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The secret behind headaches: Why are pseudomigraines related to lymphocytes?
Lymphocytosis is an abnormal increase in the number of lymphocytes in the cerebrospinal fluid (CSF). This is often seen as a sign of infection or inflammation within the nervous system and can be seen in a variety of neurological disorders, such as pseudomigraine, Susac syndrome, and encephalitis. Lymphocytes make up about a quarter of the body's white blood cells, but are often rare in the CSF. Under normal conditions, the number of white blood cells in CSF is usually less than 5 per microliter. In the case of Pleocytosis, the number of lymphocytes may explode to more than 1,000 cells per microliter.
An increase in the number of lymphocytes is usually accompanied by an increase in cerebrospinal protein concentration, and also includes pleocytosis of other types of white blood cells.
Symptoms and signs
While it varies depending on the specific disease, mild lymphocytosis is generally thought to begin when lymphocyte numbers enter the range of 10-100 per cubic millimeter. In healthy individuals, only 0-5 white blood cells are typically present in the CSF. According to research, the lymphocyte concentration in patients with pseudomigraine ranges from 10 to 760 cells per cubic millimeter, with an average concentration of 199 ± 174 cells. When the number of white blood cells rises above 500 per cubic millimeter, the CSF display will appear cloudy, which is often related to the inflammatory immune response during viral infection. Although these diseases exhibit diversity, they often share some similar symptoms, most notably headaches and neurological deficits.
Cause
Lymphocytosis in the cerebrospinal fluid is often the result of an immune response triggered by neurovascular inflammation. In many cases, viral infection is believed to be the underlying cause of lymphocytosis, a process in which the immune system produces antibodies to neural and vascular antigens. This may be related to viral meningitis and Mollaret's disease. In addition, certain non-viral infections, such as Lyme disease, have also been considered as potential causes. In some diseases, the infection in turn triggers an autoimmune response, causing lymphocyte levels to rise.
Diagnosis
The presence of lymphocytosis is usually confirmed by lumbar puncture, followed by clinical analysis of the cerebrospinal fluid. Combined with analysis of the appearance and pressure of the CSF, along with measurements of glucose and protein, white blood cell counts 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 return a normal range of 0-5 white blood cells per microliter, this does not rule out the possibility of disease.
Related diseases
Viral encephalitis
In encephalitis, inflammation of the brain leads to loss of neurological function, causing symptoms such as fever, confusion, memory loss, personality changes, paralysis, seizures, and speech impairment. Viral infections can directly lead to encephalitis or trigger a cascade that ultimately leads to autoimmunity, both mechanisms ultimately leading to increased CSF lymphocyte concentrations. Research shows that more than 90% of people infected with herpes simplex virus will show varying degrees of lymphocytosis.
Pseudomigraine
Several studies have examined the association between pseudomigraine and lymphocytosis. Pseudomigraine is characterized by a moderate or severe, usually bilateral, throbbing headache associated with transient neurological symptoms and lymphocytosis. These migraine attacks are recurring and self-limiting. Most of the subjects were between the ages of 15 and 40, and most were male. After each migraine attack, patients usually return to normal.
Susac syndrome
In Susac syndrome, an autoimmune response damages blood vessels in the brain, retina, and inner ear, resulting in loss of neurological function. Such patients exhibit higher lymphocyte and protein concentrations and gradually recover function after treatment with immunosuppressive drugs such as steroids and atazanavir.
Treatment methods
The most appropriate way to restore lymphocyte numbers to normal levels is to treat the disease that causes them to increase. For conditions caused by viral or bacterial infections, medications that combat these pathogens have proven effective. Since herpes simplex infection often results in lymphocytosis, acyclovir and varasicoid are commonly prescribed medications.
Historical background
The identification of lymphocytosis was made possible with the advent of diagnostic lumbar puncture and microbiological, biochemical, and immunological testing techniques for analysis of cerebrospinal fluid. Although the first lumbar puncture was performed in the late 19th century, tests that revealed elevated numbers of lymphocytes in the CSF were introduced much later.
In the history of medicine, these discoveries are not only easily ignored, but may also change the health management of many patients. Can lymphocytosis become a predictor of future neurological diseases?
