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PubMed2004

Intrathecal fluorescein to localize cerebrospinal fluid leakage in bilateral mondini dysplasia.

Recurrent meningitis caused by bilateral Mondini dysplasia presents a difficult diagnostic and therapeutic dilemma. A high-resolution computed tomographic scan with intrathecal contrast provided a false-positive identification for the side of cerebrospinal fluid leak in this patient. We report the intraoperative use of intrathecal fluorescein with mastoid tap to identify the side of cerebrospinal fluid leak in a 16-month-old boy with bilateral Mondini malformations. Both ears had been obliterated for recurrent cerebrospinal fluid leaks, while meningitis occurred after unilateral cochlear implantation.

Cerebrospinal Fluid Rhinorrhea↗
PubMed1991

Cerebrospinal fluid losses through ventricular catheters leading to hyponatremia in two children.

I have presented two cases of patients with hyponatremia due to excessive cerebrospinal fluid losses from ventricular drains. The possibility of such losses exists whether the drain is used to treat hydrocephalus or to monitor intracranial pressure. I find normal saline (sodium concentration = 154 mEq/L) to be an appropriate fluid to replace ongoing losses of cerebrospinal fluid from a ventricular drain and currently start such replacement therapy (mL for mL) when the drain is placed.

Catheterization↗
PubMed1993

Brain uptake of thallium-201 from the cerebrospinal fluid compartment.

The present report elucidates the movement of 201Tl through the cerebrospinal fluid compartment and its subsequent uptake by normal brain. Autoradiographic studies of rat brain, after stereotaxic 201Tl injection into either the lateral or fourth ventricle, reveal that 201Tl moves freely through the cerebrospinal and extracellular fluid compartments. Subsequent to lateral ventricular injection, central thalamic and specific hypothalamic nuclei are heavily labeled. Densely labeled mesencephalic nuclei include the periaqueductal grey and oculomotor nuclear complex. Labeling of giant cells within the vestibular complex is suggestive of neuronal uptake. Major fiber tracts are devoid of label confirming that 201Tl uptake does not occur in white matter. Most labeling following fourth ventricle injection occurs within the caudal medulla and cervical spinal grey. Our findings suggest that 201Tl uptake by normal brain from the cerebrospinal fluid occurs as a function of thallium concentration and neuronal activity.

Animals↗
PubMed1980

Cerebrospinal fluid adrenaline and noradrenaline in depressed patients.

Mean adrenaline concentration in cerebrospinal fluid measured by a sensitive and specific isotope-derivative assay was significantly lower in 15 depressed patients during illness compared with 18 control subjects. At the time of recovery cerebrospinal adrenaline levels had increased markedly to normal levels. Cerebrospinal fluid noradrenaline did not differ in patients compared with controls. The present findings suggest that adrenaline as a neurotransmitter may be involved in affective disorders.

Adult↗
PubMed1981

Effect of tryptophan administration on tryptophan, 5-hydroxyindoleacetic acid and indoleacetic acid in human lumbar and cisternal cerebrospinal fluid.

Tryptophan 5-hydroxyindoleacetic acid and indoleacetic acid were measured in cerebrospinal fluid taken during pneumoencephalography from patients, some of whom took a 3 g or 6 g tryptophan load at various times before. Measurements were made on both lumbar and cisternal cerebrospinal fluid and the results showed similarities between indoleamine metabolism in human brain and spinal cord. Our data suggested that (1) the blood-brain barrier active transport system for tryptophan is not far from saturation with tryptophan and the rate-limiting enzyme in 5-hydroxytryptamine (5HT) synthesis, tryptophan hydroxylase, is about half saturated. Therefore, both 3 g and 6 g tryptophan loads produced the same maximum rise in 5HT synthesis of just under 100%, (2) tryptamine differs from 5HT in two respects. It is more sensitive to changes in tryptophan availability than 5HT and the 6 g load increased brain tryptamine metabolism more than the 3 g load; also some of the tryptamine in brain is derived from peripheral sources and diffuses from blood to brain, (3) although the brain tryptamine content is much lower than that of 5HT, its rate of metabolism as indicated by CSF metabolite levels is not. In controls the rate of tryptamine metabolism is 15% of the rate of 5HT metabolism and this can increase to 40% after a 6 g tryptophan load.

Adolescent↗
PubMed1994

Frequency and significance of isolation of Ureaplasma urealyticum and Mycoplasma hominis from cerebrospinal fluid and tracheal aspirate specimens from low birth weight infants.

To investigate the pathogenicity of Ureaplasma urealyticum and Mycoplasma hominis in preterm infants, we conducted a study to determine (1) frequency of isolation from cerebrospinal fluid and tracheal aspirate specimens and (2) clinical outcomes and effect of erythromycin treatment in ureaplasma-colonized infants. From the cerebrospinal fluid of 920 infants, U. urealyticum was isolated from 2 (0.2%) and M. hominis from none. From tracheal aspirate specimens from 224 infants, U. urealyticum was recovered from 37 (17%) and M. hominis from 4 (2%). Demographic characteristics and clinical outcomes were compared in very low birth weight infants (< 1500 gm) who were culture-positive or -negative for U. urealyticum. Although infants with positive results were less mature than their cohorts with negative results, there were no substantive differences in clinical outcomes between the two groups. Initiation of erythromycin treatment of infants with positive ureaplasma culture results at a mean age of 16.4 days did not appear to alter the clinical outcome. We conclude that in preterm infants (1) infection of the cerebrospinal fluid by U. urealyticum is infrequent, (2) ureaplasma organisms are frequently present in tracheal aspirate specimens but do not appear to be related to the presence or the subsequent development of respiratory disease, and (3) initiation of erythromycin treatment at 1 to 3 weeks of age does not alter the clinical course.

Cerebrospinal Fluid↗
PubMed1991

[Study of human immunodeficiency virus in the cerebrospinal fluid. Value and limitations].

Several markers of HIV infection can be detected in the cerebrospinal fluid, including viruses that are replicable in cell cultures, viral antigens and, at an early stage, stigmas of immunization against the virus. Some studies make a distinction between HIV isolated in cerebrospinal fluid and in serum. Cerebrospinal HIV isolates differ from serum isolates in their macrophage tropism, their antigenicity and their low cytotoxicity, but there is little difference in their capacity for replication. Studies aimed at finding virological markers to diagnose HIV-induced neurological lesions have given discordant results. Longitudinal studies are necessary to determine prognostic markers. New techniques, such as amplification by polymerase chain reaction, will perhaps provide new data.

Biomarkers↗
PubMed1992

Plasma and cerebrospinal fluid measures of arginine vasopressin secretion in patients with bulimia nervosa and in healthy subjects.

Bulimia nervosa is a psychiatric syndrome associated with intense hunger, deficient satiety mechanisms, an obsessional preoccupation with the adverse consequences of eating, ritualistic binge eating, and subsequent purging to forestall the effects of the binge. The morbidity of this illness reflects both the psychological suffering associated with a life organized around pathological eating behaviors, as well as medical complications such as fluid and electrolyte imbalances that occur largely as a result of purging and laxative abuse. We report here a study of the osmoregulation of plasma arginine vasopressin secretion and of vasopressin levels in the cerebrospinal fluid. This study was undertaken because vasopressin not only functions as the antidiuretic hormone, and thus as a principal modulator of fluid and electrolyte balance, but also because, in animals, centrally directed vasopressin delays the extinction of behaviors acquired during aversive conditioning. Thirteen normal-weight female patients with bulimia nervosa were studied after at least 1 month of nutritional stabilization and supervised abstinence from binge eating and purging. Plasma vasopressin, plasma sodium, and subjective thirst were measured serially before and during a 2-h infusion of 3% hypertonic saline (0.1 ml/kg min). In addition, cerebrospinal fluid was obtained by lumbar puncture upon admission and at 1 week before hypertonic saline infusion in 11 of these patients and in an additional 11 female patients who did not participate in the hypertonic infusion study. Fifteen healthy normal weight individuals (4 female, 11 male) served as controls for the hypertonic saline infusion and a separate group of 11 healthy normal weight female controls underwent puncture. Compared to controls, bulimic subjects showed a significant reduction in the plasma vasopressin response to hypertonic saline; in 12/13, plasma vasopressin correlated closely with plasma sodium, whereas in one patient vasopressin fluctuated erratically, with no relation to plasma sodium. Cerebrospinal fluid vasopressin levels were significantly higher in patients, and correlated positively with basal thirst level, which was enhanced in bulimics. Compared to controls, patients showed significant polyuria. We conclude that patients with bulimia nervosa have abnormal levels of vasopressin in their plasma and cerebrospinal fluid during abstinence from binge eating and purging. The disturbance in osmoregulation may aggravate the maintenance of adequate fluid volume in these patients, while the increase in centrally directed vasopressin may have relevance to their obsessional preoccupation with the aversive consequences of eating and weight gain.

Adult↗
PubMed1991

Effect of long-term vigabatrin therapy on selected neurotransmitter concentrations in cerebrospinal fluid.

Ten patients, suffering from drug-resistant complex partial seizures were treated for a period of up to 3 years with vigabatrin (Sabril). Vigabatrin is a novel antiepileptic agent, whose action is based on the inhibition of gamma-aminobutyric acid (GABA) aminotransferase, the enzyme responsible for the catabolism of the neurotransmitter GABA. Samples of lumbar cerebrospinal fluid were obtained from the patients prior to commencing vigabatrin therapy, and thereafter at 6 months, 1 year, 2 years, and up to 3 years following the initiation of vigabatrin treatment. The influence of vigabatrin on the cerebrospinal fluid concentrations of free and total GABA, homocarnosine, homovanillic acid, 5-hydroxyindoleacetic acid, and 3-methoxy-4-hydroxyphenylethylene glycol, as well as of the drug itself, was assessed. All patients demonstrated a clinical response to vigabatrin, and the drug was well tolerated over the entire observation period. Mean (+/- SD) reduction of seizure frequency was 65% +/- 23% (range, 26% to 100%) when comparing the end of the treatment period to the previgabatrin baseline. The cerebrospinal fluid concentrations of both free and total GABA and of the dipeptide homocarnosine showed approximately 2- to 5-fold increases over baseline values, with free GABA and homocarnosine being the more sensitive variables. Cerebrospinal fluid concentrations of homovanillic acid, 5-hydroxyindoleacetic acid, and 3-methoxy-4-hydroxyphenylethylene glycol were not altered in a significant manner over the observation period. These findings support the concept that the effects of vigabatrin are restricted to an effect on GABA catabolism and do not extend to the neurotransmitters dopamine and norepinephrine. Clinical efficacy and elevation of GABA and homocarnosine concentration were sustained over the period of observation.

Adult↗
PubMed1997

Aluminium speciation in cerebrospinal fluid of acutely aluminium-intoxicated dialysis patients before and after desferrioxamine treatment; a step in the understanding of the element's neurotoxicity.

BACKGROUND: The association between aluminium and dialysis encephalopathy and deterioration of the neurological state during desferrioxamine treatment of dialysis patients is well established. At present little is known about the speciation and the mechanisms underlying the element's neurotoxicity. METHODS: Aluminium speciation was performed in cerebrospinal fluid samples of acutely aluminium-intoxicated dialysis patients using a recently developed high-performance liquid chromatographic/electrothermal atomic absorption spectrometric hybrid method. RESULTS: Baseline cerebrospinal fluid aluminium levels of samples taken shortly after the intoxication were low but elevated (5.0 +/- 2.0 micrograms/l, n = 3) as compared to subjects with normal renal function (< 1 microgram/l). In contrast to the situation noted in serum and to the iron speciation in cerebrospinal fluid, aluminium was not bound to transferrin but appeared as two distinct compounds, the main fraction eluting at the elution volume of aluminium-citrate/silicate. The second compound was not identified. Forty-four hours after desferrioxamine administration the cerebrospinal fluid aluminium levels had increased up to a concentration of 10.3 +/- 2.5 micrograms/l (n = 3). This was accompanied by a change in the speciation profile with aluminium appearing at the elution volume of aluminoxamine. CONCLUSIONS: Our findings may contribute to a better understanding of the neurotoxic effects of aluminium and its desferrioxamine chelate in dialysis patients.

Adult↗
PubMed1987

Factors affecting cerebrospinal fluid flow in a shunt.

Nineteen hydrocephalic patients were studied to determine factors affecting cerebrospinal fluid (CSF) flow through shunts. This study was based on our previously reported method by which fluctuations in CSF flow through a shunt of from 0.01 ml min-1 to 1.93 ml min-1 were identified, each having its own rhythmic pattern. While CSF flow in a supine position was less than 0.01 ml min-1, head elevation to 60 degrees led to increases in CSF flow from 0.12 ml min-1 to 0.17 ml min-1. Sudden respiratory changes such as coughing also affected CSF flow. CSF flows were higher than average between 10 pm and 7 am, and changes in CSF flow were related to slight increases in ICP during REM sleep. There is no relationship between CSF flow in a shunt and daily fluid intake which varied from 27 ml kg-1 to 103 ml kg-1, and no significant changes in CSF flow resulting from rapid intravenous injection of Glycerol and Ringer's solution.

Cerebrospinal Fluid↗
PubMed1980

Transport of choline out of the cranial cerebrospinal fluid spaces of the rabbit.

The role which carrier-mediated transport and passive diffusion play in the clearance of quaternary ammonium compounds from cerebrospinal fluid was evaluated by ventriculocisternal perfusion in rabbits by using [14C]choline as the primary test compound. Choline was transported out of cerebrospinal fluid by two processes: a saturable, carrier-mediated process with a Tmax of 70.5 ng/min and Kt of 2.2 microgram/min; and, a passive nonsaturable process with a cerebrospinal fluid perfusate clearance of 11.5 microliter/min. N1-methylnicotinamide depressed the clearance of choline as well as that of hexamethonium, suggesting that these cations share a common transport process. Ouabain reduced the clearance of choline and hexamethonium. Passage of choline into brain occurred by passive diffusion.

Animals↗
PubMed1976

Clearance of 3-methoxy-4-hydroxyphenylglycol from the cerebrospinal fluid.

The clearance of 3-methoxy-4-hydroxyphenylglycol (MHPG) from the cerebrospinal fluid of cats was studied. Both ventriculocisternal and cerebral subarachnoid perfusions demonstrated relatively high clearances that could not be blocked by probenecid. MHPG removal increased proportionally at all concentrations studied, suggesting diffusional clearance from cerebrospinal fluid. Bulk clearance accounted for only one-third of MHPG clearance from brain, and the likely mechanism of MHPG removal from the central nervous system is by diffusion to capillary blood. Differences between amine metabolites removed by mediated transport and diffusion are summarized, and it is suggested that a rapid unblockable diffusional clearance mechanism tends to make lumbar levels of MHPG a poor index of brain norepinephrine metabolism.

Animals↗
PubMed1988

High levels of NPY in rabbit cerebrospinal fluid and immunohistochemical analysis of possible sources.

We have analyzed rabbit cerebrospinal fluid for neuropeptide Y (NPY)-like immunoreactivity, using high performance liquid chromatography (HPLC) and radioimmunoassay (RIA) and examined the anatomical relationship of NPY-containing fibers to the cerebral vasculature and the third cerebral ventricle. Cerebrospinal fluid (CSF) obtained from the cisterna magna of rabbits was injected into a C18 column and subjected to HPLC. The fractions were collected, dried and reconstituted in buffer for NPY radioimmunoassay. A single peak of NPY immunoreactivity was obtained which corresponded in retention time to synthetic porcine NPY. Analysis of CSF samples produced displacement curves parallel to the standard curve. Immunohistochemistry revealed numerous NPY-labeled fibers which penetrated the ependymal lining of the third cerebral ventricle and directly bordered the ventricular lumen. Other fibers were observed in the pia which lines the ventral aspect of the hypothalamus. The basilar artery, its branches and other cerebral vessels were surrounded by NPY-labeled fibers. The results show that: (1) approximately 1 ng/ml of NPY immunoreactivity which corresponds chromatographically to synthetic porcine NPY is present in rabbit CSF; (2) NPY-containing fibers surround the basilar artery and other cerebral vessels; (3) NPY may be released into the CSF from axons in the pia and from axons which penetrate the ependymal lining of the third ventricle. These observations form the basis for our analysis of the vasoconstrictor effects of NPY and its role in cerebrovasospasm after experimental subarachnoid hemorrhage.

Animals↗
PubMed1998

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis of proteins in human cerebrospinal fluid.

Matrix-assisted laser desorption/ionization time-of-flight mass spectra of proteins in cerebrospinal fluid analyzed without prior purification are presented. Less than 100 fmol amounts of proteins in the 10,000 to 20,000 u mass range and linked to human disease (multiple sclerosis, Alzheimer's disease, and stroke) were detected in a complex mixture of proteins and peptides, in the presence of high concentrations of salts, lipids and free amino acids. The mass resolution was sufficient to distinguish between the non-hydroxylated and hydroxylated forms of a 13,400 u protein. Simple fractionation of the cerebrospinal fluid using microbore-reversed phase high performance liquid chromatography improved signal-to-noise ratios in the mass spectra. High-accuracy peptide mass mapping and database searching were utilized to confirm the identity of several proteins. The presented results show that matrix-assisted laser desorption/ionization time-of-flight mass spectrometry could be used as a tool to perform rapid screening of chemically altered proteins in small volumes of biological fluids.

Blotting, Western↗
PubMed1983

[Ventriculo-lumbar gradient of concentration of total cerebrospinal fluid proteins: 2.- Influence of CSF drainage by ventriculoatrial shunt].

On a previous paper, based upon the data obtained from comparative studies of cerebrospinal fluid samples of two groups of patients with neurocysticercosis in activity, one with patency, the other one with blockage of the spinal subarachnoid space, evidence was presented that the concentration gradient of proteins along the neuraxis was the consequence of the escape of water from cerebrospinal fluid. The second paper is a continuance of that one. The material for this survey consisted of the clinical records of 11 patients with neurocysticercosis who during the course of the disease presented severe intracranial hypertension which required ventriculoatrial shunt as an emergency operation in order to allow survival. After surgery, it was observed a marked improvement in the clinical picture. Later, it was noticed a large increase in the protein content of the spinal fluid of the majority of the patients, as compared with the results verified prior to surgery. However, in these spinal fluid samples the increase in protein content was observed without a simultaneous rise in cell count, suggesting an improvement in the inflammatory condition. It seems very likely that this large elevation of the protein content in the subarachnoid fluid is the consequence of a reduction in the spinal fluid flow rate due to the ventricle-venous shunt.(ABSTRACT TRUNCATED AT 250 WORDS)

Central Nervous System Diseases↗
PubMed1991

Determination of gangliosides and sulfatide in human cerebrospinal fluid with a microimmunoaffinity technique.

An immunostaining procedure has been developed for the assay of the gangliotetraose gangliosides and sulfatide in cerebrospinal fluid. Gangliosides of the gangliotetraose series were individually determined with cholera toxin B-subunit (CT-B) and an anti CT-B monoclonal antibody after chromatography and sialidase hydrolysis to GM1 on high performance thin-layer plates. Sulfatide was determined by thin-layer chromatography using an anti-sulfatide antibody. The method was applied to normal cerebrospinal fluid from 20 adults and 30 children. The concentration of the gangliotetraose series gangliosides in adults varied from 100-300 nmol/l with a mean value of 230 +/- 56 nmol/l. Corresponding values for sulfatide were 30-225 nmol/l and 140 +/- 46 nmol/l. The values for gangliosides and sulfatide in children increased during development. The major gangliosides in cerebrospinal fluid of adults were GT1b and GD1b and in children GD1a and GT1b.

Adolescent↗