Immunoglobulins in the cerebrospinal fluid of the newborn infant

Immunoglobulins IgG, IgA and IgM were studied in serum and cerebrospinal fluid (CSF) samples from 36 newborn infants in the second day of life. According to parameters previously established in the same laboratory for normal newborn infants, serum proteins were normal in all samples and CSF composition was normal as to blood pigments, cells, total proteins and protein fractions in all samples. Immunoglobulins concentrations were determined by two methods: radial immunodiffusion (RID) and nephelometry. Concentrations found (mean +/- standard deviation) were as follows (mg/dl). Serum: through the RID method IgG 1346 +/- 299.1, IgM 10.4 +/- 2.26, IgA 1.1 +/- 1.06; through nephelometry IgG 1372 +/- 319.7, IgM 10.6 +/- 4.10, IgA 1.5 +/- 0.31. Cerebrospinal fluid: IgA and IgM were not detected by the methods employed; IgG was detected by both methods, and values were 11.1 +/- 2.52 by RID and 9.6 +/- 7.04 by nephelometry. IgG relations and IgG index were also evaluated; values of the IgG index (0.5 +/- 0.14) are emphasized. Considerations are made in order to point out data obtained as to characterize normal values for immunoglobulins in the cerebrospinal fluid of normal newborn infants.     

Low cerebrospinal fluid pressure syndromes

Only 12 years ago the first report on pachymeningeal gadolinium enhancement in low-pressure headaches appeared in the literature. In this short interval the enormous impact of MRI on so-called "spontaneous intracranial hypotension" and "low-pressure head-aches" has become obvious. A much broader clinical and imaging spectrum of the disease is now recognized and a substantially larger number of patients is diagnosed. In the past decade there has been remarkable progress in understanding this disorder and its associated cerebrospinal fluid (CSF) dynamics. Some of the older concepts or presumptions have been challenged while novel observations continue to appear in the literature. We are still in the learning phase.     

Normal cerebrospinal fluid protein,increased intracranial pressure,and the guillain-barré syndrome

A patient who had the Guillain-Barré syndrome (GBS) with associated increased intracranial pressure (ICP) and papilledema is described. The cerebrospinal fluid protein level and electrophoretic pattern were normal. This indicates that abnormal or excessive CSF protein is not the cause of the ICP and papilledema associated with GBS.     

Lymphocyte subpopulations in the cerebrospinal fluid: III. Normal values

For cerebrospinal fluid (CSF) samples from 50 subjects previously selected to represent suitably a normal control group and for a methodology that may be actually used for CSF samples even with normal cell count, it is possible to characterize lymphocyte subpopulations with normal statistical distribution and low dispersion of results for all lines considered. Data (mean +/- standard deviation) here estimated were (%): for B-lymphocyte subpopulation 7.0 +/- 1.44; for T lymphocyte subpopulation 76.0 +/- 2.92; for T-active lymphocytes 53.7 +/- 3.26; for T-avid lymphocytes 19.2 +/- 4.32 when all T subpopulation is considered, and 11.1 +/- 2.04 when only T-active subpopulation is studied; for T-sensitized or actually activated 22.3 +/- 3.95. These data may suggest that lymphocytes actually related to immunological activation will be properly represented by the difference between T-lymphocytes and its T-active line in each case. In every samples T and T-active lymphocytes are different subpopulations when surface receptor density is considered, by evidence of avidity for sheep erythrocytes. It is also possible that killer lymphocytes, or antibody mediated cytotoxic cells, may be related to modified lymphoid cells identified in the CSF normal cytomorphological profile.     

Response of cerebrospinal fluid pressure to hyperbaric oxygenation

The response of cerebrospinal fluid pressure (CSFP) to hyperbaric oxygenation (OHP) was investigated in 13 patients with acute cerebral damage and in dogs with or without experimentally produced cerebral damage. To elucidate the mechanism of the CSFP response, continuous measurements of carotid blood flow, arterial blood pressure, central venous pressure, and superior sagittal sinus pressure and CSFP were made before, during and after OHP. There was considerable variation in the response of CSFP to OHP in the patients, but three main patterns emerged; type I (nine cases), CSFP decreased at the beginning and rose again at the end of OHP, type II (two cases), CSFP fell with OHP and remained significantly lower than pretreatment level after it, and type III (two cases), CSFP showed little change with OHP. An animal without cerebral damage commonly showed a type I response of CSFP to OHP; the changes of CSFP at the beginning and end of OHP are mainly due to the changes of the cerebral blood flow. There may be two different actions of OHP on cerebral oedema, one decreasing cerebral oedema and another (mainly affecting the normal brain) producing cerebral oedema. Information obtained from the response of CSFP to OHP may be useful in judging the severity and pathophysiological state of cerebral damage.     

Headache and spontaneous low cerebrospinal fluid pressure syndrome

Neurological Sciences - We examined 59 consecutive patients presenting between 1993 and 2006 at our centre diagnosed with headache associated with spontaneous intracranial hypotension syndrome...     

Normal cerebrospinal fluid levels of insulin in patients with Parkinson's disease

Summary. We compared CSF levels insulin, measured by a Radioimmunoanalysis method, in 24 patients with Parkinson's disease (PD) and 21 matched controls. The CSF insulin levels did not differ significantly between PD patients and controls. CSF insulin levels were not correlated with age, age at onset, duration of the disease, scores of the Unified Parkinson Disease Rating Scale of the Hoehn and Yahr staging in the PD group. Antiparkinsonian therapy did not influence significantly and CSF levels of insulin. These results suggest that CSF insulin concentrations are not a biological marker of PD and its severity. Received July 14, 1999; accepted September 16, 1999     

Resistance in cerebrospinal fluid flow in normal pressure hydrocephalus]

C.S.F. resistance to flow (Rf) was measured in 24 patients by the mean of a constant infusion manometric test, and the results were compared with those of pneumo-encephalography and isotope cisternography. It is concluded that Rf is constantly elevated in patients with normal pressure hydrocephalus, is at least as reliable as the two other tests and therefore provides a really valuable aid to the identification of the patients to be shunted.     

Long-term recording of cerebrospinal fluid pressure in freely behaving rats

Literature values for 'normal', 'control', 'resting' or 'baseline' cerebrospinal fluid pressure (CSF-p) of rats reveal a large variability. Anesthesia, restraint, brief recordings at variable times from various sites and simultaneous infusions into the recording cannula may partly explain the variability. Here, we report values of continuous, day/night CSF-p recordings from a lateral ventricle in conscious, relatively unrestrained and freely behaving rats. The mean (+/- S.E.M.) daytime/nighttime values were 11.4 +/- 2.0 and 14.9 +/- 2.3 cm H2O, respectively (P less than 0.05). Minimum, but not maximum CSF-p's during the day were lower (P less than 0.05) than at night. The results provide a normative data base for studies designed to evaluate experimental or pathological phenomena affecting CSF-p.     

Late onset X-linked hydrocephalus with normal cerebrospinal fluid pressure

A family with X-linked hydrocephalus with normal cerebrospinal fluid (CSF) pressure and in which three brothers and a grandson of case 1, a proband, were affected is reported. The symptoms at onset were epileptic attacks that started in adulthood in the three brothers and at the age of 6 years in the grandson. In the three brothers, from 10 to 27 years after the onset of epileptic episodes, disorganization of intelligence and psychiatric deterioration were gradually noticed by their families. At the same time, they showed occasional urinary incontinence. Brain computed tomography (CT) scans revealed dilatation of the ventricular systems. Based on the results of the measurement of CSF pressure and radioactive-iodinated human serum albumin (RISA)-cysternography, two of the brothers were diagnosed as having normal pressure hydrocephalus (NPH), and they were treated neurosurgically. However, no obvious improvement in clinical symptoms was observed. Although the grandson had shown normal psychomotor development during his early childhood, temporal epilepsy and temper tantrums started at the age of 6 years. Computed tomography-scanning revealed dilatation of the ventricular system similar to the other three cases at the age of 8 years. With the diagnosis of NPH, the patient underwent a shunt operation, which resulted in no obvious effects. As it is reasonable to surmise that the pathological gene would have been transferred via the daughter of the proband to the grandson, it is suggested that the inheritance manner might be X-linked recessive. The cases presented here are different from the cases of hydrocephalus due to stenosis of the aqueduct Sylvius (HSAS) and other types of X-linked hydrocephalus reported previously in terms of the age of onset, course, symptoms, and CT findings. Thus, it is suggested that the present cases might be a new type of X-linked hydrocephalus.     

IgE in the cerebrospinal fluid

The level of IgE in the cerebrospinal fluid (CSF) was determined by particle counting immunoassay. With a limit of sensitivity of 0.2 IU/ml, this immunoglobulin was detected neither in CSF of non-neurological patients (n = 27) nor of patients with sciatica (n = 13). IgE was present in samples from some patients with either multiple sclerosis (MS) or various infections of the central nervous system. In these cases, an IgE index [CSF IgE/serum IgE: CSF albumin/serum albumin] was calculated as 0.29 (SD 0.12). This value is not abnormal as the mean IgG and monomeric IgA indices are 0.45 and 0.34, respectively. Therefore, the IgE detected in most of the CSF samples was not locally produced. However, most patients with tuberculous meningitis had clearly an increased IgE index suggesting a local biosynthesis, but we failed to detect any IgE antibody activity against purified protein derivatives.     

Effect of endoscopic third ventriculostomy on cerebrospinal fluid pressure in the cerebral ventricles

We aimed to show how endoscopic third ventriculostomy (ETV) treatment may affect cerebrospinal fluid (CSF) flow dynamics in hydrocephalus, with and without aqueductal stenosis. Hydrocephalus is a neurological disorder which is characterized by enlarged brain ventricles. The periodic motion of CSF flow as a function of the cardiac cycle was prescribed as the inlet boundary condition at the foramen of Monro, and ETV was modeled as a 5 mm diameter hole in the anterior wall of the third ventricle. The results show that ETV reduces the pressure in the ventricles by nine-fold in the model with aqueductal stenosis, and three-fold in the model without aqueductal stenosis. More importantly, ETV changes the temporal characteristics of the CSF pressure waveform in the model without aqueductal stenosis, such that there is higher pressure in the ventricle during diastole. This study suggests that changes in the temporal characteristics of the CSF pressure waveform in the ventricles may be the reason why ETV treatment is not effective for hydrocephalus without aqueductal stenosis.