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PubMed2003

Paraspinous muscle flaps for the treatment and prevention of cerebrospinal fluid fistulas in neurosurgery.

STUDY DESIGN: A prospective clinical study was conducted to evaluate the efficacy of paraspinous muscle flaps in preventing and managing cerebrospinal fluid fistulas in high-risk neurosurgery patients. OBJECTIVES: To evaluate the efficacy of paraspinous muscle flap coverage using a "vest-over-pants" closure in the prevention and treatment of cerebrospinal fluid fistulas. SUMMARY OF BACKGROUND DATA: Previous studies have described paraspinous muscle flaps for the closure of complex spinal wounds, but none has addressed their use for the prevention and treatment of cerebrospinal fluid fistulas. METHODS: This prospective clinical study evaluated nine consecutive patients with either refractory cerebrospinal fluid fistulas or high risk for cerebrospinal fluid leaks after spinal surgery. Bilateral paraspinous muscle flaps were used as primary flaps and closed using an overlapping vest-over-pants technique in eight of nine cases. The latissimus dorsi and trapezius muscles were recruited as additional muscle flaps for closure of thoracolumbar and high thoracic deficits, respectively. RESULTS: Paraspinous muscle flaps provided immediate wound coverage in seven high-risk patients undergoing spinal surgery and two patients with recurrent cerebrospinal fluid fistulas. Postoperative hospitalization averaged 14.4 days. There was no evidence of a cerebrospinal fluid fistula after an average follow-up of 176.7 days. No wound infections occurred. The only complications were a superficial hematoma, which was drained percutaneously on postoperative day 6, and a seroma, which was drained during the follow-up period and eventually resolved. CONCLUSIONS: Paraspinous muscle flaps allow effective treatment and prevention of cerebrospinal fluid fistulas in selected high-risk patients and provide simple durable coverage of complex spinal wounds with minimal morbidity.

Adult↗
PubMed1995

Cerebrospinal fluid treponemal antibodies in untreated early syphilis.

OBJECTIVE: Examine prevalence and diagnostic utility of cerebrospinal fluid (CSF) treponemal antibodies in early syphilis. DESIGN: Comparison study. SETTING: Sexually transmitted diseases clinic. PATIENTS: Forty patients with untreated early syphilis who underwent lumbar puncture. Fifteen were human immunodeficiency virus seropositive. MEASUREMENTS: Cerebrospinal fluid cell count, protein, VDRL test, and antibodies to Treponema pallidum by microhemagglutination test for T pallidum (MHA-TP) and fluorescent treponemal antibody absorption test (FTA-ABS); albumin ratio; and IgG index. RESULTS: Cerebrospinal fluid cell count was not available for one sample, and this patient was excluded from analysis. Of 39 patients, eight (21%) had reactive CSF-VDRL (definite neurosyphilis). Eleven (28%) had mildly elevated cell count or protein concentration, but nonreactive CSF-VDRL (possible neurosyphilis). Twenty had normal cell count and protein concentration, and non-reactive CSF-VDRL (normal). Cerebrospinal fluid MHA-TP and CSF FTA-ABS were reactive in all eight with neurosyphilis. Cerebrospinal fluid MHA-TP was reactive in seven (70%) of 10 with possible neurosyphilis and in six (32%) of 19 with normal CSF. Cerebrospinal fluid FTA-ABS was reactive in four (36%) of 11 with possible neurosyphilis and in five (28%) of 18 with normal CSF. A reactive CSF treponemal test was associated with higher mean CSF cell count and reactive CSF-VDRL. CONCLUSION: When criteria to define neurosyphilis depend on cell count or CSF-VDRL reactivity, the sensitivity of CSF treponemal antibodies is high. Nonreactive CSF treponemal tests may help to exclude a diagnosis of neurosyphilis in patients with early syphilis.

Antibodies, Bacterial↗
PubMed2000

Neurotrophin-3 levels in cerebrospinal fluid from children with bacterial meningitis, viral meningitis, or encephalitis.

Neurotrophin-3 levels were measured in the cerebrospinal fluid of 35 patients with bacterial meningitis, viral meningitis, or encephalitis by two-site enzyme immunoassay. Elevated cerebrospinal fluid levels of neurotrophin-3 were demonstrated in 8 of 18 patients with bacterial meningitis. Follow-up examination of the eight patients at the convalescent stage showed diminished cerebrospinal fluid levels of neurotrophin-3. In contrast, none of the 17 patients with viral meningitis or encephalitis showed an elevation of neurotrophin-3 levels in cerebrospinal fluid. No relationships were observed between neurotrophin-3 levels and cerebrospinal fluid cell numbers, cerebrospinal fluid protein levels, serum C-reactive protein concentrations, or outcome in bacterial meningitis. Since neurotrophin-3 is involved in the survival of neurons and the modulation of the immune system, neurotrophin-3 could play a neuroprotective or immunomodulatory role in bacterial meningitis.

Adolescent↗
PubMed1978

[Relationship between immunoglobulin levels in cerebrospinal fluid and serum].

By means of radial immunodiffusion, immunoglobulins A, G, M and albumin were determined in serum and unconcentrated cerebrospinal fluid from 182 controls and 141 patients. Concentrations in cerebrospinal fluid and serum of patients did not correlate, not even in those groups whose elevated immunoglobulin and albumin concentrations in cerebrospinal fluid resulted from damage to the blood-cerebrospinal fluid barrier, as in inflammatory diseases and neoplastic processes of the central nervous system or of the meninges.--Concentrations of immunoglobulins in cerebrospinal fluid should therefore be evaluated independently of the serum concentrations. Cerebrospinal fluid and serum constitute samples from two separate compartments which are capable of independent immune reactions.

Albumins↗
PubMed2001

Cerebrospinal fluid and plasma concentrations of nitric oxide metabolites in postoperative patients with subarachnoid hemorrhage.

OBJECTIVE: To measure cerebrospinal fluid and plasma concentrations of nitrate and nitrite as indicators of nitric oxide production in adults after subarachnoid hemorrhage (SAH). DESIGN: A prospective, clinical study. SETTING: Multidisciplinary intensive care unit. PATIENTS: Nine patients (three males and six females, aged 29-64 yrs) with aneurysm-induced SAH were studied. Glasgow Coma Scale score on admission ranged from 9 to 15. Ruptured aneurysms were clipped within 72 hrs of ictus, and then conventional hypervolemic, hemodilution, and induced hypertension methods were applied. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nitrate and nitrite concentrations of patients were examined sequentially by a capillary zone electrophoresis every day for 13 days. As a control group, cerebrospinal fluid was sampled from patients (n = 9, six males and three females, aged 30-60 yrs) without neurologic disorders who underwent spinal taps for spinal anesthesia, and plasma from healthy human volunteers (n = 43, 21 males and 22 females, aged 23-49 yrs). There were no significant differences over time in cerebrospinal fluid nitrate concentrations after SAH. Concentrations of cerebrospinal fluid nitrate after SAH were increased compared with control values. Plasma nitrate concentration was decreased compared with control values, but the value on day 14 was increased significantly (p < .05) compared with those during days 2-11. Plasma and cerebrospinal fluid nitrite concentrations after SAH were similar to those in control subjects. Similar concentrations of nitric oxide metabolite in plasma and cerebrospinal fluid were observed between the patients with and without symptomatic vasospasm. CONCLUSION: The increase of cerebrospinal fluid nitrate after SAH may attribute to the endogenous nitric oxide production in the injured brain.

Adult↗
PubMed1994

[Time-course of adenosine deaminase activity in the cerebrospinal fluid in patients with tuberculous meningitis].

The level of adenosine deaminase (ADA) activity in the cerebrospinal fluid is used as a supportive diagnostic measure for tuberculous meningitis. However the time-course of adenosine deaminase activity of the cerebrospinal fluid in patients with tuberculous meningitis remains unknown. The present study describes 4 patients with tuberculous meningitis in whom ADA activity in the cerebrospinal fluid was serially determined in order to clarify the effects of anti-tuberculous chemotherapy on ADA activity in the cerebrospinal fluid. In two of these patients the ADA did not show a high activity in the early stage of the disease. But in all cases the ADA showed a high activity after all, and gradually declined and reached the normal level at approximately 1 month after the initiation of chemotherapy. It seems that the decrease in the ADA activity was seen when T cells in the cerebrospinal fluid returned to a static state upon removal of mycobacterial antigen by the treatment. The level of ADA in the cerebrospinal fluid is considered to be one of the useful measures for diagnosis and follow-up in patients with tuberculous meningitis.

Adenosine Deaminase↗
PubMed2005

Descending thoracic aortic aneurysm repair: 12-year experience using distal aortic perfusion and cerebrospinal fluid drainage.

BACKGROUND: The benefit of distal aortic perfusion and cerebrospinal fluid drainage over the "clamp and sew" technique during repairs of the descending thoracic aorta is still being debated. The purpose of this report is to analyze our experience with regard to neurologic deficit (paraplegia and paraparesis) and mortality using the adjuncts of distal aortic perfusion and cerebrospinal fluid drainage. METHODS: Between February 1991 and September 2004, we repaired 355 descending thoracic aortic aneurysms. Excluded from analysis were 29 patients who required profound hypothermic circulatory arrest as a result of transverse arch involvement and 26 patients with aortic rupture, leaving a group of 300 patients for which outcomes were analyzed. Mean patient age was 67 years, and 102 (34%) of the patients were women. The adjunct group of distal aortic perfusion and cerebrospinal fluid drainage used in 238 (79.3%) patients was compared with a group of 62 patients who underwent simple cross-clamp with or without the addition of a single adjunct. Multivariable data were analyzed by Cox regression. RESULTS: The incidence of neurologic deficit after all repairs was 2.3% (7 of 300 patients). The incidence of neurologic deficit (immediate and delayed) in the adjunct group was 1.3% (3 of 238 patients), and in the nonadjunct group was 6.5% (4 of 62 patients; p < 0.02). One case of delayed paraplegia occurred in each group. All neurologic deficits occurred in patients with aneurysmal involvement of the entire descending thoracic aorta (extent C; p < 0.02). Statistically significant predictors for neurologic deficit were the use of the adjunct (odds ratio [OR], 0.19; p = 0.02), previous repaired abdominal aortic aneurysm (OR, 7.0; p = 0.005), type C aneurysm (OR, 13.73; p = 0.02), and cerebrovascular disease history (OR, 4.7; p < 0.03). Thirty-day mortality was 8% (24 of 300 patients). Significant multivariate predictors of 30-day mortality were preoperative renal dysfunction (OR, 4.6; p < 0.01) and female sex (OR, 2.9; p < 0.03). CONCLUSIONS: Repairs of the descending thoracic aorta using the adjunct of distal aortic perfusion and cerebrospinal fluid drainage can be performed with a low incidence of neurologic deficit and an acceptable mortality. The use of the adjuncts should be considered during elective repairs of the descending thoracic aorta.

Adolescent↗
PubMed1992

Cerebrospinal fluid isoniazid concentrations in children with tuberculous meningitis: the influence of dosage and acetylation status.

Cerebrospinal fluid (CSF) and plasma isoniazid (INH) concentrations were determined on 96 occasions in 38 children (median age 1.5 years) with tuberculous meningitis, and the effects of INH elimination status and test dosages of 10 mg/kg body weight and 20 mg/kg body weight was studied. Maximum cerebrospinal fluid INH concentrations were reached during the period 2 to 4 hours after dosing and cerebrospinal fluid and plasma INH concentrations did not differ significantly during this period. Cerebrospinal fluid INH concentrations following a dosage of 10 mg/kg (4.6 +/- 2.4 micrograms/mL) were, however, significantly lower than those following a dosage of 20 mg/kg (11.6 +/- 2.7 micrograms/mL). Cerebrospinal fluid INH concentrations in faster acetylators at a dosage of 10 mg/kg (3.2 +/- 1.1 micrograms/mL) were significantly lower than in slower acetylators (7.7 +/- 1.3 micrograms/mL), as was the case with a dosage of 20 mg/kg, where faster acetylators had cerebrospinal fluid INH concentrations of 10.5 +/- 2.5 micrograms/mL compared with 14.1 +/- 1.4 microgram/mL in slower acetylators. Following dosages of both 10 mg/kg and 20 mg/kg, INH concentrations in excess of the minimal inhibitory concentration for Mycobacterium tuberculosis persisted in the CSF 12 to 14 hours later. Despite the patients' being young and frequently malnourished, suffering from advanced forms of tuberculous meningitis, and receiving high dosages of INH, rifampicin, and pyrazinamide, none developed any clinical signs of hepatotoxicity and in only one child did the serum bilirubin level rise to 19 micrograms/mL.

Acetylation↗
PubMed2000

Identification of Gal(beta 1-3)GalNAc bearing glycoproteins in cerebrospinal fluid of amyotrophic lateral sclerosis (ALS) patients.

Glycoproteins in cerebrospinal fluid of 55 patients with amyotrophic lateral sclerosis (ALS), six disease controls (multifocal motor neuropathy, sensorimotor neuropathy, Guillain-Barré syndrome, spinal muscular atrophy type II, motor neuropathy with monoclonal gammopathy) and 20 healthy controls were separated by PAGE electrophoresis and then detected immunochemically with peanut agglutinin (PNA). In 36 amyotrophic lateral sclerosis patients the 262 kDa glycoprotein was significantly increased (over the normal mean +/- SD x 2), which was associated with a decrease in the 114 kDa fraction. In the remaining patients, both fractions were either equal in concentration or the 114 kDa glycoprotein predominated. In normal cerebrospinal fluid, the 114 kDa glycoprotein predominated over the other glycoproteins. The total amount of separated glycoproteins was increased in 15 amyotrophic lateral sclerosis patients. In 12 of them it was followed by an increase in the percentage of the 262 kDa glycoprotein. There was no correlation between the content of the peanut agglutinin-labelled glycoproteins and the patients' age, duration and severity of the disease. There was a correlation between the 262 kDa glycoprotein being increased in cerebrospinal fluid and the electrophysiological pattern of denervation seen in electromyographic study. The glycoproteins change, similar to that occurring in amyotrophic lateral sclerosis patients, was also observed in one case of multifocal motor neuropathy (MMN). We suggest that in amyotrophic lateral sclerosis and multifocal motor neuropathy, the peanut agglutinin-labelled glycoproteins are released in excess from the nervous tissues into the cerebrospinal fluid as a result of neuronal degeneration. The question to be answered is, whether the released glycoproteins are becoming targets for auto-antibodies.

Adult↗
PubMed1994

Human cytomegalovirus DNA in cerebrospinal fluid.

To determine the involvement of human cytomegalovirus (CMV) in conditions of neurological impairment, detection of CMV DNA was attempted in cerebrospinal fluid obtained from 45 neurologically affected children aged from 1 month to 17 years by means of the polymerase chain reaction. Four patients (congenital CMV encephalopathy with West's syndrome, acute encephalitis, chronic epileptic encephalopathy, and lissencephaly) had CMV DNA in their cerebrospinal fluid. CMV DNA was absent in the cerebrospinal fluid of 11 neurologically unaffected controls aged from 1 month to 11 years. Three patients with acute CMV hepatitis had no CMV DNA in their cerebrospinal fluid. Among the four patients who had CMV DNA in their cerebrospinal fluid, two did not excrete CMV DNA or CMV antigen in the urine. The possible pathogenetic significance of CMV DNA in the cerebrospinal fluid is discussed. By applying the polymerase chain reaction to cerebrospinal fluid, the mode of brain invasion by CMV can be clarified further.

Adolescent↗
PubMed1983

In vitro colonisation of cerebrospinal fluid shunts.

A reliable method of colonizing cerebrospinal fluid shunts has been developed in vitro. A simulated cerebrospinal fluid is described in which the test organism (Staphylococcus epidermidis) multiplied. All experiments were conducted in a CO2 enriched atmosphere.

Carbon Dioxide↗
PubMed2003

Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches.

OBJECTIVE: To determine whether the choice of surgical approach affects the rate of postoperative cerebrospinal fluid leakage in patients who have undergone surgical resection of acoustic neuroma. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Three hundred patients who underwent surgery for acoustic neuromas were selected by consecutive medical record number until 100 resections via each surgical approach (translabyrinthine, middle fossa, and retrosigmoid) had been gathered. MAIN OUTCOME MEASURES: Surgical approach used, cerebrospinal fluid leak incidence, tumor size, patient age. RESULTS: Postoperative cerebrospinal fluid leak of any severity was observed in 13% of translabyrinthine, 10% of middle fossa, and 10% of retrosigmoid patients. These difference in the rate of cerebrospinal fluid leakage were not statistically significant (p = 0.82). The majority of leaks were managed conservatively with fluid and activity restriction, often accompanied by a period of lumbar subarachnoid drainage. There was a need to return to the operating room for a definitive procedure in 4% of translabyrinthine, 2% of middle fossa, and 3% retrosigmoid patients; again not statistically different among the approaches (p = 0.43). Tumor size was not correlated with cerebrospinal fluid leak rate (p = 0.13). Patient age, for patients older than 50 years, was suggestive of increased odds of cerebrospinal fluid leak (p = 0.06). CONCLUSION: Neither surgical approach nor tumor size affects the rate of postoperative cerebrospinal fluid leakage or the necessity of managing a leak with a return to the operating room. Cerebrospinal fluid leakage rates have remained stable in recent decades despite numerous innovative attempts to improve dural closure, seal transected air cell tracts, and occlude anatomic pathways. The finding that leak rates were similar among three dissimilar surgical techniques suggests that factors other than techniques of wound closure, such as transient postoperative rises in cerebrospinal fluid pressure, may be responsible for these recalcitrant cases.

Adult↗
PubMed1978

Components in multiple sclerosis cerebrospinal fluid that are detected by radioimmunoassay for myelin basic protein.

Components in cerebrospinal fluid that are antigenically related to myelin basic protein have been identified by a technique described recently [Barbarese, E., Braun, P. E. & Carson, J. H. (1977) Proc. Natl. Acad. Sci. USA 74, 3360-3364] involving separating the cerebrospinal fluid proteins by sodium dodecyl sulfate/polyacrylamide gel electrophoresis and measuring the individual components by radioimmunoassay for myelin basic protein. Samples of cerebrospinal fluid from 48 different patients (23 with definite multiple sclerosis, 4 with suspected multiple sclerosis, and 21 with other neurological diseases) were examined by this technique. The results indicate that cerebrospinal fluid can contain at least three separate components that are detected by radioimmunoassay for myelin basic protein. On the basis of their apparent molecular weights, the three components were identified as follows: component I, intact myelin basic protein; component II, proteolytic fragments of myelin basic protein; and component III, a protein of unknown origin with an apparent molecular weight of 50,000. Most samples of cerebrospinal fluid (45 of 48) from patients with multiple sclerosis and from patients with other neurological diseases contained components I and II. Component III was detected in all of the samples from patients with definite multiple sclerosis, in three of four samples from patients with suspected multiple sclerosis, and in none of the samples from patients with other neurological diseases. Some implications of these findings are discussed.

Humans↗
PubMed1997

Presence of adrenomedullin-like immunoreactivity in the human cerebrospinal fluid.

The presence of adrenomedullin-like immunoreactivity in the cerebrospinal fluid was studied by radioimmunoassay in 13 subjects with various neurological diseases. The concentrations of adrenomedullin-like immunoreactivity in the cerebrospinal fluid were 9.4 +/- 3.1 pmol/l (mean +/- SD, n = 13). Reverse-phase high performance liquid chromatography of the extract of the pooled cerebrospinal fluid showed that approximately 40% of the adrenomedullin-like immunoreactivity was chromatographically identical to human adrenomedullin (1-52). This is the first report that demonstrates the presence of adrenomedullin-like immunoreactivity in the human cerebrospinal fluid.

Adrenomedullin↗
PubMedDate not supplied

Headache in cerebrospinal fluid volume depletion syndrome: a case report.

Cerebrospinal fluid (CSF) volume depletion syndrome is due to leakage of cerebrospinal fluid through lesions of the dural sac at the level of the cranial base or of the spine. When past medical history is negative for recent trauma or surgery, the term spontaneous intracranial hypotension (SIH) is used. SIH is characterized clinically by orthostatic headache, neck pain, nausea, emesis, horizontal diplopia, tinnitus, plugged ear, hearing difficulties, blurring of vision, facial numbness, and upper limb radicular symptoms. In SIH, brain and cervical MR scans show a diffuse pachymeningeal gadolinium enhancement that ends at the site of CSF leakage. The application of epidural blood patches has been proposed as an effective therapy for SIH. Here we describe a case of SIH with very unusual headache features; the patient reported a paradoxical pattern of postural headache provoked by clinostatic position. The CSF leakage was identified at the convexity of the skull and headache disappeared following treatment with fluid, analgesics and steroids.

Cerebrospinal Fluid Pressure↗
PubMed1974

Rapid diagnosis of infection by gas-liquid chromatography: analysis of sugars in normal and infected cerebrospinal fluid.

A highly reproducible procedure was developed for gas-liquid chromatographic analysis of trimethylsilyl derivatives of normal human cerebrospinal fluid. Fourteen normal human cerebrospinal fluid samples tested with this procedure contained alpha- and beta-glucose as well as isomers of two unidentified sugars. Chromatographic changes in three cases of meningeal inflammation (two cryptococcosis and one thalamic astrocytoma) were limited to decreased concentrations of all sugars. In one case of early meningitis, the concentrations of the unknown sugars decreased before glucose. Now that a reproducible chromatogram of the trimethylsilyl derivatives of normal human cerebrospinal fluid has been established, more samples of abnormal cerebrospinal fluid should be prepared by these methods and examined by gas-liquid chromatography. It may be possible to identify unique products of infectious agents which will permit rapid diagnosis of central nervous system infection.

Adolescent↗
PubMed1993

Human macrophage colony-stimulating factor levels in cerebrospinal fluid.

Macrophage colony-stimulating factor (M-CSF) levels in the cerebrospinal fluid of 14 patients with meningitis and of 14 patients suffering from a disease other than meningitis were measured using an enzyme-linked immunosorbent assay. All four bacterial meningitis patients had M-CSF levels in the cerebrospinal fluid which exceeded 1540 U/ml, and the mean value was 3333 +/- 1481 U/ml. The mean M-CSF level in the cerebrospinal fluid of the ten aseptic meningitis patients was 393 +/- 175 U/ml, which was higher than that of patients who suffered from a disease other than meningitis (179 +/- 90 U/ml) (P < 0.01). There was no clear correlation between the M-CSF levels and the numbers of white blood cells, granulocytes, or monocytes in the cerebrospinal fluid. These elevated M-CSF levels were thought to be of a local origin, since most patients with high M-CSF levels in the cerebrospinal fluid had relatively low M-CSF levels in the serum.

Adult↗