Subject(s)
Edema/cerebrospinal fluid , Edema/diagnosis , Fetal Monitoring/adverse effects , Birth Injuries/complications , Drainage , Edema/etiology , Female , Humans , Infant , Labor, Obstetric , Magnetic Resonance Imaging , Male , Pregnancy , ScalpABSTRACT
Periorbital and conjunctival oedema has been reported anecdotally by patients with raised intracranial pressure states. We present three clinical cases of this phenomenon and discuss the current evidence for pathways by which cerebrospinal fluid (CSF) drains in relation to conjunctival oedema. We reviewed the available literature using PubMed, in regards to conjunctival oedema as it relates to intracranial hypertension, and present the clinical history, radiology and orbital photographs of three cases we have observed. Only one previous publication has linked raised intracranial pressure (ICP) to conjuctival oedema. The weight of evidence supports the observation that the majority of CSF drains along the cranial nerves as opposed to via the arachnoid projections. Conjunctival oedema may be a clinical manifestation of CSF draining via the optic nerve in elevated ICP states.
Subject(s)
Edema/cerebrospinal fluid , Edema/etiology , Intracranial Hypertension/cerebrospinal fluid , Intracranial Pressure/physiology , Optic Nerve/surgery , Adult , Child , Drainage/methods , Female , Humans , Intracranial Hypertension/complications , Male , Middle Aged , PregnancyABSTRACT
Posttraumatic herniation of brain and CSF into the eyelid, variously termed as blepharocele, blepharoencephalocele, or encephalocele, is not a common entity, with only a few reported cases in the literature. A 4-year-old girl was seen for gradually increasing left upper eyelid swelling after she had sustained a head injury due to a fall from height. A few days later she developed swelling of the upper eyelid. Posttraumatic CSF blepharocele was suspected. The patient underwent surgery with excellent cosmetic outcome. This case is discussed with a review of literature.
Subject(s)
Cerebrospinal Fluid Rhinorrhea/etiology , Edema/cerebrospinal fluid , Eyelids/injuries , Eyelids/pathology , Cerebrospinal Fluid Leak , Cerebrospinal Fluid Rhinorrhea/surgery , Child, Preschool , Craniocerebral Trauma/complications , Craniotomy , Edema/etiology , Female , Glasgow Coma Scale , Humans , Neurologic Examination , Neurosurgical Procedures , Tomography, X-Ray Computed , Treatment Outcome , Wounds, Nonpenetrating/complicationsSubject(s)
Edema/parasitology , Fever/parasitology , Trypanosoma lewisi/isolation & purification , Trypanosomiasis, African/complications , Animals , Edema/blood , Edema/cerebrospinal fluid , Edema/drug therapy , Female , Fever/blood , Fever/cerebrospinal fluid , Fever/drug therapy , Gambia , Humans , Infant , Melarsoprol/therapeutic use , Parasitemia/drug therapy , Treatment Outcome , Trypanocidal Agents/therapeutic use , Trypanosoma lewisi/classification , Trypanosomiasis, African/blood , Trypanosomiasis, African/cerebrospinal fluid , Trypanosomiasis, African/drug therapyABSTRACT
Eicosanoids are known mediators of inflammation, vascular permeability, and are involved in microcirculatory blood flow regulation. To study their potential involvement in the pathophysiology of CNS trauma we used a rabbit spinal cord trauma model. Rabbits were subjected to lumbar spinal cord trauma produced by a modification of the Allen weight-drop method. TXB2, 6-keto-PGF1 alpha, PGE2, and 5-hydroxyeicosatetraenoic acid (5-HETE) release from spinal cord slices incubated ex vivo were measured by radioimmunoassay at 5, 30 min, 24 hrs, and 2 wks after trauma. Five and 30 min after trauma the TXB2/6-keto-PGF1 alpha ratio was elevated and the release of 5-HETE at 5 min after trauma increased in the injured spinal cord whereas release of 6-keto-PGF1 alpha and PGE2 remained at base-line levels. In the thoracic spinal cord, TXB2 and 6-keto-PGF1 alpha release were increased at 30 min after trauma. Release of 5-HETE from the injured spinal cord was also elevated 24 hrs after trauma. Two wks after trauma, TXB2 and 6-keto-PGF1 alpha release were also elevated in the injured spinal cord. Measurements of tissue water content by microgravimetry indicated progressive edema in the injury site while histopathological evaluation indicated progressive damage and tissue destruction. The results of this study suggest that eicosanoids may be involved in the pathophysiology of spinal cord trauma through two potential mechanisms: 1) site specific increase in the TXB2/6-keto-PGF1 alpha ratio immediately following trauma which is due primarily to an increase in TXA2 synthesis; 2) the increase synthesis of 5-HETE which signals the activation of the 5-lipoxygenase pathway of arachidonate metabolism and production of mediators that are involved in inflammatory mechanisms and may affect local blood flow regulation and blood-spinal cord barrier integrity.
