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。     

血性脑脊液对内皮细胞分泌ET和NO的影响

目的观察血性脑脊液对内皮细胞分泌内皮素(Endothelin,ET)和一氧化氮(NitricOxyde,NO)的影响。方法建立脐静脉内皮细胞体外培养的方法,用放射免疫方法测定ET含量,用硝酸还原酶法测定NO的代谢产物NO     

表现为血性脑脊液改变的低颅压综合征7例临床分析

低颅压综合征是指颅内压降低（脑脊液压力〈70mmH2O）而以头痛为突出症状的临床综合征。头痛多为体位性，在临床上较为常见，而表现为血性脑脊液（CSF）改变的并非少见，易误诊为蛛网膜下腔出血（SAH）。近3年我们收治的26例低颅压综合征巾有7例CSF呈血性改变。现就7例血性CSF改变的低颅压综合征的临床资料作如下分析，以提高对以血性CSF改变为主要表现的低颅压综合征的认识。     

腰椎穿刺血性脑脊液细胞学检查结果的分析及临床应用价值

临床工作中,经常会遇到送检的脑脊液标本为血性脑脊液.由于其成因复杂,国内至今少有文献涉及并引起关注,成为临床检验工作中的疑难问题,给临床诊断特别是基层医疗单位的诊断带来一定的困难或导致误诊、漏诊.     

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.     

微创硬通道技术加脑脊液净化治疗重型脑室出血(附19例分析)

我院采用YL—1型穿刺针行脑室穿刺引流加腰穿脑脊液净化等综合措施治疗重型脑室出血19例,疗效满意,报告如下。1对象与方法1.1临床资料男12例,女7例;年龄30～72岁。11例有高血压病史。浅昏迷3例,中度昏迷9例,深昏迷7例;偏瘫8例,肌强直11例,去皮质状态3例。原发性脑室出血13例;继发性脑室出血6例,其中胼胝体出血破入脑室1例,丘脑出血破入脑室3例,壳核出血破入脑室2例。双侧脑室铸型14例,单侧脑室铸型5例,合并第三脑室、导水管、第四脑室积血19例。1.2治疗方法所有病人均在发病后24h内手术。根据CT片或在CT扫描下定位,一侧脑室铸型时穿刺患…     

侧脑室外引流及脑脊液净化治疗蛛网膜下腔出血的疗效观察

目的 探讨蛛网膜下腔出血的治疗方法，评价其治疗效果。方法 治疗组(28例)采用侧脑室外引流及脑脊液净化加常规内科治疗；对照组(30例)采用常规内科治疗。结果 治疗组无1例死亡，对照组死亡4例(13.3％)。治疗组急性脑积水与脑血管痉挛的发生率均为3.6％，对照组急性脑积水与脑血管痉挛的发生率分别为13．3％和20％。治疗组疗效明显优于对照组。结论 侧脑室外引流结合脑脊液净化是治疗蛛网膜下腔出血的有效方法。     

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 ,…     

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。     

1727例脑脊液细胞学检查结果分析

目的:探讨脑脊液细胞学(CSFC)检查在中枢神经系统疾病中的诊断价值。方法:采用玻片离心法收集脑脊液细胞,经瑞-姬染色后在显微镜油镜下观察。结果:总结分析1727份CSFC检查结果,中枢神经系统感染性疾病207例(其中包括新型隐球菌感染6例),脑出血7例,中枢神经系统白血病和淋巴瘤19例,中枢神经系统肿瘤20例。结论:CSFC检查对于中枢神经系统疾病的诊断和鉴别诊断具有重要意义。     

Antiepileptic Properties of Cerebrospinal Fluid After Activation of the Antiepileptic System of the Brain

Intraventricular injection of cerebrospinal fluid (CSF) obtained from cats with chronic electrical stimulation of cerebellar vermal cortex resulted in suppression of epileptic foci activity in cat brain cortex, an increase in time to first seizure, and weakening of generalized seizures in rats. The CSF obtained from cats after electroshock seizures induced less pronounced, although significant antiepileptic action in comparison with the CSF of cats with cerebellar stimulation on the model of generalized seizures in rats. The antiepileptic action of CSF obtained from cats with electrostimulation of cerebellar vermis and from electroshock cats is due to appearance of peptide factors in CSF.     

Pharmacokinetic Effects of Vigabatrin on Cerebrospinal Fluid Amino Acids in Humans

Summary: A study was conducted to assess the impact of single dosing and different dosing intervals of vigabatrin [gamma vinyl GABA (GVG)] in 11 patients with drug-resistant complex partial seizures. Cerebrospinal fluid (CSF) concentrations of total GABA, free GABA, homocarnosine, homovanillic acid (HVA), GVG, and 5- hydroxyindolacetic acid were measured up to seven days after a single dose. GVG levels were maximal within 24 h, suggesting that GVG acts to inhibit GABA-transami-nase, and may also increase biogenic amines.     

Histamine in Cerebrospinal Fluid of Children with Febrile Convulsions

Summary: Febrile convulsions (FC) are frequent acute neurologic disturbances of childhood. The cellular and neurochemical mechanisms causing FC are unclear. Among other mechanisms, the CNS histamine (HA) has been suggested to participate in seizure control and thermoregulation. We evaluated the possible role of HA in regulation of FC by measuring HA and tele-methylhis- tamine (t–MH) concentrations in the cerebrospinal fluid (CSF) of children with FC. The study group consisted of 35 children treated for acute FC in the hospital. The control groups consisted of (a) feverish children without seizures ( n =23), (b) convulsive children without fever ( n =7), and (c) children with neither fever nor convulsions ( n =21). HA was assayed by high-performance liquid chromatography (HPLC) with fluorescence detection, and t-MH was measured by gas chromatography-mass spectrometry. CSF HA concentration in the group of febrile Convulsions occur rather frequently in connection with febrile children without seizures was significantly higher (0.69 ± 0.16 pmol/ml, mean k SE) than in children with FC (0.36 ± 0.07 pmol/ml, p <0.05, analysis of variance, ANOVA). HA concentration was 0.37 ± 0.18 pmoVml in the group of nonfebrile convulsive children and 0.36 k 0.08 pmol/ml in the nonfebrile nonconvulsive group. No statistical differences in t–MH were detected between groups. The increased susceptibility to seizures during fever may be connected to the lack of increase in CSF HA in the FC group. The data support the hypothesis that the central histaminergic neuron system may be involved in inhibition of seizures associated with febrile illnesses in childhood.     

Penetration of Valproate and its Active Metabolites into Cerebrospinal Fluid of Children with Epilepsy

Summary: Levels of the antiepileptic drug valproate (VPA) and five of its active metabolites (2-en-VPA, 3-keto-VPA, and 3-,4-, and 5-hydroxy-VPA) were determined by gas chromatography-mass spectrometry in cerebrospinal fluid (CSF) of 15 epileptic children undergoing chronic treatment with VPA. In eight of these children, total and free drug and metabolite concentrations in plasma were also measured. All VPA metabolites present in plasma could also be detected in CSF, although concentrations were substantially'lower than those of the parent compound. CSF concentrations of VPA and most of its metabolites were positively correlated with total and free concentrations in plasma. However, concentrations in CSF were always significantly lower than free plasma concentrations, which may be explained by asymmetric transport at the blood-CSF barrier. The data on low CSF levels of VPA metabolites do not exclude the possibility that accumulation of active metabolite(s) may occur in certain brain areas during chronic treatment of epileptic patients with VPA.     

Selective Cerebrospinal Fluid Hypothermia: Bioengineering Development and In Vivo Study of an Intraventricular Cooling Device (V-COOL)

Hypothermia is a promising therapeutic strategy for severe vasospasm and other types of non-thrombotic cerebral ischemia, but its clinical application is limited by significant systemic side effects. We aimed to develop an intraventricular device for the controlled cooling of the cerebrospinal fluid, to produce a targeted hypothermia in the affected cerebral hemisphere with a minimal effect on systemic temperature. An intraventricular cooling device (acronym: V-COOL) was developed by in silico modelling, in vitro testing, and in vivo proof-of-concept application in healthy Wistar rats (n = 42). Cerebral cortical temperature, rectal temperature, and intracranial pressure were monitored at increasing flow rate (0.2 to 0.8 mL/min) and duration of application (10 to 60 min). Survival, neurological outcome, and MRI volumetric analysis of the ventricular system were assessed during the first 24 h. The V-COOL prototyping was designed to minimize extra-cranial heat transfer and intra-cranial pressure load. In vivo application of the V-COOL device produced a flow rate-dependent decrease in cerebral cortical temperature, without affecting systemic temperature. The target degree of cerebral cooling (− 3.0 °C) was obtained in 4.48 min at the flow rate of 0.4 mL/min, without significant changes in intracranial pressure. Survival and neurological outcome at 24 h showed no significant difference compared to sham-treated rats. MRI study showed a transient dilation of the ventricular system (+ 38%) in a subset of animals. The V-COOL technology provides an effective, rapid, selective, and safe cerebral cooling to a clinically relevant degree of − 3.0 °C.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-022-01302-y.     

Multiplex Analysis of Cytokines in the Serum and Cerebrospinal Fluid of Patients With Alzheimer's Disease by Color-Coded Bead Technology

Background and purpose

The availability and promise of effective treatments for neurodegenerative disorders are increasing the importance of early diagnosis. Having molecular and biochemical markers of Alzheimer''s disease (AD) would complement clinical approaches, and further the goals of early and accurate diagnosis. Combining multiple biomarkers in evaluations significantly increases the sensitivity and specificity of the biochemical tests.

Methods

In this study, we used color-coded bead-based Luminex technology to test the potential of using chemokines and cytokines as biochemical markers of AD. We measured the levels of 22 chemokines and cytokines in the serum and cerebrospinal fluid (CSF) of 32 de novo patients (13 controls, 11 AD, and 8 Parkinson''s disease [PD]).

Results

MCP-1 was the only cytokine detectable in CSF, and its levels did not differ between control and disease groups. However, the serum concentration of eotaxin was significantly higher in AD patients than in the control group.

Conclusions

The analysis of multiple inflammatory mediators revealed marginal differences in their CSF and serum concentrations for the differential diagnosis of AD and PD. These results provide evidence that immunological responses are not major contributors to the pathogenesis of AD and PD.     

脑脊液髓鞘碱性蛋白抗体检测对格林-巴利综合征的临床价值

目的探讨格林-巴利综合征（GBS）中枢神经髓鞘的免疫性损伤。方法GBS患者20例，神经系统其它疾病组（OND）20例，非神经系统疾病手术者33例。以酶联免疫吸附法检测73份脑脊液（CSF）中髓鞘碱性蛋白IgG（MBP－IgG）。结果GBS患者、OND患者和非神经系统疾病手术者CSF中MBP－IgG阳性率分别为55％、30％和9.1％。GBS患者CSF中MBP-IgG阳性率与发病天数有关。结论部分GBS有中枢神经髓鞘的免疫性损害，证实GBS是自身免疫性脱髓鞘病。