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At least 1,225 records · Page 68Linked to original sources
PubMed1997

Contemporary management of cerebrospinal fluid rhinorrhea.

Management of patients with cerebrospinal fluid rhinorrhea (CSF) remains controversial. Most studies recommend either an endoscopic or an external extracranial approach, depending on the surgeon's preference. Eighteen patients with CSF rhinorrhea have been managed at our institution since 1990. The causes of the CSF rhinorrhea consisted of functional endoscopic sinus surgery (7), lateral rhinotomy with excision of a benign nasal tumor (3), spontaneous rhinorrhea (7), and secondary repair after intranasal ethmoidectomy (1). In 11 patients the CSF leak was recognized at the time of surgery; in 10 of these patients it was repaired during the primary surgery, whereas one patient underwent secondary repair after failure of conservative management of his CSF fistula. Seven patients underwent exploration for spontaneous CSF rhinorrhea. Four patients had computer tomography scans that showed the leak, and two patients had cisternography to localize the leak. One patient underwent magnetic resonance cisternography. Both of these leaks were identified with cisternography and were then confirmed intraoperatively. Repair methods included a pedicled septal mucosal flap (4), a free mucosal graft from the septum (7), and a middle turbinate (5). Two patients had obliteration of the sinus with muscle/fascia and fibrin glue. Eight patients were repaired endoscopically. The remainder underwent repair through external approaches. Seventeen patients (at a minimum 1 year follow-up) remain free from leakage. One patient required a second repair 8 months after surgery. Iatrogenic trauma remains the most common cause of CSF rhinorrhea. Management at the initial setting is the least morbid approach and is successful in 95% of cases. Whether an endoscopic or external approach is used depends on surgical expertise and experience.

Adult↗
PubMedDate not supplied

[Comparative characteristics of the changes in the protein makeup and immunobiological properties of the cerebrospinal fluid and blood serum in experimental trypanosomiasis in rabbits].

Changes in proteins and immunobiological properties of cerebrospinal fluid and serum of blood during trypanosomosis of rabbits infected with T. ninaekohljakimovae are described. Changes of the protein composition and immunobiological properties in cerebrospinal fluid and serum have been shown to differ in the degree, character and time of their display. The dependence of changes in the concentration of immunoglobulins IgM, IgG, IgA (according to the data of immunoelectrophoresis) of blood serum on its protective properties was investigated. The role of cerebral barrier mechanisms in the formation of immunity in the central nervous system is shown.

Animals↗
PubMed1990

gamma-Glutamylglutamine identified in plasma and cerebrospinal fluid from hyperammonaemic patients.

gamma-Glutamylglutamine has been identified in plasma and cerebrospinal fluid. Preparative high voltage electrophoresis was used to isolate the compound from two to three ml of sample. Analysis of archival material from eight patients with urea cycle disorders showed that plasma gamma-glutamylglutamine was 20-214 mumol/l when the plasma glutamine was greater than 1,000 mumol/l and that the relationship was strongly positive (P less than 0.0005). Plasma gamma-glutamylglutamine concentration was also raised in one patient with secondary hyperammonaemia, but not in three other cases, one of whom had a plasma glutamine of 10,000 mumol/l. Cerebrospinal fluid from the last patient contained 97 mumol/l of gamma-glutamylglutamine. Samples of cerebrospinal fluid from two patients with urea cycle disorders were available and the gamma-glutamylglutamine levels were 203 and 313 mumol/l. gamma-Glutamylglutamine and 5-oxoproline concentrations were not significantly increased in urine from any of these patients.

Ammonia↗
PubMed1977

Relationship between plasma and cerebrospinal fluid insulin levels of dogs.

Several experiments are reported in which insulin or glucose was administered intravenously to anesthetized dogs. Plasma and cerebrospinal fluid levels of glucose and immunoreactive insulin were determined at several intervals before and after the administrations. Intravenous insulin (0.2 U/kg) administered as either a pulse or a 1-h infusion caused a large increase of plasma insulin, but a relatively small increase of cerebrospinal fluid insulin. When endogenous insulin was elevated by the administration of glucose (100 mg/kg), cerebrospinal fluid insulin changed only slightly. A significant correlation was found between steady-state plasma and CSF endogenous insulin levels. The results are interpreted to indicate that the level of insulin in the cerebrospinal fluid reflects basal plasma level plus an integral over time of the insulin response to challenge. The implications of such a system are discussed.

Animals↗
PubMed1980

Determining time of death of a dog by analyzing blood, cerebrospinal fluid, and vitreous humor collected at postmortem.

Blood, cerebrospinal fluid, and vitreous humor collected at antemortem and postmortem from 60 dogs were analyzed to determine what chemical value may be used for estimating time of death. Euthanatized dogs were maintained at 4 C, 20 C, or 37 C for 3, 6, 12, 24, or 48 hours. At postmortem, vitreous humor potassium values increased with increased time and increased temperature. Cerebrospinal fluid chloride values decreased; potassium and phosphorus values increased markedly, and calcium and creatinine values increased slightly. Blood potassium, phosphorus, and creatinine values increased; sodium and chloride values decreased. Within 6 hours after death, blood carbon dioxide values decreased to a quarter of values determined at antemortem.

Animals↗
PubMed1975

Cerebrospinal fluid acid-base and lactate changes after seizures in unanesthetized man II. Alcohol withdrawal seizures.

Acid-base changes in arterial blood and lumbar cerebrospinal fluid were correlated with simultaneously determined lactate levels in patients admitted after alcohol withdrawal seizures. Arterial and cerebrospinal fluid lactate was elevated in association with a marked respiratory alkalosis in 13 patients studied 5 to 12 hours after the seizure. Similar elevations of arterial and cerebrospinal fluid lactate were found in five patients during delirium tremens without antecedent withdrawal seizure. The cerebrospinal fluid lactate determined on admission appeared to correlate best with the length and severity of the alcohol withdrawal syndrome that developed in patients after a withdrawal seizure.

Adult↗
PubMed1981

[Cerebrospinal fluid passage of therapeutic immunoglobulins of the IgG class in infectious inflammatory disease of the CNS].

Immunoglobulins are often used as an optimizing therapy in cases of infectious diseases of the central nervous system. To clarify the question of whether or not an intravenously administered compound of the IgG class is able to penetrate the cerebrospinal fluid barrier despite its high molecular weight, 12 anti-HBs negative patients received 20 ml each of a beta-Propiolacton treated IgG compound with a high anti-HBs titre (1 : 115 000) used as a marker. Four patients having an inconspicuous fluid condition were consulted for control. Five patients were suffering from slight disturbances and three other patients had severe disorders of the blood-cerebrospinal fluid barrier function resulting from inflammatory diseases of the central nervous systems. Cerebrospinal fluid was produced by way of lumbar puncture resp. drainage for the determination of anti-HBs. Simultaneously, the concentration of antibodies in serum was determined. In all patients having barrier disturbances, anti-HBs was evident in the cerebrospinal fluid, the transfer of intravenously administered immunoglobulins to cerebrospinal fluid increasing in correlation with the degree of the barrier disorder. The therapeutical importance of immunoglobulin therapy in treating infections of the central nervous system is pointed out.

Adult↗
PubMed2000

Quantitative determination of melatonin in human plasma and cerebrospinal fluid with high-performance liquid chromatography and fluorescence detection.

A validated new and precise reversed-phase high-performance liquid chromatographic method for the determination of melatonin in human plasma and cerebrospinal fluid, with 5-fluorotryptamine as internal standard, is described. Liquid-liquid extraction with dichloromethane was performed under alkaline conditions. After evaporation of the organic solvent, the extract was dissolved in eluent and chromatographed on a base-deactivated octadecyl column, using an eluent composed of 650 mL potassium dihydrogenphosphate solution (0.07 mol/L water), adjusted to a pH of 3.0 with a 43% phosphoric acid solution, mixed with 350 mL methanol. Fluorescence detection at an excitation wavelength of 224 nm and an emission wavelength of 348 nm was used for quantitation. Melatonin and 5-fluorotryptamine chromatographed with retention times of 5.3 and 9. 3 min, respectively. Mean recoveries of 96% (n = 10) and 95% (n = 5) were found for melatonin in plasma and cerebrospinal fluid respectively. 5-Fluorotryptamine was found to have a mean recovery of 90% (n = 10) and 82% (n = 5) in plasma and cerebrospinal fluid, respectively. The repeatability coefficients of variation for both melatonin and 5-fluorotryptamine in plasma were 4-5% [five different samples (r = 5) on two consecutive days (n = 2)], with reproducibility coefficients of 1.6-7% (n = 2, r = 5) and 0.9-4% (n = 2, r = 5) for melatonin and internal standard, respectively. In cerebrospinal fluid the repeatability coefficient of variation of the extraction procedure was 5% (n = 1, r = 5) for melatonin and 7% (n = 1, r = 5) for 5-fluorotryptamine. The correlation coefficients of the calibration curves were 0.9998 (n = 2) in plasma at a concentration range of 0.108-25.9 ng/mL and 0.9994 (n = 2) at a concentration range of 0.108-25.9 ng/mL in cerebrospinal fluid. The limit of detection was determined at 8 pg/mL which enables to measure melatonin concentrations at physiological concentrations reached during daytime.

Adult↗
PubMed1988

Cerebrospinal fluid pyrazinamide concentrations in children with tuberculous meningitis.

Cerebrospinal fluid pyrazinamide concentrations were determined by high pressure liquid chromatography in 53 samples from 13 children who had tuberculous meningitis complicated by increased intracranial pressure. Peak concentrations of up to 50 micrograms/ml were achieved between 1 1/2 and 2 1/2 hours after pyrazinamide administration and in most cases a concentration of 20 micrograms/ml or more was achieved. We conclude that pyrazinamide easily gains entry into the cerebrospinal fluid of children with tuberculous meningitis and should be included in treatment regimens for that disease.

Child, Preschool↗
PubMedDate not supplied

[Changes in the cerebrospinal fluid lactate concentration of children with cranio-cerebral injuries].

Examination of the cerebrospinal fluid in 43 children with craniocerebral trauma revealed a dependence of the lactate content on the degree of the injury (9.2 +/- 1.2 mg% in mild trauma; 13.5 +/- 1.7 mg% in moderate trauma; 18.3 +/- 1.7 mg% in severe trauma) and the clinical course. The cerebrospinal fluid is normalized 7-10 days after a moderate brain trauma, and in 3 weeks after a severe trauma. The findings suggest that the values of the cerebrospinal fluid lactate content are lower in children than in adults (9.7 mg%, on the average, in children under 10 years of age, and 11.3 mg% in those over 10 years of age).

Acute Disease↗
PubMed1994

The total peroxyl radical-trapping ability of plasma and cerebrospinal fluid in normal and preeclamptic parturients.

Plasma and cerebrospinal fluid total peroxyl radical-trapping antioxidative parameter (TRAP) and the main antioxidant components of TRAP (vitamin E, ascorbic acid, uric acid, protein sulfhydryl groups, and the unidentified antioxidant proportion) were analyzed in 11 preeclamptic parturients, 9 healthy parturients with an uncomplicated pregnancy, and 10 healthy nonpregnant women. In addition, the possible effects of ongoing labor were studied in 10 healthy parturients. The samples of plasma and cerebrospinal fluid (CSF) were collected at cesarean section (pregnant women) or minor surgical procedure (nonpregnant women). Normal pregnancy or ongoing labor induced no significant changes in total TRAP, as compared with nonpregnant women, but significant changes in the percentage contributions of individual antioxidants were noted in plasma and CSF. In preeclampsia, a significant increase in TRAP was noted in both plasma and CSF. This increase was mainly due to an increased proportion of uric acid and unidentified antioxidants in plasma samples, and an increased proportion of unidentified antioxidants in CSF. The concentration of CSF ascorbic acid was decreased in preeclampsia, and a negative correlation between CSF ascorbic acid and blood pressure was observed.

Antioxidants↗
PubMed1992

Quantitation of HIV-1 proviral DNA in cells from cerebrospinal fluid.

The number of proviral copies in the cerebrospinal fluid of 13 patients in various stages of HIV-1 infection was determined using the polymerase chain reaction. HIV-1 proviral DNA was detected at a median value of 1 provirus per 300 cells with a range from 1 per 20 to 1 per 2,400 cells and a mean value of 1 provirus per 570 cells. Interestingly, this indicates a higher proportion of infected cells in cerebrospinal fluid than is reported to be the case for blood mononuclear cells. However, a clear correlation of these findings to the CDC stage or to neurologic complications was not obvious.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pharmacokinetics, cerebrospinal fluid concentration, and safety of intravenous rifampin in pediatric patients undergoing shunt placements.

The objectives of this study were to characterize the pharmacokinetics and determine the cerebrospinal fluid concentrations and safety of intravenous rifampin in pediatric patients undergoing shunt placement. Nine patients (mean age 5.6 y) received a single dose of rifampin, 20 mg.kg-1, administered intravenously 1 h prior to surgery. The peak serum concentrations ranged from 13.5-26.7 micrograms.ml-1; cerebrospinal fluid concentrations ranged from 0.12-3.0 (mean: 1.4) micrograms.ml-1. The mean total clearance, apparent distribution volume, and elimination half-life were 0.29 l.kg-1.h-1, 1.11.kg-1, and 2.8 h. The concentrations of rifampin achieved in the cerebrospinal fluid exceeded the minimum inhibitory concentrations by 100- to 1000-fold against Staphylococcus epidermidis. However, 5 of 9 patients developed cutaneous reactions during intravenous rifampin prophylactic therapy. Because of the high frequency of adverse effects and more than adequate rifampin concentrations achieved in the cerebrospinal fluid, rifampin doses lower than that used in this study may be evaluated in future studies.

Adolescent↗
PubMed1992

Immunoreactive ACTH in the cerebrospinal fluid of the rat: decrease after mediobasal hypothalamic lesion and hypophysectomy, increase after adrenalectomy.

The effect of various anaesthetics and of the manipulations of the hypothalamo-pituitary-adrenocortical system (hypophysectomy, adrenalectomy and lesion of the mediobasal hypothalamus) was studied on immunoreactive-ACTH levels in the plasma and in the cerebrospinal fluid in the rat. The anaesthetics used (Hypnorm, pentobarbital, urethan and Ketanest) were without effect on immunoreactive-ACTH concentration in the cerebrospinal fluid. Immunoreactive-ACTH was significantly decreased after hypophysectomy and elevated after adrenalectomy in both cerebrospinal fluid and plasma. Destruction of the mediobasal hypothalamus resulted in reduced immunoreactive-ACTH content in the cerebrospinal fluid (about 20% of control) in both experiments, whereas immunoreactive-ACTH levels in the plasma of the lesioned rats were lower only in one of the two experiments performed. These data suggest that the main source of the immunoreactive-ACTH in the cerebrospinal fluid of the rat is the hypothalamus; the contribution of the pituitary gland being less than 50% of the radioimmunoassayable ACTH.

Adrenalectomy↗
PubMed1990

Cartilage cells in cerebrospinal fluid.

A rare case in which cartilage cells were observed in cerebrospinal fluid is reported and the literature reviewed. This phenomenon, occurring in 0.2% of the cerebrospinal fluid specimens, is thought to be caused by accidental puncture of the intervertebral disk. It has the potential of being mistaken for a malignant process.

Cartilage↗
PubMed1985

Cerebrospinal fluid monoamine and monoamine metabolite concentrations in melancholia.

Cerebrospinal fluid levels of norepinephrine and six monoamine metabolites were measured in 28 medication-free depressed patients. Patients with a major depressive episode with melancholia (n = 15) had significantly lower levels of the three dopamine metabolites: homovanillic acid (HVA), dihydroxyphenylacetic acid (DOPAC), and conjugated dihydroxyphenylacetic (CONJDOPAC), when compared with a combined group of patients with a major depressive episode or dysthymic disorder (n = 13). In patients with major depressive episode with melancholia, levels of HVA and of the serotonin metabolite 5-hydroxyindoleacetic acid significantly correlated with the severity of depression. In the total group of 28 depressed patients, cerebrospinal fluid (CSF) levels of norepinephrine significantly correlated with symptoms of anxiety. In both patients with major depressive episode and major depressive episode with melancholia, those who were non-suppressors on the dexamethasone suppression test had significantly higher CSF levels of the norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol compared to those who were suppressors.

3,4-Dihydroxyphenylacetic Acid↗
PubMedDate not supplied

Cerebrospinal fluid leakage during dacryocystorhinostomy in a patient with meningoencephalocele.

PURPOSE: To report a rare case of cerebrospinal fluid leakage during dacryocystorhinostomy in a patient with Mobius syndrome and meningoencephalocele and to explain our experience in the management of this complication. METHODS: A 9-year-old girl with a history of surgically repaired fronto-ethmoidal meningoencephalocele and bilateral canthopexy was diagnosed with Mobius syndrome and underwent sequential bilateral dacryocystorhinostomy and silicone intubation because of dysgenesis of the lacrimal drainage pathway. RESULTS: Both dacryocystorhinostomies resulted in cerebrospinal fluid leakage, which spontaneously ceased with conservative management. CONCLUSIONS: Dacryocystorhinostomy surgery in patients with a history of trauma or surgery or congenital defects around the base of the nose or lacrimal system may rarely result in cerebrospinal fluid leakage; thus an ophthalmologist should be familiar with its management.

Cerebrospinal Fluid Rhinorrhea↗