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PubMed1998

The correlation between cerebrospinal fluid pressure and retrolaminar tissue pressure.

PURPOSE: To measure the effects of cerebrospinal fluid pressure (CSFp) on retrolaminar tissue pressure (RLTp) and the translaminar pressure gradient (TLPG), particularly at low CSFp, which is the normal situation in erect posture. METHODS: Micropipettes coupled to a servonull pressure system were passed into eyes of anesthetized dogs to the optic disc and advanced in steps through the lamina cribrosa to the optic nerve subarachnoid space (ONSAS), while pressure measurements were taken. Cerebrospinal fluid pressure and intraocular pressure (IOP) were monitored and controlled. The TLPG was measured at varying IOPs and CSFps. The RLTp and ONSAS pressure (ONSASp) were measured at varying CSFps. In separate experiments, the optic nerve dura was incised, and pressure measurements were taken across the pia mater. RESULTS: The TLPG was strongly correlated to the difference between IOP and CSFp (r=0.93; n=18) when CSFp was more than zero. Mean RLTp was 3.7+/-0.2 mm Hg (SEM; n=15) when CSFp was 0 mm Hg. The ONSASp and RLTp were largely dependent on the presence of CSFp higher than break point pressures of -0.5 mm Hg and 1.33 mm Hg, respectively. However, below these break points, RLTp (slope 0.07) and ONSASp (slope 0.18) were little influenced by CSFp. Separate measurements across the pia mater revealed that 95% of the pressure drop occurred within 100 microm of the pial surface. CONCLUSIONS: The TLPG and RLTp are dependent on CSFp when CSFp is more than -0.5 mm Hg. Below this level, there is no hydrostatic continuity between the intracranial and optic nerve subarachnoid space. In this range, RLTp is stable and is little influenced by CSFp changes.

Animals↗
PubMed1984

[Study on penetration of cefotiam into the cerebrospinal fluid].

Cefotiam (CTM) is a new cephem antibiotic which has potent activities against Gram-positive and Gram-negative bacteria. We investigated the prophylactic treatment of CTM in orthopedic surgery and the concentrations of CTM Gram-negative in cerebrospinal fluid. The mean serum concentration at 2 hours after the drip infusion of CTM (3 g) was 28.28 +/- 5.48 micrograms/ml, and the mean concentration of CTM in cerebrospinal fluid was 0.58 +/- 0.07 micrograms/ml. From the result of multi-regression analysis in group I (12 cases, over 40 years old) and group II (10 cases, below 39 years old), it was suggested that the factor of age had a marked effect on cerebrospinal fluid concentrations of CTM. (Group I greater than Group II) High concentrations of CTM in cerebrospinal fluid after the 3 g-administration, exceeding the MIC80 for most causative organisms, suggested very useful prophylactic treatment of CTM in orthopedic surgery.

Adult↗
PubMed1987

[Clinical evaluation of cefuzonam in pediatrics and a study on the penetration into cerebrospinal fluid].

Studies were carried out on the penetration of cefuzonam (L-105, CZON), a new synthetic cephalosporin antibiotic, into cerebrospinal fluid, and on the clinical efficacy against bacterial infections. The results are summarized as follows: Concentrations of CZON in cerebrospinal fluid at 1 hour after intravenous administration of 100 mg/kg in cases of furunculosis of the external canal, encephalitis and mumps meningitis were 0.56 micrograms/ml, 1.44 micrograms/ml and 0.33 micrograms/ml, respectively. Concentrations of CZON in cerebrospinal fluid at 1 hour after intravenous administration of 100 mg/kg in 3 cases of purulent meningitis were 2.80-6.40 micrograms/ml at the acute stage and 0.56-1.45 micrograms/ml even at the recovering stage. Sensitivities of clinically isolated strains to CZON were determined and expressed as MIC. MICs of CZON on Haemophilus influenzae, Escherichia coli, Proteus mirabilis and Klebsiella pneumoniae were similar to MIC's of cefmenoxime (CMX), and lower than those of cefoperazone (CPZ), cefmetazole (CMZ), cefatiam (CTM) and Cefazolin (CEZ). The MIC of CZON on Staphylococcus aureus was similar to those of CEZ, CMZ and CTM, and lower than those of CMX and CPZ. Clinical responses of CZON were good in 2 cases of purulent meningitis, good in 2 cases of pyothorax, excellent in 1 case of septicemia, excellent in 3 cases of urinary tract infections, excellent in 7 cases and good in 3 cases out of 10 cases of pneumonia. Clinical responses of other diseases were excellent in 4 cases of bronchitis, good in 1 case of furunculosis of the external canal, excellent in 1 case of tonsillitis. No side effects nor abnormal laboratory findings were observed except 2 cases of mild diarrhea out of 24 cases.

Bacterial Infections↗
PubMed1997

Excitatory amino acid levels in cerebrospinal fluid of patients with infantile spasms.

Infantile spasm is an age-specific epileptic encephalopathy. Long-term intellectual outcome of affected infants remains poor. The pathogenesis of infantile spasms, as well as the development of mental retardation, remains unclear. Increased excitatory amino acid neurotransmission may play a role in neuronal dysfunction and epilepsy. To study the significance of cerebrospinal fluid excitatory amino acids in infantile spasms, we determined glutamate and aspartate concentrations in cerebrospinal fluid of 13 patients with infantile spasms and 13 controls. The aspartate level in cerebrospinal fluid of the patients with infantile spasms (968 +/- 416 nmol/l) was higher than the control group (426 +/- 272 nmol/l). No difference in the mean glutamate levels was found between the patients (966 +/- 395 nmol/l) and the controls (1135 +/- 594 nmol/l). The elevated aspartate levels in cerebrospinal fluid of the patients with infantile spasms might be secondary to change in metabolism of aspartate. Aspartate is an excitatory and neurotoxic neurotransmitter, which might have a role in triggering the spasms and the development of neuronal dysfunctions in the patients with infantile spasms.

Aspartic Acid↗
PubMedDate not supplied

Transport and production of cerebrospinal fluid (CSF) change in aging humans under normal and diseased conditions.

In three control groups of lumbar (L), cisternal (C), and ventricular (V) cerebrospinal fluid (CSF) with prealbumin contents of ventricular origin (CSF-V-prealbumin) within the reference range, indications for an increased transport of V-CSF into spinal space are presented in the elderly as well as an elevated production of V-CSF. Indications for a diminished V-CSF production, respectively, an increased transport of CSF-V-prealbumin into the spinal space were found in elderly patients suffering from diverse CNS diseases. As these alterations proved to be not disease-specific, the age-related increase of CSF transport was discussed with respect to brain atrophy and enlarged CSF spaces in the elderly central nervous system (CNS). CSF serum prealbumin content, an indicator of blood-brain-barrier function, increased with age similarly to albumin in the "normal" elderly, respectively with diverse CNS diseases. Age- and disease-related decreases of albumin and prealbumin contents in blood serum may lead to wrong interpretations.

Adolescent↗
PubMed1984

Penicillin concentrations in serum and cerebrospinal fluid after intramuscular injection of aqueous procaine penicillin 0.6 MU with and without probenecid.

Paired specimens of cerebrospinal fluid and serum were taken from 21 patients to estimate penicillin concentrations two to three hours after the last dose of a course of 14-21 daily intramuscular injections of procaine penicillin 0.6 MU. Of 10 patients treated with procaine penicillin alone, eight had no detectable penicillin and two had sub-treponemicidal concentrations (less than 0.018 mg/l) in the cerebrospinal fluid. Of 11 patients treated with procaine penicillin as above and probenecid 2 g a day by mouth, three had no detectable penicillin, two had sub-treponemicidal concentrations, and six had treponemicidal concentrations of penicillin in the cerebrospinal fluid. All 21 patients had treponemicidal concentrations of penicillin in the serum. This dose of procaine penicillin alone or with probenecid is therefore not recommended for treating neurosyphilis.

Biological Assay↗
PubMed1982

[Comparative study with 2 new and 8 known nutrient media for cultivation of fastidious and nonfastidious microbial agents from cerebrospinal fluid and other body fluids].

Rapid physical, biochemical and immunological methods may be useful in the detection of microbial agents in cerebrospinal fluid and in other body fluids. However, these methods are no substitution for the cultivation of the microbial agents. Microorganisms which are most frequently responsible for meningitis are fastidious in their growth requirements. Their detection with the help of conventional blood culture media which are not supplemented with blood or its components, leads to a high quota of false-negative results. Taking this problem into consideration, the authors developed the following two new media: "MOPS Electrolyte Broth A" for culturing obligate aerobic and facultative anerobic microorganisms, and "MOPS Electrolyte Broth AN" for culturing facultative anaerobic and obligate anaerobic bacteria. Performance tests have been carried out with the two above mentioned media and eight commercially manufactured blood culture media in original bottles. Twenty representative test strains including the most important and fastidious microbial agents of meningitis have been considered in this study. The inoculum size was about 10(2) CFU per culture bottle. The two new media, which were not supplemented with blood or body fluids, proved to be more effective than the conventional blood culture media supplemented with 10% fresh human blood for culturing the considered spectrum of microorganisms.

Aerobiosis↗
PubMed1983

Increased hypoxanthine concentrations in cerebrospinal fluid of infants with hydrocephalus.

Hypoxanthine, the end product of purine metabolism, is usually very elevated in body fluids during severe hypoxia. We measured hypoxanthine in the cerebrospinal fluid of hydrocephalic preterm infants (12 with posthemorrhagic, one with congenital hydrocephalus) to determine whether hydrocephalus is associated with anaerobic metabolism of brain tissue. Cerebrospinal fluid hypoxanthine was undetectable in normal infants. In hydrocephalic infants, the concentration of hypoxanthine ranged from 7.5 mumol/L to 28 mumol (means = 14.3 mumol/L). The hypoxanthine concentrations fell from a mean of 12.8 mumol/L to a mean of 2.0 mumol/L (P less than 0.05) with successful treatment of the ventriculomegaly by lumbar puncture or by ventriculoperitoneal shunt. Patients with acute posthemorrhagic hydrocephalus had similar concentrations of hypoxanthine (means = 14.5 mumol/L) as patients with late or with congenital hydrocephalus (means = 13.8 mumol/L), indicating that brain hypoxia is probably a consequence of the ventriculomegaly and not of the hemorrhagic insult.

Cerebral Hemorrhage↗
PubMed1989

Alternative pathways for drainage of cerebrospinal fluid in the canine brain.

Although the brain has no formal lymphatic system, a substantial quantity of cerebrospinal fluid (CSF) has nonetheless been shown to drain via cervical lymphatics. To pursue further the issue of alternative drainage pathways for CSF, we infused a solution of Ringer's lactate (RL) into the cisterna magna of the dog brain and monitored both the flow and concentration of total protein of cervical lymph. This maneuver promoted a nearly three-fold rise in intracranial pressure and was accompanied by a rise in cervical lymph flow and fall in its protein content. In addition, a profuse nasal discharge (11.4 ml/hr) developed with a moderately high protein content of the rhinorrhea fluid (1.8 g/dl), along with similar appearance times of Evans blue dye (instilled in the cisterna magna) in both cervical lymph and the rhinorrhea fluid (48-70 minutes after infusion). These findings suggest alternative drainage pathways for CSF besides the arachnoid villi (Pacchionian bodies) including connections with lymphatics in the neck and along the olfactory nerve, and around the cribiform plate to the nasal submucosa, and with proptosis, perhaps also through the aqueous humor-canal of Schlemm and nasolacrimal duct.

Animals↗
PubMed1987

CT-ventriculography to control the passage of cerebrospinal fluid. Technical note.

In conventional ventriculography used to confirm free passage of cerebrospinal fluid (CSF), bony overprojections often makes it difficult to visualize the contrast medium in the cranio-spinal subarachnoid spaces. CT-ventriculography offers an alternative. Because of the high density resolution, even small amounts of contrast material can be seen in the subarachnoid spaces of the cranio-cervical region. Its usefulness is demonstrated in a series of 15 cases.

Cerebral Ventriculography↗
PubMed1991

The role of the perforated segment of the ventricular catheter in cerebrospinal fluid leakage into the brain.

Two cases of gross post-operative cerebrospinal fluid (CSF) leakage along an indwelling ventricular catheter are reported. The CSF appeared to leak through the perforations of the ventricular catheter, as well as at the site of penetration of the ventricular wall. A small or slit ventricle with high intraventricular pressure may thus be a predisposing factor for this localized CSF collection.

Catheters, Indwelling↗
PubMedDate not supplied

Cerebrospinal fluid pseudocysts: sonographic appearance and clinical management.

Eight patients with 10 intraperitoneal cerebrospinal fluid pseudocysts occurring as a complication of ventriculoperitoneal (VP) shunt procedure were reviewed to determine the sonographic characteristics as well as the etiologic basis for the pseudocysts. An additional 10 patients with VP shunts, being routinely evaluated for genitourinary tract abnormality, were reviewed to determine the sonographic characteristics and the amount of fluid present in the abdomen with a normally functioning VP shunt in place. We found that a small amount or no peritoneal fluid is found in the patient with a normally functioning VP shunt. Larger, localized, simple or loculated fluid collections are abnormal and compatible with pseudocyst formation. Debris was identified in the majority of the fluid collections. We believe that ultrasonography is the method of choice in evaluation of complications of the distal end of the VP shunt. Our series suggests that infection is the principle cause for pseudocyst development despite the frequent absence of systemic signs of infection. Appropriate treatment involves removal of the peritoneal catheter and treatment of the infection. The catheter may later be replaced intraperitoneally.

Adolescent↗
PubMed2004

Evaluating the effect of decompression surgery on cerebrospinal fluid flow and intracranial compliance in patients with chiari malformation with magnetic resonance imaging flow studies.

OBJECTIVE: To quantify the effect of decompression surgery on craniocervical junction hydrodynamics and on global intracranial compliance (ICC) in patients with Chiari I malformation by use of magnetic resonance measurements of cerebrospinal fluid and blood flow. Studying the effect of decompression surgery may improve our understanding of the pathophysiological characteristics of Chiari I malformation and aid in identifying patients who will benefit from the procedure. METHODS: Twelve patients were studied with a 1.5-T magnetic resonance imaging scanner before and after decompression surgery. Cine phase contrast magnetic resonance images were used to quantify maximum cord displacement, maximum systolic cerebrospinal fluid velocity and volumetric flow rate, and overall ICC. ICC was derived by use of a previously reported method that measures small changes in intracranial volume and pressure that occur naturally with each cardiac cycle. RESULTS: After surgery, changes were documented both in the local hydrodynamic parameters and in ICC. However, only the change in ICC, an average increase of more than 60%, was statistically significant. Increased ICC, which was associated with improved outcome, was measured in 10 of the 12 patients, no significant change was documented in 1 patient, and decreased ICC was measured in 1 patient whose symptoms persisted after surgery. CONCLUSION: An increase in the overall compliance of the intracranial compartment is the most significant and consistent change measured after decompression surgery. Changes in cord displacement, cerebrospinal fluid velocities, and flow in the craniospinal junction were less consistent and less affected by the operation. Thus, ICC may play an important role in the outcome of decompression surgery related to improving symptoms and restoring normal neurological hydrodynamics in patients with Chiari I malformations.

Adult↗