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At least 415 records · Page 23Linked to original sources
PubMed1994

Cerebrospinal fluid shunt infections.

Cerebrospinal fluid (CSF) shunt infection is one of the most frequent and disabling complications. We reviewed the records of 306 patients who underwent CSF shunt surgery from 1983 through 1992. Six hundred and twelve procedures were performed in these 306 patients. Infection occurred following 46 of the procedures for an infection rate of 7.5% per procedure. The 46 infections involved 39 patients. There were 8 recurrent infections. The infection rate per child was 12.7%. Staphylococcal species were isolated in 50% of all infections. Patients younger than 1 year old and children with multiple revisions have a greater risk of infection than those of older. Myelomeningocele and meningitis had higher infection rate among other etiologies. Patients with multiple revisions had higher infection rate than those with single revision or none. The incidence of infection was higher in cyst-peritoneal shunts than both ventriculo-atrial and ventriculo-peritoneal shunts. Mortality was high in Gram negative infections.

Adolescent↗
PubMed1993

The gravitational shunt: an alternative approach to cerebrospinal fluid shunting.

Current cerebrospinal fluid shunts use complex differential pressure values to regulate drainage. Such systems are prone to overdrainage and obstruction, and thus have an unpredictable effect on intracranial pressure (ICP). The gravitational shunt (GS) introduces an alternative approach. It uses a single, simple valve to balance the pressures generated within a vertical shunt system. The ICP is then regulated by the position of the valve along the cranioabdominal shunt axis and not by the mechanical properties of the valve. Bench testing demonstrated that when using the GS (1) a linear correlation (r = 0.91, p < 0.001) exists between the ICP and the position of the valve along the vertical shunt axis, (2) positive and negative ICPs are maintained, and (3) the ICP can be predicted by an equation derived from theoretical principles. The GS uses a single, simple valve as a pressure regulator and an antisiphon device. It allows the maintenance of a normal negative ICP in the upright position without risk of over-drainage. The other benefits of this system are discussed.

Cerebrospinal Fluid Shunts↗
PubMed1994

Multiple sclerosis:cerebrospinal fluid.

Examination of cerebrospinal fluid (CSF) in the context of multiple sclerosis (MS), is valuable for several reasons. First, routine diagnostic evaluation of CSF cell counts and various forms of immunoglobulin determination are important to differentiate MS from other diseases. Second, because MS most probably is an organ-specific inflammatory disease and CSF is often the closest one can get to the target organ, examination of this fluid may allow basic studies on the immunopathogenesis of the disease, and indications of different aspects of inflammation should be considered when evaluating treatments aimed at reducing central nervous system inflammation. This article describes measurements taken at the cellular level in blood and CSF, of myelin-antigen autoreactive B- and T-cell responses, as well as cytokine production. Patients with MS display greatly increased numbers of cells in the CSF that produce antibodies against a variety of myelin antigens, such as myelin basic protein, proteolipid protein, and myelin-oligodendrocyte glycoprotein. Such antibodies may promote demyelination, and autoreactive B cells may enhance antigen presentation to T cells. There is also an increased number of T cells in MS, which in response to a broad range of myelin antigens and peptides, produce cytokines. The production of interferon-gamma, belonging to the T helper-1 type of cells, may have a disease up-regulatory role, while production of other cytokines, such as transforming growth factor beta, may counteract disease. Accurate measurements of cellular production of cytokines will be important in the design and monitoring of immunotherapy.

Autoantigens↗
PubMed1987

Spontaneous cerebrospinal fluid otorrhea.

Spontaneous cerebrospinal fluid (CSF) otorrhea is rare. We present four new cases and an analysis of the literature. Two distinct subtypes occur. Seventy-two percent of cases are the childhood type with congenital defects of the otic capsule. Meningitis, usually pneumococcal and frequently recurrent, occurs in 92% of these cases. CSF otorrhea follows myringotomy for a presumed serous effusion. The child usually has unilateral and sometimes bilateral absence of cochlear and vestibular function and commonly exhibits a Mondini deformity. CSF usually enters the inner ear through a dural defect in the lateral aspect of the internal auditory canal and exists through the oval window. Treatment should consist of stapedectomy and packing of the vestibule with muscle or subtotal petrosectomy. Twenty-eight percent of cases of spontaneous CSF otorrhea are the adult type characterized by bony dehiscenses, most commonly of the tegmen tympani or tegmen mastoideum and less commonly of the posterior fossa plate. The meningeal defects are either meningoencephaloceles or simply holes in the dura. Therapy should consist of a mastoidectomy in conjunction with a transtemporal supralabyrinthine (middle fossa) approach if a meningoencephalocele of the tegmen is found.

Adolescent↗
PubMed2003

Beta-trace protein test: new guidelines for the reliable diagnosis of cerebrospinal fluid fistula.

OBJECTIVE: Cerebrospinal fluid (CSF) fistulas need to be reliably diagnosed for the optimal management. Recently, in preference to beta2-transferrin, another CSF protein, beta-trace protein (betaTP), is similarly used with a new method for CSF diagnosis. This study evaluates the sensitive interpretation and limits of this new betaTP test for use in routine CSF fistula diagnosis. METHODS: Nephelometric detection of betaTP has been made in nasal secretion, serum, and CSF samples from healthy individuals as well as patients with reduced glomerular filtration rate and with bacterial meningitis. Additionally, 53 patients with suspected CSF rhinorrhea are also analyzed. RESULTS: The betaTP test can also be used to reliably diagnose CSF rhinorrhea even slightly better than the beta2-transferrin test. It should not be used for patients with renal insufficiency and bacterial meningitis as they substantially increase serum and decrease CSF betaTP values, respectively. CONCLUSION: Quantitative measurement of betaTP is a noninvasive, highly sensitive, quick, and inexpensive method that can be used for the detection of CSF rhinorrhea in nasal secretions. However, in cases where there is doubt about the interpretation, the results should be proved with beta2-transferrin test or sodium-fluorescein test.

Adolescent↗
PubMedDate not supplied

Tumorlike clusters of immature cells in cerebrospinal fluid of infants.

Cerebrospinal fluid (CSF) samples from four infants 3 days to 4 months of age with a history of prematurity or birth trauma were found to contain clusters of immature cells. These cells were arranged in groups or syncytia, sometimes with nuclear molding, and were cytologically characterized by scant basophilic cytoplasm, nuclei with fine nuclear chromatin, and small nucleoli. The picture simulated the appearance of metastatic tumor admixed with hemosiderin-laden macrophages, erythrocytes, and leukocytes. Because of the low numbers of cells or aggregates present in CSF samples and the relatively small quantity of CSF obtained, immunohistochemical and flow cytometric evaluations were not performed. Prior studies have designated these immature cells as undifferentiated leptomeningeal cells or cells from the subependymal germinal matrix and have associated their presence with intraventricular hemorrhage (IVH) in premature newborns. Three of our patients had a history of prematurity; the fourth patient suffered a traumatic birth but was not premature. In long-term follow-up, the patients have not shown progression of neurologic deficits or evidence of malignancy. Thus, it is important to recognize that in infants with a history of IVH, subarachnoid hemorrhage, or ventricular drainage devices, the presence of tumorlike clumps of cells associated with hemosiderin-laden macrophages most likely does not represent metastatic tumor.

Abortion, Spontaneous↗
PubMed1988

[Assessment of a commonly available latex particle agglutination test in rapid, bacteriologic cerebrospinal fluid diagnosis].

36 cerebrospinal fluid specimens (CSF) from patients with bacterial meningitis were tested for the presence of bacterial antigens with the "Slidex Meningite Kit" (Bio Merieux). This kit has latex particles coated with antibodies against hemophilus influenzae type B (Hib) streptococcus pneumoniae (SP) and neisseria meningitidis (NM) group A and C. With the LAT we could detect the bacterial antigens in 84% of bacterial meningitis cases, 23 of the 27 of Hib meningitis (85.2%), all of the 6 cases of SP meningitis (100%) and two of the three NM meningitis cases. The test is handicapped by the fact, that there is no antiserum against NM sero-group B, the main cause of NM meningitis in Austria. There were no false positive results with the LAT. False negative results were obtained in 19.2% of Hib and in one case of NM. Even under sufficient antibiotic therapy and with negative culture we could detect 9 Hib- and 1 NM-cases during the first 12-48 hours of therapy with this method. The LAT-Kit is a useful addition to standard methods of CSF examinations in bacterial meningitis. With the LAT a rapid bacteriological diagnosis is possible within 15 minutes. The Kit is also able to identify bacterial antigens even with negative culture and after initiation of antibiotic treatment.

Antigens, Bacterial↗
PubMed2005

Quantitative proteomic analysis of age-related changes in human cerebrospinal fluid.

Identification of cerebrospinal fluid (CSF) biomarkers of the common age-related neurodegenerative diseases would be of great value to clinicians because of the difficulties in differential diagnoses of these diseases in clinical practice. Proteins are one class of potential biomarkers currently under investigation in the hope that different ensembles of proteins will aid in the diagnosis of these diseases, as well as in the assessment of progression and response to therapy. However, before undertaking a rational approach to CSF protein biomarkers of age-related neurodegeneration, we must first systematically identify CSF proteins and determine whether their levels change with normal aging. In this study, we used a powerful shotgun proteomic method, two-dimensional microcapillary liquid chromatography electrospray ionization tandem mass spectrometry, to identify proteins in human CSF. Additionally, using pooled CSF samples, we quantitatively compared the CSF proteome of younger adults with that of older adults using isotope-coded affinity tags (ICAT). From these studies we identified more than 300 proteins in CSF and found that there were 30 proteins with >20% change in concentrations between older and younger individuals. Finally, we validated changes in concentration for two of these proteins using Western blots in CSF from a separate set of individuals. These data not only expand substantially our current knowledge regarding human CSF proteins, but also supply the necessary information to appropriately interpret protein biomarkers of age-related neurodegenerative diseases.

Adult↗
PubMed2006

Effects of time, initial composition, and stabilizing agents on the results of canine cerebrospinal fluid analysis.

BACKGROUND: Cerebrospinal fluid (CSF) is considered highly labile, but not all samples are analyzed immediately. Changes in the composition of CSF could potentially affect diagnostic test results and thus influence decisions about patient management. There has been little scientific inquiry into how variables such as time, initial composition, and storage conditions affect results of standard laboratory analysis of CSF. OBJECTIVES: The objectives of this study were to determine the effects of time, protein concentration, and presence or absence of exogenous stabilizing agents on standard CSF analysis results. METHODS: Thirty abnormal CSF samples from 26 dogs were evaluated. Samples were divided into aliquots comprising different treatment groups and stored at 4 degrees C. Total nucleated cell count (TNCC), differential cell count (DCC), and cell morphology were evaluated for all groups; protein concentration was measured for selected groups. Unaltered aliquots were analyzed immediately (T0Hr) and at 2, 4, 8, 12, 24, and 48 hours (T2Hr-T48Hr); aliquots with added fetal calf serum (FCS) or hydroxyethyl starch (hetastarch) were analyzed at T48Hr. RESULTS: Significant time-dependent changes were observed in DCC in unaltered samples. Mononuclear cells deteriorated more rapidly than did neutrophils. Based on microscopic examination and subjective scoring of cell morphology, cells were consistently more degenerate by T24Hr compared with T0Hr. Samples with protein concentrations > or =50 mg/dL were less susceptible to cell deterioration than those with lower protein concentrations. Adding either FCS or hetastarch improved sample stability. CONCLUSIONS: Delayed analysis of canine CSF by 4-8 hours is unlikely to alter diagnostic interpretation, especially for samples with protein concentrations > or =50 mg/dL. The likelihood of misinterpretation is higher for samples with low cellularity or low protein concentration. We provide specific recommendations for adding FCS or hetastarch to samples that will not be analyzed within 1 hour.

Animals↗
PubMed2006

Prolonged Jackson-Pratt drainage in the management of lumbar cerebrospinal fluid leaks.

BACKGROUND: Cerebrospinal fluid (CSF) leak is a complication of spinal surgery. Intraoperative or postoperative identification of a CSF leak often results in wound healing complications, lumbar drain placement, and/or reoperation. These complications usually extend a patient's hospital stay, can be painful, and have their own associated risks. The authors describe a technique that may improve on traditional interventions by managing postoperative CSF leaks after lumbar instrumentation without an additional procedure or extended hospitalization. METHODS: A retrospective review of lumbar instrumentation cases performed by 5 attending surgeons from the Division of Neurosurgery, University of California at San Diego, was performed. In all, 184 charts were reviewed, spanning a 3-year period. There were 16 cases in which a dural tear and repair were carried out and subsequently treated with subfascial Jackson-Pratt (JP) drainage. Of those 16 cases, 8 patients were managed with prolonged JP drainage using the intraoperatively placed subfascial drain. Patients were discharged home on oral antibiotics according to the customary criteria with the JP drain in place and were instructed regarding proper drain maintenance. Jackson-Pratt drains were removed in clinic in a delayed fashion, approximately 10 to 17 days postoperatively. Patients were subsequently reevaluated at regular intervals for any persistent CSF leak. RESULTS: In the 8 cases reviewed, all patients were discharged in a time frame comparable to that of patients undergoing similar instrumentation in which no CSF leak was identified, or in whom a CSF leak was identified and repaired intraoperatively. No patients suffered complications arising from prolonged drain presence. No patients suffered from persistent CSF leak after drains were removed. CONCLUSION: Our study suggests that routine intraoperative subfascial JP drain placement aids in the early diagnosis of postoperative lumbar CSF leak. Primary closure of dural tear remains the standard of care. Furthermore, in select cases, prolonged JP drainage in the setting of postoperative CSF leak may be a useful technique for the treatment of these leaks.

Adult↗
PubMed1994

Cerebrospinal fluid leak following acoustic neuroma removal.

Cerebrospinal fluid (CSF) leak has been a constant and unresolved complication of acoustic tumor surgery. This study retrospectively reviews 381 primary acoustic tumor surgeries performed by a single, senior, neurotologist and neurosurgeon team from 1979 through 1991. There were 68 cerebrospinal fluid leaks in 66 patients (66/381; 17%). There was no significant difference in the incidence of CSF leak between the translabyrinthine group (21%) and the retrosigmoid transmeatal group (16%). Translabyrinthine leaks were evenly divided between rhinorrhea and the postauricular wound while retrosigmoid transmeatal leaks were predominantly rhinorrhea. Eleven of 14 translabyrinthine wound leaks responded to pressure dressing and suture. The remaining 3 ceased with continuous lumbar cerebrospinal fluid drainage. Ten of 14 cases of translabyrinthine rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with revision of the mastoidectomy/labyrinthectomy cavity. Twenty-one of 28 cases of retrosigmoid transmeatal rhinorrhea responded to continuous lumbar cerebrospinal fluid drainage, and those in whom it failed were cured with extracranial, transmastoid revision. The incidence of cerebrospinal fluid leak was not influenced by age, sex, size of tumor, postoperative hydrocephalus, or the intraoperative use of autologous fibrin glue. Meningitis was an unusual complication, occurring in 3% of all patients.

Cerebrospinal Fluid Rhinorrhea↗
PubMedDate not supplied

[Reibergrams: essential element in cerebrospinal fluid immunological analysis].

INTRODUCTION: The cerebrospinal fluid analysis is not displace on diagnosis of neurological disease in spite of the development of imaging techniques. DEVELOPMENT: Divulge the reibergrams as essential part of cerebrospinal fluid analysis. To perform a reibergram you have to quantify albumin, IgA, IgM and IgG in serum and cerebrospinal fluid. Then you have to calculate the quotients cerebrospinal fluid/serum and to plot the quotients in the reibergram. From the patterns you can have further information than single analyses. In contrast, the reibergram can yield the following information: about the intrathecal synthesis of immunoglobulins, CSF-blood barrier permeability and according to clinical data and symptoms can expect help in differential diagnosis by direct plausibilities or by suggesting the true diagnosis by pointing away from other diseases like opportunistic infections, neuro-tuberculosis and autoimmune inflammatory disease. It would be possible to detect an intrathecal tumour metastasis, monitoring efficacy of therapy and course of disease among others further knowledges. CONCLUSION: Reibergrams represent the best way to characterize blood-cerebrospinal fluid barrier function and intrathecal synthesis of immunoglobulins on neurological disorders.

Albumins↗
PubMed1996

[Leakage of cerebrospinal fluid. Diagnosis and treatment].

Leakage of cerebrospinal fluid may occur after fracture of the skull base or after surgery on the skull base, nose, or paranasal sinuses. Further causes of cerebrospinal fluid leakage are tumours and malformations. It may also occur spontaneously. We describe four case reports illustrating diagnostic and surgical problems. Cerebrospinal fluid oto- and rhinorrhoea should be suspected in cases of recurring purulent meningitis. Immunologic demonstration of beta(2)-transferrin in secretions from the nose and ear is a diagnostic sign of cerebrospinal fluid or perilymph. Digital subtraction cisternography, CT cisternography, and flow-sensitive magnetic resonance imaging are sensitive methods for localising dural leakage. Frontal craniotomy has been the traditional surgical approach. The recent involvement of transnasal endoscopic sinus surgery and microsurgery has made it possible to treat cerebrospinal fluid oto- and rhinorrhoea with a high degree of success and less operative morbidity.

Adolescent↗
PubMed1983

Species-dependent variables in blood cerebrospinal fluid barrier for proteins.

Cerebrospinal fluid/plasma concentration quotients for immunoglobulin G (I) and albumin (A) were determined in guinea pigs. Age and sex-dependent influences on these quotients (I/A) were analyzed and compared with the values for human lumbar, cisternal and ventricular cerebrospinal fluid. The ratio I/A, which characterizes the molecular size-dependent selectivity of the blood cerebrospinal fluid barrier function for proteins, was found to be a constant in a single species, but showed marked interspecies differences.

Aging↗
PubMed1989

CSF T-cell subsets in multiple sclerosis: relationship to cerebrospinal fluid myelin basic protein and clinical activity.

Cerebrospinal fluid myelin basic protein and cerebrospinal fluid and peripheral blood T-cell subsets have been studied in patients with multiple sclerosis and other inflammatory and non-inflammatory nervous system diseases. These biological parameters have been correlated with clinical disease activity. No changes in peripheral blood T-cell subsets were seen in multiple sclerosis patients. Low cerebrospinal fluid T8+ cells occurred only in multiple sclerosis, while high cerebrospinal fluid T4+ cells were detected both in clinically active multiple sclerosis and in inflammatory nervous system diseases. A close relationship was found between cerebrospinal fluid T4/T8 ratio and myelin basic protein in relapsing multiple sclerosis patients.

Adolescent↗
PubMed1979

Cerebrospinal fluid rhinorrhea complicating pregnancy.

Cerebrospinal fluid rhinorrhea is an uncommone occurrence, especially when a history of previous trauma is absent. This report describes a case of cerebrospinal fluid rhinorrhea occurring in a pregnant patient during the pushing portion of her Lamaze exercises, and discusses the management of labor and delivery.

Adult↗