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[The foregoing letter was referred to Dr. Karpas, who replies:]
As a general rule, the cerebrospinal fluid in brain tumors of a non-syphilitic etiology is usually free from abnormal constituents. However, in cases in which the fluid shows an increase of albumin or lymphocytosis, one must think of two possible conditions: (1) a syphilitic factor in addition to the neoplasm, and (2) the production of some irritation which may result from the tumor growth coming into close contact with the meninges, causing the pathologic phenomena of the cerebrospinal fluid. Tumors in the cerebellopontine angle may cause sufficient irritation of the meninges to account for the increase of cells and globulin content. In my experience with brain tumors, I have found no pathologic conditions of the cerebrospinal fluid. Dr. Diller's suggestions are worthy of attention—indeed, our knowledge of the cerebrospinal fluid in tumors is not at all exhausted. The more records
Karpas MJ. Cerebrospinal Fluid in Brain Tumors. JAMA. 1913;61(9):703. doi:10.1001/jama.1913.04350090071025