注氧脑脊液置换治疗外伤性蛛网膜下腔出血的疗效观察

目的 :观察注氧脑脊液置换治疗外伤性蛛网膜下腔出血 (SAH)的临床效果。方法 :113例SAH均行腰穿放出 5～ 2 0ml血性脑脊液 ,在鞘内注射等量生理盐水和氧气 5ml,对脑脊液中红细胞消除时间和临床转归进行观察。结果 :113例注氧 3～ 6次 ,平均4次脑脊液中红细胞消除。临床治愈 5 8例 ,治愈率 5 1 3 % ;好转 3 9例 ,有效率 3 5 3 % ;并发脑梗死 9例 (7 9% ) ,轻度脑积水 4例(3 5 % )。结论 :注氧脑脊液置换可有效提高SAH病人的存活率和生存质量     

微创手术与脑脊液净化联合治疗继发性脑室出血的疗效分析

目的　观察微创手术、脑脊液净化联合应用对继发性脑室出血的疗效。方法　采用YL -1型一次性颅内血肿粉碎穿刺针 ,对 67例继发性脑室出血进行微创颅内血肿清除和 /或侧脑室引流 ,并对其中 3 2例手术后病人行脑脊液净化 ,每次用生理盐水等量置换出血性脑脊液 3 0～ 5 0ml ,隔 1～ 3d 1次 ,用 2～ 4次。将联合应用脑脊液净化的病人作为观察组 ,未做脑脊液净化的病人作为对照组。于手术前、手术后 2周进行GCS评分。 3个月时进行BI评分。结果　手术前观察组与对照组病人GCS评分无明显差异(P >0 2 ) ,术后 2周两组有极显著性差异 (P <0 0 0 1) ,3个月后BI评分亦有显著性差异 (P <0 0 1) ,结论　微创手术、脑脊液净化联合治疗继发性脑室出血 ,对意识障碍生活能力的改善优于单纯应用微创和 /或脑室引流组。     

注氧脑脊液置换治疗外伤性蛛网膜下腔出血的疗效观察

目的：观察注氧脑脊液置换治疗外伤性蛛网膜下腔出血（SAH）的临床效果。方法：113例SAH均行腰穿放出5－20ml血性脑脊液，在鞘内注射等量生理盐水和氧气5ml，对脑脊液中红细胞消除时间和临床转归进行观察。结果：113例注氧3－6次，平均4次脑脊液中红细胞消除。临床治愈58例，治愈率51．3％；好转39例，有效率35．3％；并发脑梗死9例（7.9%)，轻度脑积水4例（3.5%)。结论：注氧脑脊液置换可有效提高SAH病人的存活率和生存质量。     

大总量脑脊液差量置换治疗蛛网膜下腔出血47例临床分析

目的 观察大总量脑脊液差量置换治疗蛛网膜下腔出血的有效性及安全性.方法 腰穿缓慢放出血性脑脊液5～10ml,以等量或不等量生理盐水进行置换5～15次,共置换出血性脑脊液40～100ml,隔日一次,总疗程5～7次.结果 47例经脑脊液置换后头痛、恶心、呕吐及意识障碍等症迅速缓解,脑血管痉挛、脑积水等并发症明显减少.结论 大总量脑脊液差量置换治疗蛛网膜下腔出血是一种迅速缓解临床症状,减少并发症发生及降低病死率、致残率的有效方法 .     

头颅CT扫描与脑脊液细胞学检查对诊断蛛网膜下腔出血的价值

目的 :探讨头颅CT扫描与脑脊液检查对诊断蛛网膜下腔出血的价值。方法 :对 30例经头颅CT及腰穿脑脊液检查诊断为原发性SAH者行脑脊液细胞学检查 ,检查时间为病程中的 3、7、15、2 3、35d。结果 :30例原发性SAH ,CT阳性者 18例 ,阳性率 6 0 % ;腰穿脑脊液外观均匀血性 18例 ,黄变 7例 ,清 5例 ,血性和黄变占 83 % ;找到SAH特征细胞 ,即红细胞吞噬细胞和含铁血黄素吞噬细胞 2 3例 ,占 76 6 %。结论 :CT阴性不能排除原发性SAH ,其可通过腰穿脑脊液外观、红细胞形态观察及脑脊液细胞学检查而 10 0 %确诊 ,远较CT阳性率 6 0 %高 (P <0 0 1)     

相位对比法脑脊液电影磁共振成像在诊断脑室-腹腔分流装置梗阻中的应用

目的探讨相位对比法脑脊液电影磁共振成像(PC cine MRI)在诊断脑室-腹腔分流装置梗阻中的价值,为诊断脑室-腹腔分流装置梗阻提供一种新方法。方法体外试验中将生理盐水以0、2.17、10、20 ml/h速度流经脑室-腹腔分流管,应用PC cine MRI对引流管内液体进行定向观察,CSF-QFlow软件进行定量分析。应用同样的方法对8例怀疑分流管梗阻的病人进行流量检测并进行分析,将疑似梗阻病人的脑脊液的流速,与体外试验速度2.17 ml/h的检测结果进行对照分析。结果体外试验时,与流速为2.17、10、20 ml/h相应值比,流速为0 ml/h的MRI检测值均明显降低(P0.01)。根据临床拔管指征(每天分流量小于50 ml,换算流速为2.17 ml/h)作为梗阻的标准,6例病人均低于此标准,可诊断为梗阻,此方法诊断结果与临床治疗结果吻合率为100%。结论 PC cine MRI技术简单、无创、可靠,可为诊断分流装置梗阻提供参考。     

头颅CT扫描与脑脊液细胞学检查对诊断蛛网膜下腔出血的价值

目的：探讨头颅CT扫描与脑脊液检查对诊断蛛网膜下腔出血的价值。方法：对30例经头颅CT及腰穿脑脊液检查诊断为原发性SAH者行脑脊液细胞学检查,检查时间为病程中的3、7、15、23、35d。结果：30例原发性SAH,CT阳性者18例,阳性率60％;腰穿脑脊液外观均匀血性18例,黄变7例,清5例,血性和黄变占83％;找到SAH 征细胞,即红细胞吞噬细胞和含铁血黄素吞噬细胞23例,占76．6％。结论：CT阴性不能排除原发性SAH,其可通过腰穿脑脊液外观、红细胞形态观察及脑脊液细胞学检查而100％确诊,远较CT阳性率60％高（P＜0．01）。     

血性脑脊液对胚胎神经干细胞增殖和分化的影响

目的 观察体外血性脑脊液培养对神经干细胞增殖和分化的影响,以期为临床治疗这类患者提供依据.方法 提取终止妊娠的16周人胚胎脑细胞,冻存于液氮中.组织复苏后,在DMEM/F12培养基(含EGF、bFGF、B27和N2)中培养14 d可获得形态完好的神经球(神经干细胞).从颅脑外伤患者和非外伤患者分别留取血性脑脊液和正常脑脊液.将制备的胚胎神经干细胞分为两组,分别用血性脑脊液和正常脑脊液培养.动态观察神经干细胞在两组脑脊液中生长、增殖和分化的情况.用免疫细胞化学技术对两组脑脊液中神经干细胞的分化进行标记和鉴定.结果 神经干细胞在两组脑脊液中均能存活、增殖和分化.但神经干细胞在血性脑脊液中分化速度较快,分化比例也较高.在血性脑脊液中,神经干细胞更倾向于向胶质细胞分化;而在正常脑脊液中,神经干细胞更倾向于向神经元分化.结论 血性脑脊液可能会影响神经干细胞的分化速度和分化方向.这一结果对采用神经干细胞治疗颅脑外伤和蛛网膜下腔出血等疾病有一定提示作用.     

脑脊液净化治疗6例全脑室铸型出血患者的疗效观察

全脑室铸型出血发病率较低 ,但传统的内外科治疗死亡率高达 75 %～ 10 0 % [1] 。我院自 1999年以来应用硬通道双侧侧脑室额角穿刺结合腰大池持续引流脑脊液净化治疗 6例全脑室铸型出血者 ,取得较满意的临床疗效 ,现报道如下。1　资料和方法1.1　一般资料　本组男 4例 ,女 2例 ,年龄 5 0～ 79岁 ,平均6 5岁。均经头颅ＣＴ证实为全脑室铸型出血 ,其中高血压性脑出血 4例 ,原因不明 2例。用哥拉斯格计分法 (ＧＣＳ)计算 ,5分 3例 ,6～ 8分 3例。病灶侧瞳孔散大 1例 ,双侧瞳孔缩小5例 ,瞳孔对光反应迟钝 4例 ,消失 1例。 6例中伴肺部感染1例 ,…     

血液净化治疗神经系统免疫性疾病

血液净化 (Ｐｌａｓｍａｐｈｅｒｅｓｉｓ或ｐｌａｓｍａｅｘｃｈａｎｇｅ ,ＰＥ)是指通过非肾途径将体内的代谢废物、毒素、抗体、免疫复合物、药物以及其他有害和致病物质从血液中排出体外 ,以实现使机体向康复状态转变的治疗方法。现将有关ＰＥ治疗神经系统免疫性疾病的文献综述如下 ,与同道共勉。一、ＰＥ的种类目前 ,国外已开展的ＰＥ方法有多种 ,这里简单介绍单纯血浆置换、二重膜滤过和免疫吸附 3种方法[1,2 ] 。1 单纯血浆置换法 :该法把患者的血液导入血浆交换装置 ,通过离心和单层膜滤过将血液分成有形血细胞和血浆两部分 ,在弃去…     

脑脊液净化治疗蛛网膜下腔出血

４５例原发性蛛网膜下腔出血患者接受了脑脊液净化治疗，多数做了３～５次，最多者做９次。每次脑脊液出量２０～７０ｍｌ，平均总出量１６８±６２ｍｌ。４例急性期复发出血。３个月后３３例患者基本康复，无明显神经系统后遗症，１１例有神经功能缺陷。１例因暴发性肝炎，消化道大出血死亡。作者结合文献讨论了脑脊液净化治疗蛛网膜下腔出血的机理，指出其可清除积血，降低颅压，预防或减轻血管痉挛与迟发性缺血性神经缺陷，降低病死率与致残率。     

In Vivo MicroRNA Detection and Quantitation in Cerebrospinal Fluid

Alterations in microRNA (miRNA) expression in postmortem brain tissue or peripheral blood have been linked to schizophrenia. Cerebrospinal fluid might provide an in vivo biomarker more directly reflecting functional changes in the brain. The goals of this study were to determine the feasibility of detecting miRNAs in cerebrospinal fluid and to compare miRNA levels in cerebrospinal fluid versus blood. Four healthy volunteers and four patients with psychotic disorders underwent a lumbar puncture and a blood draw. Expression of 378 validated miRNAs was assessed from each biofluid type for each subject using microarray technology. Five miRNAs were chosen for validation with quantitative polymerase chain reaction. A substantial number of miRNAs (n?=?95) were exclusively or predominately detected in cerebrospinal fluid (CSF). Levels of 35 miRNAs detected in both CSF and blood samples in all subjects were poorly correlated. The investigation of miRNAs in CSF can help advance the understanding of psychiatric diseases and particularly schizophrenia.     

隐球菌性脑膜炎23例脑脊液细胞学分析

目的分析隐球菌性脑膜炎脑脊液细胞学特点,比较脑脊液细胞学染色、墨汁染色、乳胶凝集实验检出隐球菌的敏感度及特异度,以提高对隐球菌性脑膜炎的认识。方法总结2008年1月至2013年2月确诊的23例隐球菌脑膜炎患者与同期住院的23例非隐球菌脑膜炎患者临床资料及脑脊液细胞学资料并予以分析。结果脑脊液细胞瑞氏吉姆萨染色检测灵敏度91.3%,明显高于墨汁染色灵敏度43.4%,差异有统计学意义(P0.05);脑脊液细胞学瑞氏吉姆萨染色检测特异度100%,明显高于乳胶凝集实验法特异度56.5%,差异有统计学意义(P0.05)。结论脑脊液细胞学检查比传统的墨汁染色法及乳胶凝集实验有更高的灵敏度及特异度,且更直接,是一种先进快捷便利的检测方法。     

GABA in Cerebrospinal Fluid of Children with Febrile Convulsions

In 23 children with febrile convulsions the concentration of gamma-aminobutyric acid (GABA) in lumbar cerebrospinal fluid (CSF) was measured by a radioreceptor assay. The mean CSF GABA concentration of 134 (range, 73-294) pmoles/ml was significantly lower than that of 16 seizure-free children serving as controls, who had 210 (range, 117-475) pmoles/ml. The reduction in CSF GABA levels in patients with febrile convulsions was not reflected in plasma GABA concentrations. These data provide further evidence that impairment of GABA neurotransmission may contribute to an increased seizure propensity.     

Cerebrospinal fluid absorption mechanism--based on measurement of CSF flow rate in shunt tube

The cerebrospinal fluid (CSF) absorption mechanism in cases of hydrocephalus was investigated on the basis of measurements of CSF flow in a shunt tube after ventriculo-peritoneal shunt surgery, monitoring of intracranial pressure, CT findings, radioisotope cisternography, cerebral blood flow, EEG, PSP tests and changes in neurological findings. The subjects were 6 males and 7 females aged from 18 to 70. CSF flow rates in the shunt tubes were between 0.01 and 1.93 ml/min. Calculating the daily volume of CSF flow, the subjects were divided into two groups: Group A (8 patients) with a volume of less than 150 ml/day (0.01-0.25 ml/min), and Group B (5 patients) with between 150 and 500 ml/day (0.01-1.93 ml/min). Monitoring of intracranial pressure prior to the shunt operation was performed in 10 cases. These pressure values ranged between 4 and 25 mmHg (mean: 7-8 mmHg), and there was no difference between the two groups. The pre-and post-operative radioisotope cisternography findings indicated improvement of ventricular dilatation, periventricular lucency and ventricular reflux. After the shunt operations, there was neurological improvement in 6 of the 8 Group A cases but only in 2 of the 5 Group B cases. Considering the CSF flow volumes of the two groups, it appears that in Group A the shunt tube is not the main CSF circulation pathway. This could mean that resistance to CSF absorption in the cerebrospinal space has decreased after the shunt operation and there has been recovery of the physiological CSF absorption pathways. In other words, neurological improvement can be expected in this group A.     

Elevated Cerebrospinal Fluid Protein Is Associated with Unfavorable Functional Outcome in Spontaneous Subarachnoid Hemorrhage

Background/objective: Subarachnoid hemorrhage (SAH) is a devastating neurologic event for which markers to assess poor outcome are needed. Elevated cerebrospinal fluid (CSF) protein may result from inflammation and blood-brain barrier (BBB) disruption that occurs during SAH. We sought to determine if CSF protein level is associated with functional outcome after SAH. Methods: We prospectively collected single-center demographic and clinical data for consecutive patients admitted with spontaneous SAH. Inclusion required an external ventricular drain and daily CSF protein and cellular counts starting within 48 hours of symptom onset and extending through 7 days after onset. Seven-day average CSF protein was determined from daily measured values after correcting for contemporaneous CSF red blood cell (RBC) count. Three-month functional outcome was assessed by telephone interview with good outcome defined as modified Rankin score 0-3. Variables univariately associated with outcome at P less than .25 and measures of hemorrhage volume were included for binary logistic regression model development. Results: The study included 130 patients (88% aneurysmal SAH, 69% female, 54.8 ± 14.8 years, Glasgow Coma Scale [GCS] 14 [7-15]). Three-month outcome assessment was complete in 112 (86%) patients with good functional outcome in 74 (66%). CSF protein was lower in good outcome (35.3 [20.4-49.7] versus 80.5 [40.5-115.5] mg/dL; P < .001). CSF protein was not associated with cerebral vasospasm, but delayed radiographic infarction on 3 to 12-month neuroimaging was associated with higher CSF protein (46.3 [32.0-75.0] versus 30.2 [20.4-47.8] mg/dL; P = .023). Good 3-month outcome was independently associated with lower CSF protein (odds ratios [OR] .39 [.23-.70] for 75th versus 25th percentile of protein; P = .001) and higher admission GCS (OR 1.23 [1.10-1.37] for good outcome per GCS point increase; P < .001). Parenchymal hematoma predicted worse outcome (OR 6.31 [1.58-25.25]; P = .009). Results were similar after excluding nonaneurysmal SAH and after including CSF RBC count, CT score, and intraventricular hemorrhage volume in models. Conclusions: Elevated average CSF protein is associated with poor outcome after spontaneous SAH. Further research should investigate if elevated CSF protein identifies patients in whom mechanisms such as BBB disruption contribute to poor outcome.     

Extraordinarily Long-Term Posttraumatic Cerebrospinal Fluid Fistula

Most posttraumatic cerebrospinal fluid (CSF) leakage is noticed by the patients with the first symptom, rhinorrhea. A 38-year-old woman presented with frequent clear continuous rhinorrhea and otorrhea for 5 years after basilar skull fracture. After this, meningitis was developed with subsequent CSF fistula. Her clinical symptom was improved by medical treatment. The dural defect and CSF leakage were not detected by computerized tomography (CT) cisternography. We report a rare case of persistent posttraumatic CSF fistula that continued for five years.     

协同刺激分子在格林-巴利综合征患者 脑脊液、血及周围神经中的表达

目的　探讨协同刺激分子在格林 巴利综合征 (GBS)患者脑脊液、血和周围神经组织中的表达及其作用。方法　用RT PCR法及原位杂交法观察GBS患者外周血、脑脊液和周围神经组织中协同刺激分子B7 1、B7 2、CD2 8、CTLA 4的表达。结果　GBS患者外周血、CSF和周围神经组织中协同刺激分子CD2 8、B7 1、B7 2在炎性细胞上的表达明显高于对照组 ;GBS患者CSF中CD2 8、B7 1、B7 2mRNA的表达明显高于外周血。结论　在GBS发病过程中协同刺激分子的表达对T细胞的活化 ,进而导致体液免疫和细胞免疫反应起重要作用。     

脑脊液细胞学检查联合癌胚抗原免疫细胞化学染色在脑膜癌病早期诊断中的应用

目的:探讨脑脊液细胞学检查联合癌胚抗原(CEA)免疫组化染色在脑膜癌病(Meningeal Carcinomatosis,MC)早期诊断中的应用价值。方法:脑脊液细胞学检查采用Shandon Cytospin4离心沉淀仪玻片离心法,CEA免疫细胞化学采用SP法。结果:33例经脑脊液细胞学检查均发现异常细胞,其中首次脑脊液细胞学检查阳性率为87.88%(29/33),22例结合CEA免疫组化染色,阳性率为81.82%(18/22);结论:脑脊液细胞学检查结合免疫细胞化学染色是诊断脑膜癌的重要手段,且两者互为补充。     

Cerebrospinal fluid glucose and leukocyte responses in experimental meningitis

The fall in cerebrospinal fluid (CSF) glucose and CSF leukocyte response was studied in cats with experimental meningitis. Klebsiella pneumoniae or Streptococcus pneumoniae were injected intracisternally, and the latter organisms were incubated with CSF in vitro. When 10(6)-10(9)K. pneumoniae were incubated with 4 ml of CSF, the time time necessary for the glucose to decrease to less than 10 mg/dl ranged from 6.5 to 2.5 h, at a rate proportional to the size of the inoculum. When the same numbers of bacteria were injected intracisternally, the time ranged from 9 to 3 h, and the CSF leukocyte response did not exceed 1200 WBC/mm3. At this time, only minimal histological changes in brain and choroid plexus were seen. Twenty hours after intrathecal K. pneumoniae, large numbers of leukocytes (up to 4 X 10(4)/mm3) were recovered from the CSF. Regardless of the number of leukocytes, however, hypoglycorrhachia occurred when the CSF contained more than 10(7) bacteria/ml. At this interval, large numbers of leukocytes were seen invading the stroma of the choroid plexus, leptomeninges and perivascular spaces. When 10(8) S. pneumoniae were injected intracisternally, CSF glucose concentration decreased as rapidly as with K. pneumoniae. The spinal fluid leukocyte response to S. pneumoniae was, however, greater than that to K. pneumoniae. These results suggest that under the conditions of these studies, hypoglycorrhachia of bacterial meningitis is the result of metabolism of the bacteria with little contribution from the leukocytes.