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On the occurence of vanillic acid in human brain and cerebrospinal fluid.

3-methoxy-4-hydroxyphenylbenzoic (vanillic) acid was previously shown to be one of the endogenous metabolites of adrenaline and noradrenaline. Using thin-layer chromatographic methods for identification and quantification of phenolic acids and phenolic alcohols, the authors identified vanillic acid in different regions of the human brain. The concentration of vanillic acid in the cerebrospinal fluid was also determined and compared to the concentration of 3-methoxy-4-hydroxyphenylethylene glycol. The identification of VA in the human brain suggests that the vanillic acid of the cerebrospinal fluid originates, at least in part, from the catecholamines in the brain. The authors discuss other possible origins of vanillic acid besides the noradrenaline catabolism of dopamine. As the concentration of vanillic acid in the cerebrospinal fluid was found to be greater than the concentration of 3-methoxy-4-hydroxyphenylethylene glycol, it might be important for clinical biological studies to measure vanillic acid in the cerebrospinal fluid as well as the other alcoholic and acid catabolites of the catecholamines.

Brain Chemistry↗

Urinary tract obstruction secondary to cerebrospinal fluid cysts.

Bilateral hydroureteronephrosis secondary to mechanical kinking of the ureteral-conduit anastomosis or ureteral compression caused by a large intra-abdominal cerebrospinal fluid cyst should be considered in patients who have ventriculoperitoneal shunts, abdominal ascites, and deteriorating upper tracts. Therapy directed at correction of the cerebrospinal fluid cyst should be sufficient to correct the urologic dysfunction.

Abdomen↗

A 2-year prospective follow-up study of children and adolescents with disruptive behavior disorders. Prediction by cerebrospinal fluid 5-hydroxyindoleacetic acid, homovanillic acid, and autonomic measures?

A 2-year prospective follow-up study of 100% (N = 29) of a sample of children and adolescents with disruptive behavior disorders found that the baseline lumbar cerebrospinal fluid monoamine metabolite concentration and autonomic nervous system activity predicted some subsequent outcomes. The 5-hydroxyindoleacetic acid concentration significantly predicted severity of physical aggression during follow-up. The skin conductance level significantly predicted institutionalization. Correlations were in predicted directions with lower cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations and autonomic activity correlated with poor outcome. Moreover, in multivariate analyses, which included nonlaboratory measures as predictors, cerebrospinal fluid and autonomic measures still contributed significantly to the prediction. However, hypothesized predictions of cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations for suicide attempts and of low autonomic nervous system activity for arrests were not supported thus far. Patients are still at risk; consequently, these results must be considered preliminary. Nonetheless, the results suggest that further investigation of relationships between biological factors and outcome of children with disruptive behavior disorders is warranted.

Adolescent↗

[Beta trace protein in the cerebrospinal fluid and serum in meningoencephalitis].

INTRODUCTION: beta-trace protein or D2 prostaglandin synthase is a dual functional protein. Its role and clinical value in cerebrospinal fluid is under study. MATERIAL AND METHODS: Seventy four pediatric patients suffering from viral meningoencephalitis and 7 with bacterial meningoencephalitis were studied. Sera and cerebrospinal fluid samples were taken. Albumin and beta-trace protein were quantified by immunodiffusion and nephelometry respectively. RESULTS: Increased cerebrospinal fluid beta-trace protein levels in comparison with normal value were observed. Nevertheless such expected increment was no possible seen in bacterial meningoencephalitis. CONCLUSIONS: beta-trace protein may contribute with the etiological diagnosis in meningoencephalitis.

Albumins↗

Endothelin-1 in cerebrospinal fluid in elderly patients with hypertension and dementia.

Endothelin-1, a potent endothelium-derived vasoconstrictive peptide, is also known to exist in the central nervous system. We determined endothelin-1-like immunoreactivity in cerebrospinal fluid by a radioimmunoassay in 32 normotensive or hypertensive elderly subjects (79 +/- 8 years old) with or without multi-infarction dementia. The mean value of endothelin-1-like immunoreactivity in cerebrospinal fluid was significantly (P < .05) elevated in subjects with essential hypertension (> or = 160/95 mm Hg, n = 5, 79 +/- 9 years old) compared with those with borderline hypertension (140-159/90-94 mm Hg, n = 4, 78 +/- 5 years old) and normotensive subjects (< 140/90 mm Hg, n = 23, 79 +/- 8 years old). The value of endothelin-1-like immunoreactivity in cerebrospinal fluid was significantly (P < .05) positively correlated with both systolic (r = .38) and diastolic (r = .42) blood pressures in all subjects. On the other hand, mean values of endothelin-1-like immunoreactivity in cerebrospinal fluid were also significantly (P < .05) elevated in the groups of patients with multi-infarction dementia that had profoundly decreased Mini-Mental State scores (< or = 10, n = 6) and moderately decreased Mini-Mental State scores (11 to 20, n = 14) compared with those values in subjects with normal cognitive function (score for Mini-Mental State > or = 21, n = 12).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

[Concentrating cerebrospinal fluid cells with the sedimentation chamber--comparative methodologic studies].

The loss of cerebrospinal fluid cells is considerable when the sedimentation chamber was used. Methodical variations resulted in an increasing cell count on the slide. The absolute number of lymphocytes increased more than that of monocytes. Caused by the higher cell count, especially lymphocytes, the relative values in cell differentiation between lymphocytes and monocytes are changed. For differential counting of lymphocytes, monocytes and other cerebrospinal fluid cell types the elevated cell count is an important factor. Differentiation between subpopulations of lymphocytes by means of this procedure however is problematically because the loss of lymphocytes can be of a selective nature.

Cell Count↗

The effect of corticosteroids on serum and cerebrospinal fluid nitric oxide levels in multiple sclerosis.

Multiple sclerosis is a disease characterized by perivascular infiltrates and demyelination of the white matter in the central nervous system. In this study, we compared the serum and cerebrospinal fluid nitric oxide levels before and after methylprednisolone therapy, and during remission period, and investigated the relationship of nitric oxide to the activity of multiple sclerosis. Cerebrospinal fluid and serum nitric oxide levels were measured blind as nitrite plus nitrate, using the nitrate reductase and Griess reaction method in 20 patients with multiple sclerosis before and after corticosteroid therapy, and during remission period, and in 20 control subjects. Mean cerebrospinal fluid and serum nitric oxide levels were highest in the pretreatment group and lowest in the control group. There was no correlation with nitric oxide levels in these two groups. Although corticosteroid therapy did not have any great effect on Expanded Disability Status Scales, it led to a decrease in nitric oxide levels. The possible cause of this might be the inhibition of nitric oxide synthesis by methylprednisolone, or a decrease in multiple sclerosis activity. We conclude that serum or cerebrospinal fluid nitric oxide levels do not reflect the activity in multiple sclerosis.

Adolescent↗

The morphological correlates of primate cerebrospinal fluid absorption.

Arachnoid villi from cynomolgus monkeys subjected to various states of cerebrospinal fluid (CSF) absorption have been examined with scanning (SEM) and transmission (TEM) electron microscopy. Pressures within the superior sagittal sinus and the subarachnoid space were rigidly controlled, both prior to and during perfusion fixation and, as such, we created and studied conditions of normal, absent and increased cerebrospinal fluid absorption. Under normal conditions, the most prominent feature of the CSF/blood interface was the presence of endothelial intracytoplasmic vacuoles. The presence of these vacuoles was suggested with SEM and readily confirmed with TEM. Occasionally, these vacuoles coalesced with both the CSF and sagittal sinus fronts, thereby creating transcellular channels as identified by TEM or surface pores as seen with SEM. Villi perfused during conditions of no CSF flow exhibited none of the previously described vacuoles, channels, or pores, whereas increased CSF flows were associated with increased numbers of these structures. The significance of these findings was discussed in relation to CSF absorption and to previously reported ultrastructural studies.

Animals↗

[Cerebrospinal fluid proteins in the course of subacute sclerosing panencephalitis in children].

In cerebrospinal fluid samples obtained from lumbar tap from 31 children with subacute sclerosing panencephalitis the concentration of total protein was determined and electrophoretic separation of protein fractions on paper was carried out from 1 to 28 months after the onset of first clinical symptoms. Moreover, in 22 children the concentration of IgG was determined by electroimmunodiffusion. The reference group included 22 children without organic diseases of the central nervous system. In nearly half the samples of the cerebrospinal fluid obtained from these children a rise was observed in total protein level, and in most samples a significant fall of albumin proportion and an evident rise of this relative proportion of globulins (tau + gamma) and IgG immunoglobulins was observed. No correlation was demonstrated between changes in cerebrospinal proteins and the phase of the disease and its duration.

Adolescent↗

Repair of intractable cerebrospinal fluid rhinorrhea with mucosal flaps and recombinant human basic fibroblast growth factor: technical case report.

OBJECTIVE AND IMPORTANCE: Repair of a cerebrospinal fluid leak is not always easy, especially when a large fistula, with concomitant infection and injured mucosa, has developed from repeated transsphenoidal operations. We repaired such a sellar floor defect with mucosal flaps via the endonasal endoscopic approach and finally obliterated the fistula by promoting granulation-like tissue formation with recombinant human basic fibroblast growth factor (bFGF). CLINICAL PRESENTATION: A 27-year-old woman with intractable cerebrospinal fluid rhinorrhea was referred to our department after repeated operations for a relapsing Rathke's cleft cyst. Endonasal endoscopic examination revealed a large bone defect on the sellar floor through which previously packed fat and fascia were exposed to the nasal cavity. INTERVENTION: Mucosal flaps were harvested endoscopically from the nasal septum and the superior and middle turbinates. These pedicled flaps were transposed to the sellar defect. The flaps survived but did not cover the whole area, resulting in gaps between the flaps through which cerebrospinal fluid still leaked. Recombinant bFGF was repeatedly applied endoscopically to the mucosal flaps. The flaps turned into granulation-like tissue, and complete mucosal covering was finally achieved. CONCLUSION: bFGF has a wide range of biological effects, including stimulation of fibroblast growth and promotion of angiogenesis. It accelerates wound healing and is used clinically to treat dermal ulcers. The method presented here to treat an intractable fistula with mucosal flap and recombinant bFGF may suggest a new clinical application of bFGF. This possibility should be examined in a large number of patients in the future.

Aged↗

A field study of meningoencephalitis in calves with particular reference to analysis of cerebrospinal fluid.

Meningoencephalitis was recorded in 10 two- to 14-day-old calves during a two-year field study. Analysis of lumbosacral cerebrospinal fluid revealed a marked increase in protein concentration with a pronounced neutrophilic pleocytosis. Three calves with positive bacteriological cultures which were treated with chloramphenicol survived whereas six calves treated with penicillin G had to be destroyed on humane grounds after their condition deteriorated. Only two of the 10 calves had concurrent lesions of omphalophlebitis which may indicate that this is not the major route of bacterial invasion in neonatal meningoencephalitis. None of the constituents of cerebrospinal fluid proved to be a reliable prognostic indicator of meningoencephalitis. It is concluded that the analysis of cerebrospinal fluid is a useful ancillary aid in the investigation of abnormal mental states in neonatal calves and a sensitive test for the presence of an inflammatory lesion involving the leptomeninges.

Animals↗

Application of an improved biuret method to the determination of total protein in urine and cerebrospinal fluid without concentration step by use of Hitachi 7170 auto-analyzer.

A biuret automated colorimetric assay for total protein in urine and cerebrospinal fluids was established. The procedures were as follows. Acidify all urine sample before analysis. Add precipitant Na(2)WO(4) to urine samples. After 10 min, centrifuge, decant the supernatant fluid, drain the inverted tubes on absorbent tissue, dissolve the precipitation with 0.1 mol/L NaOH, and finally adapt the reconstituted urine to the Hitachi 7170 analyzer. A cell-free cerebrospinal fluid sample produced by centrifugation can be inserted in an auto-analyzer for protein measurement directly. The program: mix 35 microl sample (CSF or reconstituted urine) and standard with 0.2 mol/L NaOH; incurable at 37 degrees C for 5 min, and real A1. Add concentrated biuret reagent, and 10 min later measure absorbance A2 at 546 nm vs. reagent blank. Secondary wavelength was 700 nm. The test results were calculated against a one-point standard. This biuret colorimetric method was relatively simple, fast, and accurate for the determination of protein in urine and cerebrospinal fluid, with a wide linearity extending from 0.125 g/L up to 6 g/L, had a good correlation with Benzethonium chloride turbidimetry technique, and was a practical routine method.

Albumins↗

Signs and symptoms of cerebrospinal fluid shunt malfunction in the pediatric emergency department.

OBJECTIVES: Pediatric patients with cerebrospinal fluid shunts frequently present to the emergency department for evaluation of possible shunt malfunction. Most shunt studies appear in the neurosurgical literature. To our knowledge, none have reviewed presenting signs and symptoms of shunt malfunction in patients who present to the pediatric emergency department. The study objective was to evaluate the medical record of children with cerebrospinal fluid shunts who presented to a pediatric emergency department to determine if any signs and/or symptoms were predictive of shunt malfunction. METHODS: A retrospective chart review was conducted on 352 pediatric patients aged 0 to 18 years, who presented to the pediatric emergency department between January 1, 1998, and December 31, 2002, with signs and/or symptoms that prompted an evaluation for possible shunt malfunction. RESULTS: Univariate analysis of all signs and symptoms revealed lethargy (odds ratio, 1.99; 95% confidence interval, 1.15-3.42; P = 0.02) and shunt site swelling (odds ratio, 2.56, 95% confidence interval, 1.08-6.07, P = 0.03) to be significantly predictive of shunt malfunction. Logistic regression analysis continued to show significance for lethargy (odds ratio, 2.20; bias-corrected 95% confidence interval, 1.11-3.63) and shunt site swelling (odds ratio, 3.10; bias-corrected 95% confidence interval, 1.38-9.05), but found no other study variable to be significant. Bootstrap resampling validated the importance of the significant variables identified in the regression analysis. CONCLUSIONS: In this study, lethargy and shunt site swelling were predictive of shunt malfunction. Other signs and symptoms studied did not reach statistical significance; however, one must maintain a high index of suspicion when evaluating children with an intracranial shunt because the presentation of malfunction is widely varied. A missed diagnosis can result in permanent neurological sequelae or even death.

Adolescent↗

[Serial measurement of anti-interleukin-8 IgG autoantibody in cerebrospinal fluid of infants with bacterial meningitis].

We serially measured concentrations of interleukin (IL)-8 and anti-IL-8 IgG autoantibody in cerebrospinal fluid of infants with bacterial meningitis, and also measured these concentrations in cerebrospinal fluid obtained from infants without meningitis on admission. We have reported that the IL-8 concentration in cerebrospinal fluid of infants with purulent meningitis rapidly decreases after the initiation of therapy. Thus, in the present study, the IL-8 concentration in infants with purulent meningitis only before the initiation of therapy was significantly higher compared with that in infants without meningitis. However, the concentration of anti-IL-8 IgG autoantibody was still high after the initiation of therapy. The concentration of anti-IL-8 IgG autoantibody was significantly higher compared with that in infants without meningitis until the 15th day after the initiation of therapy. The time lag between the decrease of IL-8 and anti-IL-8 IgG autoantibody demonstrated in the present study could be used to indicate the past presence of a large amount of IL-8, even if the IL-8 concentration was already low.

Autoantibodies↗

Hyponatraemia caused by repeated cerebrospinal fluid drainage in post haemorrhagic hydrocephalus.

Three hyponatraemic infants had post-haemorrhagic hydrocephalus which was treated by repeated drainage of cerebrospinal fluid. Each required oral sodium supplements. The concentration of sodium in the cerebrospinal fluid was such that as much as 3 mmol of sodium could have been removed with each ventricular tap. Serum sodium concentrations should be monitored closely in any infant requiring regular drainage of cerebrospinal fluid.

Cerebral Hemorrhage↗