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The Fall in Cerebrospinal Fluid Sugar in Meningitis: Some Experimental Observations

The Fall in Cerebrospinal Fluid Sugar in Meningitis: Some Experimental Observations Abstract Two years after the first description of lumbar puncture by Quincke,1 Lichtheim noted the sugar content of the cerebrospinal fluid (CSF) to be decreased in bacterial meningitis.2 This observation was confirmed by other early investigators3 and, along with the demonstration of micro-organisms by smear or culture, has been recognized as the sine qua non of purulent meningitis for over 50 years. Diminution in CSF sugar to a slighter degree has been described in meningeal infections due to tubercle bacilli, yeasts, and spirochetes,4 sarcoidosis of the nervous system,5 diffuse leptomeningeal carcinomatosis6,7 and subarachnoid hemorrhage.8 Despite the unquestioned validity of these empiric observations, and the recognized importance of hypoglycorrhachia in differential diagnosis, the mechanism governing the disappearance of sugar from the CSF in any or all of these disease entities remains obscure. Cells, micro-organisms, alterations in meningeal permeability, and accelerated utilization of glucose by References 1. Quincke, H.: Über Hydrocephalus, Verhandlungen des Congresses für innere Medicin, 10th Congress, Wiesbaden, April 6-9, 1891, p. 321. 2. Lichtheim, L.: Verein fur wissenschaftliche Heilkunde in Königsberg i. Pr. Sitzung am 10 April 1893 , Deutsche med. Wchnschr. 19:1234, 1893.Crossref 3. Mestrezat, W., and Roger, H.: Analyses du liquide cephalo-rachidien dans la meningite cerebrospinale a meningocoques , Compt. rend. Soc. biol. 11:203, 1909. 4. Merritt, H. H., and Moore, M.: Acute Syphilitic Meningitis , Medicine 14:119, 1935.Crossref 5. Pennell, W. H.: Boeck's Sarcoid with Involvement of the Central Nervous System , A.M.A. Arch. Neurol. & Psychiat. 66:728, 1951. 6. Strange, L. F.: Metastatic Carcinoma to the Leptomeninges , Tr. Am. Neurol. A. 77:181, 1952. 7. Berg, L.: Hypoglycorrhachia of Non-Infectious Origin; Diffuse Meningeal Neoplasia , Neurology 3:811, 1953. 8. Madonick, M. J., and Savitsky, N.: Spinal Fluid Sugar in Subarachnoid Hemorrhage , J. Nerv. & Ment. Dis. 108:45, 1948. 9. Kelley, A. G.: Sugar Findings in Normal and Pathological Spinal Fluids , South. M.J. 16:407, 1923. 10. Hendry, E.: The Cause of Reduction of Sugar Content of Cerebrospinal Fluid in Meningitis , Arch. Dis. Childhood 14:307, 1939. 11. Baltch, A., and Osborne, W.: Inquiry into Causes of Lowered Spinal Fluid Sugar Content: In Vivo and in Vitro Observations , J. Lab. & Clin. Med. 49:882, 1957. 12. Ino, I.: Experimental Studies on the Sugar in the Cerebrospinal Fluid , Acta scholae med. univ. Kioto 3:609, 1919-20. 13. Fremont-Smith, F., and Dailey, M. E.: Cerebrospinal Fluid Sugar and the "Streptococcus of Poliomyelitis," Arch. Neurol. & Psychiat. 25:206, 1931. 14. Goldring, S., and Harford, C. G.: Effects of Leukocytes and Bacteria on Glucose Content of CSF in Meningitis , Proc. Soc. Exper. Biol. & Med. 75:669, 1950. 15. Mott, F. W.: The Oliver-Sharpey Lectures on the Cerebrospinal Fluid , Lancet 2:1, 1910. 16. Hubbard, R. P., and Wilson, D. C.: Note on the Probable Relationship Between the Glycolytic Power of the Spinal Fluid and the Number of Cells Present , Clifton M. Bull. 14:73, 1928. 17. Fasold, H., and Schmidt, H. A.: Über die Glykolyse und das Verhalten der Milchsäure im normalen und pathologischen Liquor cerebrospinalis , Klin. Wchnschr. 8:1532, 1929. 18. Nielsen, O. J.: Untersuchungen über Glykolyse in Spinalflüssigkeiten , Ztschr. ges. exper. Med. 64:522, 1929. 19. Mader, A.: Über Ursache und Bedeutung der Zuckerveränderungen im Blut und Liquor bie zerebralen Erkrankungen des Kindes , Jahrb. Kinderh. 126:187, 1930. 20. Cohen, H., and Libman, J.: The Glucose Content of Cerebrospinal Fluid After Withdrawal , Quart. J. Med. 5:185, 1936. 21. Soedjono, D. P.: Het glucose-, melkzuur-, en chloridengehalt evan den liquor cerebrospinalis bij meningitides , Maandschr. kindergeneesk. 7:337, 1937-1938. 22. Loebel, R. O.; Shorr, E., and Richardson, H. G.: The Influence of Foodstuffs upon Respiratory Metabolism and Growth of Human Tubercle Bacilli , J. Bact. 26:139, 1933. 23. Weichsel, M., and Herzger, G.: Significance of the Diminution of the Spinal Fluid Sugar in Tuberculous Meningitis , J. Pediat. 9:763, 1936.Crossref 24. Wasz-Hockert, O.; Brander, E., and Paatela, M.: Reduced Concentration of Cerebrospinal Fluid Glucose in Tuberculous Meningitis: Experimental Studies , Ann. paediat. Fenniae 2:320, 1956. 25. Davis, R., and Brown, H.: Spinal Fluid Sugar Determinations in Experimental Hypoglycemia of Dogs , J. Lab. & Clin. Med. 19:1049, 1933-1934. 26. Fremont-Smith, F.; Dailey, M. E.; Merritt, H. H.; Carroll, M. P., and Thomas, G. W.: The Equilibrium Between Cerebrospinal Fluid and Blood Plasma: I. The Composition of the Human Cerebrospinal Fluid and Blood Plasma , Arch. Neurol. & Psychiat. 25:1271, 1931. 27. Kasahara, M., and Ultani, E.: The Effect of Insulin upon the Reducing Substance in the Cerebrospinal Fluid of Normal Rabbits , J. Biol. Chem. 59:433, 1924. 28. Grayzel, H. G., and Orent, E. R.: Blood and Cerebrospinal Fluid Sugar , Am. J. Dis. Child. 34:1007, 1927. 29. Schjött, A.: The Sugar Curve in the Cerebrospinal Fluid After Oral Administration of Glucose , Acta psychiat. et neurol. 6:247, 1931. 30. Canelas, H. M.; Netto, A. S. F.; Levy, J. A.; Valente, M. I., and Bittencourt, J. M. T.: Estudo das relacões entre as taxas de glicose no líqüido cefalorraqueano e no sangue , Arg. neuro-psiquiat. 11:371, 1953. 31. Lambers, H.: Über die Permeabilität der Blutliquorschranke bei tuberculöser Meningitis , Monatsschr. Kinderh. 102:77, 1954. 32. Sifontes, J. E.; Williams, R. D. B.; Lincoln, E. M., and Clemons, H.: Observations on the Effect of Induced Hyperglycemia on the Glucose Content of the Cerebrospinal Fluid in Patients with Tuberculous Meningitis , Am. Rev. Tuberc. 6:732, 1953. 33. Osnato, M., and Killian, J. A.: Significant Chemical Changes in the Spinal Fluid in Meningitis with Special Reference to Lactic Acid Content , Arch. Neurol. & Psychiat. 15:738, 1926. 34. De Sanctis, A. G.; Killian, J. A., and Garcia, T.: Lactic Acid of Spinal Fluid in Meningitis: Practical, Diagnostic, and Prognostic Value , Am. J. Dis. Child. 46:239, 1933. 35. Kapetzky, S. J., and Fishberg, E. H.: Changes in Distribution Ratio of Constituents of Blood and Spinal Fluid in Meningitis , J. Lab. & Clin. Med. 18:796, 1933. 36. Choremis, K.; Constantinides, V., and Nicolaides, P.: Pyruvic Acid in Cerebrospinal Fluid During Various Infectious Diseases with Central Nervous System Involvement , Ann. paediat. 180:337, 1953. 37. Tyler, R.: Spinal Fluid Alcohol in Yeast Meningitis , Am. J.M. Sc. 232:560, 1956. 38. Froesch, E. R., and Renold, A. E.: Specific Enzymatic Determination of Glucose in Blood and Urine Using Glucose Oxidase , Diabetes 5:1, 1956. 39. Petersdorf, R. G.; Garcia, M., and Swarner, D. R.: Mechanism of Hypoglycorrhachia in Experimental Pneumococcal Meningitis , Proc. Soc. Exper. Biol. & Med. 102:669, 1959. 40. Petersdorf, R. G.; Swarner, D. R., and Garcia, M.: Synergistic Action of Pneumococci and Leukocytes in Lowering Cerebrospinal Fluid Glucose , Proc. Soc. Exper. Biol. & Med. 103:380, 1960. 41. Sbarra, A. J., and Karnovsky, M. L.: The Biochemical Basis of Phagocytosis; 1. Metabolic Changes During the Ingestion of Particles by Polymorphonuclear Leukocytes , J. Biol. Chem. 234:1355, 1959. 42. Becker, H.; Munder, G., and Fischer, H.: Über den Leukocytenstoffwechsel bei der Phagocytose. Hoppe-Seylers , Ztschr. physiol. Chem. 313:266, 1958.Crossref 43. Hartman, J. D., and Reindenberg, M.: Comparison of the Glycolytic Activity of Blood and Exudate Leukocytes , J. Appl. Physiol. 12:477, 1958. 44. Petersdorf, R. G.; Swarner, D. R., and Garcia, M.: Further Observations on the Mechanism of Hypoglycorrhachia in Experimental Meningitis , Proc. Soc. Exper. Biol. & Med. 104:65, 1960. 45. Cohn, Z. A., and Morse, S. I.: Interactions Between Rabbit Polymorphonuclear Leukocytes and Staphylococci , J. Exper. Med. 110:419, 1959. 46. Wood, W. B., Jr.: Studies on the Cellular Immunology of Acute Bacterial Infections , Harvey Lect . 47:72, 1951-52. 47. Cohn, Z. A., and Morse, S. I.: Functional and Metabolic Properties of Polymorphonuclear Leukocytes: I. Observations on the Requirements and Consequences of Particle Ingestion , J. Exper. Med. 111:667, 1960. 48. Cohn, Z. A., and Morse, S. I.: Functional and Metabolic Properties of Polymorphonuclear Leukocytes: II. The Influence of a Lipoplysaccharide Endotoxin , J. Exper. Med. 111:689, 1960. 49. Mackaness, G. B.: The Phagocytosis and Inactivation of Staphylococci by Macrophages of Normal Rabbits , J. Exper. Med. 112:35, 1960. 50. Harter, D. H., and Petersdorf, R. G.: A Consideration of the Pathogenesis of Bacterial Meningitis: Review of Experimental and Clinical Studies , Yale J. Biol. & Med. 32:280, 1960. 51. Petersdorf, R. G., and Swarner, D. R.: Unpublished observations. 52. Stahelein, H.; Karnovsky, M. L.; Farnham, A. E., and Suter, E.: Studies on the Interaction Between Phagocytes and Tubercle Bacilli: III. Some Metabolic Effects in Guinea Pigs Associated with Infection with Tubercle Bacilli , J. Exper. Med. 105:265, 1957. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

The Fall in Cerebrospinal Fluid Sugar in Meningitis: Some Experimental Observations

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Publisher
American Medical Association
Copyright
Copyright © 1961 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1961.00450070023003
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Abstract

Abstract Two years after the first description of lumbar puncture by Quincke,1 Lichtheim noted the sugar content of the cerebrospinal fluid (CSF) to be decreased in bacterial meningitis.2 This observation was confirmed by other early investigators3 and, along with the demonstration of micro-organisms by smear or culture, has been recognized as the sine qua non of purulent meningitis for over 50 years. Diminution in CSF sugar to a slighter degree has been described in meningeal infections due to tubercle bacilli, yeasts, and spirochetes,4 sarcoidosis of the nervous system,5 diffuse leptomeningeal carcinomatosis6,7 and subarachnoid hemorrhage.8 Despite the unquestioned validity of these empiric observations, and the recognized importance of hypoglycorrhachia in differential diagnosis, the mechanism governing the disappearance of sugar from the CSF in any or all of these disease entities remains obscure. Cells, micro-organisms, alterations in meningeal permeability, and accelerated utilization of glucose by References 1. Quincke, H.: Über Hydrocephalus, Verhandlungen des Congresses für innere Medicin, 10th Congress, Wiesbaden, April 6-9, 1891, p. 321. 2. Lichtheim, L.: Verein fur wissenschaftliche Heilkunde in Königsberg i. Pr. Sitzung am 10 April 1893 , Deutsche med. Wchnschr. 19:1234, 1893.Crossref 3. Mestrezat, W., and Roger, H.: Analyses du liquide cephalo-rachidien dans la meningite cerebrospinale a meningocoques , Compt. rend. Soc. biol. 11:203, 1909. 4. Merritt, H. H., and Moore, M.: Acute Syphilitic Meningitis , Medicine 14:119, 1935.Crossref 5. Pennell, W. H.: Boeck's Sarcoid with Involvement of the Central Nervous System , A.M.A. Arch. Neurol. & Psychiat. 66:728, 1951. 6. Strange, L. F.: Metastatic Carcinoma to the Leptomeninges , Tr. Am. Neurol. A. 77:181, 1952. 7. Berg, L.: Hypoglycorrhachia of Non-Infectious Origin; Diffuse Meningeal Neoplasia , Neurology 3:811, 1953. 8. Madonick, M. J., and Savitsky, N.: Spinal Fluid Sugar in Subarachnoid Hemorrhage , J. Nerv. & Ment. Dis. 108:45, 1948. 9. Kelley, A. G.: Sugar Findings in Normal and Pathological Spinal Fluids , South. M.J. 16:407, 1923. 10. Hendry, E.: The Cause of Reduction of Sugar Content of Cerebrospinal Fluid in Meningitis , Arch. Dis. Childhood 14:307, 1939. 11. Baltch, A., and Osborne, W.: Inquiry into Causes of Lowered Spinal Fluid Sugar Content: In Vivo and in Vitro Observations , J. Lab. & Clin. Med. 49:882, 1957. 12. Ino, I.: Experimental Studies on the Sugar in the Cerebrospinal Fluid , Acta scholae med. univ. Kioto 3:609, 1919-20. 13. Fremont-Smith, F., and Dailey, M. E.: Cerebrospinal Fluid Sugar and the "Streptococcus of Poliomyelitis," Arch. Neurol. & Psychiat. 25:206, 1931. 14. Goldring, S., and Harford, C. G.: Effects of Leukocytes and Bacteria on Glucose Content of CSF in Meningitis , Proc. Soc. Exper. Biol. & Med. 75:669, 1950. 15. Mott, F. W.: The Oliver-Sharpey Lectures on the Cerebrospinal Fluid , Lancet 2:1, 1910. 16. Hubbard, R. P., and Wilson, D. C.: Note on the Probable Relationship Between the Glycolytic Power of the Spinal Fluid and the Number of Cells Present , Clifton M. Bull. 14:73, 1928. 17. Fasold, H., and Schmidt, H. A.: Über die Glykolyse und das Verhalten der Milchsäure im normalen und pathologischen Liquor cerebrospinalis , Klin. Wchnschr. 8:1532, 1929. 18. Nielsen, O. J.: Untersuchungen über Glykolyse in Spinalflüssigkeiten , Ztschr. ges. exper. Med. 64:522, 1929. 19. Mader, A.: Über Ursache und Bedeutung der Zuckerveränderungen im Blut und Liquor bie zerebralen Erkrankungen des Kindes , Jahrb. Kinderh. 126:187, 1930. 20. Cohen, H., and Libman, J.: The Glucose Content of Cerebrospinal Fluid After Withdrawal , Quart. J. Med. 5:185, 1936. 21. Soedjono, D. P.: Het glucose-, melkzuur-, en chloridengehalt evan den liquor cerebrospinalis bij meningitides , Maandschr. kindergeneesk. 7:337, 1937-1938. 22. Loebel, R. O.; Shorr, E., and Richardson, H. G.: The Influence of Foodstuffs upon Respiratory Metabolism and Growth of Human Tubercle Bacilli , J. Bact. 26:139, 1933. 23. Weichsel, M., and Herzger, G.: Significance of the Diminution of the Spinal Fluid Sugar in Tuberculous Meningitis , J. Pediat. 9:763, 1936.Crossref 24. Wasz-Hockert, O.; Brander, E., and Paatela, M.: Reduced Concentration of Cerebrospinal Fluid Glucose in Tuberculous Meningitis: Experimental Studies , Ann. paediat. Fenniae 2:320, 1956. 25. Davis, R., and Brown, H.: Spinal Fluid Sugar Determinations in Experimental Hypoglycemia of Dogs , J. Lab. & Clin. Med. 19:1049, 1933-1934. 26. Fremont-Smith, F.; Dailey, M. E.; Merritt, H. H.; Carroll, M. P., and Thomas, G. W.: The Equilibrium Between Cerebrospinal Fluid and Blood Plasma: I. The Composition of the Human Cerebrospinal Fluid and Blood Plasma , Arch. Neurol. & Psychiat. 25:1271, 1931. 27. Kasahara, M., and Ultani, E.: The Effect of Insulin upon the Reducing Substance in the Cerebrospinal Fluid of Normal Rabbits , J. Biol. Chem. 59:433, 1924. 28. Grayzel, H. G., and Orent, E. R.: Blood and Cerebrospinal Fluid Sugar , Am. J. Dis. Child. 34:1007, 1927. 29. Schjött, A.: The Sugar Curve in the Cerebrospinal Fluid After Oral Administration of Glucose , Acta psychiat. et neurol. 6:247, 1931. 30. Canelas, H. M.; Netto, A. S. F.; Levy, J. A.; Valente, M. I., and Bittencourt, J. M. T.: Estudo das relacões entre as taxas de glicose no líqüido cefalorraqueano e no sangue , Arg. neuro-psiquiat. 11:371, 1953. 31. Lambers, H.: Über die Permeabilität der Blutliquorschranke bei tuberculöser Meningitis , Monatsschr. Kinderh. 102:77, 1954. 32. Sifontes, J. E.; Williams, R. D. B.; Lincoln, E. M., and Clemons, H.: Observations on the Effect of Induced Hyperglycemia on the Glucose Content of the Cerebrospinal Fluid in Patients with Tuberculous Meningitis , Am. Rev. Tuberc. 6:732, 1953. 33. Osnato, M., and Killian, J. A.: Significant Chemical Changes in the Spinal Fluid in Meningitis with Special Reference to Lactic Acid Content , Arch. Neurol. & Psychiat. 15:738, 1926. 34. De Sanctis, A. G.; Killian, J. A., and Garcia, T.: Lactic Acid of Spinal Fluid in Meningitis: Practical, Diagnostic, and Prognostic Value , Am. J. Dis. Child. 46:239, 1933. 35. Kapetzky, S. J., and Fishberg, E. H.: Changes in Distribution Ratio of Constituents of Blood and Spinal Fluid in Meningitis , J. Lab. & Clin. Med. 18:796, 1933. 36. Choremis, K.; Constantinides, V., and Nicolaides, P.: Pyruvic Acid in Cerebrospinal Fluid During Various Infectious Diseases with Central Nervous System Involvement , Ann. paediat. 180:337, 1953. 37. Tyler, R.: Spinal Fluid Alcohol in Yeast Meningitis , Am. J.M. Sc. 232:560, 1956. 38. Froesch, E. R., and Renold, A. E.: Specific Enzymatic Determination of Glucose in Blood and Urine Using Glucose Oxidase , Diabetes 5:1, 1956. 39. Petersdorf, R. G.; Garcia, M., and Swarner, D. R.: Mechanism of Hypoglycorrhachia in Experimental Pneumococcal Meningitis , Proc. Soc. Exper. Biol. & Med. 102:669, 1959. 40. Petersdorf, R. G.; Swarner, D. R., and Garcia, M.: Synergistic Action of Pneumococci and Leukocytes in Lowering Cerebrospinal Fluid Glucose , Proc. Soc. Exper. Biol. & Med. 103:380, 1960. 41. Sbarra, A. J., and Karnovsky, M. L.: The Biochemical Basis of Phagocytosis; 1. Metabolic Changes During the Ingestion of Particles by Polymorphonuclear Leukocytes , J. Biol. Chem. 234:1355, 1959. 42. Becker, H.; Munder, G., and Fischer, H.: Über den Leukocytenstoffwechsel bei der Phagocytose. Hoppe-Seylers , Ztschr. physiol. Chem. 313:266, 1958.Crossref 43. Hartman, J. D., and Reindenberg, M.: Comparison of the Glycolytic Activity of Blood and Exudate Leukocytes , J. Appl. Physiol. 12:477, 1958. 44. Petersdorf, R. G.; Swarner, D. R., and Garcia, M.: Further Observations on the Mechanism of Hypoglycorrhachia in Experimental Meningitis , Proc. Soc. Exper. Biol. & Med. 104:65, 1960. 45. Cohn, Z. A., and Morse, S. I.: Interactions Between Rabbit Polymorphonuclear Leukocytes and Staphylococci , J. Exper. Med. 110:419, 1959. 46. Wood, W. B., Jr.: Studies on the Cellular Immunology of Acute Bacterial Infections , Harvey Lect . 47:72, 1951-52. 47. Cohn, Z. A., and Morse, S. I.: Functional and Metabolic Properties of Polymorphonuclear Leukocytes: I. Observations on the Requirements and Consequences of Particle Ingestion , J. Exper. Med. 111:667, 1960. 48. Cohn, Z. A., and Morse, S. I.: Functional and Metabolic Properties of Polymorphonuclear Leukocytes: II. The Influence of a Lipoplysaccharide Endotoxin , J. Exper. Med. 111:689, 1960. 49. Mackaness, G. B.: The Phagocytosis and Inactivation of Staphylococci by Macrophages of Normal Rabbits , J. Exper. Med. 112:35, 1960. 50. Harter, D. H., and Petersdorf, R. G.: A Consideration of the Pathogenesis of Bacterial Meningitis: Review of Experimental and Clinical Studies , Yale J. Biol. & Med. 32:280, 1960. 51. Petersdorf, R. G., and Swarner, D. R.: Unpublished observations. 52. Stahelein, H.; Karnovsky, M. L.; Farnham, A. E., and Suter, E.: Studies on the Interaction Between Phagocytes and Tubercle Bacilli: III. Some Metabolic Effects in Guinea Pigs Associated with Infection with Tubercle Bacilli , J. Exper. Med. 105:265, 1957.

Journal

Archives of Neurology – American Medical Association

Published: Jan 1, 1961

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