Nature of the Blood-Cerebrospinal Fluid Barrier Permeability Revealed by Isohemagglutinin Tests

Abstract

It has been stated that blood-cerebrospinal fluid barrier permeability is capricious. This is possibly a confession that the meaning and mechanism of permeability are yet incompletely understood. It is not surprising that this is so for careful study of standard texts and original papers since 1910 leads one to conclude the theories of origin, function and fate of cerebrospinal fluid are far from agreed upon.

Studies of variations in the permeability of the barrier have been prosecuted from two points of view. Foreign substances have been introduced, more commonly into the blood stream, occasionally into the subarachnoidal space, and their fate traced. Such substances have been crystalloids, as bromide; colloids, colored and uncolored, and McKinley and Holden 1 utilized the bacteriophage. Again, study has been made of blood elements not normally found in the cerebrospinal fluid whose presence there may be taken as evidence of increased permeability. Of these may be mentioned induced antibodies and naturally occurring antibodies such as hemolysins and isohemagglutinins. Three references exist dealing with this last indicator of permeability.

Weil and Wall 2 found no isohemagglutinins in 12 cerebrospinal fluids from such conditions as syphilis of the central nervous system, hemiplegia, brain tumor and myoclonic encephalitis. On the other hand Herman and Halber 3 found isohemagglutinins in 11 of 80 fluids examined. These fluids came from more than 30 widely different types of pathology, although most involved the central nervous system either organically or functionally. In 6 of 22 cases of bacterial meningitis the cerebrospinal fluids contained isohemagglutinins but the 6 cases of tuberculous meningitis included were all negative. Two of 3 cases of cord tumor, 2 of 4 cases of sclerosis, and 1 of 3 cases of chorea accounted for the remaining 5 positives. Parr 4 examined 104 cerebrospinal fluids at Beirut and found 6 containing isohemagglutinins.