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Cerebrospinal fluid pressure.

The cerebrospinal fluid pressure at the foramen of Monro in man in the recumbent position is less than 100 mm water relative to atmospheric pressure. The oscillations in the pressure wave due to respiration and cardiac pulsation vary with the actual pressure and increase as the overall pressure rises. In man lying horizontally the oscillation at the foramen of Monro is usually less than 50 mm water pressure, of which the cardiac component is about 15 mm and the respiratory component 35 mm water pressure. The fluid pressure within the cranial cavity is not uniform. In the recumbent face upwards position the pressure at the frontal pole is close to atmospheric or slightly subatmospheric but at the occipital pole is of the order of 160 to 190 mm water pressure. Examples are given showing the effect of posture on cerebrospinal fluid pressures in man and in the goat. The concentration of arachnoid granulations and venous lacunae near the vertex and the pressures in this region are discussed. The need for more precise methods of pressure measurement in the superior sagittal sinus is outlined by citing the Pitot tube. Pressure studies on patients with presenile dementia and dilated cerebral ventricles are reported.

Brain Diseases↗

Propionibacterium [correction of Proprionibacterium] acnes infections of cerebrospinal fluid shunts.

Ventricular cerebrospinal fluid shunt infections with Propionibacterium acnes are generally low-grade, indolent infections. Typical presentations include gradual shunt malfunction, nausea, headache, malaise, and infrequently, fever. In all, 489 shunt procedures performed between January 1992 and December 1995, and in 15 of these cases P. acnes was subsequently cultured from reservoir taps or an intraoperative culture which was obtained when the existing shunt components were revised. Six of these, representing 14.6% of shunt infections, were considered to be true P. acnes shunt infections, as they were associated with either CSF leukocytosis or the identification of gram-positive rods by gram stain. The others were considered to be probable contaminants. Detailed analysis of all 15 of these cases revealed that no patient had positive CSF cultures after removal of the infected shunt and the initiation of antibiotics. Given the benign characteristics of P. acnes shunt infections, the broad sensitivity to antibiotics, and the rapid sterilization of the cerebrospinal fluid, it may be possible to treat such cases with short-term perioperative antibiotics and replacement of the shunt components, in place of prolonged external ventricular drainage and antibiotics. This would have eliminated 8 operative procedures and reduced the estimated length of stay by 77 patient-days in these 15 children.

Adolescent↗

Immunoassay of P2 protein in cerebrospinal fluid in neurological disorders.

Cerebrospinal fluid samples were obtained at lumbar puncture from 53 patients with a wide variety of neurological disorders. Cerebrospinal fluid samples were tested for the presence of P2 protein, a constituent of myelin, with an enzyme linked immunosorbent assay technique using a specific polyclonal antibody. High concentrations of P2 in the cerebrospinal fluid paralleled a raised IgG index (clearance ratio), the presence of oligoclonal bands, as well as raised white cell counts or depressed albumin:IgG ratios. Twenty one patients had been diagnosed as having definite or probable multiple sclerosis and the remaining 32 had other conditions. Of the 13 patients with high positive P2, 12 (92%) were in the multiple sclerosis category; of the 40 patients with low (12) or undetectable (28) P2 concentrations, only nine (23%) were diagnosed as having multiple sclerosis. In this patient population the presence of high immunoreactive P2 concentrations in cerebrospinal fluid was closely associated with evidence of intrathecal immunoglobulin synthesis and with the clinical diagnosis of multiple sclerosis. On this basis it is suggested that immunoassay of P2 concentration in the cerebrospinal fluid may be of potential value in the investigation of patients with demyelinating disorders.

Adolescent↗

Leukocyte subpopulations in cerebrospinal fluid of normal rabbits.

Cerebrospinal fluid leukocytes from 48 apparently healthy New Zealand white rabbits were examined to define the number and types of cells present. The cerebrospinal fluid contained 0 to 7 leukocytes/mm3 (median 3/mm3). This small pool of mononuclear cells was comprised of 40 to 79% lymphocytes (median 67%) and 21 to 60% monocytes (median 33%). T lymphocytes were the predominant cell type, outnumbering B cells by approximately 100 to 1. In contrast to cerebrospinal fluid, normal rabbit blood contained nearly equal proportions of B and T cells (median 39% and 46% of lymphocytes, respectively). Three cerebrospinal fluid samples from apparently healthy rabbits had greater than 20 leukocytes/mm3.

Animals↗