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The dark power of brain inflammation: How does lymphocytosis affect the nervous system?
Lymphocytosis is an abnormal increase in the number of lymphocytes in the cerebrospinal fluid and is often seen as a sign of infection or inflammation within the nervous system. It may be associated with a variety of neurological diseases, such as pseudomigraine, Schuursack syndrome and encephalitis. Normally, the number of white blood cells in cerebrospinal fluid should be less than 5 per microliter, but in the case of lymphocytosis, the number may soar to more than 1,000 per microliter.
Although lymphocytes make up only about a quarter of white blood cells, they are relatively rare in cerebrospinal fluid. Behind these bright numbers lie many potential threats.
Symptoms and Signs
Mild cases of lymphocytosis usually begin when the lymphocyte count enters the range of 10 to 100 cells per cubic millimeter. In healthy people, the number of white blood cells in the cerebrospinal fluid is usually only 0-5 per microliter. In patients with pseudomigraine, studies have shown that lymphocyte concentrations range from 10 to 760 cells per cubic millimeter, with a mean concentration of 199 ± 174 cells per cubic millimeter. When the white blood cell count exceeds 500 per cubic millimeter, the cerebrospinal fluid may appear cloudy in diagnostic tests, a change that often corresponds to an inflammatory immune response during a viral infection.
Causes
Lymphocytosis in the CSF is usually the result of an immune response to neurovascular inflammation. Many cases point to viral infection as the underlying cause of lymphocytosis, with the immune system producing antibodies against neural and vascular antigens. This may be associated with viral meningitis and Mollaret's disease. Certain nonviral infections, such as Lyme disease, have also been suggested as potential causes. In some diseases, infection triggers an autoimmune response that leads to increased levels of lymphocytes.
Diagnosis
The presence of lymphocytosis is usually detected by lumbar puncture followed by clinical analysis of the cerebrospinal fluid. By testing the appearance and pressure of the cerebrospinal fluid and measuring the glucose and protein levels, the white blood cell count can be used to detect or diagnose a variety of conditions, including subarachnoid hemorrhage, multiple sclerosis, and various types of meningitis. Although a lumbar puncture may show a white blood cell count within normal range, this does not rule out the possibility of an underlying disease.
Related diseases
Viral encephalitis
In encephalitis, inflammation of the brain causes damage to nerve function and patients may experience fever, confusion, memory loss, personality changes, paralysis, seizures and speech problems. Viral infection may directly cause encephalitis or trigger a chain reaction that ultimately leads to autoimmunity, both mechanisms leading to increased CSF lymphocyte concentrations. For patients infected with herpes simplex virus, more than 90% will be found to have varying degrees of lymphocytosis. Intravenous acyclovir can be used to prevent viral replication, and increasing the dose of acyclovir is advisable if lymphocytosis persists.
Pseudo-migraine
Several studies have been conducted on the correlation between pseudomigraine and lymphocytosis. Pseudo-migraine is characterized by moderate or severe bilateral throbbing headaches accompanied by transient neurologic symptoms and lymphocytosis. These migraine attacks are recurrent and self-limited. The subjects examined in these studies ranged in age from 15 to 40 years old, and the majority were male. All patients were symptom-free after each migraine attack.
Schusack syndrome
In Schusselbach syndrome, an autoimmune reaction damages blood vessels in the brain, retina, and cochlea, leading to loss of neurological function. These patients experienced hearing and vision loss and were found to have elevated levels of lymphocytes and proteins in their cerebrospinal fluid. Treatment with immunosuppressive drugs such as steroids and azathioprine has been shown to be highly effective, with patients gradually regaining lost function within just a few weeks.
Treatment methods
The best way to return lymphocyte counts to normal levels is to treat the disorder that caused them to increase. In cases where the underlying cause of the infection is viral or bacterial, drugs that are effective against these pathogens have been found to be effective. Because herpes infections often cause lymphocytosis, acyclovir and valacyclovir are commonly prescribed. In cases where lymphocytosis is caused by an autoimmune response, it may be treated with immunosuppressive drugs such as steroids.
Conclusion
The history of lymphocytosis can be traced back to the end of the 19th century. With the development of lumbar puncture technology, microbiological, biochemical and immunological tests on cerebrospinal fluid became possible. Although early lumbar punctures were performed in the late 19th century, tests that revealed lymphocytosis in cerebrospinal fluid were performed much later. Today, lumbar punctures are often used to diagnose or rule out certain conditions, such as meningitis, and to determine if infection is present in the cerebrospinal fluid. As science and technology advance, can we gain a deeper understanding of the potential effects of lymphocytosis on the nervous system?
