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At least 1,207 records · Page 67Linked to original sources
PubMed1998

Spinal-cerebrospinal fluid leak demonstrated by radiopharmaceutical cisternography.

Cerebrospinal fluid (CSF) leaks are known to occur under several conditions: lumbar puncture performed for contrast myelography, spinal surgery, spinal stab wounds, fracture of the thoracic spine, inadvertent spinal puncture during epidural anesthesia, traumatic lumbar meningocele, and bronchopleural subarachnoid fistula due to bronchogenic carcinoma. Spontaneous spinal leaks are uncommonly encountered in neurosurgical practice, but they are increasingly recognized as a cause of spontaneous intracranial hypotension. Most CSF leaks are located at the cervicothoracic junction or in the thoracic spine. The disease is often self-limiting. A CSF leak can be detected directly by accumulation of radioactivity outside the subarachnoid space or suggested indirectly by the rapid disappearance of tracer from the subarachnoid space and early appearance in the urinary bladder. In this paper we present two unusual cases of CSF leak identified by radiopharmaceutical cisternogram.

Adult↗
PubMed1987

Alcohol consumption and blood-cerebrospinal fluid barrier dysfunction in man.

The cerebrospinal fluid (CSF)/serum albumin ratio has been used a marker for blood CSF barrier permeability in 116 normal patients. We attempted to correlate the CSF/serum albumin ratio with a number of clinically measurable parameters including alcohol consumption. Alcohol consumption had a significant effect on the blood-CSF barrier. Our data indicate that alcohol increases blood CSF barrier permeability in a dose-dependent manner. The measured values of parameters indirectly indicative of alcohol consumption, such as gamma-glutamyltranspeptidase (gamma-GT) and erythrocyte mean corpuscular volume (MCV), were also correlated with enhanced blood-CSF barrier permeability. Although an apparent influence of age, body weight and sex on blood-CSF barrier permeability was observed, these correlations were not separable from the effect of alcohol consumption.

Adolescent↗
PubMedDate not supplied

Management of pregnant women with cerebrospinal fluid shunts.

As more women with cerebrospinal fluid shunts reach child-bearing age, neurosurgeons, obstetricians and other health care providers will increasingly be called upon to care for them once they become pregnant. A review of the literature reveals that these patients may develop symptoms of shunt malfunction as uterine size increases. In most cases, symptoms can be managed conservatively during pregnancy and usually resolve following delivery. The presence of a CSF shunt per se, is not a contraindication to pregnancy and eventual fetal and maternal outcome has been excellent in the majority of cases. Labor and delivery should be allowed to progress naturally and interventions limited to those indicated for obstetrical reasons alone. Peripartum prophylactic antibiotics may be indicated and special care ought to be exercised if epidural analgesia or cesarian section is deemed necessary. Genetic investigations and counseling may be indicated in selected patients.

Adolescent↗
PubMed1988

Increased concentrations of tyrosine and phenylalanine in the cerebrospinal fluid as a possible reflection of related changes of the brain tissue in newborns with intra-uterine growth retardation.

Plasma and cerebrospinal fluid concentrations of tyrosine and phenylalanine were measured fluorometrically in human term neonates appropriate for gestational age and in neonates small for gestational age with severe intra-uterine growth retardation of Type II. The intra-uterine retarded newborns showed significant differences of both plasma and cerebrospinal fluid tyrosine levels as compared with the non-retarded newborns: the mean plasma and cerebrospinal fluid tyrosine were determined to be 2.0 and 2.5 times, respectively, higher in the retarded group. The mean cerebrospinal fluid phenylalanine content was also increased in these newborns. The findings may reflect cellular disturbances of the tyrosine metabolization in the developing brain as it can also be found in experimental intra-uterine growth retarded animals.

Biomarkers↗
PubMed1985

Normal cerebrospinal fluid values in children: another look.

Cerebrospinal fluid samples sterile for virus and bacteria from 371 patients who had no evidence of CNS pathology were examined. The patients were divided into five age categories. The white blood cell polymorphonuclear, and mononuclear cell counts were evaluated. The frequency distributions for these cell counts were markedly skewed, so values were calculated as percentiles for each age group. WBC values were highest for CSF obtained from patients in younger age categories, but 25% of patients from all age categories had two or three WBCs in their CSF. Patients from all but the 3- to 6-month category had three polymorphonuclear cells in their CSF 5% of the time. There was no significant difference in CSF WBC count between patients who had seizures and those who did not. Knowledge of normal values in different age groups is needed for the interpretation of CSF findings, but it should be used in conjunction with other clinical and laboratory findings.

Age Factors↗
PubMed1995

Surgical decisions in the management of cerebrospinal fluid rhinorrhoea.

The surgical management of cerebrospinal fluid (CSF) rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery in the management of sinusitis. The clear anatomical exposure of the roof of the nasal and the sinus cavities by the endoscope offers the surgeon an opportunity to identify the area of the CSF leak, which enables one to adequately plan the treatment. The incidence of iatrogenic CSF rhinorrhoea has also increased, especially after the introduction of endoscopic sinus surgery. This study and presentation will analyze the various medical and surgical decisions that can be offered in the management of CSF rhinorrhoea from the authors' combined 10-year experience. The early identification of high-risk patients prior to surgery will be stressed including the various diagnostic options which are currently available in isolating the leak. The technique of endoscopic repair in the surgical management of the various leaks and the timing of the repair will be discussed in detail.

Adolescent↗
PubMed1975

[Behavior of cerebrospinal fluid proteins in degenerative diseases].

132 cerebrospinals fluids from patients with degenerative diseases of the central nervous system have been analyzed for protein distribution in agar gel electrophoresis. After subdivision into diagnostically well defined groups these patients were compared with 48 with metabolic and psychiatric diseases and with 79 normal controls. The majority of diagnostic groups showed a tendency to permeability impairment. Other outstanding deviations were not found, except for single cases which were not statistically typical of the groups as a whole. However, the "degenerative type" of proteinogram emphasized in the literature predominated not only in the degenerative groups but also in certain other diseases with destruction of central nervous tissue which do not belong to the degenerative diseases in the strict sense. On the other hand, there are some degenerative subgroups without this "typical" electrophoretic pattern. There would thus appear to be grounds for amending the term "degenerative" into "tissue destroying" or "atrophic type", to avoid misinterpretation.

Alpha-Globulins↗
PubMed1996

Isolation of Mycobacterium tuberculosis from cerebrospinal fluid by the centrifugation & filtration methods.

Cerebrospinal fluid (CSF) samples were collected in 2 bottles each, from 112 children, examined clinically for tuberculous meningitis (TBM) One was processed by the centrifugation method and the other by the filtration method for the isolation of M. tuberculosis. Of these specimens, 11 and 13 yielded M. tuberculosis by the centrifugation method and the filtration method, respectively. In 7 specimens M. tuberculosis was isolated by both the methods; in 4, only by the centrifugation method, and in 6, only by the filtration method. Using both the methods, 17 (15.2%) of 112 specimens were culture positive for M. tuberculosis. The improvement in the rate of isolation, thus obtained, assumes importance as the confirmation of the diagnosis of TBM in all the clinically suspected cases is always desired. Moreover, the filtration method is simple and inexpensive and it can be carried out even in remote hospitals and the membranes, after filtration, can be transported to central mycobacteriology laboratory for culture of tubercle bacilli.

Bacteriological Techniques↗
PubMed1998

Trans-sphenoidal treatment of postsurgical cerebrospinal fluid fistula: CT-guided closure.

Cerebrospinal fluid (CSF) leakage after trans-sphenoidal surgery is a troublesome complication with a risk of meningitis and pneumocephalus. We suggest CT-guided intrasphenoidal injection of fibrin sealant through a 12-gauge needle as a simple alternative to surgical management of CSF fistulae. We treated eight patients, operated via the trans-sphenoidal route (five pituitary adenomas, three craniopharyngiomas), for a postoperative CSF leak by CT-guided intrasphenoidal injection of fibrin sealant alone in three cases and fibrin sealant and autologous blood in 5. CT was obtained 10 days after the procedure in all cases. In four patients, the CSF leak was closed successfully at the first attempt. The procedure was repeated on the four remaining patients because only a reduction in leakage was obtained at the first attempt. This procedure preserves olfaction and avoids the risk of frontal lobe damage. It could therefore represent the treatment of choice in many cases of anterior cranial fossa postsurgical CSF leaks.

Adult↗
PubMed1990

Cerebrospinal fluid neuropeptide Y in Alzheimer's disease.

The cerebrospinal fluid neuropeptide Y level was measured by radioimmunoassay in 20 patients with probable Alzheimer's disease and in 19 controls. The mean level was lower in patients (69.5 +/- 36.7 pg/ml) than in controls (103 +/- 21.8 pg/ml; p less than 0.001). Patients with a disease duration of greater than 2 years had cerebrospinal fluid neuropeptide Y levels lower than those with shorter disease duration (p less than 0.02). These results suggest that neuropeptide Y containing cells may be involved in Alzheimer's disease. No correlation was found between neuropeptide Y levels and degree of cognitive impairment or age at disease onset.

Aged↗
PubMedDate not supplied

Cerebrospinal fluid in cerebral hemorrhage and infarction.

Cerebrospinal fluid (CSF) abnormalities were correlated with pathological diagnoses in 61 patients with autopsy-verified intracerebral hemorrhage or cerebral infarction. Lumbar punctures were performed within one week of onset of symptoms. The CSF color and red blood cell counts were the most useful CSF parameters in differentiating between intracerebral hemorrhage and cerebral infarction. In 75% of the patients with intracerebral hemorrhage, the CSF was either grossly bloody or xanthochromic; in 25%, the CSF was clear. In patients with cerebral infarction, the CSF was never grossly bloody; in two patients with hemorrhagic infarction, the CSF was xanthochromic. The CSF pressure, protein values and leukocyte counts were less useful in differentiating intracerebral hemorrhage from cerebral infarction. Cases with hemorrhagic infarction could not be separated from those with ischemic infarction on the basis of CSF analysis. In clear CSF, the polymorphonuclear neutrophilic leukocyte (PNL) counts were never greater than 20 per cubic millimeter. In xanthochromic or cloudy CSF, leukocyte counts, especially PNLs, were frequently elevated, occasionally to the high levels.

Cerebral Cortex↗
PubMed1991

Role of NaCl cotransport in cerebrospinal fluid production: effects of loop diuretics.

Cerebrospinal fluid (CSF) is secreted primarily by the choroid plexus (CP) located in the cerebral ventricles. Although much is known about ionic composition of cisternal CSF, the mechanisms involved in secretion of CSF in mammals are still not understood. The main aim of this report is to critically review the role of NaCl cotransport carrier in CSF production. On the basis of the studies in the literature, a model for CSF production by the CP is proposed. In this model, CP cells are assumed to be equipped with an NaCl cotransport carrier located on the basolateral (blood-facing) membrane. Because Na+ and Cl- are the two principal ions in CSF, their continued secretions into cerebral ventricles by CP cells require an adequate intracellular supply, which may be guaranteed by the NaCl cotransport carrier. Although this appears to be a reasonable assumption, making the processes involved in CSF production similar to those of other secretory epithelial cells, the presence of such a carrier in mammalian CP remains controversial. The reasons for this controversy are critically reviewed, and some suggestions for further studies are made.

Animals↗
PubMed1976

PCO(2) and rate of formation of cerebrospinal fluid in the monkey.

Changes in cerebrospinal fluid formation rate (VF) with hypocapnia were measured by the ventriculocisternal perfusion technique in 24 rhesus monkeys anesthetized with nitrous oxide. In addition cerebral blood flow (CBF) was measured by the hydrogen clearence methods, Vf in control animals declined at a mean rate of 2.3 mul/min each hour during the last 4.5 h of a 7-h perfusion although variables known to effect Vf remained stable. Three hours after perfusion began, Vf of normocapnic controls was 41.4 mul/min +/- 5.4; CBF, 59P ML/100 G PER MIN. When Pco(2) was reduced to half of control, Vf fell to 35.6 mul/min +/- 6.3 and CBF fell by 27%. When Pco(2) was doubled, Vf fell to 33.1 mul/min +/- 5.3 and CBF increased threefold. The difference in Vf id significant only for the hypercapnic group (p=0.01). When animals were used as their own controls, three were no significant differences in Vf with hypercapnia compared to normocapnia. These results indicated that in the monkey variations of Pco(2) within broad physiologic limits, which are sufficient to cause large changes in CBF, have little effect of Vf.

Acidosis↗
PubMed2006

Occurrence of overlooked zoonotic tuberculosis: detection of Mycobacterium bovis in human cerebrospinal fluid.

The paucibacillary nature of the cerebrospinal fluid (CSF) has been a major obstacle in the diagnosis of human tuberculous meningitis (TBM). This study shows that with molecular techniques direct precise determination to the species level of mycobacterial pathogens can be made. The present report describes the utility of a nested PCR (N-PCR) assay (A. Mishra, A. Singhal, D. S. Chauhan, V. M. Katoch, K. Srivastava, S. S. Thakral, S. S. Bharadwaj, V. Sreenivas, and H. K. Prasad, J. Clin. Microbiol. 43:5670-5678, 2005) in detecting M. tuberculosis and M. bovis in human CSF. In 2.8% (6/212) of the samples, M. tuberculosis was detected, and in 17% (36/212), M. bovis was detected. Mixed infection was observed in 22 samples. Comparative analysis of clinical diagnosis, smear microscopy, and N-PCR in 69 patients (TBM, 25; non-TBM, 44) showed that the sensitivity of N-PCR (61.5%) was greater than that of smear microscopy (38.4%). Determination to the species level is important from the viewpoint of determining the prevalence of these mycobacteria in a community and would influence strategies currently adopted for the prevention of tuberculosis.

Animals↗
PubMed2005

Risk factors of cerebrospinal fluid rhinorrhea following transsphenoidal surgery.

OBJECTIVE: Cerebrospinal fluid (CSF) rhinorrhea is a potentially life-threatening complication following transsphenoidal surgery (TSS). METHODS: To elucidate the risk factors that may affect the incidence of postoperative CSF rhinorrhea, we retrospectively reviewed 200 consecutive cases of TSS performed by a single surgeon for 168 adenomas and 32 other sellar and parasellar lesions. RESULTS: Intra-operative CSF leakage was encountered in 38 cases (19.0%). Its incidence did not correlate to tumor size. Among 4 microadenoma cases with CSF leak, 3 were ACTH adenomas. In contrast, postoperative CSF rhinorrhea was observed in 5 cases (2.5%), all following TSS for adenomas. It was frequently noted in cases with prior TSS (3/40, 7.5%, p = 0.0235) and prior radiotherapy (2/7, 28.6%, p < 0.0001). Two cases who required surgical intervention had received TSS and radiotherapy previously. CONCLUSION: The risk of postoperative CSF rhinorrhea is significantly increased in cases with prior TSS or radiotherapy or both. In addition, these cases tended to show delayed CSF leaks and require sellar reconstruction for its treatment. When a CSF leak was encountered during TSS in these high-risk cases, thorough sellar reconstruction and long-term follow-up is necessary.

Adenoma↗
PubMed1983

Mitogen and antigen stimulation of multiple sclerosis cerebrospinal fluid lymphocytes in vitro.

Responses of cerebrospinal fluid (CSF) and peripheral blood (PB) lymphocytes from 20 MS patients to phytohemagglutinin (PHA), measles, rubella, mumps and herpes simplex virus antigens were followed during periods of from 6 to 13 months. Up to 6 examinations, each with 1-5 stimulants, were performed with a lymphocyte blast transformation test. Most of the patients responded with their CSF cells to PHA (14/19) and at least to some of the viral antigens tested (15/20) during the follow-up. Although the maximal responses of CSF and PB cells to PHA and measles virus antigen were of the same magnitude, non-reactive or weakly responding lymphocytes were more common in CSF than in PB. In 7 of 15 patients having viral antigen responsive CSF cells simultaneous reactivity to several antigens could be shown. The stimulation results of CSF lymphocytes did not correlate with the numbers of CSF leukocytes or the intrathecal IgG synthesis. A negative correlation was observed between the strength of the CSF cellular response to PHA or measles virus antigen and the rate of intrathecal antibody synthesis to measles virus antigen, suggesting that the stimulated cells may at least partially represent suppressor cells.

Adult↗
PubMed1995

Cerebrospinal fluid analysis in children with seizures.

Cerebrospinal fluid (CSF) examinations of 212 children aged two to 24 months with idiopathic nonfebrile seizures, complex febrile seizures, or status epilepticus, who had a lumbar puncture within 24 hours of the convulsion, were reviewed to determine whether an idiopathic convulsion can result in CSF abnormalities. Children with complex febrile seizures had a median CSF white blood cell count of 1 cell/mm3 (range 0-19 cells/mm3) and a median CSF polymorphonuclear (PMN) cell count of 0 cells/mm3 (range 0-8 cells/mm3). The CSF white blood cell (WBC) count was elevated above the upper limit of normal of 5 cells/mm3 in 9.8% and the absolute number of polymorphonuclear cells was more than 0 cells/mm3 in 26.2% of the complex febrile seizure subjects. Values at the 95th percentile were calculated; a total of 8 WBC/mm,3 4 PMN/mm,3 protein of 73 mg/dl and glucose of 119 mg/dl determined the 95th percentile CSF values for the patients with complex febrile seizures. Patients with nonfebrile seizures or with status epilepticus had similar findings. We conclude that complex febrile, idiopathic nonfebrile convulsions or status epilepticus may affect CSF findings in children: CSF with > 20 WBC/mm3 or > 10 PMN/mm3 should not be attributed to seizures.

Cerebrospinal Fluid Proteins↗
PubMed1993

Angiotensin II decreases the rate of production of cerebrospinal fluid.

The choroid plexus, which produces cerebrospinal fluid (CSF), contains receptors for angiotensin II and a very high concentration of angiotensin-converting enzyme. Circulating angiotensin II decreases blood flow to the choroid plexus. The first goal of this study was to examine the hypothesis that angiotensin II decreases the production of CSF. The second goal was to determine whether effects of angiotensin II on the production of CSF were receptor-mediated. Production of CSF was measured in chloralose-anesthetized rabbits using ventriculocisternal perfusion of artificial CSF containing blue dextran. Rabbits received either vehicle, angiotensin II, angiotensin II in the presence of an angiotensin II antagonist (saralasin), or saralasin intravenously. Increases in blood pressure, during administration of angiotensin II, were prevented by withdrawal of blood. Under control conditions, CSF production averaged 7.2 +/- 0.2 microliters/min (mean +/- S.E.). Angiotensin II (100 ng/kg/min i.v.) decreased CSF production by 24 +/- 3% (P < 0.05, n = 8). In the presence of saralasin (1 microgram/kg/min i.v.), angiotensin II had no significant effect on CSF production (-4 +/- 6%, P > 0.05, n = 7). Vehicle did not affect CSF production significantly (-2 +/- 6%, P > 0.05, n = 7). Saralasin alone decreased production of CSF (-21 +/- 5%, P < 0.05, n = 7). To test the specificity of saralasin in blocking effects of angiotensin II receptor stimulation on CSF production, the carbonic anhydrase inhibitor acetazolamide was administered in the presence and absence of saralasin.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetazolamide↗