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PubMed1981

[Cerebrospinal fluid G immunoglobulins in nervous system diseases].

Cerebrospinal fluid IGG and the relations with total protein, and with prealbumin + albumin and the IGG index were studied in 160 patients with various neurological disorders. These patients were distributed in 8 groups according to diagnosis as follows: inflammatory (21 cases); demyelinating (31 cases); degenerative (10 cases); cerebrovascular (19 cases); tumoral (3 cases); convulsive (20 cases); headache (11 cases); other neurological disorders (45 cases). According to the results (table 1) the best applicability of IGG study is the group of chronic inflammatory diseases (neurosyphilis and neurocysticercosis) and the demyelinating disorders (multiple sclerosis). Emphasis is given to the possibility of the occurrence of local synthesis of IGG in the central nervous system in these 2 groups.

Central Nervous System Diseases↗
PubMed1983

Ventricular cerebrospinal fluid concentrations of trimethoprim-sulphamethoxazole.

Ventricular cerebrospinal fluid (CSF) trimethoprim-sulphamethoxazole (TMP-SMZ) concentrations were measured in 15 patients. At varying times, not exceeding eight hours prior to surgery, each patient received a dose of 5 mg/kg TMP with 25 mg/kg SMZ as a 1 h intravenous infusion. The mean ventricular CSF TMP concentration was 1.1 mg/l with a range of 0.5-3.2 mg/l. The SMZ concentration was 17.9 mg/l with a range of 5-40 mg/l. There was no apparent relationship between achievable CSF concentrations and the time elapsed after drug administration. The CSF concentrations were achieved despite the lack of meningeal inflammation. In 11 of 14 patients, the levels exceeded the minimum inhibitory concentrations for Staphylococcus aureus and Staph. epidermidis.

Anti-Infective Agents↗
PubMed2002

Blocking cerebrospinal fluid absorption through the cribriform plate increases resting intracranial pressure.

Cerebrospinal fluid (CSF) drains through the cribriform plate (CP) in association with the olfactory nerves. From this location, CSF is absorbed into nasal mucosal lymphatics. Recent data suggest that this pathway plays an important role in global CSF transport in sheep. In this report, we tested the hypothesis that blocking CSF transport through this pathway would elevate resting intracranial pressure (ICP). ICP was measured continuously from the cisterna magna of sheep before and after CP obstruction in the same animal. To block CSF transport through the CP, an external ethmoidectomy was performed. The olfactory and adjacent mucosa were removed, and the bone surface was sealed with tissue glue. To restrict our analysis to the cranial CSF system, CSF transport into the spinal subarachnoid compartment was prevented with a ligature tightened around the thecal sac between C1 and C2. Sham surgical procedures had no significant effects, but in the experimental group CP obstruction elevated ICP significantly. Mean postobstruction steady-state pressures (18.0 +/- 3.8 cmH(2)O) were approximately double the preobstruction values (9.2 +/- 0.9 cmH(2)O). These data support the concept that the olfactory pathway represents a major site for CSF drainage.

Absorption↗
PubMed1991

Liquorpheresis eliminates blocking factors from cerebrospinal fluid in polyradiculoneuritis (Guillain-Barré syndrome).

Cerebrospinal fluid (CSF) derived from six patients with polyradiculoneuritis (Guillain-Barré syndrome, GBS) treated by liquorpheresis was injected into rat sciatic nerve. By measuring spinal evoked potentials after stimulation of the tibial nerve, we observed slowing or dispersion of nerve conduction in those cases where the CSF had been taken before liquorpheresis. CSF of the same patient, sampled after liquorpheresis, showed minor effects only. Impairment of nerve conduction was seen between 5 and 20 min after injection, normal function being restored on the third day. These results suggest that liquorpheresis eliminates blocking factors from the CSF of patients with GBS. We postulate this as the effect by which liquorpheresis improves neurological symptoms in Guillain-Barré syndrome.

Animals↗
PubMed1998

Cerebrospinal fluid markers in multiple sclerosis: an overview.

Cerebrospinal fluid (CSF), with its protein markers, is a formidable material for investigating the relationships among the various cell types involved during the initial phase of plaque formation, or, successively, in the remyelination process. Its analysis may give definite help in better focusing on therapeutic objectives and therapeutic tools. Therefore, the possible use of CSF MBP, S-100, GFAP, N-CAM, NGF, and CNTF in pathogenetic studies and in clinical follow-up is critically reviewed. The need for correct interpretation of the data, for uniformity and reliability of the analytical methods, and for easy access to them is stressed. CSF examination and MRI should not be considered as alternative tools, or in competition, but should be used together, to take the maximum advantage of their individual possibilities.

Biomarkers↗
PubMed1986

Quantitative analysis of the cellular constituents of the cerebrospinal fluid in chronic relapsing experimental allergic encephalomyelitis.

Cerebrospinal fluid (CSF) was taken from guinea pigs in various stages of chronic relapsing experimental allergic encephalomyelitis (CR-EAE). The leucocytes in CSF samples were counted and subjected to immunocytochemical analysis using monoclonal antibodies selectively recognising guinea pig T cells, macrophages or Ia antigens. The results showed that total leucocyte numbers and the proportion of macrophages in CSF were elevated in the acute phase of CR-EAE but samples of CSF from animals in early relapse did not show a significant elevation in leucocyte count or macrophage content. In addition the level of T cell activation was higher in CSF than in peripheral blood during disease and was highest in the acute and immediately post-acute phases of the CR-EAE.

Animals↗
PubMedDate not supplied

[The cerebrospinal fluid in bacterial meningitis].

Samples of 1815 cerebrospinal fluid (CSF) were studied in a meningitis outbreak during 1989 in São Paulo, Brazil. Neisseria meningitis 56% with 44% type B, Haemophilus influenzae 17%, from which 72% in children (days to 3-year-old) and Streptococcus pneumoniae 14% from which 60% in children (day to 1-year-old) of 443 (24%) of all strains. Cytochemistry study showed: purulent or turbidity aspects in 70 to 79% positive bacterioscopy or culture of CSF; white cells count > 500/mm3; glucose < 45 mg/dl; protein > 90 mg/dl in 90% of all patients. We concluded that: CSF prognostic factors: (aspect and cytochemistry) were correlated with bacterial meningitis. Bacterioscopy and positive cultures were correlated to NM, SP and HI isolation from these patients (Goodman Test).

Adolescent↗
PubMed1983

Current management of cerebrospinal fluid rhinorrhea.

Forty-two patients with cerebrospinal fluid (CSF) rhinorrhea presenting over a 5 year period were analyzed as to age, sex, etiology, anatomical and clinical findings, and methods of investigation and treatment. Eighty-eight were traumatic in origin, with the most common anatomical sites being ethmoid, frontal and sphenoid sinuses, and the cribriform plate region. Meningitis and pneumocephalus were the most frequently associated clinical findings each present in 31% of the cases. Chemical analysis of the CSF for protein was positive in 88% of cases vs. 13% when the protein content was quantitatively analyzed. The demonstration and localization of CSF leaks were most effective using metrizamide and CAT scanning when they were active and by indium cisternography when they were small, intermittent, or questionable. The clinical management was divided into medical and surgical approaches with the advantages and disadvantages discussed.

Adolescent↗
PubMed1978

Intracranial pressure regulation: a comparative model of cerebrospinal fluid systems.

A comparative model of the cerebrospinal fluid (CSF) system in rat, dog and man was derived from manometric data using low volume, short duration infusions into the subarchanoid space in order to describe the mechanisms governing intracranial pressure dynamics. The mathematical model indicates that steady-state elevations of intracranial pressure are regulated primarily by a nonlinear, pressure dependent outflow resistance to CSF reabsorption. While the form of the resistance relationship is similar for the three species tested, differences in the magnitude of CSF outflow parameters are apparent. Model stimulation on a digital computer suggests that parameter changes within the resistance relationship can have a profound effect on the intracranial pressure. In contrast, intracranial compliance acts only to buffer transient changes in volume prior to the establishment of steady-state CSF pressures.

Animals↗
PubMed1980

[Semiologic value of erythrocyte macrophages in the cerebrospinal fluid].

An investigation was made in the cerebrospinal fluid of 82 patients who had bleeding into the subarachnoid space or other neurologic disorders in order to study the macrophages. The ages of these patients ranged from 24 hours to 80 years. It was verified that the macrophages with red blood cell could be demonstrated from 24 hours until 30 days after the onset of the bleeding. The macrophages with hemosiderin were observed after the 6th day after the onset of the bleeding, and they could be seen in some cases after 70 days. It was discussed the assertion that the simultaneous presence of red blood cell and hemosiderin in the cytoplasm always indicates repeated hemorrhage. In a 24-hour-old newborn baby with bleeding in the subarachnoid space it was found macrophage with hemosiderin. This anomalous finding pointed out to hemorrhage during the intrauterine life.

Adolescent↗
PubMedDate not supplied

Laboratory analysis of cerebrospinal fluid.

OBJECTIVE: To review the physiology of cerebrospinal fluid (CSF), normal laboratory reference values, and key aspects of CSF sample collection, gross and microscopic examination, microbiologic testing, and chemical analysis. DATA SOURCES: Recent professional literature. STUDY SELECTION: Selected manually by the authors. DATA EXTRACTION: Articles manually by the authors. DATA SYNTHESIS: CSF is formed by a combined process of plasma ultrafiltration and active secretion. Mechanical and osmotic barriers exist between plasma and CSF and between CSF and brain. Lumbar puncture is the preferred technique for CSF sampling. Normal CSF should be clear, colorless, and free of clotted material. CSF can be examined for presence of microbes using stains. Additionally, the chemical composition of CSF can be examined; tests of interest include glucose, protein, lactate, enzymes, glutamine, specific amino acids, biogenic amines, and various drugs. CONCLUSION: Visual, microscopic, and chemical examination of CSF is essential to the clinical management of patients with CNS disease.

Cerebrospinal Fluid↗
PubMed1991

[The effect of amino acids on neurotransmitter metabolites in the cerebrospinal fluid].

Metabolites of neurotransmitters of dopamine, homomovanillic acid (HVA), and of serotonin, 5-hydroxyindole acetic acid (5-HIAA), were assessed in cerebrospinal fluid by the method of high pressure liquid chromatography with electrochemical detection. The HVA concentration in cerebrospinal fluid rose markedly in a two-month-old infant with intracranial hypertension caused by a communicating hyporesorptive hydrocephalus following administration of tyrosine, the precursor of dopamine. The 5-HIAA concentration in cerebrospinal fluid rose significantly in a 20-month-old boy with epilepsy and arrested psychomotor development after administration of 5-hydroxytryptophan, the precursor of dopamine. Biochemical normalization of concentrations of neurotransmiteed metabolites did not lead to changes in the clinical condition of the children.

Child, Preschool↗
PubMed1995

Cerebrospinal fluid shunt infections in children.

We reviewed cerebrospinal fluid (CSF) shunt infections treated in the Royal Children's Hospital, Melbourne from 1981 to 1991. Forty-one episodes of CSF shunt infection were found after 900 shunt operations, an infection rate of 4.5%. Clinical symptoms were nonspecific in 31.7% of episodes, and in 17.1% of episodes the initial CSF sample was normal on microscopy and biochemistry, although a pathogen was isolated on culture. Most episodes occurred within 4 months of the last operation on the shunt, the exception being infections caused by Haemophilus influenzae. Four patients died during treatment, but none could be attributed to infection alone. Treatment of suspected CSF shunt infection should not be withheld because of lack of firm clinical diagnosis or normal CSF microscopy, and episodes occurring more than 4 months after the last operation on the CSF shunt should receive antibiotic cover for H. influenzae.

Adolescent↗
PubMed1979

Zoster meningitis and radiculomeningitis after tick bite. Cytological findings in cerebrospinal fluid.

Cytological changes in 9 samples of cerebrospinal fluid (CSF) from 5 patients with zoster meningitis and 12 samples from 5 patients with radiculomeningitis after tick bite were examined. 5 days after the onset of the skin eruption, the CSF cells in zoster meningitis consisted of many mononuclear blast forms--large lymphocytes and 'immature' plasma cells. 11-15 days after the onset of the skin rash, they were replaced by small lymphocytes, some 'mature' plasma cells and monohistiocytes. In radiculomeningitis after tick bite, however, the CSF cells examined 10-21 days after the onset of radicular pain consisted of many large lymphocytes, immature plasma cells and a few neutrophils. From these findings, it might be suggested that the acute meningeal reaction of zoster meningitis subsides within about 1 week after the onset of the skin rash, but that of radiculomeningitis after tick bite continues at least for 2-3 weeks after the onset of radicular pain.

Adolescent↗
PubMed1980

Isoelectric focusing of cerebrospinal fluid proteins in ischemic cerebrovascular disease.

The cerebrospinal fluid (CSF) protein patterns, in ischemic cerebrovascular disease (ICD), of varying extension were studied by isoelectric focusing (IEF) in 100 patients at different intervals after the onset of symptoms. The diagnoses were based on conventional clinical examinations and CSF spectrophotometry in all cases. Computed tomography was performed on 52 cases. One or more CSF protein aberrations were noted in 94 patients. Some of these findings were most common with small lesions including TIA. Other aberrations were most frequent with the more extensive infarctions. A regional increase in the gammaglobulin range was found in six cases. The findings were most frequent in the first days after the stroke except for barrier damage which reached a maximum during the second week. The IEF findings of CSF seem to be of diagnostic value. Taken together with the clinical signs and CT findings, they could conceivably give prognostic information.

Adult↗
PubMed1987

Modulation of neuronal MAO activity, 5-HT uptake and imipramine binding by endogenous substances in dog cerebrospinal fluid.

Addition of small amounts of dog cerebrospinal fluid (CSF) inhibited both type A and type B monoamine oxidase (MAO) in dog brain mitochondria. The inhibition was competitive with 5-HT as substrate, but non-competitive with beta-phenylethylamine as substrate. Tricyclic antidepressants also exhibited competitive inhibition with type A MAO, but were non-competitive with type B MAO. The endogenous materials in CSF activate [3H]-imipramine specific, dose-dependent binding in dog brain preparations. The maximum number of binding sites (Bmax) increased, but the dissociation constant (Kd) was altered significantly in the presence of CSF. Addition of CSF induced a marked activation of uncompetitive [14C]-5-HT uptake in dog brain preparations. Moreover, there were reversibilities of the inhibition of MAO activity or of the activation of imipramine binding and 5-HT uptake by CSF substance after dilution experiment. These results indicate the possible presence of an endogenous psychotic drug-like substance in CSF.

Animals↗
PubMed1992

Human immunodeficiency virus type 1 is present in the cerebrospinal fluid of a majority of infected individuals.

Cerebrospinal fluid (CSF) specimens from 63 patients with different severities of human immunodeficiency virus (HIV-1) infection, including asymptomatic virus carriers, were examined for the presence of HIV-1 by using polymerase chain reaction (PCR) and virus isolation. Polyadenylated RNA, presumably associated with virus particles, was extracted and reverse transcribed, and the pol region was amplified in a nested PCR. Virus could be detected in 90% of the CSF specimens examined by PCR, and data on isolation of virus from CSF were in agreement with these figures. In fact, when several CSF specimens from the same individual were studied, HIV-1 could be isolated from 80% of the patients. The presence of the viral RNA in CSF was independent of the clinical stage of infection and of neurological symptoms. These results show that the spread of HIV-1 to the brain represents an early event during infection and occurs in the majority of asymptomatic individuals.

Blood↗
PubMedDate not supplied

[Diagnostic value of quantitative and qualitative studies of cerebrospinal fluid immunoglobulins in multiple sclerosis].

The author reports the results of quantitative and qualitative investigations of immunoglobulins in the cerebrospinal fluid in multiple sclerosis and their evaluation in the aspect of their diagnostic usefulness. Determinations of the relative Ig level and the IgG index were of greater diagnostic usefulness than determinations of absolute Ig level. Already determination of the absolute level was valuable in cases with normal total protein level in the fluid. The results of quantitative determinations of Ig in the fluid were insufficient, however, for differential diagnosis against the group of diseases with local Ig production. Evaluation of the oligoclonal character of Ig in the fluid based on electrophoretic separation in agar and agarose was very useful in the diagnosis, but this phenomenon occurs also in a limited group of other central nervous system diseases. The abnormal ratio of kappa to lambda chains in the cerebrospinal fluid is of decisive importance for the diagnosis of multiple sclerosis. Complex quantitative and qualitative determinations of Ig in the cerebrospinal fluid are a significant advance in the diagnosis of multiple sclerosis making possible the correct diagnosis in cases with monosymptomatic or oligosymptomatic onset already in the first stage of the disease, and also in clinically silent periods e.g. before the first phase of the disease.

False Negative Reactions↗