and to establish the benefit of such examination with a view to aetiological dia­gnosis.

Material and methods:
CSF findings among 227 hospitalized children with paretic involvements of the peripheral or central nervous system were evaluated retrospectively. CSF was analysed cytologically and bio­chemically. Detected were antibodies against neurotropic viruses, Borrelia and viral nucleic acids by means of PCR.

Inflammatory changes due to aseptic meningitis were found in 125 (55%) children, elevation of proteins only in nine (4%) children, and CSF examination was negative in the remaining 93 (41%) children. Cytological examination revealed white blood cells with a predominance of lymphocytes (mean 110, median 10). Median CSF protein was 0.4 g/ l and median CSF glucose was 3.34 mmol/ l. Disruption of the blood‑CSF barrier was determined in 55/ 113 (51%) children, while this condition was severe in 9% of the examined children. Borrelial aetiology was confirmed in 52% of the children, while pleocytosis was revealed in 86% of those samples. Viral and mycoplasmal aetiology was proven in 11% of the children only serologically. The aetiology remained unproven in 37% of the children.

CSF examination contributed to the dia­gnosis of paretic involvements in children. Even despite negative meningeal signs in children, spinal tap should be performed to exclude or confirm meningitis. In our geographic conditions, peripheral facial palsy is dia­gnosed in 95% of children with the predominance of borrelial aetiology. Paretic involvements of other aetiologies occur only rarely.

Key words:
cerebrospinal fluid – pleocytosis – peripheral facial palsy – neuroborreliosis – herpes virus


1. Stanek G, Fingerle V, Hunfeld KP, Jaulhac B, Kaiser R,Krause A et al. Lyme borreliosis: clinical case definition for dia­gnosis and management in Europe. Clin Microbio­l Infect 2011; 17(1): 79– 79. doi: 10.1111/ j.1469‑ 0691.2010.03175.x.

2. Logar M, Arnez M, Kolbl J, Avsic‑ Zupanc T, Strle F. Comparison of the epidemiological and clinical features of tick‑ borne encephalitis in children and adults. Infection 2000; 28(2): 74– 77.

3. Chen CY, Chang YC, Huang CC, Lui CC, Lee KW,Huang SC. Acute flaccid paralysis in infants and young children with enterovirus 71 infection: MR paging and clinical correlates. Am J Neuroradiol 2001; 22(1): 200– 205.

4. Doja A, Bitnun A, Ford Jones EL, Richardson S, Tellier R, Petric M et al. Pediatric Epstein Barr virus –  associated encephalitis: 10‑year review. J Child Neurol 2006; 21(5): 384– 391.

5. Endo A, Izumi H, Miyashita M, Okubo O, Harada K. Facial palsy associated with mumps parotitis. Pediatr Infect Dis J 2001; 20(8): 815– 816.

6. Reiber H, Felgenhauer K. Protein transfer at the blood cerebrospinal fluid barrier and the quantitation of the humoral immune response within the central nervous system. Clin Chem Acta 1987; 163(3): 319– 328.

7. Christen HJ. Lyme neuroborreliosis in children. Ann Med 1996; 28(3): 235– 240.

8. Tveitnes D, Oymar K, Natas O. Acute facial palsy in children: how often is it lyme borreliosis? Scand J Infect Dis 2007; 39(5): 425– 431.

9. Tuerlinckx D, Glupczynski Y. Lyme neuroborreliosis in children. Expert Rev Anti Infect Ther 2010; 8(4): 455– 463. doi: 10.1586/ eri.10.15.

10. Belman AL, Reynolds L, Preston T, Postels D, Grimson R, Coyle PK. Cerebrospinal fluid findings in children with Lyme disease associated facial nerve palsy. Arch Pediatr Adolesc Med 1997; 151(12): 1224– 1228.

11. Halperin JJ. Nervous system Lyme disease. Vector Borne Zoonotic Dis 2002; 2(4): 241– 247.

12. Mygland A, Ljostad U, Fingerle V, Rupprecht T, Schmutzhard E, Steiner I. EFNS guidelines on the dia­gnosis and management of European Lyme neurobor­reliosis. Eur J Neurol 2010; 17(1): 8– 16. doi: 10.1111/ j.1468‑ 1331.2009.02862.x.

13. Dlouhý P, Honegr K, Krbková L, Pícha D, Roháčová H, Štruncová V. Lymeská borrelióza: doporučený postup v dia­gnostice, léčbě a prevenci. Klin Mikrobio­l Inf Lek 2011; 17(4): 144– 149.

14. Lebech AM, Hansen K, Brandrup F, Clemmensen O, Halkier‑ Sorensen L. Dia­gnostic value of PCR for detection of Borrelia burgdorferi DNA in clinical specimens from patients with erythema migrans and Lyme neuroborreliosis. Molecular Dia­gnosis 2000; 5(2): 139– 150.

15. Cerar T, Ogrinc K, Cimperman J, Lotric‑ Furlan S, Strle F, Ruzic‑ Sabljic E. Validation of cultivation and PCR methods for dia­gnosis of Lyme neuroborreliosis. J Clin Microbio­l 2008; 46(10): 3375– 3379. doi: 10.1128/ JCM.00410‑ 08.

16. Avery RA, Frank G, Eppes SC. Dia­gnostic utility of Borrelia burgdorferi cerebrospinal fluid polymerase chain reaction in children with Lyme meningitis. Pediatr Infect Dis J 2005; 24(8): 705– 708.

17. Tang YW, Hibbs JR, Tau KR, Qian Q, Skarhus HA, Smith TF et al. Effective use of polymer­ace Chin reaction for dia­gnosis of central nervous system infections. Clin Infect Dis 1999; 29(4): 803– 806.

18. Rupprecht TA, Pfister HW, Angele B, Kastenbauer S,Wilske B, Koedel U. The chemokine CXCL13 (BLC): a putative marker for neuroborreliosis. Neurology 2005; 65(3): 448– 450.

19. Silanpää H, Skogman BH, Sarvas H, Seppälä IJ,Lahdenne P. Cerebrospinal fluid chemokine CXCL13 in the dia­gnosis of neuroborreliosis in children. Scand J Infect Dis 2013; 45(7): 526– 530. doi: 10.3109/ 00365548.2013.776700.

20. Lotric‑ Furlan S, Strle F. Peripheral facial palsy in patients with tick‑ borne encephalitis. Clin Microbio­l Infect 2012; 18(10): 1027– 1032. doi: 10.1111/ j.1469‑ 0691.2011.03719.x.

21. Saksida A, Duh D, Lotric‑ Furlan S, Strle F, Petrovec M, Avsic‑ Zupanc T. The importance of tick‑ borne encephalitis virus RNA detection for early differential dia­gnosis of tick‑ borne encephalitis. J Clin Virol 2005; 33(4): 331– 335.

22. Holzmann H. Dia­gnosis of tick‑ borne encephalitis. Vaccine 2003; 21 (Suppl 1): S36– S40.

23. Furuta Y, Ohtani F, Aizawa H, Fukuda S, Kawabata H, Bergström T. Varicella‑ zoster virus reactivation is an important cause of acute peripheral facial paralysis in children. Pediatr Infect Dis J 2005; 24(2): 97– 101.

24. Kanerva M, Mannonen L, Piiparinen H, Peltomaa M, Vaheri A, Pitkäranta A. Search for Herpesviruses in cerebrospinal fluid of facial palsy patients by PCR. Acta Otolaryngol 2007; 127(7): 775– 779.

25. Hanson KE, Alexander BD, Woods CH, Petti C, Reller LB. Validation of laboratory screening criteria for herpes simplex virus testing of cerebrospinal fluid. J Clin Microbio­l 2007; 45(3): 721– 724.

26. Jeffery KJ, Read SJ, Peto TE, Mayon‑ White RT, Bangham CR. Dia­gnosis of viral infections of the central nervous system: clinical interpretation of PCR results. Lancet 1997; 349(9048): 313– 317.

27. Davies NW, Brown LJ, Gonde J, Irish D, Robinson RO, Swan AV et al. Factors influencing PCR detection of viruses in cerebrospinal fluid of patients with suspected CNS infections. J Neurol Neurosurg Psychiatry 2005; 76(1): 82– 87.

28. Finsterer J. Management of peripheral facial nerve palsy. Eur Arch Otorhinolaryngol 2008; 265(7): 743– 752. doi: 10.1007/ s00405‑ 008‑ 0646‑ 4.

29. Gilden DH. Clinical praktice. Bell’s palsy. N Engl J Med 2004; 351(13): 1323– 1331.

30. Bremell D, Hagberg L. Clinical characteristics and cerebrospinal fluid parameters in patients with peripheral facial palsy caused by Lyme neuroborreliosis compared with facial palsy of unknown origin (Bell’s palsy). [online] BMC Infect Dis 2011; 11: 215. Available from: http:/­ 1471– 2334/ 11/215.

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