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PubMed1980

Quantitation and comparison of phenobarbital levels in the plasma, saliva, and cerebrospinal fluid of the rat, and the demonstration of an alteration of drug passage by ethanol.

In this study, the ability and extent of three biological fluids--plasma, saliva, and cerebrospinal fluid--to compartmentalize intravenously administered phenobarbital was examined and correlated. The three fluid compartments show markedly different levels of phenobarbital, though this probably does not reflect qualitative differences in the barriers that separate them, but rather in the nature of the compartments themselves. In addition to the quantitation and correlation of drug levels in the various compartments, intravenous administration of 400 mg/kg ethanol following the intravenous administration of 20 mg/kg phenobarbital was shown to alter the passage of phenobarbital into the different fluid compartments, causing a significant increase in the phenobarbital level of cerebrospinal fluid as compared to controls receiving no ethanol. Though the effect seen in the cerebrospinal fluid is significant, while the effect in saliva is not (though the trend was present), it is felt that the action of ethanol to alter drug passage is a non-specific effect on the vasculature. This finding of altered drug passage may help explain the observed synergistic interaction of ethanol and various sedative drugs.

Animals↗
PubMed1987

Spontaneous cerebrospinal fluid otorrhea.

A case of spontaneous cerebrospinal fluid otorrhea due to a congenital tegmen tympani defect is reported. The etiology and pathogenesis of cerebrospinal fluid otorrhea and of the spontaneous congenital form in particular is discussed, together with the clinical picture and the methods of diagnosis. Reviewing the literature, a middle ear exploration is considered to be the procedure of choice to ascertain the presence and determine the exact locus of the cerebrospinal fluid leak.

Bone Transplantation↗
PubMedDate not supplied

Lumbar puncture for evaluation of latent syphilis in hospitalized patients. High prevalence of cerebrospinal fluid abnormalities unrelated to syphilis.

OBJECTIVE: To determine the prevalence of abnormal neurologic findings and cerebrospinal fluid abnormalities in hospitalized patients with serologic evidence of latent syphilis. DESIGN: Cross-sectional survey. METHODS: Consecutively admitted hospital inpatients from an inner-city population were screened for serologic evidence of syphilis with reactive plasma reagin and confirmatory fluorescent treponemal antibody absorption assays. In those with reactive tests, such clinical findings as a history of treatment for syphilis, neurologic abnormalities, presence of human immunodeficiency virus infection, and rapid plasma reagin titer were correlated with cerebrospinal fluid white blood cell count, protein level, and VDRL result. RESULTS: Of 490 consecutive patients, 52 (11%) had serologic evidence of syphilis. Forty-three (83%) of these underwent lumbar puncture. Of the 43, 31 (72%) were seronegative for human immunodeficiency virus and 12 (28%) were seropositive. No patient had a reactive cerebrospinal fluid VDRL test. Cerebrospinal fluid abnormalities were seen in 32% of human immunodeficiency virus-seronegative patients and in 67% of human immunodeficiency virus-seropositive patients. Cerebrospinal fluid abnormalities were not predicted by history of treatment for syphilis, abnormal neurologic findings, or an elevated rapid plasma reagin titer. Cerebrospinal fluid IgG indexes in patients with elevated cerebrospinal fluid protein levels suggested that the protein abnormalities were not caused by local antibody production. Nonreactive cerebrospinal fluid fluorescent treponemal antibody absorption tests suggest that the cerebrospinal fluid abnormalities were not the result of neurosyphilis. CONCLUSIONS: There was a high prevalence of cerebrospinal fluid abnormalities in hospitalized patients with latent syphilis detected by routine screening. Because of the nonspecificity of the cerebrospinal fluid findings, routine lumbar puncture for such patients appears to contribute little to the treatment of latent syphilis.

Adolescent↗
PubMed1995

Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery.

Cerebrospinal fluid leakage is the most common complication of translabyrinthine acoustic neuroma surgery. This retrospective study reviews patients who had translabyrinthine acoustic neuroma surgery at the Gruppo Otologico, Piacenza, Italy, and ENT Department of Bergamo General Hospital, Bergamo, Italy, during the last 6 years. The incidence of postoperative cerebrospinal fluid leakage was 6.2%, and 75% of these patients underwent another surgery to control the cerebrospinal fluid leakage. A modification of translabyrinthine approach was used in patients with highly pneumatized temporal bones to prevent cerebrospinal fluid leakage in these high-risk patients.

Adolescent↗
PubMed2002

Incidence of occult cerebrospinal fluid fistula during paranasal sinus surgery.

OBJECTIVE: To determine the incidence of occult cerebrospinal fluid fistulas after endoscopic paranasal sinus surgery. DESIGN: Prospective diagnostic test study with a 6-month follow-up in case of cerebrospinal fluid detection. SETTING: Tertiary care hospital. SUBJECTS: The study population comprised 69 patients undergoing routine endoscopic paranasal sinus surgery. Patients with an obvious intraoperative or postoperative cerebrospinal fluid fistula were not included. INTERVENTION: Analysis of 112 samples from intraoperative applied tamponades and of 69 serum samples using a nephelometric research assay for beta-trace protein (prostaglandin D synthase). MAIN OUTCOME MEASURES: Incidence of occult cerebrospinal fluid fistula during endoscopic paranasal sinus surgery as indicated with the help of a test for beta-trace protein; at least a 6-month follow-up of patients with an occult cerebrospinal fluid fistula; and relation of occult cerebrospinal fluid fistula with surgical experience of the surgeon. RESULTS: Beta-trace protein was found in ethmoid roof samples from 2 patients, giving an incidence of 2.9% for occult cerebrospinal fluid fistula. Both patients were operated on by very experienced surgeons. Signs of a cerebrospinal fluid fistula were not found at follow-up at least 6 months after surgery. CONCLUSIONS: Nephelometric beta-trace protein assay is a highly sensitive method to detect otherwise unobserved cerebrospinal fluid fistulas. The clinical course of the 2 patients with an occult cerebrospinal fluid fistula indicated the possibility of an uneventful follow-up of patients with small fistulas.

Adult↗
PubMed1994

Microvessel count and cerebrospinal fluid basic fibroblast growth factor in children with brain tumours.

Tumour growth is angiogenesis-dependent; brain tumours have more intense neovascularisation than other tumours and produce basic fibroblast growth factor, a potent angiogenic mediator. Because little is known about the release of basic fibroblast growth factor from brain tumours into extracellular fluids, we tested cerebrospinal fluid (CSF) from 26 children and young adults with brain tumours and 18 controls for basic fibroblast growth factor and for proliferative activity on cultured capillary endothelial cells. We also measured the density of microvessels in tumours by immunohistochemical staining. Basic fibroblast growth factor was detected in the CSF of 62% (16 of 26) patients with brain tumours but in none of the controls. Specimens with basic fibroblast growth factor stimulated DNA synthesis of capillary endothelial cells in vitro. Endothelial proliferative activity was blocked by neutralising antibodies to basic fibroblast growth factor. Basic fibroblast growth factor correlated with mitogenic activity in CSF in vitro (p < or = 0.0001), and with density of microvessels in histological sections (p < or = 0.005). A microvessel count of > or = 68 per 200 x field was associated with tumour recurrence (p = 0.005) and with mortality (p = 0.02). Basic fibroblast growth factor in brain tumours may mediate angiogenesis as measured by microvessel density in histological sections, so has potential as both a marker for neoplasia and a target for tumour treatments. Furthermore, evaluation of cerebrospinal fluid basic fibroblast growth factor, along with microvessel quantitation in biopsied tumours, may provide improved prognostic information for the management of patients with brain tumours.

Adolescent↗
PubMed1977

Differentiation of communicating hydrocephalus and presenile dementia by continuous recording of cerebrospinal fluid pressure.

Continuous monitoring of the cerebrospinal fluid pressure and observation of the pressure during intrathecal infusion of normal saline at two rates were performed in patients with communicating hydrocephalus and cerebral atrophy of other causes. Constant or temporarily increased cerebrospinal fluid pressure was observed only in communicating hydrocephalus. Reduction of intracranial pressure by a ventriculoatrial shunt was associated with clinical improvement. The intrathecal infusion test was capable of detecting reduced absorption of cerebrospinal fluid if more than one infusion rate was employed. Using both tests it is easier to determine which patients with communicating hydrocephalus should be treated with a shunt operation.

Adult↗
PubMed2002

Clinical significance of Candida species isolated from cerebrospinal fluid.

Candida species have only rarely been isolated from the cerebrospinal fluid. Some of these isolates are true pathogens with a high morbidity and mortality, while others are only colonizers or contaminants. Spontaneous recovery from Candida meningitis has also been reported. The purpose of this study was to identify factors indicative of patients positive for Candida from cerebrospinal fluid who should receive antifungal therapy. A total of 36 patients with a positive cerebrospinal fluid culture for Candida were included in this retrospective analysis. Seventeen of these patients had received antifungal therapy under the impression of Candida meningitis. The differences in the case fatality rate and the duration of hospitalization between the antifungal treatment and untreated groups were statistically significant (p<0.04 and p<0.005, respectively). Statistical analysis showed a significant difference in the percentage of patients with previous ventricular shunt (14/17 vs 8/19, p<0.05), central venous line in situ (9/17 vs 1/19, p<0.005), multiple positive cerebrospinal fluid culture (11/17 vs 1/19, p<0.0005), isolation of Candida at least 20 days after hospitalization in adults (6/7 vs 1/13, p<0.005), and cerebrospinal fluid white blood cell count (median 77 vs 2 /mm3, p<0.005). These results suggest that antifungal agent should be initiated promptly in patients whose cerebrospinal fluid is positive for Candida and who have one or more of the identified risk factors.

Adult↗