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The origin of cerebrospinal fluid somatostatin: hypothalamic or disperse central nervous system secretion?

The present study deals with the origin of somatostatin in cerebrospinal fluid. Two groups of experiments were performed: (1) Diagnostic lumbar puncture was performed in 37 patients admitted for various neurological diseases. Immunological determination of albumin and gamma-globulin, and radioimmunological analysis of somatostatin in successive cerebrospinal fluid taps demonstrated that while the protein concentration was approximately 20% lower in the 11th ml compared to the 1st ml drawn, the somatostatin concentration was constant. (2) Intravenous arginine infusion (30 G/30 min) induced identical patterns of plasma growth hormone in 8 patients with multiple sclerosis in relapse, in 6 patients with multiple sclerosis in the stable phase, and in 7 patients in whom no neurological disease was eventually diagnosed. Cerebrospinal fluid somatostatin was significantly lower in the patients with multiple sclerosis in relapse than in the two other groups, while cerebrospinal fluid growth hormone concentration was identical. There was no correlation between basal or arginine provoked plasma growth hormone and the cerebrospinal fluid content of somatostatin. The results indicate that cerebrospinal fluid somatostatin is released dispersely from the central nervous system including the spinal cord - and that it offers no indication of the activity or tone of hypothalamic growth hormone release inhibiting control of the pituitary gland.

Adult↗

[Diagnostic value of siderophages in the cytogram of cerebrospinal fluid].

The demonstration of siderophages in the cerebrospinal fluid is a very reliable diagnostic tool for identifying hemorrhage in the subarachnoid space and ventricular system. Siderophages are found 4 days after spontaneous or traumatic subarachnoid hemorrhage and persist in some cases up to 120 days, which makes them a reliable indicator of a previous hemorrhage. These findings are the result of an investigation in which 110 samples of cerebrospinal fluid, obtained from 105 patients, were examined for siderophages by the membrane filtration method.

Brain Concussion↗

Schizophrenia: elevated cerebrospinal fluid norepinephrine.

Concentrations of norepinephrine in cerebrospinal fluid are higher in schizophrenic patients, particularly in those with paranoid features, than in normal volunteer subjects of the same age. This observation supports recent reports of elevated concentrations of norepinephrine in specific brain areas adjacent to the cerebral ventricles of paranoid schizophrenic patients. Overflow of the amine from periventricular regions into the cerebrospinal fluid may reflect abnormally high release or diminished enzymatic destruction of norepinephrine in patients with schizophrenia.

Adult↗

Cerebrospinal fluid leak in a premature neonate.

Cerebrospinal fluid (CSF) cranial leaks in neonates are rare, and only four case reports have been published previously. Two of the previous cases were also in preterm newborns delivered at 30 weeks gestation. We present a case of CSF leak in a premature neonate delivered at 30 weeks gestation. Our approach to treatment was different from that previously described. After the initial treatment with local packing bandage failed to stop CSF leakage, local exploration with wound suturing was done, with resultant ceasing of leakage within 12 hours of birth. This case presents a rare complication of CSF leakage caused by internal scalp monitoring. This complication seems to be more frequent in premature babies, thus special consideration should be taken in premature infants before applying such monitoring.

Cerebrospinal Fluid Otorrhea↗

Rapid fluorometric assay for cerebrospinal fluid immunoglobulin G.

Using a new quantitative immunofluorometric procedure, we measured cerebrospinal fluid immunoglobulin G levels in 59 patients and compared the results with values obtained by the most precise currently available method--the immunoprecipitin method of Kabat--and a radial immunodiffusion technique. The absolute immunoglobulin G values determined by the fluorometric assay correlated closely with the other methods. This technique offers several advantages over most conventional techniques for measuring low levels of immunoglobulin G: (1) Small, drop-sized (5 to 10 micronl) samp les of cerebrospinal fluid are used, (2) a large number of samples can be tested, (3) the range of sensitivity is sufficiently wide that cerebrospinal fluid and serum levels can be determined simultaneously, and (4) the technique is fast, requiring 3.5 hours to perform. The fluorometric method is rapid, reproducible, and easy. It suitability for laboratories engaged in the measurement of cerebrospinal fluid immunoglobulin G appears promising.

Fluorometry↗

Moxalactam penetration into cerebrospinal fluid in patients with bacterial meningitis.

Penetration of moxalactam into the cerebrospinal fluid was studied in 11 patients with bacterial meningitis undergoing treatment with other antibiotics. Moxalactam at a dose of 20 mg/kg was administered as three 30- to 45- min infusions at 8-h intervals, once between days 2 and 4 and a second time between days 11 and 20 of treatment with the other antibiotics. Serum and cerebrospinal fluid were sampled 60, 90, or 120 min after the third moxalactam dose for measurement of the concentration of this drug by high-performance liquid chromatography. The concentration of moxalactam in cerebrospinal fluid ranged from 1.5 to 11 micrograms/ml, depending on the sampling time and the time elapsed since the onset of the disease. These concentrations in cerebrospinal fluid were equal to or higher than the minimum inhibitor concentrations for Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae (including ampicillin-resistant strains), and most of the gram-negative bacilli except for Pseudomonas aeruginosa. These results show that moxalactam has good penetrability when the meninges are inflamed and that it might be considered in cases of bacterial meningitis when the susceptibility of the pathogen indicates its usefulness.

Adult↗

Oscillations of cerebrospinal fluid pressure in nonhydrocephalic persons.

Spontaneous cerebrospinal fluid (CSF) pressure oscillations with a wavelength of 0.5-2/min (B-waves) are used as a criterion for shunt insertion in hydrocephalic patients. We describe CSF pressure oscillations in two nonhydrocephalic patients with normal baseline CSF pressure. Intracranial pressure was recorded via a ventricular drainage in a 54-year-old male who had a lumber CSF leak after surgery for lumbar spinal stenosis and disc herniation after the leak was closed. In the second patient, a 42-year-old male, CSF pressure was monitored via a lumbar drainage which was placed for treatment of a subcutaneous CSF effusion after resection of a recurrent temporal meningioma. CSF pressure oscillations of a wavelength of 0.5-2/min were observed with a relative frequency of 50% (patient 1) and 60% (patient 2) of the recorded time. Also longer waves were observed. Our data suggest that CSF pressure oscillations are not confined to hydrocephalic patients with raised intracranial pressure.

Adult↗

[Levels of interleukin-6 and tumor necrosis factor-alpha in the cerebrospinal fluid of full-term newborns with hypoxic-ischemic encephalopathy].

OBJECTIVE: To determine cerebrospinal fluid levels of interleukin-6 and tumor necrosis factor-alpha in full-term infants with hypoxic-ischemic encephalopathy, comparing with control infants. METHODS: Controlled, prospective study, performed between July 1999 and October 2001 with two groups of full-term newborns: 20 controls with no sepsis and/or meningitis and Apgar score > or =9 at first and fifth minutes; and cases, 15 asphyxiated full-term newborns with Apgar < or =4 and < or =6 at first and fifth minutes, umbilical blood cord pH<7.20 and/or umbilical arterial blood lactate>3.0 mmol/L, and requiring positive pressure ventilation for at least 2 minutes after birth. Cerebrospinal fluid samples were collected within 48 hours of birth for determination of interleukin-6 and tumor necrosis factor-alpha by enzyme immunoassay. RESULTS: Groups were similar concerning birthweight, gestational age, type of delivery and mean time required for cerebrospinal fluid sample collection. The samples were collected at mean with 17 hours of life. The medians cerebrospinal fluid levels in asphyxiated newborn infants were: 157.5 pg/ml for interleukin-6 and 14.7 pg/ml for tumor necrosis factor-alpha, significantly higher than the controls (interleukin-6: 4.1 pg/ml and tumor necrosis factor-alpha: 0.16 pg/ml). CONCLUSIONS: Full-term newborns with hypoxic-ischemic encephalopathy present higher cerebrospinal fluid interleukin-6 and tumor necrosis factor-alpha levels than the controls, possibly because of the local cerebral production of these cytokines, especially tumor necrosis factor-alpha. These results support a recommendation for future studies with brain blockers of the actions of these cytokines for neuroprotective strategies.

Asphyxia Neonatorum↗

[Diagnosis of cerebrospinal fluid leakages by gamma-cisternography].

Cerebrospinal fluid (CSF) leakages either secondary (traumatic) or spontaneous (non-traumatic) are first considered in their frequency and origin. The exact topography of the various meningeal and cranial lesions involved are difficult to assess particularly in the most important groups of persistant traumatic CSF rhinorrhea and recurrent meningitis. Among the various diagnostic approaches, direct observation is always necessary, but of limited value. Standard X-rays must be followed by multidirectionnal tomography (Polytome) and, whenever available, computed tomodensitography of the base of the skull. Brain pneumography provides a thorough setting fourth of the congenital or acquired cerebral lesions as well as the new cranio-meningeal conditions. Difficulties encountered with the techniques of subdurography and Pantopaque injection are underlined. Three radioisotope techniques are considered. 1) The earlier technique of cotton-pledgets only shows the external orifice. 2) The recent proposal of nuclide cranial subdurography is criticized for ignoring the leptomeningeal bag. 3) Radioisotope cisternography (RIC) or gamma-cisternography is described more precisely. It remains the most complete and appropriate method for observing the natural behaviour of the leakage. RIC with fistulography is performed through suboccipital injection of 99mTc-DTPA. RIC provides essential clues on the relative importance of associated dynamic disturbances of the third circulation and morphological changes of its anatomical bed (stenoses and widenings of the ependymal and leptomeningeal spaces). If present, the leakage may be directly shown on the RIC pictures. If rhinorrhea is abundant, there is no difficulty in assessing side and site of the fistula. If rhinorrhea is occult, dubious or intermittent, diagnosis is often difficult. There are also indirect signs of rhinorrhea: leptomeningeal dilatation near a frontal or ethmoidal fracture, contamination of the rhinopharynx, examination of the handkerchieves for presence of radioactive material. Statistical results from the literature are summarized in a table.

Cerebrospinal Fluid Otorrhea↗

Pharmacokinetics of tiazofurin in the plasma and cerebrospinal fluid of rhesus monkeys.

The pharmacokinetic disposition of tiazofurin in plasma and cerebrospinal fluid was examined in rhesus monkeys. Tiazofurin was readily detectable in both plasma and cerebrospinal fluid within 20 min of commencement and for 24 h after a short i.v. infusion of the drug. The mean clearance of tiazofurin from plasma was 70 +/- 23 (SD) ml/min/sq m after a dose of 100 mg/kg and 106 +/- 38 ml/min/sq m after a dose of 500 mg/kg with no evidence of dose dependency. The data for plasma elimination of tiazofurin were fit to a triexponential equation for comparison with data from other species. The t 1/2 alpha was 0.23 h, t 1/2 beta was 1.9 to 2.0 h, and t 1/2 gamma was 6.8 to 7.1 h. The ratio of area under the cerebrospinal fluid drug concentration-time curve to the area under the plasma drug concentration-time curve was 0.28, which suggests significant penetration of the blood-brain barrier. These results demonstrate the propensity of tiazofurin to enter the cerebrospinal fluid and, probably, the brain, and suggest a potential role for this agent in the treatment of central nervous system cancer.

Animals↗

[Caprine arthritis-encephalitis: detection of specific antibodies in the cerebrospinal fluid and synovia].

Following transmission studies cerebrospinal fluid and synovia were checked for the presence of specific antibodies from ten seronegative goats derived from seropositive females and from 16 seropositive goats showing typical clinical symptoms. In the samples from the seronegative goats it was not possible to detect any specific antibodies whereas in 14 of the 16 seropositive goats specific antibodies were found in the synovia and in two goats specific antibodies could be found in the cerebrospinal fluid. The conclusion was that the local clinical symptoms may be the result of an antigen-antibody reaction.

Animals↗

Cerebrospinal fluid leakage during endscopic forehead lifting.

PURPOSE: To report a case of endoscopic brow lift in which cerebrospinal fluid leakage was encountered. METHOD: A 69-year-old otherwise healthy man underwent endoscopic forehead lifting. RESULTS: An area of strong adherence was encountered in the area of the left superior paracentral scalp incision. As the adherence was released, clear fluid extruded (cerebrospinal fluid) and a burr hole was discovered. Absorbable gelatin sponge was placed over the dural defect and burr hole, and closure of the endoscopic scalp incisions was accomplished. CONCLUSION: Caution is suggested in performing this procedure when a patient has any history of a head trauma.

Aged↗

[Selenium concentration in the cerebrospinal fluid of children].

Following a wet digestion of 0.5-2.0 ml cerebrospinal fluid in an open system using 2.0 ml nitric acid and 1.0 ml perchloric acid (240 degrees C) and a reduction step with 1.0 ml hydrochloric acid, Selenium can be determined polarographically after adding 100 micrograms Copper(II)-ions to the analyte (15 ml; water/perchloric acid). Selenium concentrations in cerebrospinal fluid of children younger than one year (2.49 +/- 1.67 ng/ml) are significantly higher (p = 0.0074) than those of older children (1.28 +/- 0.97 ng/ml). Independent of the children age and diseases the Selenium concentrations correlate distinctly with cell numbers and protein contents. A correlation between Selenium content and cell numbers alone could not be proved. The nonsignificant differences between the Selenium concentrations in cerebrospinal fluids of children with hydrocephalus, leukemia (with or without involvement of the central nervous system), and other diseases, respectively, may be interpreted by considering the protein content of the cerebrospinal fluid and the age of the children.

Adolescent↗

Sphenoidal cerebrospinal fluid rhinorrhea: an original surgical approach.

Management of patients with sphenoidal cerebrospinal fluid rhinorrhea remains controversial. With consideration of the etiology of cerebrospinal fluid leaks, size of the sinus, location of the fistula, and previous surgery, one may choose either an extracranial or transcranial approach. In two patients in whom conventional procedures failed or seemed to be inapplicable, the cerebrospinal fluid leak was successfully treated through an original transfacial approach with palpebral incisions. A transzygomatic osteoplastic flap provided access to close the fistula and to exclude the sinus with a bone graft.

Adult↗

[Selenium concentration in the cerebrospinal fluid of children].

Following a wet digestion of 0.5-2.0 ml cerebrospinal fluid in an open system using 2.0 ml nitric acid and 1.0 ml perchloric acid (240 degrees C) and a reduction step with 1.0 ml hydrochloric acid, Selenium can be determined polarographically after adding 100 micrograms Copper(II)-ions to the analyte (15 ml; water/perchloric acid). Selenium concentrations in cerebrospinal fluid of children younger than one year (2.49 +/- 1.67 ng/ml) are significantly higher (p = 0.0074) than those of older children (1.28 +/- 0.97 ng/ml). Independent of the childrens age and diseases the Selenium concentrations correlate distinctly with cell numbers and protein contents. A correlation between Selenium content and cell numbers alone could not be proved. The non-significant differences between the Selenium concentrations in cerebrospinal fluids of children with hydrocephalus, leukemia (with or without involvement of the central nervous system), and other diseases, respectively, may be interpreted by considering the protein content of the cerebrospinal fluid and the age of the children.

Adolescent↗

Neuron-specific enolase is a marker of cerebral ischemia and infarct size in rat cerebrospinal fluid.

Neuron-specific enolase concentrations were measured in samples of rat cerebrospinal fluid obtained repeatedly before and after occlusion of the middle cerebral artery. A method for reliable, repeated sampling of cisternal cerebrospinal fluid was developed for this purpose. Occlusion of the middle cerebral artery induced cerebral infarcts of slightly variable size with good correlation to raised neuron-specific enolase concentrations. Sham operation caused only superficial cortical damage at the site of surgery and was followed by an early, slight, and transient increase in neuron-specific enolase concentration. With our technique, the development of cerebral infarcts can be studied in individual rats under experimentally controlled conditions over an extended period of time. Analysis of neuron-specific enolase can be used in trials of drugs for mitigating the effect of ischemia. Information concerning the release of neuron-specific enolase from ischemic cerebral tissue to the cerebrospinal fluid is important because neuron-specific enolase in the cerebrospinal fluid can be determined in patients suffering from cerebrovascular insult.

Animals↗

Cerebrospinal fluid abnormalities in homosexual men with and without neuropsychiatric findings.

We have studied cerebrospinal fluid obtained from 38 homosexual or bisexual men participating in a prospective study of the neuropsychological disorders associated with human immunodeficiency virus (HIV) infection. Twenty-two subjects had neuropsychiatric findings and seropositivity, 11 asymptomatic subjects had seroconverted within 6 to 24 months, and 5 subjects were seronegative controls. Only 1 had acquired immunodeficiency syndrome-related complex, and none had the acquired immunodeficiency syndrome when initially studied. There was a high rate of cerebrospinal fluid abnormalities in men with neuropsychiatric findings, including pleocytosis (41%), elevated IgG and IgG index (47%), and oligoclonal bands (18%). Even in the absence of neuropsychiatric findings, the asymptomatic HIV-seropositive subjects frequently had spinal fluid abnormalities. Of those with neuropsychiatric findings, HIV p24 antigen was detectable in cerebrospinal fluid in only 1 individual, yet HIV was isolated in 11 of 16 (69%) compared to 2 of 7 (29%) of those without neuropsychiatric findings. The identification of cerebrospinal fluid abnormalities in individuals known to have become infected within 6 to 24 months supports the hypothesis that the nervous system is an early target for HIV.

Adolescent↗