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A newborn with cerebrospinal fluid leakage secondary to a fetal scalp electrode is presented. Although infrequent complications from fetal scalp electrode monitoring may be significant. Personnel using these monitoring devices should be alert to possible complications.
The advent of functional transnasal endoscopic sinus surgery has brought new opportunities in the repair of difficult cerebrospinal fluid leaks of the paranasal sinuses. The following four case reports illustrate the repair of cerebrospinal fluid leaks with the use of rigid transnasal endoscopy for enhanced angled visualization and illumination. A description of surgical techniques and instrumentation involving transnasal endoscopy in repair of sphenoidal and ethmoidal cerebrospinal fluid fistulas is reported. A discussion of etiology, diagnoses, and conservative versus surgical management of cerebrospinal fluid rhinorrhea is presented.
Cerebrospinal fluid leaks are common after translabyrinthine surgery. Minor modifications in surgical technique have proved helpful in decreasing the incidence of this complication. They involve incision design, packing techniques, monitoring eardrum integrity, and dressing care.
The concentration of cefotiam (CTM), a newly synthesized cephem derivative antibiotic in serum and cerebrospinal fluid after single intravenous treatment was determined and its utility in the field of cerebral neurosurgery was studied. 1. One gram or 2 g of CTM was intravenously administered for 1 time to 10 patients admitted to our department. Dose dependency was observed in the progress of the mean serum concentration. There was no difference in the specific rate of constant, and the ratio of AUC between the group treated with 1 g and the one with 2 g was 1:1.9. The biological half-lives of the elimination phase for both dose levels were about 1.1 hours. 2. Disparity was recognized in the cerebrospinal fluid concentration in spite of the dose dependency. Although a case with comparatively high value of 1.37 micrograms/ml at 60 minutes after administration were seen in the 1 g treatment group, generally the migration concentration was low. Good cerebrospinal fluid concentration was attained in all of the cases in the 2 g treatment group, and the peak values ranged from 0.59 to 10.16 micrograms/ml. 3. The concentration ratio of cerebrospinal fluid to serum in the 2 g treatment group elevated till 360 minutes after administration, and the maximum values ranged from 15.8 to 89.8%. 4. The migration to the cerebrospinal fluid was faster in cases with slight inflammation than those without inflammation in the 2 g treatment group. 5. It was assumed that the prophylactic effect of CTM 2 g administration against staphylococci, streptococci and Klebsiella pneumoniae which are the major causative organisms can be expected in postoperative infection in the field of cerebral neurosurgery.
A prospective study on 61 previously healthy patients with acute mono-symptomatic optic neuritis is reported. Interest was focused on changes in the cerebrospinal fluid and the clinical course with possible development of multiple sclerosis. At the beginning of the disease, a mononuclear pleocytosis was noted in 51 per cent of the patients, an elevated IgG level in 18 per cent, and an oligoclonal IgG distribution in 41 per cent. These results are in sharp contrast to those in multiple sclerosis. Eleven patients have so far developed definite multiple sclerosis. At onset only five of these had cerebrospinal fluid findings indistinguishable from those in multiple sclerosis, with pleocytosis and bands on electrophoresis. In five more patients, who subsequently developed multiple sclerosis, the cerebrospinal fluid IgG was normal at onset, but an oligoclonal IgG appeared during the follow-up; there was no correlation in time between the appearance of new symptoms and cerebrospinal fluid changes. In six patients with normal cerebrospinal fluid and four patients with only mononuclear pleocytosis at the onset of disease, the IgG pattern became oligoclonal on electrophoresis during the follow-up period, although the patients had no further symptoms or signs of disease. It was concluded, therefore, that the cerebrospinal fluid was often normal in the first attack of what later proved to be multiple sclerosis, and that a normal fluid did not preclude a development into definite multiple sclerosis. Sometimes IgG bands appeared in previously normal cerebrospinal fluid, although the patients had not experienced new symptoms.
The specificity and sensitivity of the assay for beta-glucuronidase in cerebrospinal fluid were evaluated to determine the usefulness of this test for the detection of neoplastic meningitis. The enzyme activity was first measured in cerebrospinal fluid from 131 patients with various disorders and was then prospectively measured in cerebrospinal fluid from 30 patients with cytologic results that were positive for or suggestive of malignant disease. Within the first group, elevated levels of beta-glucuronidase were found only among patients with neoplastic processes in the central nervous system, including neoplastic meningitis. Among 26 patients with neoplastic processes in the central nervous system, including neoplastic meningitis. Among 26 patients with positive cytologic results, 13 had elevated beta-glucuronidase activities. Elevated values were more frequent among patients with adenocarcinoma (75%) and myelogenous leukemia (60%). The patients with these two disorders also had the highest enzyme activities. The correlation of th beta-glucuronidase level with other cerebrospinal fluid values, including total protein, glucose content, and cell count, was not significant. The findings of this study indicate that measurement of beta-glucuronidase in cerebrospinal fluid can be used as an adjunctive diagnostic test for neoplastic meningitis. The results should be interpreted with caution, however, because of the possibility that the elevated enzyme levels may be due to acute or subacute bacterial or fungal meningitis.
The ADVIA 120 cerebrospinal fluid (CSF) assay (Bayer; Bayer Corp., Tarrytown, NY, USA) provides a new, automated analysis of CSF specimens. We evaluated this method by comparing its performance with classic chamber counting and microscopic analysis of CSF samples.
PURPOSE: To measure the tissue pressure gradient through the optic disk and to determine the relationship between intraocular, cerebrospinal fluid, and retrolaminar tissue pressures. The relationship of optic nerve subarachnoid space pressure to intracranial cerebrospinal fluid pressure also was explored. METHODS: Micropipettes coupled to a pressure transducer were passed through pars plana and vitreous to enter the optic disk in the anesthetized dog. Using a micromanipulator, pipettes penetrated the optic disk in steps while pressure measurements were taken. In some animals, pipettes also were passed into the optic nerve subarachnoid space. Lateral ventricle cerebrospinal fluid pressure, intraocular pressure, and arterial blood pressure were measured concurrently, and the effect of raising CSF pressure was explored. RESULTS: Retrolaminar tissue pressure was largely dependent on the surrounding cerebrospinal fluid pressure, which was on average 8.6 +/- 3.5 mm Hg (SD, n = 8) higher, and was independent of intraocular pressure. Most (85% +/- 15% [SD, n = 8]) of the pressure drop between intraocular pressure and retrolaminar pressure occurred across the anterior 400 microns of disk tissue. When the intraocular pressure was 21 mm Hg and the cerebrospinal fluid pressure was zero, retrolaminar tissue pressure averaged 7 mm Hg and the translaminar pressure gradient was 3.08 +/- 0.29 mm Hg/100 microns tissue (SD, n = 3). Optic nerve subarachnoid space pressure was equivalent to lateral ventricular pressure. CONCLUSIONS: These results show that cerebrospinal fluid pressure largely determines retrolaminar tissue pressure; hence, along with intraocular pressure, it is of major importance in setting the translaminar tissue pressure gradient. Results also demonstrate hydrostatic continuity between the optic nerve subarachnoid space and the lateral ventricle. That the translaminar pressure gradient can vary independently of intraocular pressure may be of importance in understanding the pathophysiology of glaucoma.
A panel of monoclonal antibodies was systematically applied to cerebrospinal fluid from 17 patients with suspected neoplastic meningitis and the results were compared with those obtained from routine cytological preparations. The antibody panel consisted of markers for neuroectodermal tissue ( UJ13A ), epithelial cytokeratin ( LE61 ), leucocytes ( 2D1 ), and neoplastic neuroblasts ( UJ181 .4). Additional antibodies were used to refine diagnosis when indicated. Cerebrospinal fluid samples from 12 patients with non-neoplastic conditions were used as controls. The use of monoclonal antibodies gave a positive diagnosis in 16/17 cases and the cells were accurately categorised as carcinoma (5/6 cases), neuroectodermal tumour (8/8 cases), and lymphoma (3/3 cases). In the 14 cases examined by routine cytology, malignant cells were reported in 10 cases and accurately categorised in only 3/14 cases. Immunocytological testing of cerebrospinal fluid with an antibody panel has greatly increased the accuracy with which malignant cells can be identified and categorised.
Soon after cerebrospinal fluid (CSF) shunts became available in the late 1950s, infection was recognized as a serious complication of their use, although the bacterial cause of the infections and the way in which they arose was not clarified for a number of years. Subsequent research has since revealed their etiology and provided data that have improved the understanding of aspects of diagnosis, treatment, and prevention.
Cytomorphological findings in the cerebrospinal fluid (CSF) of two patients suffering plasma cell leukemia and non Hodgkin's mixed cell lymphoma are reported. In the first were found immature plasma cells, polynucleate giant cells with giant nucleoli and atypical mitoses. In the second one polynucleate giant cells with hypercromatic and polyfissured nuclei and atypical mitoses are prominent. It is emphasized the importance of the early cytomorphological CSF study in patients with myelo or lymphoproliferative diseases.
While leakage of cerebrospinal fluid is an intermittent and usually short-lived phenomenon, it may be fatal. The difficulty of making this diagnosis has led to the adoption of many diagnostic procedures. Fifteen patients have been studied by radionuclide cisternography with the concomitant use of nasal pledgets. Six of the studies showed cerebrospinal fluid leakage; the sensitivity of the technique was 100%. The site of leakage was confirmed surgically in three of the patients. No other technique offers comparable sensitivity with high patient acceptance and low morbidity.
Cerebrospinal fluid composition has been studied in low and normal birthweight piglets. Values for urea, Ca, K, Cl and P did not differ between the two groups. However, glucose concentration was lower in low birthweight subjects and Mg and Na values were higher. Total leukocytes were also higher in low birthweight piglets. These differences may suggest that blood-brain-barrier is not at the same stage of maturation in low birthweight as in normal birthweight subjects.
Immunosorption of cerebrospinal fluid with updated "Pall" immunofilters (Germany) was successfully performed in 3 patients with progressing hormone-resistant Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy. It was proved that clinical improvement in the patients' state correlated with a decrease in the contents of both total protein and immunoglobulins G, A, M in cerebrospinal fluid. It was suggested that the removal of these humoral factors had decreased a degree of inflammatory and demyelinating processes in inflammatory demyelinating polyneuropathies and had improved, thereby, the results of the treatment.
2102 samples of lumbar cerebrospinal fluid (CSF) were examined by qualitative cytology for atypical plasma cells. Samples from seven patients contained such cells. Retrospective investigation of these patients revealed that four of them had had neuroborreliosis, one had multiple sclerosis, one herpes zoster and one malignant non-Hodgkin lymphoma. It is concluded that in a case of unexplained meningoradiculitis with lymphoplasmocytic reaction in the CSF, morphological analysis of the plasma cells can provide important diagnostic pointers.
Ten neuropeptides were measured by RIA in human cerebrospinal fluid obtained from 30 normal volunteers. The levels of seven peptides (corticotropin releasing factor, adrenocorticotropin, vasoactive intestinal peptide, somatostatin, beta-endorphin, beta-lipotropin, and the N-terminal fragment of proopiomelanocortin) were highly, positively correlated with one another. This result is consistent with the hypothesis that cerebrospinal fluid levels of these seven peptides are a function of some common regulatory factor, such as shared release into the cerebrospinal fluid.
The drainage of cerebrospinal fluid (CSF) from the lumbar subarachnoid space is an effective technique for the treatment of CSF fistula and control of intracranial pressure in children and adults. The use of the lumbar drain poses unique challenges, however, in the pediatric population. We present a safe and effective method of pump-controlled lumbar subarachnoid drainage. This technique allows accurate titration of CSF removal while providing a closed system which is not sensitive to position changes or patient activity. Four case histories are reviewed.
The cells of the cerebrospinal fluid consist of three systems: the lymphatic immune-competent system, the "mononuclear phagocyte system (MPS)" and the reticulo-histiocytic system (RHS). Within the lymphatic cells the lymphocytic line and the plasmocytic line must be considered separately, although the two cell-lines are from their origin functionally inter-connected; they constitute the immune-system. To the "mononuclear phagocyte system" belong the monocytes and the macrophages. The reticulo-histiocytic system includes the cell-forms which are definitely excluded from the "mononuclear phagocyte system". The investigations show that most of the cells in the CSF originate from the blood.