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Baseline serum and cerebrospinal fluid magnesium levels in normal pregnancy and preeclampsia.

OBJECTIVE: To determine whether baseline cerebrospinal fluid magnesium levels in preeclampsia differ from those in normal pregnancy, and to ascertain whether pre-treatment cerebrospinal fluid magnesium levels correlate with serum levels, which would suggest a baseline alteration in the blood-brain barrier in preeclampsia. METHODS: When spinal analgesia or anesthesia was administered for delivery, serum and cerebrospinal fluid magnesium levels were determined in 20 normal gravidas and 20 preeclamptic women not treated with magnesium sulfate. Data were analyzed by two-sided Student t test and regression analysis. RESULTS: Mean (+/- standard deviation) cerebrospinal fluid magnesium level for preeclamptic patients was 2.23 +/- 0.09 mEq/L, which was not significantly different from controls. Regression analysis revealed no significant correlation between cerebrospinal fluid and serum magnesium levels for either normal or preeclamptic gravidas. CONCLUSION: During the third trimester, there is no difference in baseline, pre-treatment cerebrospinal fluid magnesium levels in preeclamptic patients compared to normal subjects, and no correlation between cerebrospinal fluid and serum magnesium over the range of baseline values.

Adult↗

Differences in the isoelectric focusing patterns of serum and cerebrospinal fluid transthyretin.

Transthyretin isolated by polyacrylamide gel electrophoresis from human serum and cerebrospinal fluid, dissociated into its subunits, was subjected to isoelectric focusing in polyacrylamide gels containing 8 mole/L urea. The isoelectric focusing multi-component patterns of serum and cerebrospinal fluid transthyretin differ in a characteristic way, having only one main protein zone in common. Double diffusion immunotest and immunoblotting revealed the immunological identity of serum and cerebrospinal fluid transthyretin and of the main components separated by isoelectric focusing. The different isoelectric focusing zones can be consistently explained when they are ascribed to structurally identical transthyretin subunits associated with different ligands specifically occurring in either serum or cerebrospinal fluid. Only the protein zone located at the same pI in serum and cerebrospinal fluid transthyretin patterns may be assigned to ligand-free subunits. Thus, the typical differences in isoelectric focusing patterns may point to different carrier functions of transthyretin in serum and cerebrospinal fluid.

Cerebrospinal Fluid Proteins↗

Regional cerebral blood flow and cerebrospinal fluid glutamate in leukoaraiosis.

Cerebral blood flow and cerebrospinal fluid amino acids were investigated in patients with leukoaraiosis on magnetic resonance imaging. Ten patients with leukoaraiosis and without significant cerebral infarction and ten age-matched controls without abnormality on magnetic resonance imaging were studied. The regional cerebral blood flow was measured using the stable xenon computed tomography method. The blood flow was significantly lower in the leukoaraiosis area in the leukoaraiosis group than in the same area in the control group. The cerebrospinal fluid glutamate concentration was significantly higher in the leukoaraiosis group than in the control group. There was a significant negative correlation between the blood flow in the leukoaraiosis area and the cerebrospinal fluid glutamate concentration. The high concentration of cerebrospinal fluid glutamate in patients with leukoaraiosis is considered to be related to ischaemia.

Aged↗

Diagnostic use of cerebrospinal fluid lactic acid levels in meningitis.

Analysis of cerebrospinal fluid lactic acid levels in 62 patients suspected of having meningitis was performed. Lactic acid was measured enzymatically using lactic acid dehydrogenase with the liberation of NADH. In a control (no meningitis) group, 46 children had a mean cerebrospinal fluid lactic acid level of 14.7 +/- 2.2 mg/dl; 3 with febrile seizure had a mean lactic acid level of 33.5 +/- 0.98 mg/dl. In 9 cases of bacterial meningitis, the mean lactic acid level was 54.8 +/- 16.8 mg/dl. In 3 patients of aseptic meningitis, the mean lactic acid level was 34.5 +/- 1.0 mg/dl. Serial lactate determination was done in three patients and they were well correlated with the clinical response and other cerebrospinal fluid findings. These data suggest that the determination of cerebrospinal fluid lactic acid may be of diagnostic value in differentiating between bacterial and aseptic meningitis.

Adolescent↗

Elevated levels of cerebrospinal fluid guanosine 3',5'-cyclic monophosphate (C-GMP) in systemic lupus erythematosus.

Cerebrospinal fluid samples from patients with systemic lupus erythematosus (SLE) and neurologic involvement were evaluated for guanosine 3',5'-cyclic monophosphate (C-GMP) and cyclic adenosine monophosphate (C-GMP) content by radioimmunoassay and radioassay, respectively. Twenty-five samples from 15 patients with SLE had an average C-GMP level of 2.4 nM +/- 0.44 (average +/- SE) compared with 0.68 nM +/- 0.14 in a control group with lumbosacral pain (p less than 0.0002). No significant difference was noted in C-AMP content between patients with SLE and control subjects. C-GMP levels in cerebrospinal fluid samples from patients with SLE who had changing neurologic disease were higher than in those with stable neurologic disease. Elevated C-GMP levels in cerebrospinal fluid correlated with the leukocyte number in cerebrospinal fluid (r = 0.53 p less than 0.01), but not with the initial pressure, protein concentration or daily prednisone dosage. Experimental results suggested that leukocytes in the cerebrospinal fluid were not the source of elevated C-GMP levels. Thus, elevated C-GMP levels in cerebrospinal fluid of patients with SLE appeared to reflect neurologic involvement. C-GMP levels were alos found to be elevated in five patients with other active neurologic diseases; thus, measurement of C-GMP in cerebrospinal fluid may have more general diagnostic value.

Adolescent↗

Apolipoprotein E allelic influence on human cerebrospinal fluid apolipoproteins.

The major apolipoproteins (apo) on human cerebrospinal fluid lipoproteins are apoA-I and apoE. Given the association between inheritance of the varepsilon4 allele of the apoE gene (APOE4) and increased susceptibility to Alzheimer's disease, we tested the hypothesis that cerebrospinal fluid apolipoproteins may be influenced by APOE genotype and Alzheimer's disease. Lipoprotein fractions (d < 1.210 g/ml) were isolated from cerebrospinal fluid obtained from individuals with different APOE genotypes and with or without pathologically verified Alzheimer's disease. Apolipoproteins were separated by SDS-polyacrylamide gel electrophoresis and identified by silver nitrate staining, Western blotting, and N-terminal amino acid sequencing. Four protein species were detected by silver nitrate staining in subjects with an APOE3 allele: apoA-I, apoE monomer, apoE-apoA-II heterodimer, and apoE homodimer. In APOE4 homozygotes, only apoA-I and apoE monomer were detected. ApoA-II homodimer was demonstrated in all subjects by Western blotting. The relative levels of apoE- and apoA-II-containing apolipoproteins correlated with APOE genotype but were not altered by Alzheimer's disease. In contrast to apoE, no apoA-II immunoreactivity was observed with pathological structures in Alzheimer's disease brain. These differences in cerebrospinal fluid apolipoproteins may influence lipoprotein trafficking and may be an element in the stratification of risk for Alzheimer's disease with APOE genotype.

Aged↗

The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea: a 20-year experience.

Chronic cerebrospinal fluid rhinorrhea (present for 2 months or longer) is a serious condition frequently encountered by the otolaryngologist-head and neck surgeon. The purpose of this report is that it can be successfully repaired transsinally, from below, with a high rate of success. Intracranial repair has been associated with reportedly high morbidity and failure rates. From 1967 to 1987, 16 patients underwent repair of chronic cerebrospinal fluid rhinorrhea in the cribriform plate or fovea ethmoidalis at the University of Iowa with an osteomucoperiosteal flap. Follow-up data from 1.6 to 22 years demonstrated no recurrent leaks in this group of patients. Minimal morbidity and no deaths were associated with the osteomucoperiosteal flap. On the basis of our experience, we recommend this technique, which can be performed by any experienced paranasal sinus surgeon, as superior to craniotomy for the repair of chronic cerebrospinal fluid rhinorrhea from cribriform plate and fovea ethmoidalis defects.

Adolescent↗

Site of origin of spinal cerebrospinal fluid pulse wave.

: Since vascular pulsation in the cerebrospinal fluid causes the cerebrospinal fluid pulse wave (CSFPW), spinal CSFPW may serve as a monitor of spinal cord blood flow. However, there are two possible sources of spinal CSFPW: brain and spinal cord pulsation, and it is unclear for which region spinal CSFPW provides blood flow information. To resolve this question, we analyzed changes in CSFPW caused by occlusion of the large vessels in mongrel dogs. The thoracic and abdominal aorta (TA group, n = 13; AA, n = 6), bilateral internal carotid arteries (ICA, n = 7), and superior and inferior vena cava (SVC, n = 6; IVC, n = 8) were occluded. The CSFPW was measured at the second cervical and sixth lumbar spine level. To eliminate the influence of hemodynamic changes caused by the occlusion, CSFPWs were decomposed into component frequencies, harmonic waves (HWs), and analyzed using the system analysis method. After occlusion, cervical CSFPW was decreased in groups ICA (change in the first HW, 38%; P < 0.05 by Wilcoxon signed-ranks test), TA (40%; P < 0.05), and SVC (53%; P < 0.05), while lumbar CSFPW was decreased in groups TA (71%; P < 0.01), AA (78%; P < 0.05), and IVC (48%; P < 0.05). These results show that spinal CSFPW provides information on the blood flow of a relatively localized region, and could be used to monitor spinal cord blood flow.

Animals↗

Spontaneous cerebrospinal fluid otorrhoea: case report and literature review.

Cerebrospinal fluid otorrhoea may occur through the temporal bone both in children and adults. In children it is generally associated with labyrinthine malformations and usually presents with hearing loss in a child with recurrent meningitis. In adults it is sequel to direct head injury, otologic or neurotologic surgery or infection. More rarely this pathology is described as being "spontaneous", occurring without any history of trauma, surgery or infection. Spontaneous cerebrospinal fluid otorrhoea in adults may present with dull symptoms such as a blocked ear or short term conductive hearing-loss. The anatomic site of this fistula is the tegmen tympani which may have a microscopic or macroscopic bone deficiency or sometimes even a "silent" meningoencephalic herniation. The authors describe a case of spontaneous cerebrospinal fluid otorrhoea occurring in an adult patient with bilateral absence of the tegmen tympani and review the literature regarding this specific. They suggest that its actual occurrence may be underestimated. Special attention should be given to adult patients with recurrent or persistent middle ear effusion. Any suspicion should be followed by meticulous imaging and surgical exploration since this may be a lifethreatnening situation.

Cerebrospinal Fluid Otorrhea↗

Interleukin-8 is increased in cerebrospinal fluid of children with severe head injury.

OBJECTIVE: To determine interleukin (IL)-8 concentrations in ventricular cerebrospinal fluid from children with severe traumatic brain injury (TBI). DESIGN: Prospective study. SETTING: University children's hospital. PATIENTS: Twenty-seven children hospitalized with severe TBI (Glasgow Coma Scale score < or =8), seven children with cerebrospinal fluid culture-positive bacterial meningitis, and twenty-four age-equivalent controls. INTERVENTIONS: Placement of an intraventricular catheter and continuous drainage of cerebrospinal fluid. MEASUREMENTS AND MAIN RESULTS: Median [range] cerebrospinal fluid IL-8 concentration in children with TBI (0-12 hrs) (4,452.5 [0-20,000] pg/mL) was markedly greater than that in controls (14.5 [0-250]) (p < .0001) and equivalent to concentrations in children with meningitis (5,300 [1,510-22,000] pg/mL) (p = .33). Cerebrospinal fluid IL-8 remained increased in children with severe TBI for up to 108 hrs after injury. Univariate logistic regression analysis demonstrated an association between cerebrospinal fluid IL-8 and child abuse (p = .07) and mortality (p = .01). Multivariate analysis demonstrated a strong, independent association between cerebrospinal fluid IL-8 and mortality (p = .01). CONCLUSIONS: The data are consistent with an acute inflammatory component of TBI in children and suggest an association between cerebrospinal fluid IL-8 and outcome after TBI. IL-8 may represent a potential target for anti-inflammatory therapy.

Acute Disease↗

Effect of 5-hydroxytryptamine on the rate of cerebrospinal fluid production in rabbit.

Infusion of 5-hydroxytryptamine in mock cerebrospinal fluid of rabbits lowered cerebrospinal fluid production dose-dependently by nearly 30%. The effect was amplified in the presence of the monoamine oxidase inhibitor, nialamide. The 5-hydroxytryptamine-induced inhibition was partly counteracted by ketanserin, and further addition of practolol completely blocked the reduction in cerebrospinal fluid formation, suggesting that both 5-hydroxytryptamine receptors and beta 1-adrenergic receptors were involved in the response mediated by both the secretory epithelium and the vascular bed of the plexus.

Animals↗

Pulsatile cerebrospinal fluid flow measurement using phase-contrast magnetic resonance imaging in patients with cervical myelopathy.

STUDY DESIGN: A technical report is presented. OBJECTIVE: To investigate the relation between the severity of myelopathy and the degree of cerebrospinal fluid flow disturbance by using magnetic resonance imaging to measure the velocity of the cerebrospinal fluid flow in patients with cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: Analyses of pulsatile cerebrospinal fluid flow measured by phase-contrast magnetic resonance imaging in healthy subjects and patients with Arnold-Chiari syndrome have been reported. Few studies have evaluated the change of pulsatile cerebrospinal fluid flow velocity and the waveform of the plotted velocity in patients with cervical spondylotic myelopathy. METHODS: Study 1: Pulsatile cerebrospinal fluid flow was measured at C7, positioned with cervical spine flexion and extension, to investigate the influence of cervical alignment on the pulsatile cerebrospinal fluid flow in five patients with cervical spondylotic myelopathy. Study 2: In 31 patients with cervical spondylotic myelopathy, pulsatile cerebrospinal fluid flow was measured at C3 and C7, with the neck set centrally. The relevance of cerebrospinal fluid flow disturbance and the severity of myelopathy evaluated by the Japanese Orthopedic Association scoring system also were studied. RESULTS: Study 1: The waveform of plotted pulsatile cerebrospinal fluid flow velocity showed no change resulting from the position of the cervical spine. Study 2: A high correlation between the Japanese Orthopedic Association score and the cerebrospinal fluid pulsatile flow amplitude at C7 was demonstrated (r = 0.75; P < 0.0001). The average Japanese Orthopedic Association score of 14 patients whose cerebrospinal fluid flow velocity waveforms were absent was significantly lower (P < 0.0001) than that of 17 patients whose waveforms were present. CONCLUSIONS: The disturbance of pulsatile cerebrospinal fluid flow demonstrated high correlation with the severity of myelopathy. Measurement of cerebrospinal fluid flow disturbance can quantify the degree of dural sac and spinal cord compression.

Aged↗