Objective: Intracranial infection is a severe complication that can occur following neurosurgery, and early diagnosis is crucial for improving patient prognosis. In this study, we aimed to investigate, from an exploratory perspective, whether the immune microenvironment of intraoperative cerebrospinal fluid (CSF) is associated with postoperative intracranial infection (PII) in patients undergoing craniotomy for benign brain tumors. Methods: A total of 134 patients undergoing neurosurgery for benign brain tumors were included and categorized into an infection group (n = 18) and a non-infection group (n = 116). CSF samples were collected aseptically immediately after dural opening during surgery. The concentrations of 16 cytokines, including monocyte chemoattractant protein-1 (MCP-1); macrophage inflammatory protein-1α (MIP-1α) and MIP-1β; interleukin (IL)-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-12, IL-13, and IL-17; interferon (IFN)-α and IFN-γ; tumor necrosis factor-α (TNF-α); and granulocyte colony-stimulating factor (G-CSF), were quantified using Cytometric Bead Array (CBA) technology. An independent samples t-test was used for normally distributed data, while the Mann-Whitney U test was applied for non-normally distributed data. Group comparisons were performed using independent-samples t-tests or Mann-Whitney U tests for continuous variables and χ2 tests or Fisher's exact tests for categorical variables. The Benjamini-Hochberg false discovery rate (FDR) correction was applied to all 16 cytokines to control for multiple testing. Receiver operating characteristic (ROC) curve analysis was performed to assess discriminatory capacity. Statistical significance was defined as p < 0.05. Results: PII developed in 18 of 134 patients (13.4%). Age (47.78 vs. 54.86, p = 0.028) and operative duration (390 vs. 244 min, p = 0.005) showed differences in unadjusted analyses. In the unadjusted comparisons, MCP-1 and IL-4 levels were found to be significantly lower in the infection group (MCP-1: 57.78 vs. 116.03 pg/mL, p = 0.003; IL-4: 24.38 vs. 28.18 pg/mL, p = 0.032). No cytokine remained significant after FDR correction. The ROC analysis showed that age and IL-4 demonstrated mild discriminatory performance, with AUC values of 0.665 (95% CI 0.526-0.803, p = 0.025) and 0.657 (95% CI 0.540-0.774, p = 0.032), while MCP-1 and operative duration demonstrated modest discriminatory performance, with AUC values of 0.716 (95% CI 0.595-0.838, p = 0.003) and 0.708 (95% CI 0.578-0.838, p = 0.002). Conclusions: In this study, single-point intraoperative CSF cytokines were not significantly associated with PII after stringent correction for multiple testing, and did not provide a validated clinical prediction tool. The unadjusted and direction-corrected findings for MCP-1 and IL-4 remain exploratory and require validation.

Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurological disorder characterized by gait disturbance, cognitive impairment, and urinary incontinence; however, its diagnosis and prediction of shunt responsiveness remain challenging. This systematic review aimed to synthesize current evidence on cerebrospinal fluid (CSF) proteomic biomarkers in iNPH and to identify molecular patterns with diagnostic and prognostic relevance. A PRISMA-guided search of PubMed, Web of Science, and Google Scholar identified 14 eligible studies comprising 1171 iNPH patients. Proteomic analyses revealed substantial heterogeneity in study design and detected proteins; however, consistent patterns emerged. iNPH is associated with upregulation of inflammatory and extracellular matrix-related proteins and relative downregulation of synaptic and neuronal markers. Neurodegenerative proteins, including amyloid-β, tau, and neurofilament light chain, demonstrated value in differentiating iNPH from comorbid neurodegenerative diseases and in predicting response to ventriculoperitoneal shunting (VPS). These findings support a multifactorial model of iNPH involving impaired glymphatic clearance, neuroinflammation, blood-brain barrier dysfunction, and mechanical axonal stress. Multidimensional biomarker profiles, rather than single proteins, appear to provide the greatest clinical utility, highlighting the need for standardized proteomic panels and integrative predictive models. However, given the substantial heterogeneity of the included studies and the predominantly exploratory nature of current proteomic evidence, the identified proteins should be interpreted as candidate biomarkers rather than clinically validated diagnostic or prognostic tools. Multidimensional biomarker profiles appear biologically plausible and may offer greater explanatory value than single proteins, but their clinical utility requires validation in standardized prospective cohorts. The authors therefore propose a conceptual iNPH proteomic "Vulnerability Model" integrating CSF biomarkers to reflect the balance between reversible and irreversible pathology; this is currently a hypothetical model that requires rigorous statistical and clinical validation through large-scale prospective cohort studies before it can fulfill its potential for improving patient stratification and prediction of postoperative outcomes.

Mass spectrometry and high-throughput sequencing have been introduced into clinical bacteriology. We characterized strain IMB-1, previously isolated from the cerebrospinal fluid of a child, as Pseudoxanthomonas kaohsiungensis and analyzed its biological properties, resistance phenotype, and complete genome. The IMB-1 strain displayed amylolytic, weak lipolytic activities, and it exhibited a phenotypic resistance profile only for aminoglycosides. The dDDH calculation based on the complete genome sequence showed that strain IMB-1 was closely grouped with the type strain P. kaohsiungensis DSM 17583, and the dDDH (d4) value was 70.1%. A comparative pan-genome analysis was performed for four P. kaohsiungensis genomes, revealing a substantial shared core genome. The IMB-1 genome contained 508 unique gene clusters, representing the largest strain-specific gene set among the analyzed genomes, suggesting genomic plasticity and adaptation to the host-associated environment. Genome annotation revealed genes responsible for antibiotic, disinfecting agent, and antiseptic resistance. Gene clusters exhibiting the potential to form biofilms, adhere to the epithelial surface, and exhibit resistance to stress factors were identified. Our study demonstrates that strain IMB-1 is a potential opportunistic pathogen with significant pathogenic potential. The application of high-resolution whole-genome sequencing data in public health for pathogen identification and monitoring can improve the accuracy of infection source determination, reduce the scale and burden of outbreaks, and identify and quantify antimicrobial resistance in pathogens.

The glymphatic system has been proposed as a brain-wide pathway that promotes the exchange between cerebrospinal and interstitial fluids and facilitates the clearance of metabolic waste products, including amyloid-β and tau proteins. Diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) has emerged as a non-invasive magnetic resonance imaging technique proposed to indirectly assess glymphatic-related fluid dynamics. This systematic review evaluated the methodological consistency and clinical applicability of the ALPS index in neurodegenerative diseases. A structured search of PubMed (MEDLINE) and Web of Science identified human studies published up to January 2026 investigating DTI-ALPS in neurodegenerative conditions. Data regarding study populations, MRI acquisition parameters, image-processing methods, statistical approaches, and clinical associations were extracted and synthesized. Ten studies met the inclusion criteria. Across studies, lower ALPS index values were generally associated with cognitive impairment, amyloid burden, and disease severity, particularly in Alzheimer's disease. Several studies incorporated multimodal biomarkers, including amyloid positron emission tomography and cerebrospinal fluid markers, thereby improving the biological interpretation of DTI-ALPS findings. However, substantial methodological heterogeneity was identified across studies, including variability in region-of-interest placement, diffusion acquisition protocols, and image-processing pipelines. Furthermore, the interpretation of diffusivity metrics as direct measures of glymphatic flow remains controversial. Current evidence suggests that DTI-ALPS may represent a promising non-invasive imaging marker of glymphatic-related alterations; however, its biological specificity and clinical applicability remain insufficiently established. Standardized acquisition protocols, harmonized analytical pipelines, and longitudinal multicenter studies are required to clarify its role in neurodegenerative disease research.

The clinical management of patients with advanced human immunodeficiency virus (HIV) infection initiating combination antiretroviral therapy (cART) may be complicated by immune reconstitution inflammatory syndrome (IRIS), a paradoxical inflammatory response capable of unmasking previously subclinical opportunistic infections. Although classical manifestations of IRIS are well recognized, atypical presentations involving the central nervous system (CNS) and associated hyperinflammatory syndromes such as secondary hemophagocytic lymphohistiocytosis (sHLH) remain diagnostically challenging and may contribute to delayed treatment. We report the case of a 36-year-old man with advanced HIV infection (CD4+ T-lymphocyte count of 22.94 cells/µL) who developed persistent fever and neurological symptoms two weeks after initiating cART. Brain magnetic resonance imaging showed no structural abnormalities, and cerebrospinal fluid (CSF) cytochemical analysis was unremarkable. However, a multiplex polymerase chain reaction syndromic panel performed on CSF detected cytomegalovirus (CMV), supporting the diagnosis of unmasking CMV-associated neurological IRIS. During hospitalization, the patient developed a severe systemic inflammatory syndrome characterized by probable secondary hemophagocytic lymphohistiocytosis, stage 3 acute kidney injury, severe cholestatic hepatopathy, and hematologic abnormalities. Targeted antiviral therapy with valganciclovir was initiated promptly, accompanied by a short course of intravenous dexamethasone to control the hyperinflammatory response. The patient experienced progressive clinical improvement with complete recovery of neurological function, normalization of renal function, and marked resolution of hepatic and hematologic abnormalities. This case highlights the diagnostic value of multiplex molecular testing in patients with suspected neuro-IRIS when conventional neuroimaging and CSF studies are non-diagnostic. It also underscores the importance of early recognition and timely combined antiviral and immunomodulatory therapy in severe inflammatory presentations associated with advanced HIV infection.

Two infants, aged 3 and 5 months, were admitted to the neurosurgery ward with febrile meningeal signs and underwent lumbar punctures, which revealed turbid cerebrospinal fluid (CSF) with a predominantly neutrophilic pleocytosis, decreased CSF glucose levels, and elevated CSF protein levels. CSF cultures revealed alpha-hemolytic colonies. Identification by time-of-flight mass spectrometry with matrix-assisted laser desorption and ionization (MALDI-TOF) confirmed Globicatella sanguinis (G. sanguinis) in both cases. G. sanguinis is a pathogenic bacterium that is rarely isolated in clinical practice and can be misidentified as alpha-hemolytic streptococci by conventional laboratory methods. Central nervous system infections caused by G. sanguinis in infants are uncommon but potentially life-threatening. Blood cultures remained negative. Antimicrobial susceptibility testing was performed by microdilution to determine MICs according to the European Committee on Antimicrobial Susceptibility Testing and the Susceptibility Testing Committee of the French Society of Microbiology (CASFM-EUCAST) guidelines for viridans group streptococci/Streptococcus pneumoniae. In the absence of standardized guidelines specific to G. sanguinis, interpretation was based on these criteria. The isolate showed decreased susceptibility to beta-lactams and retained susceptibility to glycopeptides. Both infants received beta-lactam antibiotics. One had a favorable clinical outcome, whereas the other had a fatal outcome. These findings highlight the value of advanced identification methods (MALDI-TOF) in preventing misidentification and optimizing antibiotic therapy.

Pineoblastoma is a rare and highly aggressive embryonal tumor of the pineal region, predominantly affecting children and adolescents. It is classified as a CNS WHO grade 4 tumor and is characterized by a high risk of cerebrospinal fluid dissemination. Although leptomeningeal spread is a recognized feature of this tumor, spinal metastatic involvement at diagnosis remains uncommon and indicates high-risk disease. We report the case of a 16-year-old girl with no relevant past medical history who presented with a two-week history of sleep disturbances, right-sided strabismus, and projectile vomiting. Brain MRI demonstrated a heterogeneous pineal region mass measuring approximately 28 × 26 mm, associated with triventricular hydrocephalus. The patient underwent endoscopic ventriculocisternostomy and stereotactic biopsy. Histopathological and immunohistochemical findings confirmed the diagnosis of pineoblastoma. Staging spinal MRI revealed multiple dorsal spinal leptomeningeal nodules, consistent with CSF dissemination and spinal drop metastases. Given the rarity of pineoblastoma and the absence of a universally established pineoblastoma-specific therapeutic protocol, the case was discussed with an international pediatric neuro-oncology expert. Based on this expert recommendation, the patient was treated using a high-risk medulloblastoma-derived regimen. She received craniospinal irradiation with weekly vincristine, followed by adjuvant chemotherapy with cisplatin, cyclophosphamide, and vincristine according to an ACNS0332-based approach. At three months after completion of treatment, follow-up MRI showed complete regression of the spinal metastatic lesions and a small residual cystic lesion in the pineal region. Clinically, the patient showed marked improvement, particularly in oculomotor function. This case highlights the importance of systematic craniospinal staging at diagnosis in pineoblastoma and illustrates the potential value of early multidisciplinary and multimodal management in metastatic disease. At nine months of follow-up, the patient remained clinically stable, without evidence of spinal disease progression on serial imaging. However, this follow-up remains limited, and long-term clinical and radiological surveillance is essential because of the high risk of recurrence.