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PubMed1971

Cerebrospinal fluid production by the choroid plexus and brain.

The production of cerebrospinal fluid and the transport of (24)Na from the blood to the cerebrospinal fluid were studied simultaneously in normal and choroid plexectomized rhesus monkeys. Choroid plexectomy reduced the production of cerebrospinal fluid by an average of 33 to 40 percent and the rate of appearance of (24)Na in the cerebrospinal fluid and its final concentration were proportionately reduced. In both normal and plexectomized animals, (24)Na levels were found to be markedly greater in the gray matter surrounding the ventricles and in the gray matter bordering the subarachnoid space. That sodium exchanges in these two general areas of the brain may be linked to the formation of the cerebrospinal fluid is discussed here.

Animals↗
PubMed1994

The effect of position on magnetic resonance evaluation of cerebrospinal fluid shunt function.

Since cerebrospinal fluid shunt malfunction is common and its diagnosis often requires invasive testing, we have evaluated magnetic resonance imaging (MRI) as a noninvasive test for shunt function. In prior experiments, MRI has been shown to be capable of detecting flows as low as 0.4 cc h-1 in shunt systems. Because patient movement and position in an MRI scanner are variable, we have studied the effects of shunt position on the ability to reliably detect the rate of CSF flow. Flow related enhancement of fluid flowing from 0 to 2 cc h-1 was measured in a specialized section of tubing using multiple spin echo scans (TR2000,TE20). The angle of the specialized tubing was varied relative to the axis of the MRI scanner and then the intensity of the MR signal at specific points in the tubing was measured at different flow rates. No flow standards were used as controls. The results show that the linear relationship between signal intensity and flow that had previously been demonstrated was significantly altered by changes of position. Positions angled superior to the axis of the scanner enhanced the signal while lateral changes in the plane of the scan degraded the signal. These results suggest that in order for MRI to become an accurate test for shunt function, techniques must be developed to overcome the effects of shunt position.

Cerebrospinal Fluid Shunts↗
PubMed2003

Flow cytometric analysis of chemokine receptor expression on cerebrospinal fluid leukocytes.

Collection of cerebrospinal fluid (CSF) from the lumbar subarachnoid space is a routine procedure in clinical neurology, providing an opportunity to obtain hematogenous cells from the central nervous system environment in vivo. The ability to study individual cells in samples with low cell numbers has made flow cytometry an attractive method for studies of chemokine receptor expression on such cells. Several methodological variables such as staining temperature and cell isolation techniques may, however, influence the final outcome of the staining. In addition, low numbers of cells in the normal lumbar CSF, together with a tendency of CSF cells to decay rapidly after sampling, require meticulous handling of the samples. Here, we describe the methodology used in our laboratory to study chemokine receptor expression on cells in paired samples from peripheral blood and CSF using flow cytometry.

Antibodies, Monoclonal↗
PubMedDate not supplied

[Endoscopic closure of nasal fistulas leaking cerebrospinal fluid. Our experience].

UNLABELLED: Cerebrospinal fluid (SCF) rhinorrea results from a breakdown of the dura and supporting structures of the skull base. Trauma is responsible for 81 to 90 percent of the cases of SCF rhinorrea, and it occurs in approximately 2 percent of all head injuries. This is a retrospective review of 5 patients who underwent endoscopic treatment of CSF rhinorrea during 1997 in our hospital. The aetiology of leaks was: iatrogenic in two cases (by transphenoidal hypophysectomies), traumatic in two cases (by head injuries) and spontaneous in one (nasal encephalocele). CONCLUSION: we recommend endoscopic approach as the first line in managing CSF rhinorrea because it avoids an external incision, requires less cumbersome instrumentation and in our hands in the safest and most successful. Furthermore, we prefer the autogenous mocuperiosteum of the inferior turbinate glued over the fistula offers several advantages: it is readily available in sufficient size for the closure of most defects, only minor surgery for graft harvesting is necessary and, the texture of the mucoperiostium permits a good secure seal.

Cerebrospinal Fluid Rhinorrhea↗
PubMed2000

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks.

Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension. In this report the authors review the indications for surgery, surgical techniques, and surgery-related outcomes for these lesions. The major presenting symptoms include postural headaches, nausea, vomiting, and diplopia. Often, there is no history of traumatic injury. The most common cranial magnetic resonance (MR) imaging features include pachymeningeal gadolinium enhancement and sagging of the brain. On spinal MR images, diverticula are frequently noted. In cases in which symptoms are severe and refractory to less invasive measures, surgical intervention is indicated. Tears in the dura or leaking diverticula that are identified as the sources of the CSF leak often can be ligated or repaired. When a source of CSF egress is not found intraoperatively, packing the epidural space with blood-soaked Gelfoam or muscle at the appropriate level can lead to relief of symptoms. Occasionally the dural defect is large, irregular, or has attenuated borders that may not be possible to repair with sutures. These may be repaired by packing the defect with muscle or blood-soaked Gelfoam. Indications for and outcomes of surgery in patients with this condition will become more defined as surgeons gain experience with these procedures.

Cerebrospinal Fluid Pressure↗
PubMed1985

Amino acid transport across the human blood-CSF barrier. An evaluation graph for amino acid concentrations in cerebrospinal fluid.

The correlation of cerebrospinal fluid (CSF)/serum concentration quotients was used as a method for identification of amino acids which are transported by a common carrier system across the blood-CSF barrier. Isoleucine, leucine, valine, phenylalanine, tyrosine and lysine were found to compete for the same carrier system. This group of amino acids in man was found to be different from the system described as a neutral amino acid carrier at the blood-brain barrier in rats. In man, methionine and tryptophan do not compete with the other neutral amino acids for the same carrier system. In contrast, lysine as a basic amino acid is found to be correlated with the same transport system as the five neutral amino acids. A graph for the evaluation of pathological amino acid concentrations in CSF is presented. Patients with a blood-CSF barrier dysfunction for proteins showed partly normal, partly increased, CSF/serum concentration quotients for the amino acids. Hydroxyproline could be identified as a constituent of the amino acid pool in CSF. For proline and hydroxyproline a special control system has to be suggested because of their smaller biological variance in CSF than in blood. Contrary to the other amino acids proline and hydroxyproline have a smaller biological variation in CSF than in serum.

Adolescent↗
PubMed1983

Cerebrospinal fluid pleocytosis after seizures.

Cerebrospinal fluid (CSF) pleocytosis after seizure activity has been anecdotally reported for many years, but it has not been well documented. We reviewed the records of all adult patients admitted to Grady Memorial Hospital from November 1979 through October 1980 with the diagnosis of seizure. Of 102 patients whose CSF was examined, 35 (34%) had pleocytosis; in 31 (30%) there was no explanation for the pleocytosis despite laboratory and radiologic tests to rule out established causes. For those patients without an identifiable cause of pleocytosis the mean number of white cells was 72/cu mm with a median of 10 and a range from 3 to 464. A predominance of polymorphonuclear leukocytes (PMNs) was found in 57% of the initial CSF examinations. Eighty-six percent of patients with seizures due to ethanol withdrawal had a PMN predominance in their CSF, and 88% of patients with seizures due to a recent or remote cerebrovascular accident had a mononuclear cell predominance. The pleocytosis was usually transient; normalization of the CSF was associated with the rapid recovery of the patient. We conclude that an abnormal CSF leukocyte count may be entirely attributable to seizure activity, although the mechanism is unknown. Before assigning this cause, however, a thorough search is imperative to rule out treatable disorders that may cause CSF pleocytosis.

Adult↗
PubMed2003

Stretching and breaking characteristics of cerebrospinal fluid shunt tubing.

OBJECT: Cerebrospinal fluid (CSF) shunt system malfunction due to silastic tubing fracture necessitates revision surgery in shunt-dependent individuals. The goal of this study was to examine the mechanical stretching and breaking characteristics of new and used CSF shunt tubing catheters to determine if any inherent physical properties predispose the tubing to fracture. METHODS: Fifty-millimeter segments of new and retrieved (used) CSF shunt tubing were stretched to 120 mm in a hydraulic press to determine modulus values (modulus = stress/strain) and to measure permanent tubing deformation imparted by the applied stress and strain. Similar 50-mm tubing segments were also stretched in an electromechanical material testing system until fracture occurred; the force and strain needed to break the tubing was recorded at the time of failure. The results demonstrate that shunt tubing with a greater cross-sectional area requires greater force to fracture, and that catheters become weaker the longer they are implanted. Barium-impregnated shunt tubing, compared with translucent tubing. appears to require less applied stress and strain to break and may fracture more easily in vivo. The variety of modulus values obtained for the new catheters tested indicates that the various companies may be using materials of different quality in tubing manufacture. CONCLUSIONS: A CSF shunt catheter design that incorporates tubing with a greater cross-sectional area may lead to fewer fractures of indwelling catheters and a reduction in shunt revision surgery.

Cerebrospinal Fluid Shunts↗
PubMed1995

A no-touch technique protocol to diminish cerebrospinal fluid shunt infection.

BACKGROUND: Cerebrospinal fluid (CSF) shunts become infected primarily by bacterial organisms indigenous to the patient's skin flora, but bacteria from the operating room environment, hospital, or no obvious source may also infect a shunt. To decrease the incidence of shunt infection, a no-touch technique protocol was developed and utilized in a prospective manner. METHODS: A before-after trial analysis was performed to compare the infection rates between patients who had CSF shunts placed using the no-touch technique protocol versus patients who had surgery without the protocol. Patients were stratified by age, etiology of hydrocephalus, type of shunt surgery, and presence of a contaminated skin wound, namely, tracheostomy, gastrostomy-jejunostomy, colostomy, or halo. The differences in infection rates were analyzed with the Fisher exact test with midpoint value correction, and standard statistical methods were used to calculate the 90% confidence interval odds ratio and number to treat. RESULTS: The no-touch technique protocol resulted in a clinically significant threefold decrease in shunt infection rate from 9.1% to 2.9% (p = 0.058 at 0.10 level, odds ratio 0.305, confidence interval 0.084-1.11), and a near threefold decrease in the infection rate per patient from 11.3% to 3.9% (p = 0.032 at 0.10 level, odds ratio 0.243, confidence interval 0.065-0.906). CONCLUSIONS: The no-touch technique protocol as described herein is a useful method to decrease shunt infection. A larger prospective, randomized, multicenter clinical trial is encouraged to stringently assess the efficacy of the protocol.

Adolescent↗
PubMed1998

Clinical evaluation of the Gen-Probe Amplified Direct Test for detection of Mycobacterium tuberculosis complex organisms in cerebrospinal fluid.

Eighty-four cerebrospinal fluid (CSF) samples from different children who presented with signs and symptoms of meningitis were evaluated for the presence of Mycobacterium tuberculosis complex organisms by the Gen-Probe Amplified Mycobacterium tuberculosis Direct Test (MTD; Gen-Probe, San Diego, Calif.). All CSF samples had negative acid-fast smears by the Ziehl-Neelsen staining method. M. tuberculosis was recovered from five samples. M. tuberculosis did not grow from 19 additional samples, but the samples were from patients who fulfilled specific clinical and laboratory criteria for probable tuberculous meningitis (TBM). The remaining samples (n = 60) were from patients with other infections or noninfectious causes of meningitis. The results of the MTD were interpreted as positive or negative on the basis of recommended cutoff values for respiratory specimens. These results were interpreted as true or false positives or true or false negatives on the basis of the results of M. tuberculosis culture or whether the patient fulfilled criteria for probable TBM. The Gen-Probe MTD was 33% sensitive and 100% specific for detecting M. tuberculosis complex organisms in these 84 CSF samples. If the cutoff values for positive results were decreased for the MTD (> or = 11,000 versus > or = 30,000 relative light units), the sensitivity increased to 83% and the specificity remained 100%. These results for the MTD are encouraging considering that TBM is a highly fatal disease and difficult to diagnose by conventional laboratory techniques.

Adolescent↗
PubMedDate not supplied

Elevated intracranial pressures in spontaneous cerebrospinal fluid leaks.

BACKGROUND: Spontaneous cerebrospinal fluid (CSF) leak is a condition that previously has been considered idiopathic and classified as having "normal" intracranial pressure (ICP). We present clinical and radiographic evidence that indicates elevated ICP in this group. In addition, we review the pathophysiology and unique management issues in caring for patients with spontaneous CSF leak. METHODS: We present a retrospective review of medical records, imaging studies, ICP measurements, and surgical treatment of patients with spontaneous CSF leaks. RESULTS: Sixteen patients with spontaneous CSF leaks were surgically treated from 1996 to 2002. Ten patients underwent postoperative lumbar puncture with CSF pressure measurement during clinically indicated computed tomography cisternograms. Intracranial pressures were elevated in all 10 patients, with a mean of 26.5 cm H2O and a range of 17.3-34 cm H2O, (normal, 0-15 cm H2O). Demographically, 13/16 patients were women, all were middle-aged with a mean age of 49.6 years, and 15/16 patients were obese with a mean body mass index of 35.9 kg/m2. Radiographically, 15 patients had imaging of the sella turcica, 10 patients had completely empty sellas, and 5 patients had partially empty sellas. Surgical repair was 100% successful in leak cessation with a mean follow-up of 14.1 months. CONCLUSION: Although the precise cause and mechanism of spontaneous CSF leaks is not fully understood, this study sheds light on important factors to consider. Patients with this condition have similar physical and radiographic findings such as middle-aged, female gender, obesity, and empty sella. Additional investigation is needed to determine the exact cause of the condition, its relationship to elevated ICPs, and if further medical or surgical treatments to correct the intracranial hypertension are warranted.

Adult↗
PubMed2001

Effect of genotypic resistance on the virological response to highly active antiretroviral therapy in cerebrospinal fluid.

Paired plasma and cerebrospinal fluid (CSF) specimens drawn from 15 HIV-infected patients with neurological disease before and after a median 6-week duration of highly active antiretroviral therapy (HAART) were studied to assess the short-term virological response of CSF and whether this can be predicted on the basis of baseline resistance mutations. After treatment, the median plasma and CSF viral load (VL) decreased by, respectively, 2.08 log10 (p = 0.0001) and 0.91 log10 copies/ml (p = 0.007) in comparison with baseline. A plasma virological response was observed in all but one patient, whereas the posttreatment CSF VL increased, remained unchanged, or decreased at a substantial lower rate than in plasma of six "CSF non/slow responders" (40%). Direct sequencing of baseline specimens showed that none of these patients had reverse transcriptase (RT) or primary protease resistance mutations in the CSF alone, but two had RT mutations conferring high-level resistance to drugs included in the HAART regimen in both CSF and plasma. The other four patients had no RT or primary protease resistance mutations. There was no significant difference in the nucleotide diversity of the CSF and plasma RT sequences, baseline plasma or CSF VL, the CSF-to-plasma VL ratio, the number of CSF cells, the CD4+ cell counts, or the history of antiretroviral treatment between the CSF non-slow responders and the other patients. During this short-term follow-up and despite a plasma response, a significant proportion of HAART-treated patients with neurological symptoms showed a slow or absent CSF response. Most of these cases were not associated with the presence of resistant HIV strains in the CSF.

Adult↗
PubMed1988

Cerebrospinal fluid angiotensin II in patients with essential hypertension.

We measured components of the cerebrospinal fluid renin-angiotensin system from patients with essential hypertension under different dietary sodium intakes. The cerebrospinal fluid concentration of angiotensin II (Ang II) from the patients on a normal-sodium diet was 1.36 +/- 0.41 fmol/ml (n = 5). Neither the inactive nor the active form of renin was detected by the enzymatic activity or by the immunoreactivity, whereas angiotensinogen was detected (38.6 +/- 3.1 pmol/ml, n = 5). The Ang II level remained unchanged even after incubation of the cerebrospinal fluid at 37 degrees C for 3 h. Further, when authentic Ang II was added to the cerebrospinal fluid followed by incubation for 3 h at 37 degrees C, more than 90% of the added Ang II remained unchanged. Thus, the cerebrospinal fluid Ang II level may be reflected by the activity of the brain Ang II-forming system, as it was not affected by the cerebrospinal fluid constituents. The circulating renin-angiotensin system was stimulated by sodium depletion, and the cerebrospinal fluid concentration of Ang II also increased significantly. Sodium depletion may stimulate the brain Ang-II forming system, as it does the circulating renin-angiotensin system.

Angiotensin II↗
PubMed1986

Studies of vasopressin in the human cerebrospinal fluid.

The development of sensitive radioimmunoassays has permitted measurement of the low concentration of vasopressin in the human cerebrospinal fluid. There is accumulating evidence to suggest that vasopressin is involved in a variety of brain functions. As an effective blood-cerebrospinal fluid barrier to vasopressin has been demonstrated, the concentration of vasopressin in the cerebrospinal fluid probably reflects the release of vasopressin within the brain. In human subjects without intracranial disease, the concentration of vasopressin in the cerebrospinal fluid is in the range 0.5-2.0 pg/ml with only little diurnal variation. Intracranial disorders associated with increased intracranial pressure may cause increased cerebrospinal fluid vasopressin concentrations, whereas degenerative brain diseases are associated with low concentrations. Only little is known about the physiologic stimuli which alter the concentration of vasopressin in cerebrospinal fluid. The concentration in cerebrospinal fluid is not influenced by a number of stimuli that cause release of vasopressin into the blood, i.e. changes in plasma osmolality, postural changes, and nausea. Elevation of the intracranial pressure, changes in the composition of the cerebrospinal fluid, electrical stimulation of the hypothalamus, and severe hemorrhage provoke an increase in cerebrospinal fluid vasopressin level.

Animals↗
PubMed1977

Cerebrospinal fluid absorption in primary hypoparathyroidism.

Cerebrospinal fluid absorption has been studied in a patient with primary hypoparathyroidism, papilloedema, and epilepsy. A marked reduction of cerebrospinal fluid transport into plasma was demonstrated which returned to normal after correction of the hypocalcaemia.

Adult↗