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PubMedDate not supplied

Unusual presentations of inflammatory conditions in cerebrospinal fluid.

Unusual inflammatory reactions in cerebrospinal fluid (CSF) in five patients were explicable by the type of intracranial injury or surgical intervention that they had received or by their basic disease process. Lumbar puncture fluid from a 64-year-old man with multiple facial fractures contained neutrophils, bacteria, Candida sp. and ciliated columnar cells, findings consistent with a basilar skull fracture allowing paranasal sinus contents to enter the subarachnoid space. A 59-year-old man with angioimmunoblastic lymphadenopathy developed meningitis and suffered a respiratory arrest; a ventricular fluid contained acute inflammatory cells as well as numerous corpora amylacea. Lumbar CSF obtained during surgery from a 26-year-old man with a pontine glioma contained numerous histiocytes clustered around polarizable filaments, probably strands of gauze introduced during surgery. A specimen of CSF obtained intraoperatively from a 54-year-old man with an acoustic neuroma undergoing a second craniotomy contained multinucleated giant cells bearing suture material. A 19-year-old girl with systemic sarcoidosis had noncaseating granulomas in the right temporal lobe and multinucleated giant cells in her CSF.

Adult↗
PubMed1978

Lumbo-omental shunt for drainage of cerebrospinal fluid in hydrocephalus.

A new cerebrospinal fluid (CSF) shunting procedure is presented. By transposing a pedicle graft of the greater omentum to the lumbar CSF compartment, the CSF absorption capacity of the omentum is utilized. The operation is applicable to the treatment of communicating hydrocephalus. The technical problems and physiological effects of the operation have been studied earlier in dogs. This paper presents the first case of an intended clinical series. The patient was studied for 18 months postoperatively by different examinations, including psychometric tests, cisternography, computer tomography, echo-ventriculography, and carotid angiography with measurement of the cerebral blood flow. A gradual improvement in his clinical state was registered after the operation.

Cerebrospinal Fluid Shunts↗
PubMed1974

The cerebrospinal fluid in acute leukaemia of childhood: studies with the Cytocentrifuge.

The Cytocentrifuge enables a satisfactory cytological preparation to be made when the cells in the cerebrospinal fluid are normal in number or only slightly increased. A technique has been developed and the results of its use are described in 114 consecutive samples from 50 children with acute leukaemia, with and without involvement of the central nervous system. Analysis of the results showed that 30% of the samples with a normal cell count contained leukaemic cells when examined by Cytocentrifuge. Only 74% of the samples with raised counts were found to contain leukaemic cells. Diagnosis of leukaemic meningitis based on changes in the cell count alone in cerebrospinal fluid is clearly unreliable, and the Cytocentrifuge enables a more precise assessment of the cerebrospinal fluid to be made. It also appears that changes in the levels of protein and glucose in the cerebrospinal fluid of leukaemic patients are not directly related to the presence of leukaemic cells but are the results of changes in the cell count from whatever cause. There appears to be no value in measuring protein and glucose levels when monitoring the cerebrospinal fluid in acute leukaemia for evidence of early involvement of the central nervous system.

Cell Count↗
PubMed1995

Epidemiology of cerebrospinal fluid shunting.

The epidemiology of cerebrospinal fluid (CSF) shunting in the United States is not well known; however, with recent national surveys, the prevalence, incidence, and cost of these procedures can be estimated. The prevalence of CSF shunts in the United States appears to be greater than 125,000, though this is likely an underestimate of the true value. There are approximately 69,000 discharges each year with the diagnosis of hydrocephalus. These visits produce nearly 36,000 shunt-related procedures, 33,000 of which involve the placement of a shunt. CSF shunting procedures account for almost US$ 100 million of national health care expenditures each year. Unfortunately, nearly half of these dollars are spent on revision. The rates and costs of CSF shunting underscore the need for continued improvement in both materials and techniques.

Adolescent↗
PubMed1973

Proteins from human cerebrospinal fluid: binding with nucleic acids.

Cerebrospinal fluid (CSF) contains two groups of proteins that bind tightly to DNA and to polyriboguanylic acid, respectively. In certain diseases the amounts of a given nucleic acid bound by a constant volume of CSF may increase, while in others the amount of such proteins may be reduced. Binding of polyriboguanylic acid increased in CSF samples from patients with brain tumors, stroke, multiple sclerosis, and communicating hydrocephalus, but it significantly decreased in CSF samples from patients with obstructive hydrocephalus. These increases may or may not be proportional to the rise in total CSF proteins characteristic for these diseases. Elevated binding of DNA was observed in samples from patients with hydrocephalus, epilepsy, and cortical atrophy. The technique described may be applicable to the diagnosis of a variety of diseases of the central nervous system.

Alcoholism↗
PubMed1996

Allogeneic cartilage used for skull base plasty in children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea.

Three children with primary intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea were operated on at the Department of Neurosurgery, Hradec Králové. In two children, aged 4 and 9.5 years, freeze-dried allogeneic costal cartilage was glued into the skull base defect. This plugging was covered up with deep frozen allogeneic fascia lata. In the third child, an only 1-year-old boy, after transection of the neck of the encephalomeningocele freeze-dried allogeneic dura mater was glued on extradurally and deep-frozen allogeneic fascia lata applied intradurally. The cerebrospinal fluid rhinorrhea ceased immediately after surgery. Spontaneous atrophy of the intranasal portion of the encephalomeningocele was demonstrated respectively 11, 1, and 7 years postoperatively on computed tomography. To evaluate cartilage healing histologically, the extracted allogeneic cartilage used for orbital roof plasty after 4 months was examined. The extent of spotty regressions represented about 7% of the tissue volume. It is stressed that, once diagnosed, intranasal encephalomeningocele associated with cerebrospinal fluid rhinorrhea should be operated on for prevention of meningitis as soon as possible.

Brain↗
PubMed1978

Electron microscopic studies of cerebrospinal fluid sediment in demyelinating disease.

Cerebrospinal fluid specimens from 31 patients with multiple sclerosis (MS) and 2 with progressive multifocal leukoencephalopathy (PML) were subjected to ultracentrifugation, and the resulting pellets were examined in an electron microscope. Cell types seen in the pellets included lymphocytes, occasional plasma cells, polymorphonuclear leukocytes, monocytes, eosinophils, lipid-laden macrophages, and fibroblasts. The most interesting noncellular elements were extracellular myelin fragments, recognizable by their characteristic alternation of major dense lines and intraperiod lines. Myelin fragments were seen in the CSF from 7 of 9 patients with MS in exacerbation involving areas other than the optic nerve. These fragments were not observed in 4 specimens from patients with acute attacks manifested by optic neuritis. Myelin fragments were present in 1 of the 2 patients with PML. These observations indicate that a portion of the myelin destruction seen in MS and PML occurs extracellularly, with release of myelin fragments and degradation products into the CSF.

Cell Count↗
PubMed2006

Evidence of antibody production in the rat cervical lymph nodes after antigen administration into the cerebrospinal fluid.

We previously showed histologically that, in the rat, the cerebrospinal fluid drains from the subarachnoid space along the olfactory nerves to the nasal lymphatics and empties into the superficial and deep cervical lymph nodes. The present study was performed to investigate whether these lymph nodes play a role in the immune response of the central nervous system. For this purpose, keyhole limpet hemocyanin conjugated with fluorescein isothiocyanate (KLH-FITC) was administered into the subarachnoid space of the rat brain, and the time-kinetics and location of FITC and anti-FITC antibody forming cells in the cervical lymph nodes were studied histologically and immunohistochemically. FITC fluorescence was detected in superficial and deep cervical lymph nodes as well as the subarachnoid space and the nasal mucosa 2 h after FITC-KLH injection into the subarachnoid space. The specific antibody-forming cells first appeared in both the superficial and deep cervical lymph nodes on the 4th day after antigen administration although the reaction was more intense in the deep than in the superficial cervical lymph nodes. These cells were located in the medullary cords of the cervical lymph nodes. The number of antibody forming cells increased thereafter, reached a peak around the day 6, and then declined on day 10. These findings indicate that antigens introduced in the cerebrospinal fluid are drained into the cervical lymph nodes through the nasal lymphatics and initiate the antigen-specific immune response there. Thus, the cervical lymph nodes probably act as a monitoring site for cerebrospinal fluid and play a major role in the central nervous system immune response.

Animals↗
PubMed1984

Two-dimensional electrophoresis and "ultrasensitive" silver staining of cerebrospinal fluid proteins in neurological diseases.

Cerebrospinal fluid (CSF) proteins, as resolved by two-dimensional electrophoresis and made visible by silver staining, have been examined in patients with various neurological diseases and normal volunteers. The patterns for 15 of 20 patients with Parkinson's disease showed a protein (Mr 25 000) with charge similar to albumin, which was not seen in the patterns for any of 91 normal volunteers. Patterns for 21 of 22 multiple sclerosis patients showed novel immunoglobulin light chain proteins, also not present in the CSF of any normal volunteers. Quantitative analysis by computer-assisted densitometry in Parkinson's disease and multiple sclerosis showed that 20 of 68 and 33 of 85 proteins, respectively, were significantly altered as compared with proteins in the normal population. This ability to characterize both Parkinson's disease and multiple sclerosis molecularly provides a broad baseline for improved clinical diagnosis and may serve as an aid in exploring the underlying pathophysiology. These studies illustrate the potential of applying this methodology in the study of neurological diseases.

Adult↗
PubMed1996

Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak.

Techniques to repair cerebrospinal fluid (CSF) leak through the eustachian tube (ET) include temporary or permanent CSF diversion; middle fossa craniotomy and packing of the ET from above; and packing of the ET from behind, through the middle ear. We report a case of endoscopic closure of the ET in the nasopharynx (the front). A 26-year-old woman underwent a translabyrinthine removal of a 4.5-cm vestibular schwannoma. One year later, she developed CSF rhinorrhea and meningitis. Attempts at control of this leak included traditional approaches mentioned previously (shunting, middle fossa, middle ear packing). The leak recurred 2-3 months after each procedure. An endoscope was used transnasally to expose the ET orifice, which was incised, inverted, and cauterized. She has remained free of leak for 1 year. Our success in this difficult case suggests that this is a useful procedure for treatment of CSF rhinorrhea originating in the posterior fossa. Greater experience is needed to verify its long-term effectiveness and utility as a primary procedure for the treatment of CSF rhinorrhea.

Adult↗
PubMed1994

Fractures of the middle third of the face and cerebrospinal fluid rhinorrhoea.

The incidence of cerebrospinal fluid (CSF) rhinorrhoea in patients with facial fractures is about 25%. Although the management of facial fractures is well documented, its timing and role in the presence of CSF leak is still open to debate. This study evaluates facial manipulation in 89 facial fractures associated with CSF rhinorrhoea, with a mean follow-up of 4 years. The facial fractures were reduced in 26 patients (29%) and the CSF fistula was repaired in 75 (84%). Twenty-three (25.8%) had both facial manipulation and dural repair with no deaths, post operative infection, failure or recurrence of CSF leak. On the other hand, when facial manipulation or dural repair was performed alone, the CSF rhinorrhoea either persisted or recurred in a significant number of patients requiring further intervention. Although this is a retrospective analysis of patients treated over several years and, there has been a change in the methods of investigation and treatment of these patients, one can conclude that manipulation of facial fractures and surgical dural repair can be carried out at the same sitting without increasing the surgical morbidity and mortality.

Adult↗
PubMed1978

T and B lymphocytes in the cerebrospinal fluid of various neurological diseases.

Cerebrospinal fluids (CSF) from 66 patients with a variety of neurological disorders were studied for total protein content, absolute amount of albumin, IgA, IgG and IgM, as well as their quotients (fraction to total protein ratio), cell numbers and B cell and T cell levels. In addition, the percentage of B cells and T cells in the blood was determined in 34 patients and serum immunoglobulin levels were estimated in 51 patients. In noninflammatory diseases of the CNS, the percentage of B cells was slightly higher and T cell levels were lower in the CSF in comparison to corresponding blood values. The B cell to T cell ratio in viral meningitis was altered in the CSF. An apparent increase in the T cell level led to a decrease of B cell values. Similar changes were also found in optic neuritis. The percentage of T cells was higher in relapsing multiple sclerosis than in the chronic progressive form. There were less striking changes in the B cell to T cell ratios in the CSF of other inflammatory diseases of the CNS.

Adolescent↗
PubMed1991

Analysis of cerebrospinal fluid proteins by electrophoresis.

The cerebrospinal fluid (CSF) is a specific ultrafiltrate of plasma, which surrounds the brain and spinal cord. The study of its proteins and their alteration may yield useful information on several neurological diseases. By using various electrophoretic separation techniques, several CSF proteins have been identified derived from plasma or from brain. Different one-dimensional methods, such as agarose gel electrophoresis and isoelectric focusing, are of similar value in identifying the non-specific oligoclonal bands, which are mainly helpful in the diagnosis of multiple sclerosis and other inflammatory diseases. Isoelectric focusing has a greater resolution than other one-dimensional methods, and it yields additional data about disease-associated proteins occurring in Alzheimer's disease, Huntington's chorea and amyotrophic lateral sclerosis. Silver-stained two-dimensional gels provide more information about the complex protein composition of CSF, particularly about proteins produced in the brain, such as apolipoprotein E and neuron-specific enolase. For the detection of oligoclonal antibodies, the investigation of protein changes revealed by Parkinson's disease, schizophrenia and Creutzfeldt-Jakob disease, and the analysis of CSF immune complexes, two-dimensional electrophoresis has a greater sensitivity.

Antibodies↗
PubMed1983

[Lymphocyte subpopulations in the cerebrospinal fluid: III. Normal values].

For cerebrospinal fluid (CSF) samples from 50 subjects previously selected to represent suitably a normal control group and for a methodology that may be actually used for CSF samples even with normal cell count, it is possible to characterize lymphocyte subpopulations with normal statistical distribution and low dispersion of results for all lines considered. Data (mean +/- standard deviation) here estimated were (%): for B-lymphocyte subpopulation 7.0 +/- 1.44; for T lymphocyte subpopulation 76.0 +/- 2.92; for T-active lymphocytes 53.7 +/- 3.26; for T-avid lymphocytes 19.2 +/- 4.32 when all T subpopulation is considered, and 11.1 +/- 2.04 when only T-active subpopulation is studied; for T-sensitized or actually activated 22.3 +/- 3.95. These data may suggest that lymphocytes actually related to immunological activation will be properly represented by the difference between T-lymphocytes and its T-active line in each case. In every samples T and T-active lymphocytes are different subpopulations when surface receptor density is considered, by evidence of avidity for sheep erythrocytes. It is also possible that killer lymphocytes, or antibody mediated cytotoxic cells, may be related to modified lymphoid cells identified in the CSF normal cytomorphological profile.

Adolescent↗
PubMed1992

Coronal computerized tomography and cerebrospinal fluid rhinorrhea.

Accurate diagnosis of cerebrospinal fluid rhinorrhea (CSFR) is a challenge for physicians caring for patients with traumatic brain injury. Failure to recognize this condition may result in significant medical complications and prolong hospitalization. Two male patients who developed CSFR within 2 months of severe head injury are described. A clear nasal discharge was noted on examination approximately 30 and 35 days after head injury in both patients and a CSF fistula was suspected. High-resolution computerized tomography (CT) with coronal sections confirmed the diagnosis. Both patients underwent neurosurgical intervention to repair the fistulous tracts without recurrence. Sequelae of CSFR in one case included meningitis and pneumocephalus. Literature review shows water-soluble contrast CT cisternography (CTC) to be the gold standard for the diagnosis of CSFR. However, other diagnostic studies may include immunoelectrophoresis of rhinorrhea, use of isotope tracers, plain x-rays, tomography, and noncontrast high-resolution CT. More invasive studies like CTC are often recommended in the diagnosis of this condition, but are more costly, painful, and carry a small risk of infection. Our two case reports emphasize that high-resolution CT may be performed as a primary noninvasive diagnostic procedure before more invasive studies, and the results obtained may be sufficient for therapeutic planning.

Adult↗
PubMedDate not supplied

Magnetic resonance cisternography and thin coronal computerized tomography in the evaluation of cerebrospinal fluid rhinorrhea.

In recent years cerebrospinal fluid (CSF) rhinorrhea has been managed successfully with transnasal endoscopic techniques. The most important and often most difficult step is the precise localization of the fistula. Computerized tomographic and radionuclide cisternography are two commonly used techniques for preoperative identification of the CSF fistula when it cannot be seen clearly with nasal endoscopy. Each of these requires a lumbar puncture, and the intrathecal placement of contrast material has been associated with transient neurotoxicities. Magnetic resonance cisternography (MRC) is a noncontrast study that does not require a lumbar puncture and has been used recently in the diagnosis of spontaneous and traumatic CSF leaks. Magnetic resonance cisternography utilizes a fast spin-echo sequence with fat suppression and video image reversal that highlights CSF. This allows precise localization of the fistula in both coronal and sagittal planes. Thin section coronal computed tomography (TCCT) is another noninvasive technique that can be helpful in localizing CSF leaks. The technique of MRC and TCCT and the results of 16 CSF leaks in 15 patients are reported. There was good correlation between MRC, TCCT, and intraoperative findings. Magnetic resonance cisternography and thin coronal computerized tomography appear to be accurate and complementary, noninvasive radiographic studies that should be considered in the evaluation CSF rhinorrhea.

Cerebral Ventriculography↗
PubMed1987

Bacterial adhesion to cerebrospinal fluid shunts.

Bacterial adherence to cerebrospinal fluid (CSF) shunts was analyzed in vivo and in vitro. Scanning electron micrographs (SEM's) of catheters removed from pediatric patients with shunts infected by Staphylococcus aureus or Klebsiella pneumoniae revealed numerous bacterial cells and microcolonies, leukocytes, and erythrocytes attached to the CSF catheters' inner walls, as well as the existence of surface irregularities, such as fissures, rugosities, and holes. Permeability analyses and SEM's demonstrated that catheters develop physical alterations over the period of implantation. Different bacterial strains presented a different in vitro adherence to CSF shunts, suggesting that this attachment may be affected by specific properties of the outer structures of each strain. The attachment of microbial pathogens to CSF shunts seems to contribute to the persistence of bacterial cells within a catheter and the onset of recurrent shunt infection. This study demonstrated that some bacteria can remain attached within shunts in vitro despite a CSF flow at rates up to 200 times higher than those normally demonstrated in vivo. Furthermore, surface irregularities found throughout this study may help to anchor and hide bacterial microcolonies. Based on these findings, it seems advisable to remove an infected shunt and to replace it with a new one after proper antimicrobial therapy, in order to prevent recurrent infections.

Bacterial Adhesion↗
PubMed1997

'Bath-plug' technique for the endoscopic management of cerebrospinal fluid leaks.

In the past cerebrospinal fluid (CSF) leaks were managed via a craniotomy with intradural repair. With the advent of endoscopic sinus surgery, transnasal repair has become more popular. The comparatively low morbidity and high success rate of endoscopic repair has made it the treatment of choice for CSF leak repair. As more surgeons practice endoscopic sinus surgery, the incidence of iatrogenic CSF leaks has increased. It is important that endoscopic sinus surgeons be aware of the techniques for closing such leaks. The aim of this study is to present a new technique for the endoscopic repair of CSF leaks. Since the technique was devised the authors have used the technique on six patients. All patients had lumbar drains inserted and five patients had intra-thecal fluorescein inserted for location of the leak. All repairs have been successful with an average follow-up of 13 months. The technique consists of introducing a fat plug with a specifically secured vicryl suture into the intradural space and placing traction on the suture to seal the defect much as a bath plug seals a bath. There were no complications in any of the patients either intra- or post-operatively. The difficulties and possible complications of the technique as well as the use of a lumbar drain and intra-thecal fluorescein are discussed.

Adult↗