腹腔脑脊液假性囊肿

腹腔脑脊液假性囊肿(abdominal cerebrospinal fluidpseudocyst,ACP)是脑窜腹腔分流术(ventriculoperitonealshunt,VPS)后一种少见的并发症.它是指腩积水患者行VPS后,引流到腹腔巾的脑脊液由于不能被吸收且持续存在,连同引流管的远端被非表皮组织所包裹形成的囊肿[1].其首先由Harsh存1954年报道.     

Abdominal cerebrospinal fluid pseudocyst in a severely handicapped patient with hydrocephalus.

We present a case of an abdominal cerebrospinal fluid pseudocyst as a rare complication of a ventriculoperitoneal shunt. The patient is a severely handicapped bedridden spastic quadriplegic with hydrocephalus. He underwent surgical reconstruction of a shunt tube because of shunt disconnection at the age of 12 years. Fever and frequent vomiting developed 2 months after surgery, and abdominal fullness gradually became severe. He was diagnosed as having an abdominal cerebrospinal fluid pseudocyst on abdominal ultrasonography. If a shunt dysfunction is suspected, this type of cyst should also be considered, and abdominal ultrasonography should be performed as one of the screening tests for determining the cause of the shunt dysfunction.     

Abdominal cerebrospinal fluid (CSF) pseudocyst presented with inferior vena caval obstruction and hydronephrosis

Purpose  

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication of ventriculo-peritoneal shunt placement. A large pseudocyst may exert a significant pressure effect, but vascular or urological symptoms are extremely rare. We report an unusual case of a CSF pseudocyt causing inferior vena caval and ureteric obstruction.     

Abdominal cerebrospinal fluid pseudocysts

Abdominal cerebrospinal fluid pseudocyst is an infrequent complication of ventriculoperitoneal (VP) shunts. We reviewed ten patients with abdominal pseudocyst. There were five girls and five boys, aged between 4 months and 14 years. The number of shunt procedures prior to the presentation varied between one and five. Only one patient had had a previous shunt infection. No patients had undergone prior abdominal surgery other than VP shunting. The time from the last shunting procedure to the development of abdominal pseudocyst ranged from 3 weeks to 5 years. Presenting symptoms and signs were mainly related to abdominal complaints in all patients. Three patients also had the signs of shunt malfunction. The diagnosis was made by ultrasound in all patients. Shunt infection was determined in six patients. Repositioning of the peritoneal catheter seemed to have a higher rate of recurrence. The diagnosis of abdominal pseudocyst should be considered in VP-shunted patients presenting with abdominal complaints.     

Hepatic cerebrospinal fluid pseudocyst: a case report and review of the literature

An abdominal pseudocyst is a rare, but important complication in patients with a ventriculo-peritoneal (VP) shunt insertion. Several predisposing factors for this complication have been suggested, including infection, obstruction or dislodgement, but the pathophysiology is still unknown. However, the abdominal inflammatory process is accepted widely as a hypothesis for the formation of an abdominal pseudocyst. In this study, we report the case of a 21-year-old male that presented with a high-grade fever, poor appetite, shortness of breath and unconsciousness 1 week after receiving a VP shunt insertion for obstructive hydrocephalus. Ultrasonography and computed tomographic scans of the abdomen revealed a well-defined large hepatic cyst surrounding the peritoneal tube of the VP shunt. A hepatic cerebrospinal fluid (CSF) cyst was diagnosed and Staphylococcus epidermis was cultured via CSF. After externalization of the VP shunt and adequate antibiotic treatment, the hepatic cyst was resolved. There was no recurrence observed in the regular follow up.     

Quantitative analysis of intraspinal cerebrospinal fluid flow in normal adults

The present study quantitatively analyzed intraspinal cerebrospinal fluid flow patterns in 19 normal adults using fast cine phase-contrast magnetic resonance imaging. Results showed increased downward flow velocity and volume compared with upward flow, and the average downward flow volume of intraspinal cerebrospinal fluid decreased from top to bottom at different intervertebral disc levels. Upward and downward cerebrospinal fluid flow velocity reached a peak at the thoracic intraspinal anterior region, and velocity reached a minimum at the posterior region. Overall measurements revealed that mean upward and downward flow volume positively correlated with the subarachnoid area. Upward peak flow velocity and volume positively correlated with spinal anteroposterior diameter. However, downward peak flow velocity and volume exhibited a negative correlation with spinal anteroposterior diameter. Further flow measurements showed that flow velocity in upward and downward directions was associated with subarachnoid anteroposterior diameter, respectively. The present experimental results showed that cerebrospinal fluid flow velocity and volume varied at different intraspinal regions and were affected by subarachnoid space area and anteroposterior diameter size.     

儿童结核性脑膜炎脑脊液蛋白质组学初步研究

目的 结核性脑膜炎是致残、致死率较高的儿童时期常见中枢神经系统感染性疾病。本实验拟通过建立正常中国儿童及结核性脑膜炎患儿脑脊液蛋白质双向凝胶电泳图谱,筛选结核性脑膜炎特异性蛋白,为结核性脑膜炎的早期诊断提供线索,同时也为进一步探讨结核性脑膜炎的发病机制提供新思路。方法 收集结核性脑膜炎患儿和同年龄正常儿童脑脊液各4 ml,固相PH梯度二维聚丙烯酰胺凝胶电泳（2-DE）技术分离蛋白质,考马斯亮蓝染色,Imagescanner扫描仪以及LabScan扫描软件对凝胶进行扫描获取图像,利用图像分析软件PDQuest 7.0进行强度校正、点检测、背景消减、均一化和匹配等分析,以正常儿童脑脊液的2-DE凝胶为参考胶,将结核性脑膜炎患儿脑脊液的凝胶与之进行比较分析,寻找两组患儿脑脊液蛋白质谱的差异表达斑点。结果 正常儿童脑脊液分离获得蛋白质斑点546个,结核性脑膜炎患儿脑脊液分离获得蛋白质斑点533个,发现有64个蛋白质点存在质或量的差别,其中有14个蛋白质点仅在正常儿童CSF表达,有27个点仅在结脑患儿CSF中表达,与正常儿童CSF蛋白质点表达量比较发现,结脑患儿CSF有15个蛋白质点表达量有2倍以上上调,8个蛋白质点表达量有2倍以上下调。共选出20个差异蛋白质点进行MALDI-TOF-MS分析,获得了20张肽质量指纹图谱。进入数据库进行搜索后有15个差异蛋白质已经通过MALDI-TOF-MS鉴定。结论 本实验成功建立了正常儿童和结核性脑膜炎患儿脑脊液蛋白质2-DE图谱,通过凝胶图像分析和计算机信息处理,发现了一些与结核性脑膜炎相关的蛋白质差异位点。经质谱分析及生物信息学技术初步鉴定了部分差异蛋白质,发现载脂蛋白A-I、抗肿瘤坏死因子α抗体、HLA-II 类抗原DRB1-4、MRP14蛋白可能与结核性脑膜炎的发生发展密切相关,这些蛋白能否成为结核性脑膜炎诊断的标记物,值得进一步的研究。     

A comparative study of absence status epilepticus between children and adults

Based on the clinicoelectrographic data of 28 patients (14 children and 14 adults) with absence status epilepticus thoroughly documented by CCTV/EEG, it was found that there were significant differences between the children and adults. In childhood, absence status tended to occur in those who had experienced individual short-lived atypical absence seizures and also other types of generalized seizure. In contrast, there was a general tendency for absence status in adulthood to occur in females without individual absence seizure. With respect to the clinicoelectrographical manifestations, absence status with a decreased postural tone was prone to be associated with a more profound clouding of consciousness, whereas in those with myoclonic components there was a less profound clouding. The former was found solely in children while the latter was both in children and in adults. During absence status, the focal motor features with or without secondarily generalized convulsions were observed in 8 adult patients (57%). On the other hand, no focal motor manifestations were observed during absence status in children. Absence status is composed of two modalities: either a prolongation or repetition of absence seizures. It was demonstrated that, in children, either the prolongation or repetition of individual absence seizures developed into absence status. The short-lived absence was of an atypical nature, whereas in adults, absence status consisted of the prolongation of an absence seizure which occurred in patients with no experience of individual absence seizures. With respect to the drug treatment, antiabsence drugs had some effect in children, while none of the adult patients responded either to the antiabsence drugs or other antiepileptic drugs. The long-term seizure prognosis was not necessarily poor in children but invariably poor in adults. Four adult patients showed diffuse, but unilateral frontally accentuated asymmetrical paroxysmal activity during the status. Three of them showed initial localized spike-wave discharges in the unilateral frontal region followed by a generalized spike-wave rhythm. Furthermore, all of these 4 patients with focally accentuated ictal EEGs have shown partial motor seizures intermingled with absence status.(ABSTRACT TRUNCATED AT 400 WORDS)     

Neurochemical analysis of cerebrospinal fluid

The use of cerebrospinal fluid (CSF) analysis for studying in vivo alterations in central neuronal activity requires a relatively sophisticated knowledge of CSF physiology and pathology. Ventriculospinal concentration gradients, circadian rhythms, physical activity, stress, medications, precursor intake, concomitant illness, obstructed CSF circulation, age, and sex alter the baseline neurochemical composition of CSF. Differential probenecid blockade of the egress of acidic monoamine metabolites and cyclic nucleotides from the CSF may complicate interpretations of their accumulations. Degradation of CSF constituents during collection, storage, and analysis may introduce errors in quantification. These sources of CSF variability can be minimized with proper methodolology.     

Cerebellar medulloblastomas: a comparison between adults and children

A retrospective analysis of 19 medulloblastomas in patients aged 2 to 24 years was conducted employing 14 children (<15 years old) and 5 adults. All patients received gross total excision of the tumour with postoperative craniospinal irradiation. The patients were then followed up for more than 5 years. To determine which factors influenced the prognosis of these two age groups, we analysed the differences of the proliferating cell nuclear antigen (PCNA), the degree of tumour invasion and the outcome between adult and childhood medulloblastomas. In summary, medulloblastomas in adults and children had similar cell proliferative activity and long term survival rates but the tumours with brain stem invasion, which commonly occurred in children, had an early recurrence rate and a poor prognosis. The prognosis of medulloblastoma may depend upon the degree of tumour invasion of the brain stem.     

Cerebrospinal fluid dynamics and cerebrospinal fluid infusion in children. Part I: A revised method and a review

In the study of cerebrospinal fluid dynamics in children with macrocephaly, the lumbar CSF infusion technique has always been used. Previous studies showed, that the regulation of cerebrospinal fluid dynamics are mainly determined by Pressure-Volume Index (PVI) and outflow resistance (Ro). Recent studies have shown, that the relationship between pressure and volume is mono exponential with a constant. This result suggests a third parameter c. PVI, Ro and c were determined with a combination of bolusmethod and a constant flow infusion.     

人类脑脊液蛋白质组学研究

脑脊液（cerebrospinal fluid，CSF）是存在于脑室及蛛网膜下腔内的一种无色透明的液体，循环流动干脑和脊髓表面，大部分由脑室脉络丛分泌。正常成人脑脊液容量大约为90～150mL。CSF中含有一些小分子物质如盐和肽，蛋门质．酶等等一些在生理上有重要作用的物质一这些物质的变化包括浓度．或蛋白和肽的修饰都能够精确反映中枢神经系统疾病的病理过程，     

Spectrophotometry for cerebrospinal fluid pigment analysis

The use of spectrophotometry for the analysis of the cerebrospinal fluid (CSF) is reviewed The clinically relevant CSF pigments—oxyhemoglobin and bilirubin—are introduced and discussed with regard to clinical differential diagnosis and potentially confounding variables (the four T's: traumatic tap, timing, total protein and total bilirubin). The practical laboratory aspects of spectrophotometry and automated techniques are presented in the context of analytical and clinical specificity and sensitivity. The perceptual limitations of human color vision are highlighted and the use of visual assessment of the CSF is discouraged in light of recent evidence from a national audit in the United Kingdom. Finally, future perspectives including the need for longitudinal CSF profiling and routine spectrophotometric calibration are outlined.     

Parkinson's disease subtypes: clinical classification and ventricular cerebrospinal fluid analysis

The current study presents preliminary data regarding the development and validation of a rating system designed to classify PD patients into clinical subgroups. Using portions of the Unified Parkinson's Disease Rating Scale, a ratio value was derived, yielding three patient subtypes: a tremor-dominant group (T), an akinetic-rigid group (AR), and a mixed group (MX). Validation of the schema was conducted by grouping PD surgical candidates into specific disease subtypes and evaluating differences in neurotransmitter profiles among disease subtypes and non-PD neurological controls. High pressure liquid chromatography analysis of ventricular cerebrospinal fluid indicated 5-hydroxyindoleacetic acid was significantly lower in the AR and MX groups compared to non-PD controls; whereas, glycine was significantly higher in the AR group compared to the T, MX, and control groups. The results suggest that an operational approach can be utilized to differentiate between PD subtypes with distinct neurochemical profiles.     

回顾性分析成人化脓性脑膜炎细菌构成及其脑脊液分布特点

目的回顾性分析宁夏地区成人化脓性脑膜炎(purulent meningitis in adult,APM)患者脑脊液(cerebrospinal Fluid,CSF)细菌构成及特点。方法收集宁夏医科大学总医院2002年01月至2014年07月诊治并行细菌培养的144例化脓性脑膜炎患者临床资料,分析比较致病菌检出阳性与阴性的实验室检查特点,以及不同致病菌(革兰阳性球菌、革兰阴性杆菌及革兰阳性杆菌)患者之间实验室检查特点。结果 144例化脓性脑膜炎的细菌检出阳性率为36.8%(53例),致病细菌以革兰阳性球菌常见[64.15%(34例)],其中以葡萄球菌属为主;细菌检出阳性组患者的血中性粒细胞比例、脑脊液白细胞计数及脑脊液蛋白含量均高于阴性组(分别(82.52±9.43)%,(78.13±13.25)%,P=0.022;(4078.13±5739.24)×10~6/L,(2181.61±4440.87)×10~6/L,P=0.010;(2.99±2.67)g/L,(2.18±2.01)g/L,P=0.041)。发病10d内就诊的101例患者,细菌检出阳性组脑脊液压力、脑脊液白细胞计数、脑脊液中性粒细胞比例亦均高于阴性组((263.82±55.05)mmH_2O,(236.03±66.26)mmH_2O,P=0.032;(4660.45±5756.37)×10~6/L,(2745.97±5193.33)×106/L,P=0.008;(70.21±30.51)%,(56.79±35.54)%,P=0.048),脑脊液淋巴细胞比例较阴性组低((18.92±24.10)%,(32.02±32.10)%,P=0.023)。结论成人化脓性脑膜炎的致病菌以革兰阳性球菌多见,其细菌培养阳性患者的脑脊液与培养阴性者具有一定差异,可能会为临床诊疗提供参考价值。     

Plasma and cerebrospinal fluid concentrations of magnesium in epileptic children

In order to discriminate between conflicting reports in the literature, plasma and cerebrospinal fluid magnesium levels from epileptic children were compared with those of control children. To exclude the possibility of methodological artifacts, two methods for Mg determination were used: atomic absorption spectrophotometry and a colorimetric procedure. By both methods a significantly decreased concentration of Mg in plasma was found in epileptics. A positive correlation of the hypomagnesemia with the severity of epilepsy was found: the more severe the epilepsy, the lower was the plasma Mg. A significant increase of Mg concentration in CSF of epileptics was found. The most likely origin of Mg in CSF in epilepsy is the CNS tissue from which Mg is released. It is suggested that these alterations of Mg concentrations in plasma and CSF originate from a functional impairment of the cell membranes which might occur in epilepsy.     

Serum and cerebrospinal fluid cytokines in children with acute encephalopathy

BackgroundThe pathogenesis of acute encephalopathy (AE) remains unclear, and a biomarker has not been identified.MethodsLevels of 49 cytokines and chemokines, including osteopontin (OPN), were measured in serum and cerebrospinal fluid (CSF) of children with AE (n = 17) or febrile convulsion (FC; n = 8; control group). The AE group included acute necrotizing encephalopathy (n = 1), acute encephalopathy with biphasic seizures and late reduced diffusion (AESD; n = 3), clinically mild encephalitis/encephalopathy with a reversible splenial lesion (MERS; n = 4), and unclassified acute encephalopathy (UCAE; n = 9) that does not meet the criteria of syndrome classification. Five individuals with AE had neurological sequelae or death (poor prognosis), whereas 12 were alive without neurological sequelae (good prognosis).ResultsThe CSF:serum ratios of OPN, CC chemokine ligand (CCL)4, and interleukin (IL)-10 were significantly higher in AE than in FC. The CSF levels of macrophage inhibitory factor (MIF) and leukemia inhibitory factor (LIF) were significantly higher in the poor-prognosis group than in the good-prognosis group. The CSF:serum ratios of OPN were significantly higher in AESD and in MERS than in FC. The CSF:serum ratios of MIF and OPN were higher in MERS than in UCAE or FC.ConclusionOur results suggest that microglia-related cytokines and chemokines such as OPN, MIF, and LIF could be novel biomarkers of AE, in addition to the previously reported IL-10 and CCL4, and that MIF and LIF may be markers of poor prognosis.