Suspected transcutaneous cerebral spinal fluid leakage without postural headache after implantable intrathecal drug delivery system removal: A case report

A 55-year-old man with an implantable intrathecal drug delivery system (IDDS) implant removal surgery was performed to control a suspected implant infection. Clear discharge from a lumbar wound was detected after IDDS removal, but transcutaneous cerebral spinal fluid (CSF) leakage was not suspected because the patient did not suffer from a postural headache. Finally, a suspected CSF leakage was resolved with a single epidural blood patch.

Análise do líquido cérebro-espinhal de três doenças do sistema nervoso central de cães / Analysis of cerebral-spinal fluid of three central nervous system diseases of dogs

Foi realizado um estudo retrospectivo do líquido cérebro-espinhal de cães (LCE), atendidos pelo Serviço de Neurologia do Hospital Veterinário da Instituição, de 2004 a 2015, com o objetivo de analisar os resultados de cães com sinais neurológicos, comparar as alterações encontradas em dois locais de colheita no mesmo paciente e verificar se esse exame auxiliou o clínico em reforçar a suspeita clínica das principais doenças do sistema nervoso central. A pleocitose linfocítica esteve presente em 78,3% (29/37) das amostras de cães com cinomose e em 23,2% (10/43) de cães com DDIV. Houve dissociação albuminocitológica (DAC) em 73% (19/26) das amostras de cães com tumores IC e em 64,3% (9/14) de cães com tumores envolvendo a ME. Em cães com DDIV, houve significância estatística (p<0,05) entre o grau de disfunção neurológica e o total de células nucleadas (TCN) e total de proteínas (TP). Em 29 cães, houve a colheita do LCE da cisterna magna e da cisterna lombar e em 12 (41,4%) os resultados foram diferentes entre as duas amostras colhidas do mesmo cão, onde dois (6,9%) apresentaram alteração na amostra colhida cranial à lesão. Pode-se concluir que a pleocitose linfocítica foi a principal alteração encontrada no LCE de cães com cinomose e DDIV e DAC nas neoplasias, IC e ME, cães acometidos pela DDIV apresentaram sinais neurológicos mais severos conforme o TCN e o TP aumentaram e o LCE sofreu alteração, mesmo colhido cranial ao local da lesão e auxiliou o clínico em reforçar a suspeita clínica, mas não confirmou, as principais doenças neurológicas em cães.(AU)

A retrospective study including the analysis of the cerebrospinal fluid (CSF) of dogs neurologically affected was conducted by the Neurology Service of the Veterinary Hospital at the Institution, between 2004 and 2015. The aim of this study was to analyze the results of the CSF of dogs with neurological signs, and compare the changes in the CSF in two sampling sites in the same patient and see if this test helped the clinician to strengthen clinical suspicion of the major diseases of the central nervous system. Lymphocytic pleocytosis was present in 78.3% (29/37) of samples from dogs with distemper and in 23.2% (10/43) of samples from dogs with IVDD. The albumin cytologic dissociation (ACD) was found in 73% (19/26) of samples from dogs with IC tumors and in 64.3% (9/14) from dogs with tumors involving the SC. For dogs with IVDD, there was statistical significance (p<0.05) between the degree of neurological dysfunction and the total nucleated cells (TNC) and total protein (TP). In 29 dogs, CSF was collected from the cistern magna and the lumbar and in 12 (41.4%) the results were different between the samples of the same dog, where two cases (6,9%) showed alterations in the sample collected cranial to the injury. It can be concluded that the lymphocytic pleocytosis was the main alteration found in the CSF of dogs with distemper and IVDD and ACD in tumors. Dogs affected by IVDD had more severe neurological signs as TNC and TP increased and the CSF was altered even collected cranial to the lesion site and helped the clinician to strengthen the clinical suspicion, but not confirm, the major neurological diseases in dogs.(AU)

The study on diagnostic feasibility of CSF Aβ42, T-tau, P-tau181 detection in Alzheimer dementia / 中国神经精神疾病杂志

Objective To explore the diagnostic feasibility of Alzheimer disease (AD) associated CSF biomarker (CSF Aβ42, T-tau, and P-tau181) through establishing the cutoff value and the sensitivity and specificity of each biomarker. Methods Seventeen AD dementia patients were enrolled from Peking university first hospital during 2015 July and 2017 Feb including 5 patients that received PET scan using Pittsburgh compound-B. Forty-nine cognitive normal subjects were also enrolled as controls according to the protocol. The levels of Aβ42, T-tau, P-tau181 and the ratio of Aβ42/T-tau、Aβ42/ P-tau181 from all participants were assessed using the innotest-ELISA methods and cutoff value,sensitivity as well as specificity of each biomarker were determined according to the ROC curve. Results There were significant differences in all biomarkers between the cognitive normal controls group and AD dementia group. The cutoff value of Aβ42, T-tau, P-tau181, Aβ42/T-tau and Aβ42/ P-tau181 were 511 ng/mL, 322 ng/mL, 63 ng/mL, 14.72 and 1.74. The sensitivity were 64.7% in Aβ42, 88.2% in T-tau, 58.8% in P-tau181, 82.35% in Aβ42/T-tau and 76.47% in Aβ42/ P-tau181, respectively. The specificity were 97.05% in Aβ42, 75.5% in T-tau, 93.87% in P-tau181, 95.51 % in Aβ42/T-tau and 93.87% in Aβ42/P-tau181, respectively. Conclusion Alzheimer disease associated biomarkers (CSF Aβ42,T-tau, and P-tau181) can distinguish the cognitive normal subjects from AD dementia patients. The methods are reliable and the sensitivity as well as specificity of each biomarker are good which are close to the values reported in the literatures. Thus, this methodology is worth being promoted in the clinic.

Evidence-based clinical practice guidelines for the treatment of dural tears and the consequent cerebrospinal fluid leak during spine surgery / 中华外科杂志

Dural tears (DT) and the consequent cerebral spinal fluid (CSF) leak are not rare in spine surgeries. CSF leak can be troublesome, leading to pseudomeningocele, cutaneous CSF fistula, and meningitis. Revision surgery is unavoidable in some cases. The reported incidences of DT and CSF leak are different according to the various pathologies. Ossification of the posterior longitudinal ligament, revision spine surgery and multi-segment laminectomy have higher risks for DT. Various techniques have been described to manage this complication, such as bed rest, repair with dural substitutes, fibrin glue, gelatin sponge, lumbar drain, muscle flap, etc.Through objective evaluation of the evidence and transparency in the process of making recommendations, it is Chinese Association of Orthopaedic Surgeons′ goal to develop evidence-based clinical practice guidelines for the treatment of incidental DT and the consequent CSF leak during spine surgery. The current clinical guidelines focus on 9 clinical questions and the strength of recommendations were made based on the quality of the literature. The work group considers that this guideline recommendations aim to assist in delivering optimum, efficacious treatment and functional recovery from this complication.

Effect of lead exposure on function of blood-cerebrospinal fluid barrier and ZO-1 and occludin protein expression in vitro / 中国药理学与毒理学杂志

OBJECTIVE To establish an in vitro blood-cerebrospinal fluid barrier (BCB) model to investigate the underlying mechanism of lead-induced BCB injuries.METHODS The in vitro BCB model was established by Z310 cells.Different concentrations of Pb(AC)2 (2.5,5.0 and 10.0 mmol·L-1) were used for 24,48 and 72 h.Transendothelial electrical resistance (TEER) and flux of FITC-dextran were performed to determine the permeability of the in vitro BCB model.Western blotting and immunofluorescence methods were used to observe the expression of tight junction protein ZO-1 and occludin.RESULTS Compared with control group,Pb(AC)2 2.5,5.0 and 10.0 mmol· L-1 exposure for 48 h to Z310 cells had no significant effect on survival rate and density.TEER in different groups was gradually increasing.At the 12th day after Pb(AC)2 exposure,the values of TEER and flux of FITC-dextran in Pb(AC)2 5 and 10 mmol· L-1 groups were significantly decreased (P＜0.05).Western blotting and immunofluorescence images showed that the expression of ZO-1 and occludin were significantly decreased (P＜0.05) after Pb(AC)2 exposure for 48 h.CONCLUSION Lead exposure can cause the breakdown of BCB barriers,and this effect may be mediated by reducing the expression of ZO-1 and occludin proteins.

Effects of hypoxia on production of ATP and expression of mitochrome C in human meningothelial cells as the cerebral fluid-optic nerve barrier / 中华实验眼科杂志

Background BackgroundMeningothelial cells (MECs) are major cell type in the meningeal sheath around optic nerve,which form a fluid barrier between optic nerve and the cerebral spinal fluid.The impairment of the cerebral fluid-optic nerve barrier probably affects the balance of cerebral fluid components.Currently,the investigation on the role of MECs in neuropathy is less performed.Objective This study attempted to explore hypoxia-induced function changes of MECs,and to shed a new clus for the future research of optic nerve disorders.Methods Human MECs strains were cultured in vitro and cell suspension was prepared with the cell densities of 2.5 ×103/hole,5.0× 103/hole and 1 x 104 /hole,respectively.The suspensions of 100 μl were separately collected to incubate in 96-well plates and cultivated for 2 days in 21％ O2(normoxia group) or 1％ O2(hypoxia group).MTS was used to detect and compare the proliferative value (A490) of MECs between the normoxia group and the hypoxia group.The changes of MECs diameter and volume were measured by CASY1 assay.ATP product in the cells after MECs exposed to different oxygen environments with or without substrate (100 mmol/L pyruvate and 100 mmol/L malate) for 1,2 days were assayed by Luminometer method.The expression and distribution of cytochrome C in the cells of the normoxia group and the hypoxia group were determined by immunofluorescence.Results A490 of MECs in the 2.5× 103/hole,5.0× 103/hole and 1 × 104/hole were 0.399±0.009,0.393±0.009 and 0.496±0.026 in the hypoxia group,which were lower than 0.424±0.131,0.413±0.111 and 0.537±0.021 in the normoxia group (t =3.777,P =0.004 ; t =3.251,P =0.009 ; t =3.037,P =0.013).Compared with the normoxia group,the diameter and volume were significantly increased in the hypoxia group ([20.970 ±0.127] μm vs.[21.198 ±0.048] μm,t =-3.762,P=0.006; [5805±73] fl vs.[6026±106] fl,t=-4.124,P=0.002).ATP products were (0.900±0.225)mmol/(L· g) and (0.952± 0.075) mmol/(L · g) in the hypoxia group and the hypoxia+substrate group,which were significantly lower than (1.389±0.145) mmol/(L · g) and (1.401±0.122) mmol/(L · g) in the normoxia group and the normoxia +substrate group (P =0.001,0.002,0.001).Immunofluorescense staining showed that the green fluorescence of cytochrome C located at mitochondria of MECs in the normoxia group,but in the hypoxia group,cytochrome C distributed in the cytoplasm extensively.Conclusions Hypoxia induces malfunction of MECs,which might impact the intact of the cerebral spinal fluid-optic nerve barrier and therefore influence the microenvironment of the subarachnoid space and neuronal function.

Distribution and Antibiotic Resistance of Bacteria Isolated from Cerebral Spinal Fluid in Neurosurgical Patients: A Surveillance / 中华医院感染学杂志

OBJECTIVE To determine the distribution and antibiotic resistance of bacteria isolated from cerebral spinal fluid in neurosurgical patients. METHODS Bacterial isolates from cerebral spinal fluid specimens in Department of Neurosurgery,Beijing Tiantan Hospital were collected from Jan 2000 to Dec 2004.Distribution and antibiotic resistance of pathogens were analyzed retrospectively. RESULTS Of 438 isolates,Gram positive cocci and Gram negative bacilli accounted for 72.1%(316 isolates) and 27.9%(122 isolates),respectively.The most frequently isolated pathogen was coagulasenegative staphylococci(53.7%) followed by Staphylococcus aureus(10.5%),Enterobacter spp(6.2%),Acinetobacter spp(6.2%),and Pseudomonas aeruginosa(3.7%).The most active compounds against Gram-negative bacilli were imipenem(87% susceptibility),piperacillin/tazobactam(77%),amikacin(68%),cefepime(64%) and ceftazidime(63% susceptibility).Imipenem,cefepime,ceftazidime,and piperacillin/tazobactam demonstrated excellent activity against most of Gram negative bacilli.In S.aureus and coagulase-negative staphylococci,oxacillin resistance strains accounted for 76% and 100%,respectively. CONCLUSIONS Prevailing pathogens are Gram positive cocci in intracranial infection after neurosurgical operation,especially coagulase-negative staphylococci and S.aureus.Data collected in present study will provide valuable information for prophylactic and empirical antibiotic use in post-operative intracranial infection.

Changes of argiuine vaso-pression in blood and cerebral spinal fluid(CSF)in patients with severe brain injury after treated with mild hypothermia / 中华急诊医学杂志

Objective To study the changes of blood arginine vaso-pression(AVP)levels in patients with severe brain injury after treated with mild hypotherima.Methods Seventy-eight patients with severe brain injury were divided into mild hypothermia(33～35℃)group and normothermia group.The blood AVP levels and CSF AVP levels were determined at the third and the seventh day after brain injury.Results The AVP levels in blood and CSF of mild hypothermia group were lower than those of the normothermia group at the third and seventh day after brain injury(P＜0.05).According to GOS,prognosis of the mild hypothermia group was better than that of the nonnotbcrmia group(P＜0.05).Conclusion The mild hypothermia treatment may have inhibitive effects on the production of blood AVP,CSF AVP,and brain edema.Mild hypothermia is an effective method in the treatment of acute severe brain iniury in reducing the mortality and in increasing the survival rate.

Assessment of general and trace elements in CSF of patients with spinal cord injury / 中国康复理论与实践

@#Objective To analyze general and trace elements in cerebral spinal fluid (CSF)of patients with spinal cord injury (SCI). Methods To assess contents of general and trace elements (K, Na, Ca, Mg, Zn, Mn, Fe, Cu) in CSF of six SCI patients using ICP-AES. Results Compared with normal value, contents of Ca and Zn were significantly decreased (P<0.01), Fe and Mn were significantly increased (P<0.01), but no significant differences for Na, Mg, K and Cu in CSF of SCI patients. Conclusion The excitation of central nerve system in SCI patients may be higher than normal people indeed.

Dynamic study of cerebral spinal fluid markers in patients with tuberculous meningitis / 重庆医科大学学报

Objective:To discuss the value for earlier diagnosis and curative effect evaluation of tuberculosis meningitis(TBM)by detecting the cerebrospinal fluid(CSF)routine,biochemistry and cytology check.Methods:Dynamic Analysis of cerebrospinal fluid routine,biochemistry and cytology variation have been performed on 80 cases with TBM between prior-treatment and post-treatment.Results:There is a obviously rise performed in the cerebrospinal fluid for the pressure,biochemistry index singularity ratio and neutrophil proportion prior treatment,while a progressive decline was observed in post treatment with a significant difference.The typical TBM in forepart showed intermix cytology reaction which had most granulocytes.During the middle period of the treatment,granulocytes reduced,more over immune cells and active hyaline leukocytes increased.During the later period of the treatment,active lymphocytes reaction was the most obvious.Cerebrospinal fluid cytology was back to normal when TBM had been cured.Conclusion:The cerebrospinal fluid cytology check is a significant index in earlier diagnosis of TBM;Dynamic observation on cerebrospinal fluid cytology is helpful for earlier diagnosis of TBM.Furthermore the method has some value in judging the prognosis of the patients suffened TBM.