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Sample records for intracranial csf flow

  1. Variable impact of CSF flow suppression on quantitative 3.0T intracranial vessel wall measurements.

    Science.gov (United States)

    Cogswell, Petrice M; Siero, Jeroen C W; Lants, Sarah K; Waddle, Spencer; Davis, L Taylor; Gilbert, Guillaume; Hendrikse, Jeroen; Donahue, Manus J

    2018-03-31

    Flow suppression techniques have been developed for intracranial (IC) vessel wall imaging (VWI) and optimized using simulations; however, simulation results may not translate in vivo. To evaluate experimentally how IC vessel wall and lumen measurements change in identical subjects when evaluated using the most commonly available blood and cerebrospinal fluid (CSF) flow suppression modules and VWI sequences. Prospective. Healthy adults (n = 13; age = 37 ± 15 years) were enrolled. A 3.0T 3D T 1 /proton density (PD)-weighted turbo-spin-echo (TSE) acquisition with post-readout anti-driven equilibrium module, with and without Delay-Alternating-with-Nutation-for-Tailored-Excitation (DANTE) was applied. DANTE flip angle (8-12°) and TSE refocusing angle (sweep = 40-120° or 50-120°) were varied. Basilar artery and internal carotid artery (ICA) wall thicknesses, CSF signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and signal ratio (SR) were assessed. Measurements were made by two readers (radiology resident and board-certified neuroradiologist). A Wilcoxon signed-rank test was applied with corrected two-sided P CSF suppression. Addition of the DANTE preparation reduced CSF SNR from 17.4 to 6.7, thereby providing significant (P CSF suppression. The DANTE preparation also resulted in a significant (P CSF CNR improvement (P = 0.87). There was a trend for a difference in blood SNR with vs. without DANTE (P = 0.05). The outer vessel wall diameter and wall thickness values were lower (P CSF suppression and CNR of the approaches evaluated. However, improvements are heterogeneous, likely owing to intersubject vessel pulsatility and CSF flow variations, which can lead to variable flow suppression efficacy in these velocity-dependent modules. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018. © 2018 International Society for Magnetic Resonance in Medicine.

  2. Bernoulli's Principle Applied to Brain Fluids: Intracranial Pressure Does Not Drive Cerebral Perfusion or CSF Flow.

    Science.gov (United States)

    Schmidt, Eric; Ros, Maxime; Moyse, Emmanuel; Lorthois, Sylvie; Swider, Pascal

    2016-01-01

    In line with the first law of thermodynamics, Bernoulli's principle states that the total energy in a fluid is the same at all points. We applied Bernoulli's principle to understand the relationship between intracranial pressure (ICP) and intracranial fluids. We analyzed simple fluid physics along a tube to describe the interplay between pressure and velocity. Bernoulli's equation demonstrates that a fluid does not flow along a gradient of pressure or velocity; a fluid flows along a gradient of energy from a high-energy region to a low-energy region. A fluid can even flow against a pressure gradient or a velocity gradient. Pressure and velocity represent part of the total energy. Cerebral blood perfusion is not driven by pressure but by energy: the blood flows from high-energy to lower-energy regions. Hydrocephalus is related to increased cerebrospinal fluid (CSF) resistance (i.e., energy transfer) at various points. Identification of the energy transfer within the CSF circuit is important in understanding and treating CSF-related disorders. Bernoulli's principle is not an abstract concept far from clinical practice. We should be aware that pressure is easy to measure, but it does not induce resumption of fluid flow. Even at the bedside, energy is the key to understanding ICP and fluid dynamics.

  3. Intracranial CSF flow on cine-MR. 2. Qualitative analysis in CSF dynamics by MR signal ratio of CSF to fat tissue in healthy subjects and patients with aqueduct stenosis

    International Nuclear Information System (INIS)

    Kadowaki, Chikafusa; Hara, Mitsuhiro; Takeuchi, Kazuo; Saito, Isamu

    1994-01-01

    Changes in MR signal intensities (SIs) of CSF and relative MR signal ratios (SRs) of intraventricular CSF to fat tissue were evaluated in 5 healthy adults on cine MR images during a cardiac cycle in a study of normal intracranial CSF dynamics. The altered patterns of MR SIs and SRs in 6 patients with aqueduct stenosis were compared with normal CSF flow patterns in a demonstration of CSF dynamics changes. MR SIs of CSF within the ventricles were measured on each cine image obtained by cardiac gated, multiframe, cine MR imaging. Chronological changes in MR SIs and SRs during a cardiac cycle were compared with the actual CSF flow visualized on real cine images. In normal CSF circulation, MR SIs of CSF within the ventricles were reduced quickly following an R-wave on ECG to 15% of the R-R interval, after which SIs fluctuated slightly. These changes in MR SIs of CSF could only be related to the pulsatile CSF flow through the foramen of Monro into the anterior part of the third ventricle during early cardiac systole. MR SRs of CSF to fat tissue fluctuated according to the actual CSF flow within the ventricles during a cardiac cycle. MR SRs in the third ventricle decreased to 20-30% of the R-R interval following the R-wave due to downward CSF flow during early cardiac systole, and decreased again from late cardiac systole to diastole due to caudal CSF flow in the third ventricle. In the fourth ventricle, MR SRs of CSF decreased to 60-80% of the R-R interval because of the CSF flow through the aqueduct during cardiac diastole. In patients with aqueduct stenosis, MR SRs of CSF within the ventricles fluctuated randomly, and the amplitude of MR SRs was also greater than in subjects with a patent aqueduct. These changes were identified as turbulence and stagnation due to obstruction in the CSF pathway. Analysis of chronological changes in MR signal ratios of CSF to fat is useful in demonstrating the pathophysiologic features of intracranial CSF dynamics. (author) 52 refs

  4. Qualitative analysis of intracranial CSF flow on cine-MR imaging, with special reference to signal ratio of CSF to fat tissue

    International Nuclear Information System (INIS)

    Kadowaki, Chikafusa; Hara, Mitsuhiro; Numoto, Mitsuo; Takeuchi, Kazuo; Saito, Isamu

    1993-01-01

    Cine magnetic resonance images (MR) dramatically demonstrate the pulsatile flow of cerebrospinal fluid (CSF) stimulated by the pulsatile motion of the brain following cardiac pulsation. Reduced signal intensity, frequently observed especially in the aqueduct of Sylvius, the third ventricle and the fourth ventricle, is believed to reflect the pulsatile motion of the CSF. Qualitative analysis of MR signal intensity of CSF on each cine frame is compared with CSF flow within the ventricles on real-time cine MR images. While the chronological changes in signal intensities of CSF within the ventricles show only marginal changes in signal intensity in the third ventricle related to downward flow of CSF passing through the foramen of Monro during the early stage of cardiac systole, these changes are thought to have no significant correlation with the CSF flow in the CSF pathway. The chronological changes in relative signal ratios, SR [signal intensities of CSF/signal intensities of fat] can show CSF flow and turbulence within the ventricles. Under normal conditions, within the third ventricle the SR decreases due to pulsatile CSF flow through the foramen of Monro during the early stage of cardiac systole, and decreases because of the flow of CSF from the anterior to the posterior part of the third ventricle, the downward flow of CSF through the aqueduct leads to a lower SR during cardiac diastole. These changes in the fourth ventricle are stimulated by the changes in SR in the third ventricle. The new method of analyzing chronological changes in the relative MR signal ratio of CSF to fat [SR] has the distinct advantage of providing an accurate evaluation of CSF dynamics, and it provides us with important diagnostic information leading to clarification of the pathophysiology of CSF dynamics. (author)

  5. SPAMM, cine phase contrast imaging and fast spin-echo T2-weighted imaging in the study of intracranial cerebrospinal fluid (CSF) flow

    International Nuclear Information System (INIS)

    Connor, S.E.J.; O'Gorman, R.; Summers, P.; Simmons, A.; Moore, E.M.; Chandler, C.; Jarosz, J.M.

    2001-01-01

    AIM: To compare the qualitative assessment of cerebrospinal fluid (CSF) flow using a SPAMM (spatial modulation of magnetization) technique with cine phase contrast images (cine PC) and fast spin echo (FSE) T2-weighted images. MATERIALS AND METHODS: SPAMM, PC and T2-weighted sequences were performed on 22 occasions in 19 patients. Eleven of the studies were performed following a neuroendoscopic third ventriculostomy (NTV), and in these cases, the success of the NTV was determined by clinical follow-up. Two observers used consensus to grade the presence of CSF flow at nine different sites for each study. RESULTS: At 14 of the 178 matched sites, which could be assessed by both SPAMM and cine PC, SPAMM CSF flow grade was higher than that of cine PC. At a further 14/178 matched sites, the cine PC grade was higher than that of SPAMM. There was definite CSF flow at 113/182 (62%) of all the cine PC sites assessed, and 110/181 (61%) of all SPAMM sites assessed whilst 108/198 (54%) of FSE T2-weighted image sites demonstrated flow voids. Cine PC grades were higher than SPAMM at the cerebral aqueduct (P < 0.05, Wilcoxon sign rank test). Definite CSF flow within the anterior third ventricle was present in 4/5 (SPAMM) and 3/5 (cine PC) successful NTVs, 0/2 (SPAMM and cine PC) unsuccessful NTVs and 1/10 (SPAMM and cine PC) patients without NTV. CONCLUSION: SPAMM provides a comparable assessment of intracranial CSF flow to that of cine phase contrast imaging at all CSF sites except the cerebral aqueduct. Connor, S.E.J. et al. (2001)

  6. Cine-MR imaging in determining the flow characteristics of CSF and blood in spinal and intracranial lesions

    International Nuclear Information System (INIS)

    Post, M.J.D.; Quencer, R.M.; Green, B.A.; Hinks, R.S.; Sklar, E.M.L.; Patchen, S.J.

    1988-01-01

    The purpose of this prospective study was to determine the value of cine magnetic resonance (MR) imaging in assessing the flow patterns of patients with vascular cord neoplasms, spinal cord and subarachnoid cysts, obstructive hydrocephalus, and intracranial aneurysms. The authors' results in 26 patients showed that cine MR imaging can be used to (1) identify spinal neoplasms with prominent vascular supply; (2) help distinguish spinal cord cysts occurring above a spinal cord tumor from tumoral cysts; (3) determine which spinal cord or subarachnois cysts need shunting and, postoperatively, which cysts are adequately decompressed; (4) establish which tonsillar herniations in Chiari malformations may require resection; (5) determine the site of the block in obstructive hydrocephalus; and (6) determine the flow characteristics of an aneurysm

  7. Assessment of CSF dynamics and venous flow in the superior sagittal sinus by MRI in idiopathic intracranial hypertension: a preliminary study

    DEFF Research Database (Denmark)

    Gideon, P; Sørensen, P S; Thomsen, C

    1994-01-01

    A velocity-sensitive magnetic resonance imaging (MRI) phase-mapping method was used for non-invasive study of cerebrospinal fluid (CSF) flow in the cerebral aqueduct, for indirect calculation of supratentorial CSF production, and for measurement of blood flow in the superior sagittal sinus (SSS......, the MRI measurements suggested CSF hypersecretion in three patients, whereas increased transependymal passage of CSF could have been the cause of negative calculated CSF production rates in two others. A tendency towards lower mean blood flow in the SSS (mean 345 ml/min) in the patients than...

  8. Radiologic assessment of spinal CSF leakage in spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Han, Chang Jin; Kim, Ji Hyung; Kim, Jang Sung; Kim, Sun Yong; Suh, Jung Ho

    1999-01-01

    To assess the usefulness of imaging modalities in the detection of spinal CSF leakage in spontaneous intracranial hypotension. Fifteen patients who complained of postural headache without any preceding cause showed typical brain MR findings of intracranial hypotension, including radiologically confirmed CSF leakage. All fifteen underwent brain MRI and radionuclide cisternography. CT myelography was performed in eight patients and spinal MRI in six. Medical records, imaging findings and the incidence of spinal CSF leakage during each modality were retrospectively reviewed. CSF leakage was most common at the cervicothoracic junction, where in seven of 15 cases it was seen on radionuclide cisternography as increased focal paraspinal activity. Leakage was noted at the mid-tho-racic level in three patients, at the upper thoracic level in two, and at the cervical and lumbar levels in the remaining two. In two patients multiple CSF leaks were noted, and in all, early radioactive accumulation in the bladder was visualized. CT myelography revealed extrathecal and paraspinal contrast leakage in three of eight patients, and among those who underwent spinal MRI, dural enhancement was observed at the site of CSF leakage in all six, abnormal CSF signal in the neural foramen in one, and epidural CSF collection in one. Radionuclide cisternography is a useful method for the detection of CSF leakage in spontaneous intracranial hypotension. CT myelography and spinal MRI help determine the precise location of leakage

  9. On the pulsatile nature of intracranial and spinal CSF-circulation demonstrated by MR imaging

    International Nuclear Information System (INIS)

    Greitz, D.; Franck, A.; Nordell, B.

    1993-01-01

    Cerebrospinal fluid (CSF) flow was studied in 24 healthy volunteers using gated MR phase imaging. The subarachnoid space (SAS) was divided into 5 compartments depending on the magnitude of the pulsatile CSF flows: a high velocity compartment in the area of the brain stem and spinal cord, 2 slow ones at the upper and lower extremes of the SAS, and finally 2 intermediate velocity compartments in between. The main pulsatile spinal flow channel had a meandering pattern. The extraventricular CSF-circulation can be explained by pulsatile CSF flow without the necessity of assuming existence of a net flow. A successive time offset during the cardiac cycle has been found in the fronto-occipital direction of the interplay between the arterial expansion, brain expansion, volume changes of the CSF spaces and of the veins. It is proposed to name this time offset the intracranial ''volume wave'' (VoW). (orig.)

  10. Observation of the CSF pulsatile flow on MRI, (2)

    International Nuclear Information System (INIS)

    Ohara, Shigeki; Nagai, Hajime; Suzuka, Tomonao; Matsumoto, Takashi; Banno, Tatsuo

    1988-01-01

    In a retrospective study of the MR images of 289 neurosurgical patients, a loss of the signal intensity (the signal-void phenomenon =SVP) of the cerebrospinal fluid in the mesencephalic aqueduct was observed in 77 patients. The CSF in the cranial cavity flows toward the spinal sac in a to-and-fro manner in response to the pulsations of the brain. Because the intracranial compliance is lower than the intraspinal compliance, the systolic expansions and diastolic reductions in the brain volume are buffered by the spinal cavity via this to-and-fro flow of CSF. The SVP reflects the CSF pulsatile flow forced out of the intracranial space into the intraspinal space by the brain's pulsations. Intracranial abnormalities can be divided into two categories according to the craniospinal compliance (CC): normal CC (communicating hydrocephalus) and decreased CC (supratentorial tumor). We may expect those conditions which increase compliance to increase the CSF flow and yield a more prominent SVP. Conversely, conditions which decrease compliance may be expected to decrease the flow and extinguish the SVP. Both the brain's pulsations and the compliance of the craniospinal cavity are closely related to the presence of the SVP in CSF, as revealed by MRI. The SVP in CSF may reflect the pressure-buffering capacity of the cranio-spinal cavity. If further investigation supports our hypothesis, it may be possible to estimate the intracranial pressure noninvasively. (author)

  11. Proximal Limb Weakness Reverting After CSF Diversion In Intracranial Hypertension

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    Sinha S

    2005-01-01

    Full Text Available We report about two young girls who developed progressive visual failure secondary to increased intracranial pressure and had significant proximal muscle weakness of limbs. Patients with elevated intracranial pressure (ICP may present with "false localizing signs", besides having headache, vomiting and papilledema. Radicular pain as a manifestation of raised ICP is rare and motor weakness attributable to polyradiculopathy is exceptional. Two patients with increased intracranial pressure without lateralizing signs′ had singnificant muscle weakness. Clinical evaluation and laboratory tests did not disclose any other cause for weakness. Following theco-peritoneal shunt, in both patients, there was variable recovery of vision but the proximal weakness and symptoms of elevated ICP improved rapidly. Recognition of this uncommon manifestation of raised ICP may obviate the need for unnecessary investigation and reduce morbidity due to weakness by CSF diversion procedure.

  12. Mathematical Modelling of CSF Pulsatile Flow in Aqueduct Cerebri.

    Science.gov (United States)

    Czosnyka, Zofia; Kim, Dong-Joo; Balédent, Olivier; Schmidt, Eric A; Smielewski, Peter; Czosnyka, Marek

    2018-01-01

    The phase-contrast MRI technique permits the non-invasive assessment of CSF movements in cerebrospinal fluid cavities of the central nervous system. Of particular interest is pulsatile cerebrospinal fluid (CSF) flow through the aqueduct cerebri. It is allegedly increased in hydrocephalus, having potential diagnostic value, although not all scientific reports contain unequivocally positive conclusions. For the mathematical simulation of CSF flow, we used a computational model of cerebrospinal blood/fluid circulation designed by a former student as his PhD project. With this model, cerebral blood flow and CSF may be simulated in various vessels using a system of non-linear differential equations as time-varying signals. The amplitude of CSF flow seems to be positively related to the amplitude of pulse waveforms of intracranial pressure (ICP) in situations where mean ICP increases, such as during simulated infusion tests and following step increases of resistance to CSF outflow. An additional positive association between the pulse amplitude of ICP and CSF flow can be seen during simulated increases in the amplitude of arterial pulses (without changes in mean arterial pressure, MAP). The opposite effect can be observed during step increases in the resistance of the aqueduct cerebri and with decreasing elasticity of the system, where the CSF flow amplitude and the ICP pulse amplitude are related inversely. Vasodilatation caused by both gradual decreases in MAP and by increases in PaCO2 provokes an elevation in the observed amplitude of pulsatile CSF flow. Preliminary results indicate that the pulsations of CSF flow may carry information about both CSF-circulatory and cerebral vasogenic components. In most cases, the pulsations of CSF flow are positively related to the pulse amplitudes of both arterial pressure and ICP and to a degree of cerebrovascular dilatation.

  13. Relationship between intracranial pressure and antifungal agents levels in the CSF of patients with cryptococcal meningitis.

    Science.gov (United States)

    Wirth, Fernanda; de Azevedo, Maria Isabel; Pilla, Carmen; Aquino, Valério Rodrigues; Neto, Gustavo Wissmann; Goldani, Luciano Zubaran

    2018-04-01

    The purpose of this study was to evaluate the influence of intracranial hypertension in the cerebrospinal fluid (CSF) levels of amphotericin B and fluconazole levels of patients with cryptococcal meningitis. CSF samples and intracranial pressure were obtained by means of routine punctures performed at days 1, 7, and 14 of therapy, respectively. Amphotericin B and fluconazole CSF levels were measured by HPLC method as previously described. The minimum inhibitory concentration for amphotericin B, fluconazole, 5΄flucytosine, and voriconazole of each Cryptococcus isolate was performed according to CLSI. The predominant Cryptococcus species found was C. neoformans, and the major underlying condition was AIDS. Only one CSF sample had a detectable level for amphotericin B during the 14 days of therapy. Fluconazole CSF levels progressively increased from day 1 to day 14 of therapy for most cases. Fluconazole levels in the CSF were above the minimum inhibitory concentrations (MICs) for Cryptococcus during the initial 14 days of antifungal therapy. Variations of intracranial pressure did not affect amphotericin B and fluconazole levels in the CSF. The generalized estimating correlation (GEE) and Spearman correlation test (SCT) showed no significant correlation between the amphotericin B or fluconazole concentrations in the CSF and intracranial pressure (P = .953 and P = .093, respectively for GEE test and P = .477 and P = .847, respectively, for SCT). Combination therapy of amphotericin B with fluconazole was effective in 60% of the patients considering CSF cultures were negative in 9 of 15 patients after 14 days of therapy. Further studies are necessary to evaluate the role of intracranial hypertension on the therapeutic efficacy of different antifungal agents in patients with cryptococcal meningitis.

  14. CSF Venous Fistulas in Spontaneous Intracranial Hypotension: Imaging Characteristics on Dynamic and CT Myelography.

    Science.gov (United States)

    Kranz, Peter G; Amrhein, Timothy J; Gray, Linda

    2017-12-01

    The objective of this study is to describe the anatomic and imaging features of CSF venous fistulas, which are a recently reported cause of spontaneous intracranial hypotension (SIH). We retrospectively reviewed the records of patients with SIH caused by CSF venous fistulas who received treatment at our institution. The anatomic details of each fistula were recorded. Attenuation of the veins involved by the fistula was compared with that of adjacent control veins on CT myelography (CTM). Visibility of the CSF venous fistula on CTM and a modified conventional myelography technique we refer to as dynamic myelography was also compared. Twenty-two cases of CSF venous fistula were identified. The fistulas were located between T4 and L1. Ninety percent occurred without a concurrent epidural CSF leak. In most cases (82%), the CSF venous fistula originated from a nerve root sleeve diverticulum. On CTM, the abnormal veins associated with the CSF venous fistula were seen in a paravertebral location in 45% of cases, centrally within the epidural venous plexus in 32%, and lateral to the spine in 23%. Differences in attenuation between the fistula veins and the control veins was highly statistically significant (p CSF venous fistulas are an important cause of SIH that can be detected on both CTM and dynamic myelograph y and may occur without an epidural CSF leak. Familiarity with the imaging characteristics of these lesions is critical to providing appropriate treatment to patients with SIH.

  15. CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus.

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    Bradley, W G

    2015-05-01

    CSF normally flows back and forth through the aqueduct during the cardiac cycle. During systole, the brain and intracranial vasculature expand and compress the lateral and third ventricles, forcing CSF craniocaudad. During diastole, they contract and flow through the aqueduct reverses. Hyperdynamic CSF flow through the aqueduct is seen when there is ventricular enlargement without cerebral atrophy. Therefore, patients presenting with clinical normal pressure hydrocephalus who have hyperdynamic CSF flow have been found to respond better to ventriculoperitoneal shunting than those with normal or decreased CSF flow. Patients with normal pressure hydrocephalus have also been found to have larger intracranial volumes than sex-matched controls, suggesting that they may have had benign external hydrocephalus as infants. While their arachnoidal granulations clearly have decreased CSF resorptive capacity, it now appears that this is fixed and that the arachnoidal granulations are not merely immature. Such patients appear to develop a parallel pathway for CSF to exit the ventricles through the extracellular space of the brain and the venous side of the glymphatic system. This pathway remains functional until late adulthood when the patient develops deep white matter ischemia, which is characterized histologically by myelin pallor (ie, loss of lipid). The attraction between the bare myelin protein and the CSF increases resistance to the extracellular outflow of CSF, causing it to back up, resulting in hydrocephalus. Thus idiopathic normal pressure hydrocephalus appears to be a "2 hit" disease: benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood. © 2015 by American Journal of Neuroradiology.

  16. The Connected Steady State Model and the Interdependence of the CSF Proteome and CSF Flow Characteristics.

    Science.gov (United States)

    Metzger, Fabian; Mischek, Daniel; Stoffers, Frédéric

    2017-01-01

    Here we show that the hydrodynamic radii-dependent entry of blood proteins into cerebrospinal fluid (CSF) can best be modeled with a diffusional system of consecutive interdependent steady states between barrier-restricted molecular flux and bulk flow of CSF. The connected steady state model fits precisely to experimental results and provides the theoretical backbone to calculate the in-vivo hydrodynamic radii of blood-derived proteins as well as individual barrier characteristics. As the experimental reference set we used a previously published large-scale patient cohort of CSF to serum quotient ratios of immunoglobulins in relation to the respective albumin quotients. We related the inter-individual variances of these quotient relationships to the individual CSF flow time and barrier characteristics. We claim that this new concept allows the diagnosis of inflammatory processes with Reibergrams derived from population-based thresholds to be shifted to individualized judgment, thereby improving diagnostic sensitivity. We further use the source-dependent gradient patterns of proteins in CSF as intrinsic tracers for CSF flow characteristics. We assume that the rostrocaudal gradient of blood-derived proteins is a consequence of CSF bulk flow, whereas the slope of the gradient is a consequence of the unidirectional bulk flow and bidirectional pulsatile flow of CSF. Unlike blood-derived proteins, the influence of CSF flow characteristics on brain-derived proteins in CSF has been insufficiently discussed to date. By critically reviewing existing experimental data and by reassessing their conformity to CSF flow assumptions we conclude that the biomarker potential of brain-derived proteins in CSF can be improved by considering individual subproteomic dynamics of the CSF system.

  17. Continuous monitoring of intracranial pressure after endoscopic third ventriculostomy in the management of CSF shunt failure.

    Science.gov (United States)

    Elgamal, E A

    2010-04-01

    The effectiveness of continuous intracranial pressure (ICP) monitoring in the adaptation period, after endoscopic third ventriculostomy (ETV), and removal of the failed shunt in the management of CSF shunt failure is assessed. Nine patients with active hydrocephalus presenting with CSF shunt obstruction or infection were managed by ETV, removal of the shunt and insertion of an external ventricular drain (EVD) containing an ICP sensor for the purpose of postoperative monitoring of the ICP, and intermittent drainage of CSF. Patient ages ranged from 8 months to 24 years, and six of them were females. Hydrocephalus was obstructive in seven patients, and multiloculated in two. Six patients had an ventriculoperitoneal shunt (VPS), one with a bilateral VPS, one patient had a ventriculoatrial shunt, and one had a VPS and cystoperitoneal shunt (CPS). Shunt failure was caused by obstruction in six patients and infection in three. The post-operative ICP monitoring period ranged from 1-7 days. Intracranial hypertension was persistent in the first day after ETV in 3 patients, and up to 110 mL of CSF were drained to improve its symptoms. ETV was successful in six patients and 3 had permanent VPS. Post-operative continuous ICP monitoring and EVD insertion were very useful in the treatment of CSF shunt failure with ETV. This procedure allowed intermittent CSF drainage, relieving symptoms of elevated ICP, and provided accurate assessment of the success of the ETV and patency of the stoma in the early postoperative days by CT ventriculography and can also be used to install antibiotics in cases of infection.

  18. Frequency analyses of CSF flow on cine MRI in normal pressure hydrocephalus

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    Miyati, Tosiaki; Kasuga, Toshio; Koshida, Kichiro; Sanada, Shigeru; Onoguchi, Masahisa [Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, Ishikawa 920-0942 (Japan); Mase, Mitsuhito; Yamada, Kazuo [Department of Neurosurgery, Nagoya City University Medical School, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8602 (Japan); Banno, Tatsuo [Department of Central Radiology, Nagoya City University Hospital, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8602 (Japan); Fujita, Hiroshi [Department of Information Science, Faculty of Engineering, Gifu University, Yanagido 1-1, Gifu 501-1193 (Japan)

    2003-05-01

    Our objective was to clarify intracranial cerebrospinal fluid (CSF) flow dynamics in normal-pressure hydrocephalus (NPH). Frequency analyses of CSF flow measured with phase-contrast cine MRI were performed. The CSF flow spectra in the aqueduct were determined in patients (n=51) with NPH, brain atrophy or asymptomatic ventricular dilation (VD), and in healthy volunteers (control group; n=25). The changes in CSF flow spectra were also analyzed after intravenous injection of acetazolamide. Moreover, a phase transfer function (PTF) calculated from the spectra of the driving vascular pulsation and CSF flow in the aqueduct were assessed. These values were compared with the pressure volume response (PVR). The amplitude in the NPH group was significantly larger than that in the VD or control group because of a decrease in compliance. The phase in the NPH group was significantly different from that in either the VD or the control group, but no difference was found between the VD and control groups. The amplitude increased in all groups after acetazolamide injection. The PTF in the NPH group was significantly larger than in the control group, and a positive correlation was noted between PTF and PVR. Frequency analyses of CSF flow measured by cine MRI make it possible to noninvasively obtain a more detailed picture of the pathophysiology of NPH. (orig.)

  19. [Intracranial pressure monitoring and CSF dynamics in patients with neurological disorders: indications and practical considerations].

    Science.gov (United States)

    Poca, M; Sahuquillo, J

    2001-01-01

    The study of cerebrospinal fluid (CSF) dynamics is central to the diagnosis of adult chronic hydrocephalus (ACH). At present, many neurology and neurosurgery departments use one or more tests to guide diagnosis of this syndrome and to predict patient response to shunting. In specialised centres, the study of CSF dynamics is combined with continuous intracranial pressure (ICP) monitoring. Determination of several variables of CSF dynamics and definitions of qualitative and quantitative characteristics of ICP can be used to establish whether the hydrocephalus is active, compensated or arrested. CSF dynamics and ICP monitoring can also be used to check the correct functioning of the shunt and can be of use in the clinical management of patients with pseudotumor cerebri. Moreover, ICP monitoring is used to guide the treatment of several acute neurological processes. The aim of this review is to describe the fundamentals of CSF dynamics studies and the bases of continuous ICP monitoring. The advantages and disadvantages of several hydrodynamic tests that can be performed by lumbar puncture, as well as the normal and abnormal characteristics of an ICP recording, are discussed.

  20. Respiration and the watershed of spinal CSF flow in humans.

    Science.gov (United States)

    Dreha-Kulaczewski, Steffi; Konopka, Mareen; Joseph, Arun A; Kollmeier, Jost; Merboldt, Klaus-Dietmar; Ludwig, Hans-Christoph; Gärtner, Jutta; Frahm, Jens

    2018-04-04

    The dynamics of human CSF in brain and upper spinal canal are regulated by inspiration and connected to the venous system through associated pressure changes. Upward CSF flow into the head during inspiration counterbalances venous flow out of the brain. Here, we investigated CSF motion along the spinal canal by real-time phase-contrast flow MRI at high spatial and temporal resolution. Results reveal a watershed of spinal CSF dynamics which divides flow behavior at about the level of the heart. While forced inspiration prompts upward surge of CSF flow volumes in the entire spinal canal, ensuing expiration leads to pronounced downward CSF flow, but only in the lower canal. The resulting pattern of net flow volumes during forced respiration yields upward CSF motion in the upper and downward flow in the lower spinal canal. These observations most likely reflect closely coupled CSF and venous systems as both large caval veins and their anastomosing vertebral plexus react to respiration-induced pressure changes.

  1. Interpretation and value of MR CSF flow studies for paediatric ...

    African Journals Online (AJOL)

    Imaging techniques may be underutilised when clinicians are unaware of the technique or do not recognise its potential. Phase-contrast MR imaging (PC-MRI) is a rapid, simple and non-invasive technique that is sensitive to CSF flow. It demonstrates a mechanical coupling between cerebral blood and CSF flow throughout ...

  2. Frequency analysis of CSF flow on cine-MRI in normal pressure hydrocephalus

    International Nuclear Information System (INIS)

    Miyati, Tosiaki; Kasuga, Toshio; Imai, Hiroshi; Fujita, Hiroshi; Mase, Mitsuhito; Itikawa, Katuhiro

    2001-01-01

    To clarify the flow dynamics of intracranial cerebrospinal fluid (CSF) in normal pressure hydrocephalus (NPH), frequency analyses of CSF flow measured with an ECG-gated phase contrast cine magnetic resonance imaging (MRI) were performed. The amplitude and phase in the CSF flow spectra in the aqueduct were determined in patients with NPH after a subarachnoid hemorrhage (SAH-NPH group, n=26), an idiopathic NPH (I-NPH group, n=4), an asymptomatic ventricular dilation or a brain atrophy (VD group, n=21), and in healthy volunteers (control group, n=25). The changes of CSF flow spectra were also analyzed 5 and 15 minutes after an intravenous injection of acetazolamide. Moreover, a phase transfer function (PTF) calculated from the spectra of the driving vascular pulsation and CSF flow in the aqueduct were assessed in patients with SAH-NPH and control groups before and after acetazolamide injection. There values were compared with the pressure volume response (PVR). The amplitude of the 1st-3rd harmonics in the SAH-NPH or I-NPH group was significantly larger than in the control or VD group because of a decrease in compliance (increase in PVR). The phase of the 1st harmonic in the SAH-NPH group was significantly different from that in the control or VD group, but no difference was found between the control and VD groups. The amplitude of the 0-3rd harmonics increased, and the phase of the 1st harmonic changed in all groups after an acetazolamide injection. An evaluation of the time course of the direct current of CSF flow provided further information about the compensatory faculty of the cerebrospinal cavity. A PTF of the 1st harmonic in the SAH-NPH group was significantly larger than in the control group, and a positive correlation was noted between PTF of the 1st harmonic and PVR. In conclusion, frequency analyses of CSF flow measured by cine-MRI make it possible to obtain noninvasively a more detailed picture of the pathophysiology of NPH and of changes in intracranial

  3. Frequency analysis of CSF flow on cine-MRI in normal pressure hydrocephalus

    Energy Technology Data Exchange (ETDEWEB)

    Miyati, Tosiaki; Kasuga, Toshio; Imai, Hiroshi [Kanazawa Univ. (Japan). School of Medicine; Fujita, Hiroshi; Mase, Mitsuhito; Itikawa, Katuhiro

    2001-09-01

    To clarify the flow dynamics of intracranial cerebrospinal fluid (CSF) in normal pressure hydrocephalus (NPH), frequency analyses of CSF flow measured with an ECG-gated phase contrast cine magnetic resonance imaging (MRI) were performed. The amplitude and phase in the CSF flow spectra in the aqueduct were determined in patients with NPH after a subarachnoid hemorrhage (SAH-NPH group, n=26), an idiopathic NPH (I-NPH group, n=4), an asymptomatic ventricular dilation or a brain atrophy (VD group, n=21), and in healthy volunteers (control group, n=25). The changes of CSF flow spectra were also analyzed 5 and 15 minutes after an intravenous injection of acetazolamide. Moreover, a phase transfer function (PTF) calculated from the spectra of the driving vascular pulsation and CSF flow in the aqueduct were assessed in patients with SAH-NPH and control groups before and after acetazolamide injection. There values were compared with the pressure volume response (PVR). The amplitude of the 1st-3rd harmonics in the SAH-NPH or I-NPH group was significantly larger than in the control or VD group because of a decrease in compliance (increase in PVR). The phase of the 1st harmonic in the SAH-NPH group was significantly different from that in the control or VD group, but no difference was found between the control and VD groups. The amplitude of the 0-3rd harmonics increased, and the phase of the 1st harmonic changed in all groups after an acetazolamide injection. An evaluation of the time course of the direct current of CSF flow provided further information about the compensatory faculty of the cerebrospinal cavity. A PTF of the 1st harmonic in the SAH-NPH group was significantly larger than in the control group, and a positive correlation was noted between PTF of the 1st harmonic and PVR. In conclusion, frequency analyses of CSF flow measured by cine-MRI make it possible to obtain noninvasively a more detailed picture of the pathophysiology of NPH and of changes in intracranial

  4. Cine-MR imaging aqueductal CSF flow in normal pressure hydrocephalus syndrome before and after CSF shunt

    International Nuclear Information System (INIS)

    Mascalchi, M.; Arnetoli, G.; Inzitari, D.; Dal Pozzo, G.; Lolli, F.; Caramella, D.; Bartolozzi, C.

    1993-01-01

    Reproducibility of the aqueductal CSF signal intensity on a gradient echo cine-MR sequence exploiting through plane inflow enhancement was tested in 11 patients with normal or dilated ventricles. Seven patients with normal pressure hydrocephalus (NPH) syndrome were investigated with the sequence before and after CSF shunting. Two patients exhibiting central flow void within a hyperintense aqueductal CSF improved after surgery and the flow void disappeared after shunting. One patient with increased maximum and minimum aqueductal CSF signal as compared to 18 healthy controls also improved and the aqueductal CSF signal was considerably decreased after shunting. Three patients with aqueductal CSF values similar to those in the controls did not improve, notwithstanding their maximum aqueductal CSF signals decreasing slightly after shunting. No appreciable aqueductal CSF flow related enhancement consistent with non-communicating hydrocephalus was found in the last NPH patient who improved after surgery. Cine-MR with inflow technique yields a reproducible evaluation of flow-related aqueductal CSF signal changes which might help in identifying shunt responsive NPH patients. These are likely to be those with hyperdynamic aqueductal CSF or aqueductal obstruction. (orig.)

  5. The Value of Changing Position in the Detection of CSF Leakage in Spontaneous Intracranial Hypotension Using Tc-99m DTPA Scintigraphy: Two Case Reports.

    Science.gov (United States)

    Lu, Yu Yu; Wang, Hsin Yi; Lin, Ying; Lin, Wan Yu

    2012-09-01

    Radionuclide Cisternography (RNC) is of potential value in pointing out the sites of cerebrospinal fluid (CSF) leakage in patients with spontaneous intracranial hypotension (SIH). In the current report, we present two patients who underwent RNC for suspected CSF leakage. Both patients underwent magnetic resonance imaging (MRI) and RNC for evaluation. We describe a simple method to increase the detection ability of RNC for CSF leakage in patients with SIH.

  6. REVIEW Interpretation and value of MR CSF flow studies for ...

    African Journals Online (AJOL)

    children should be able to request this procedure from any MR imaging department, and should ... on all modern 1.5T scanners equipped with standard software and phase contrast magnetic resonance (PCMR) capabilities and analysis packages. .... Follow-up imaging demonstrates change in CSF flow to a unidirectional.

  7. Cerebral blood flow and intracranial pulsatility studied with MRI: measurement, physiological and pathophysiological aspects

    Energy Technology Data Exchange (ETDEWEB)

    Waahlin, Anders

    2012-07-01

    During each cardiac cycle pulsatile arterial blood inflates the vascular bed of the brain, forcing cerebrospinal fluid (CSF) and venous blood out of the cranium. Excessive arterial pulsatility may be part of a harmful mechanism causing cognitive decline among elderly. Additionally, restricted venous flow from the brain is suggested as the cause of multiple sclerosis. Addressing hypotheses derived from these observations requires accurate and reliable investigational methods. This work focused on assessing the pulsatile waveform of cerebral arterial, venous and CSF flows. The overall aim of this dissertation was to explore cerebral blood flow and intracranial pulsatility using MRI, with respect to measurement, physiological and pathophysiological aspects.Two-dimensional phase contrast magnetic resonance imaging (2D PCMRI) was used to assess the pulsatile waveforms of cerebral arterial, venous and CSF flow. The repeatability was assessed in healthy young subjects. The 2D PCMRI measurements of cerebral arterial, venous and CSF pulsatility were generally repeatable but the pulsatility decreased systematically during the investigation. A method combining 2D PCMRI measurements with invasive CSF infusion tests to determine the magnitude and distribution of compliance within the craniospinal system was developed and applied in a group of healthy elderly. The intracranial space contained approximately two thirds of the total craniospinal compliance. The magnitude of craniospinal compliance was less than suggested in previous studies. The vascular hypothesis for multiple sclerosis was tested. Venous drainage in the internal jugular veins was compared between healthy controls and multiple sclerosis patients using 2D PCMRI. For both groups, a great variability in the internal jugular flow was observed but no pattern specific to multiple sclerosis could be found. Relationships between regional brain volumes and potential biomarkers of intracranial cardiac-related pulsatile

  8. Cerebral blood flow and intracranial pulsatility studied with MRI: measurement, physiological and pathophysiological aspects

    International Nuclear Information System (INIS)

    Waahlin, Anders

    2012-01-01

    During each cardiac cycle pulsatile arterial blood inflates the vascular bed of the brain, forcing cerebrospinal fluid (CSF) and venous blood out of the cranium. Excessive arterial pulsatility may be part of a harmful mechanism causing cognitive decline among elderly. Additionally, restricted venous flow from the brain is suggested as the cause of multiple sclerosis. Addressing hypotheses derived from these observations requires accurate and reliable investigational methods. This work focused on assessing the pulsatile waveform of cerebral arterial, venous and CSF flows. The overall aim of this dissertation was to explore cerebral blood flow and intracranial pulsatility using MRI, with respect to measurement, physiological and pathophysiological aspects.Two-dimensional phase contrast magnetic resonance imaging (2D PCMRI) was used to assess the pulsatile waveforms of cerebral arterial, venous and CSF flow. The repeatability was assessed in healthy young subjects. The 2D PCMRI measurements of cerebral arterial, venous and CSF pulsatility were generally repeatable but the pulsatility decreased systematically during the investigation. A method combining 2D PCMRI measurements with invasive CSF infusion tests to determine the magnitude and distribution of compliance within the craniospinal system was developed and applied in a group of healthy elderly. The intracranial space contained approximately two thirds of the total craniospinal compliance. The magnitude of craniospinal compliance was less than suggested in previous studies. The vascular hypothesis for multiple sclerosis was tested. Venous drainage in the internal jugular veins was compared between healthy controls and multiple sclerosis patients using 2D PCMRI. For both groups, a great variability in the internal jugular flow was observed but no pattern specific to multiple sclerosis could be found. Relationships between regional brain volumes and potential biomarkers of intracranial cardiac-related pulsatile

  9. CSF flow: Correlation between signal void and CSF velocity measured by gated velocity phase-encoded MR imaging

    International Nuclear Information System (INIS)

    Mark, A.S.; Feinberg, D.A.

    1986-01-01

    The direction of the cerebrospinal fluid (CSF) flow in the foramen of Monro (FOM) and aqueduct was determined in 15 normal volunteers (5 of whom had also been studied with gated spin-echo sequences) using a cardiac-gated Fourier transform velocity imaging technique (VMR). The VMR showed that the periodic pattern of flow void seen in the aqueduct and FOM on the gated spin-echo images was due to antegrade CSF flow from the lateral ventricles into the third ventricle and aqueduct during systole and retrograde flow from the aqueduct into the third ventricle and lateral ventricles during late diastole. These findings could not be explained if the CSF pulsations originated in the third ventricle, as had been previously proposed, and suggest the lateral ventricles play an important role in the pulsatile motion of CSF

  10. The blood flow changes associated with idiopathic and secondary intracranial hypertension

    International Nuclear Information System (INIS)

    Bateman, G.

    2002-01-01

    Full text: The radiological diagnosis of idiopathic intracranial hypertension (IIH) is one of exclusion and as the MR venogram is prone to flow artefacts, the diagnosis of secondary intracranial hypertension (SIH) can also be problematic. The purpose of this paper is to define the blood flow characteristics, which are useful in the diagnosis of these conditions. Twelve patients with clinical findings suggestive of IIH and 12 control subjects were investigated with MR venography and MR flow quantification studies of the cerebral arteries and veins. Total cerebral blood flow, superior sagittal sinus (SSS) and straight sinus (ST) blood flows were measured. MR venography confirmed 7 of the 12 patients had venous outflow obstruction and thus SIH. The remaining 5 patients had IIH. The control patients mean total blood flow was 855 ml/min, the SSS flow was 400ml/min and the ST flow 117 ml/min. The total blood flow in the IIH patients was 46% higher (P = 0.0002) and the ST blood flow 38% higher (P = 0.05) than the control group, the SSS flow was 17% higher but this failed to reach significance. In SIH the SSS flow was reduced by 25% (P = 0.003) compared with the control group, the total and ST blood flow were not significantly altered. In IIH there is hyperaemia and the SSS appears limited in its ability to increase flow, therefore venous collaterals carry a greater load. In SIH, selective obstruction of the SSS reduces flow in this vessel but total blood flow is normal indicating there is also increased flow in collateral veins. Presumably the limited ability of the SSS to drain blood away from the brain in each condition raises venous sinus pressure and alters CSF resorption giving raised CSF pressure. Copyright (2002) Blackwell Science Pty Ltd

  11. False localizing sign of cervico-thoracic CSF leak in spontaneous intracranial hypotension.

    Science.gov (United States)

    Schievink, Wouter I; Maya, M Marcel; Chu, Ray M; Moser, Franklin G

    2015-06-16

    Spontaneous spinal CSF leaks are an important cause of new-onset headaches. Such leaks are reported to be particularly common at the cervico-thoracic junction. The authors undertook a study to determine the significance of these cervico-thoracic CSF leaks. The patient population consisted of a consecutive group of 13 patients who underwent surgery for CSF leak repair based on CT myelography showing CSF extravasation at the cervico-thoracic junction but without any evidence of an underlying structural lesion. The mean age of the 9 women and 4 men was 41.2 years. Extensive extrathecal longitudinal CSF collections were demonstrated in 11 patients. At surgery, small leaking arachnoid cysts were found in 2 patients. In the remaining 11 patients, no clear source of CSF leakage could be identified at surgery. Resolution of symptoms was achieved in both patients with leaking arachnoid cysts, but in only 3 of the 11 patients with negative intraoperative findings. Postoperative spinal imaging was performed in 9 of the 11 patients with negative intraoperative findings and showed persistence of the longitudinal intraspinal extradural CSF. Further imaging revealed the site of the CSF leak to be ventral to the thoracic spinal cord. Five of these patients underwent microsurgical repair of the ventral CSF leak with resolution of symptoms in all 5 patients. Cervico-thoracic extravasation of dye on myelography does not necessarily indicate the site of the CSF leak. Treatment directed at this site should not be expected to have a high probability of sustained improvement of symptoms. © 2015 American Academy of Neurology.

  12. Magentic resonance imaging and characterization of normal and abnormal intracranial cerebrospinal fluid (CSF) spaces: Initial observations

    International Nuclear Information System (INIS)

    Brant-Zawadzki, M.; Kelly, W.; Kjos, B.; Newton, T.H.; Norman, D.; Dillon, W.; Sobel, D.

    1985-01-01

    A retrospective review of twenty-five normal MRI brain studies performed with the spin-echo technique focused special attention on the ventricular and extraventricular cerebrospinal fluid (CSF) and revealed unique signal intensity characteristics in the two locations. In addition, MRI studies of ten patients with abnormal extraaxial fluid collections either missed with CT or indistinguishable from CSF on CT images were also analyzed. MRI is more sensitive when compared to CT in evaluating the composition of CSF. Unique signal intensity characterizes the two major CSF compartments and presumably reflects their known but subtle difference in protein concentration (10-15 mg%). Normal variant or abnormal developmental fluid collections can be better characterized with MRI than with CT. These preliminary observations are offered in view of their implications for patient management and suggest further investigation. (orig.)

  13. Cine MR CSF flow study in hydrocephalus: What are the valuable parmeters?

    International Nuclear Information System (INIS)

    Choi, Hye Young; Kim, Myung Hyun

    1997-01-01

    To evaluate the changes in diagnosis of intracranial cerebrospinal fluid (CSF) dynamics in the hydrocephalus, we studied the various parameters of cine phase contrast (PC) magnetic resonance (MR) CSF flow images in cases of acutely progressive hydrocephalus, comparing them with those in normal CSF circulation. The MR images were obtained with a 1.5T (GE Signa, GE Medical Systems, Milwaukee, USA) unit using the 2 dimensional cine PC sequence with peripheral gating and gradient recalled echo imaging in ten cases of non-obstructive hydrocephalus(NOH), three of obstructive hydrocephalus(OH), and ten controls. The time-echo time-flip angle employed were 50 to 80 msec-11 to 15 msec-12 to 15 degrees. Temporal velocity information relating to cervical pericord CSF spaces, third and fourth ventricles, and the aqueduct were plotted as wave forms which were then analyzed for configuration, amplitude parameters(Vmax, Vmin, Vdif), and temporal parameters(R-S, R-SMV, R-D, R-DMV). The statistical significance of each parameter was examined using the paired t-test. All patients with OH underwent endoscopic third ventriculostomy, whereas all with NOH underwent shunting procedures. In five ROIs, distinct reproducible configuration features were obtained at aqueduct and cervical pericord spaces, but not at ventricular levels. We determined the statistically significant differences between controls and hydrocephalus patients using temporal, rather than amplitude parameters. In NOH, the graph showed R-DMV shortening (p<0.01) at the anterior cervical pericord space. In OH, there were R-DMV shortening (p<0.05) was seen at the anterior cervical pericord space, and R-DMV shortening (p<0.02) at the posterior cervical pericord space. In one case of OH, a typical change of configuration, mirror image, was obtained at aqueduct level, and in all OH cases, the level of obstruction could be determined. The results of cine PC MR CSF flow study may be valuable for points for determining the level

  14. Visualization and quantitative analysis of the CSF pulsatile flow with cine MR phase imaging

    International Nuclear Information System (INIS)

    Katayama, Shinji; Itoh, Takahiko; Kinugasa, Kazushi; Asari, Shoji; Nishimoto, Akira; Tsuchida, Shohei; Ono, Atsushi; Ikezaki, Yoshikazu; Yoshitome, Eiji.

    1991-01-01

    The visualization and the quantitative analysis of the CSF pulsatile flow were performed on ten healthy volunteers with cine MR phase imaging, a combination of the phase-contrast technique and the cardiac-gating technique. The velocities appropriate for the visualization and the quantitative analysis of the CSF pulsatile flow were from 6.0 cm/sec to 15.0 cm/sec. The applicability of this method for the quantitative analysis was proven with a steady-flow phantom. Phase images clearly demonstrated a to-and-fro motion of the CSF flow in the anterior subarachnoid space and in the posterior subarachnoid space. The flow pattern of CSF on healthy volunteers depends on the cardiac cycle. In the anterior subarachnoid space, the cephalic CSF flow continued until a 70-msec delay after the R-wave of the ECG and then reversed to caudal. At 130-190 msec, the caudal CSF flow reached its maximum velocity; thereafter it reversed again to cephalic. The same turn appeared following the phase, but then the amplitude decreased. The cephalic peaked at 370-430 msec, while the caudal peaked at 490-550 msec. The flow pattern of the CSF flow in the posterior subarachnoid space was almost identical to that in the anterior subarachnoid space. Cine MR phase imaging is thus useful for the visualization and the quantitative analysis of the CSF pulsative flow. (author)

  15. CSF flow image using phase-contrast cine MR technique : preliminary clinical application

    International Nuclear Information System (INIS)

    Kim, Hyae Young; Choi, Hye Young; Baek, Seung Yeon; Lee, Sun Wha; Ko, Eun Joo; Lee, Myung Sook

    1997-01-01

    To evaluate the clinical usefulness of 2-D Cine PC (phase contrast) technique in visualizing the pattern and the site of abnormal CSF flow and to assess the effect of a third ventriculostomy in patients with hydrocephalus. The study group consisted of three normal controls and 13 patients with hydrocephalus, as shown on CT or MRI, and two patients who had undergone their third ventriculostomy. The technique was EKG-gated 2-D Cine PC MRI with velocity encoding 5cm/sec, TR 80msec, TE 12.3-15msec, and flip angle 15-60 degrees. Image quality was analyzed for variable sequences, and CSF flow was observed along the CSF flow pathway. We analyzed continuity and intensity of the CSF flow signal, and obstruction site and flow velocity degree were then defined. Systolic high and diastolic low signal intensity along the CSF flow-pathway, with normal asynchronicity and continuation, were clearly seen in normal controls. In three patients, there was obstruction at the ventricular level while others were either normal or showed a normal pattern with a weak signal. 'Normal' was defined as noncommunicating hydrocephalus and the latter as communicating hydrocephalus. In the two patients who had undergone ventriculostomy, a signal was in one case detected at the site of the third operation. A 2-D Cine PC CSF flow study enables us to see CSF flow signals noninvasively and to detect the site of obstruction of a CSF flow-pathway. It can therefore it can be useful for determining the application of a ventriculoperitoneal shunt and assessing the effect of a third ventriculostomy

  16. Evaluation of CSF flow in patients after endoscopic ventriculostomy of 3th ventricle with MRI

    International Nuclear Information System (INIS)

    Petkov, R.

    2006-01-01

    Full text: Phase-contrast MR imaging is wide used for qualitative assessment and quantification of the CSF flow under normal and pathologic conditions. The increasing popularity of minimally invasive liquor derivation procedures - namely endoscopic ventriculostomy of 3-th ventricle - in neurosurgery raises the question of their actual effect on CSF flow in various types of hydrocephalus. We present our experience with 2D and 3D PC MRI in qualitative assessment and quantification of the CSF flow in 23 patients after endoscopic ventriculostomy of the 3-th ventricle for hyper- or normotensive hydrocephalus of various origins. We compare parameters of the CSF flow (direction, rate and net volume for one cardiac cycle) before and after the ventriculostomy

  17. MR evaluation of cervical CSF flow. An examination in patients with spinal canal stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Iida, Makoto [Miyoshi General Hospital, Hiroshima (Japan); Kajima, Toshio; Miyasaka, Kenji; Nakanishi, Tadashi; Ono, Chiaki; Ito, Katsuhide

    1999-06-01

    To evaluate the flow dynamics of cerebrospinal fluid (CSF) throughout the cervical spine, 18 healthy controls and 14 patients with spinal canal stenosis were examined by phase-contrast cine MR. MR imaging was performed using a sagittal technique that is flow-sensitive in the craniocaudal direction. Flow encoding depicted craniocaudal flow as high intensity and caudocranial flow as low intensity. In this technique, either retrospective cardiac or peripheral gating was used to cover the complete cardiac cycle. This pulse sequence yielded 16 quantitative flow-encoded images per cardiac cycle. Using a region-of-interest cursor at each vertebral level, the graphs of flow-velocity versus time were generated. The recorded CSF at each vertebral level in the controls showed almost the same pattern in the change of flow in the craniocaudal direction, indicating that the onset of craniocaudal CSF flow was synchronous with the onset of cardiac systole in these subjects. At all vertebral levels, flow-velocity time curves showed the same variation in pattern. CSF flow was significantly lower in patients than in controls at each vertebral level (p<0.01). In addition, the flow patterns of the patients with spinal canal stenosis differed at each vertebral level. As a results, the total sum of the difference in velocity between graphs of two serial vertebrae at all sampling points (the area between the curves: ABC) per mean velocity amplitude in the patients was significantly higher than controls (p<0.05). Furthermore, the ABC per mean velocity amplitude at the stenotic level was significantly larger in the patients than that at the non-stenotic level (p<0.01). These data suggest that turbulent CSF flow occurs at the stenotic level. Thus, assessment of CSF flow dynamics is a useful adjunct to routine MRI in patients with spinal canal stenosis. (author)

  18. Experimental study on quantitative evaluation of slow pulsatile flow of CSF with cine MRI

    International Nuclear Information System (INIS)

    Matsuda, Masao

    1991-01-01

    The present study was designed to evaluate the slow pulsatile flow of cerebrospinal fluid (CSF) quantitatively with cine MRI in phantom experiment for the clinical application. The flow phantom was constructed from a plastic tube with a narrow channel to represent the central aqueduct. The phantom was filled with water to represent the CSF. The second tube filled with stationary water was positioned beside the flow phantom and acted as a control for no-flow signal strength. The ratio of signal intensity in regions of interest for the flow phantom and the control was measured. Not only the actual velocity curve of the flowing water through the phantom but also the temporal profile of signal intensity showed two main peaks with other small peaks in one cycle. This suggested a close relationship between signal intensity of cine MRI and flow velocity. A significant correlation between the signal intensity ratio and the velocity was obtained on cine MRI pulse sequences. Cine MRI was thus found to have the ability to give quantitative information about slow pulsatile flow. The most suitable pulse sequence was fast imaging with steady state free precession pulse sequence at the flip angle between 50 and 90 degrees. This preliminary study suggests that the slow pulsatile flow of CSF passing along the aqueduct can be visualized and measured. Thus, the sequence proposed has a potential for the investigation of normal and disturbed CSF circulation and the mapping of the flow pattern in different pathological conditions. (N.K.)

  19. Observation of the CSF pulsatile flow in the aqueduct using cine MRI with presaturation bolus tracking, 3

    International Nuclear Information System (INIS)

    Nakajima, Satoshi

    1992-01-01

    The to-and-fro motion patterns of the CSF flow in the aqueduct in ten normal adults, ten patients with secondary normal-pressure hydrocephalus (NPH), and fourteen patients with idiopathic ventriculomegaly were analyzed using cine MRI with presaturation bolus tracking. The to-and-fro motion patterns of the CSF flow in the aqueduct were thus classified into four types according to their maximum velocity and the relative time duration of their flow in the rostral and caudal directions. The correlation between the clinical symptoms, the CT findings, the RI-cisternography findings, the results of the ICP monitorings, and the CSF pulsatile-flow patterns were then analyzed. In secondary NPH disclosing frequent B waves on ICP monitoring, the maximum velocity of the CSF flow in the aqueduct was over 15 mm/sec, and the duration of the CSF flow was longer in the caudal direction than in the rostral direction. Furthermore, the faster the maximum velocity of the CSF flow, the larger the ventricular size on CT and the more severe the CSF malabsorption on cisternography. In idiopathic ventriculomegaly, only two cases demonstrated the same CSF flow pattern as was shown in secondary NPH; the other cases demonstrated other CSF flow patterns, which were considered to indicate hydrocephalus ex vacuo or arrested hydrocephalus. The CSF pulsatile-flow pattern was assumed to change according to the degree of the CSF circulatory disorder, its compensatory process, and the plasticity of the brain. The investigation of the CSF pulsatile flow gives important information for the evaluation of various hydrocephalic conditions. (author)

  20. Interpretation and value of MR CSF flow studies for paediatric neurosurgery

    Directory of Open Access Journals (Sweden)

    Samukelisiwe Sithembile Mbonane

    2013-03-01

    Full Text Available Imaging techniques may be underutilised when clinicians are unaware of the technique or do not recognise its potential. Phase-contrast MR imaging (PC-MRI is a rapid, simple and non-invasive technique that is sensitive to CSF flow. It demonstrates a mechanical coupling between cerebral blood and CSF flow throughout the cardiac cycle. Neurosurgeons should be able to request this procedure routinely as part of an MRI request. This paper gives an overview of the indications, technical requirements, technique and interpretation, using image examples. Indications for CSF flow studies include assessment and functionality of shunt treatment in patients with hydrocephalus; hydrocephalus associated with achondroplasia; Chiari I malformation; confirmation of aqueductal stenosis; and determining patency of a third ventriculostomy.

  1. Cerebral blood flow, glucose use, and CSF ionic regulation in potassium-depleted rats

    International Nuclear Information System (INIS)

    Schroek, H.; Kuschinsky, W.

    1988-01-01

    Rats were kept on a low-K + diet for 25 or 70 days. Local cerebral blood flow (LCBF) and local cerebral glucose utilization (LCGU) were measured in 31 different structures of the brain by means of the [ 14 C]iodoantipyrine and [ 14 C]2-deoxy-D-glucose method. After 25 and 70 days of K + depletion LCBF was decreased significantly in 27 and 30 structures, respectively, the average decrease being 19 and 25%. In contrast, average LCGU was not changed. Cisternal cerebrospinal fluid (CSF) K + concentration decreased significantly from 2.65 ± 0.02 mM in controls to 2.55 ± 0.02 mM and 2.47 ± 0.02 mM in the two treated groups. CSF [HCO 3 - ], pH, and Pco 2 were increased in K + -depleted animals. These data show that K + depletion induces an increase in CSF pH and a decrease in CSF K + concentration, both of which cause a reduction in cerebral blood flow. The increased CSF Pco 2 is secondary to the reduction of blood flow, since brain metabolism and arterial Pco 2 remained constant

  2. Quantitative analysis of the aqueductal CSF flow dynamics with FLASH sequence

    International Nuclear Information System (INIS)

    Seki, Kouji; Tsuji, Shoji; Yuasa, Tatsuhiko; Miyatake, Tadashi.

    1993-01-01

    Aqueductal cerebrospinal fluid (CSF) flow image and its dynamics were analyzed with 1.5 T MR system using ECG-gated Fast Low Flip Angle Shot (FLASH). High flip angle (90 degree) and short echo time (10 ms) were applicated. Seventeen ECG gated nine images were obtained in one cardiac cycle from the inferior midbrain. Axial imaging plane (across at 60 degree to the aqueduct) and 6 mm of slice thickness is available. The CSF flow velocity was estimated by a standard curve of signal intensity ratio, obtained by the running water in model tubes. Examinations of five normal subjects (male/female=2/3, 48.4±15 years old) were performed. The aqueductal flow signal had two peaks in one cardiac cycle. The latter oval signals within the diastolic phase represent the caudal (downward) CSF flow, and the former wedge shaped signals represent the cephalad (reverse) flow. The peak velocity of the caudal CSF flow is about 6.5 mm/s, the cephalad flow is about 4.5 mm/s. We defined two zero points of the to-and-fro curve as turning points, the first (caudal to cephalad) zero point as the 'first turning point', the second (cephalad to caudal) zero point as the 'second turning point'. In normal subjects, the first turning points are at 236±28 ms (±SD), the second turning points are at 723±67 ms (±SD) after ECG R wave. This new method is highly useful for the analyzing disorders with CSF flow abnormalities. (author)

  3. Pulsatile flow effects on the hemodynamics of intracranial aneurysms.

    Science.gov (United States)

    Le, Trung B; Borazjani, Iman; Sotiropoulos, Fotis

    2010-11-01

    High-resolution numerical simulations are carried out to systematically investigate the effect of the incoming flow waveform on the hemodynamics and wall shear stress patterns of an anatomic sidewall intracranial aneurysm model. Various wave forms are constructed by appropriately scaling a typical human waveform such that the waveform maximum and time-averaged Reynolds numbers, the Womersley number (α), and the pulsatility index (PI) are systematically varied within the human physiologic range. We show that the waveform PI is the key parameter that governs the vortex dynamics across the aneurysm neck and the flow patterns within the dome. At low PI, the flow in the dome is similar to a driven cavity flow and is characterized by a quasi-stationary shear layer that delineates the parent artery flow from the recirculating flow within the dome. At high PI, on the other hand, the flow is dominated by vortex ring formation, transport across the neck, and impingement and breakdown at the distal wall of the aneurysm dome. We further show that the spatial and temporal characteristics of the wall shear stress field on the aneurysm dome are strongly correlated with the vortex dynamics across the neck. We finally argue that the ratio between the characteristic time scale of transport by the mean flow across the neck and the time scale of vortex ring formation can be used to predict for a given sidewall aneurysm model the critical value of the waveform PI for which the hemodynamics will transition from the cavity mode to the vortex ring mode.

  4. Clinical study on the changes of plasma Hcy, β2-m, cortisol, NPY levels and NPY contents in CSF in patients with acute traumatic intracranial hemorrhage as well as patients with cerebral infarction

    International Nuclear Information System (INIS)

    Ruan Wenhua; Yang Yongqing

    2007-01-01

    Objective: To invest/gate the clinical significance of the changes of plasma Hcy, β 2 -m, cortisol, NPY levels and NPY contents in CSF in patients with acute traumatic intracranial hemorrhage as well as patients with cerebral infarction. Methods: Plasma β 2 -m, cortisol, NPY, NPY in CSF (with RIA) and plasma Hey (with CLIA ) contents were measured in 68 patients with acute traumatic intracranial haemorrhage (mild 33, severe 35) as well as 39 patients with cerebral infarction (plus 35 controls). Results: The plasma β 2 -m, Hcy and 8h, 24h cortisol levels in all these patients were significantly higher than those in controls (P 2 -m, Hcy, cortisol levels and NPY contents in CSF were very prominent in all these patients studied. (authors)

  5. Quantitative and clinical evaluation of whole CSF-axis RI image

    International Nuclear Information System (INIS)

    Tomono, Yuji; Nose, Tadao; Maki, Yutaka

    1987-01-01

    Whole CSF-axis RI scintigraphy was evaluated in 122 adult patients intending to know not only intracranial CSF flow but also the dynamics of whole CSF axis, particularly of spinal CSF flow. The change of radioactivity in several compartments was studied quantitatively with a dataprocessor on 18 cases with dilated ventricles, and more practically, clinical features and the findings of the films were comparatively studied on all the cases. The results were as follows: (1) Roughly speaking, the findings were classified into two types, i.e. a type with early RI movement to the intracranial CSF space and another with stagnation of radioactivity in spinal space till late stage, even 48 hours after RI injection (spinal stasis). (2) Although majority of the cases with spinal stasis did not show ventricular stasis, a shunt operation was not effective even when ventricular stasis was observed. (3) Spinal stasis tended to increase with aging, and was observed more frequently in cases with possible severe cerebral damage, as severe cerebrovascular disease and severe deterioration of mental activity. (4) The clearance of radioactivity of whole CSF-axis was remarkably delayed. It is considered that the spinal CSF flow is generated by intracranial CSF pulsation and, so, that spinal stasis shows the condition of lowered CSF flow by pulsation due to cerebral parenchymal damages. (author)

  6. Patterns of cerebrospinal fluid (CSF distribution in patients with spontaneous intracranial hypotension: Assessed with magnetic resonance myelography

    Directory of Open Access Journals (Sweden)

    Chuan-Han Chen

    2017-02-01

    Conclusion: Grade 3 on 3D MIP and Type D on axial MPR MRM were definite criteria of MRM for localizing CSF leakage, and Type C in the T-spine was a probable leakage sign with high sensitivity and NPV.

  7. Evaluations of CSF flow dynamics in elderly with dementia by metrizamide CT cisternography

    International Nuclear Information System (INIS)

    Nokura, Kazuya; Kabasawa, Hidehiro; Matsubara, Mitsutaka; Yamamoto, Masahiko; Nagai, Hajime

    1988-01-01

    We have investigated Metrizamide CT-cisternography in multi-infarct dementia (MID): 29 cases, senile dementia of the Alzheimer type (SDAT): 7 cases, normal pressure hydrocephalus (NPH): 8 cases and spinocerebellar degeneration (SCD): 3 cases. By quantitative manner the differences of cerebrospinal fluid (CSF) flowdynamics in each group have been evaluated. In comparison with SCD which show normal CSF flow, MID show tendency to ventricular reflux and convexity stasis. No difference was seen between MID and SDAT. Though NPH shows stronger ventricular reflux than that or MID, the stasis in MID is more severe than that of NPH. In MID group subject of older than 70 years show more severe SCF flow disturbances. When divided into two groups by ADL (Activities of daily living) scale (full of 15 points) the group of less than 6 points show slight disturbances in comparison with that of more than 6 points. And the same is true in Hasegawas dementia rating scales, namely the group of less than 21 points (full of 32.5) shows slight disturbances in comparison with that of more than 21 points. The flow dynamics pattern of slight ventricular reflux in 24 hours and stasis in convexity from 24 to 48 hours seems to be typical in either MID or SDAT. But such a pattern has never been reported in SCF flow dynamics studies. These findings may suggest that CSF flow disturbances have a close relation with aging and dementia. (author)

  8. Evaluations of CSF flow dynamics in elderly with dementia by metrizamide CT cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Nokura, Kazuya; Kabasawa, Hidehiro; Matsubara, Mitsutaka; Yamamoto, Masahiko; Nagai, Hajime

    1988-06-01

    We have investigated Metrizamide CT-cisternography in multi-infarct dementia (MID): 29 cases, senile dementia of the Alzheimer type (SDAT): 7 cases, normal pressure hydrocephalus (NPH): 8 cases and spinocerebellar degeneration (SCD): 3 cases. By quantitative manner the differences of cerebrospinal fluid (CSF) flowdynamics in each group have been evaluated. In comparison with SCD which show normal CSF flow, MID show tendency to ventricular reflux and convexity stasis. No difference was seen between MID and SDAT. Though NPH shows stronger ventricular reflux than that or MID, the stasis in MID is more severe than that of NPH. In MID group subject of older than 70 years show more severe SCF flow disturbances. When divided into two groups by ADL (Activities of daily living) scale (full of 15 points) the group of less than 6 points show slight disturbances in comparison with that of more than 6 points. And the same is true in Hasegawas dementia rating scales, namely the group of less than 21 points (full of 32.5) shows slight disturbances in comparison with that of more than 21 points. The flow dynamics pattern of slight ventricular reflux in 24 hours and stasis in convexity from 24 to 48 hours seems to be typical in either MID or SDAT. But such a pattern has never been reported in SCF flow dynamics studies. These findings may suggest that CSF flow disturbances have a close relation with aging and dementia.

  9. Cerebral blood flow autoregulation during intracranial hypertension in hypoxic lambs

    International Nuclear Information System (INIS)

    Borel, C.O.; Backofen, J.E.; Koehler, R.C.; Jones, M.D. Jr.; Traystman, R.J.

    1987-01-01

    The authors tested the hypothesis that hypoxic hypoxia interferes with cerebral blood flow (CBF) autoregulation when intracranial pressure (ICP) is elevated in pentobarbital-anesthetized lambs (3 to 9 days old). Cerebral perfusion pressure (CPP) was lowered stepwise from 73 to 23 mmHg in eight normoxic lambs and from 65 to 31 mmHg in eight other hypoxic lambs by ventricular infusion of artificial cerebrospinal fluid. In normoxic lambs, CBF measured by microspheres labeled with six different radioisotopes was not significantly changed over this range of CPP. In animals made hypoxic, base-line CBF was twice that of normoxic lambs. CBF was unchanged as CPP was reduced to 31 mmHg. Lower levels of CPP were not attained because a pressor response occurred with further elevations of ICP. No regional decrements in blood flow to cortical arterial watershed areas or to more caudal regions, such as cerebellum, brain stem, or thalamus, were detected with elevated ICP. Cerebral O 2 uptake was similar in both groups and did not decrease when CPP was reduced. These results demonstrate that normoxic lambs have a considerable capacity for effective autoregulation of CBF when ICP is elevated. Moreover, cerebral vasodilation in response to a level of hypoxia approximating that normally seen prenatally does not abolish CBF autoregulation when ICP is elevated during the first postnatal week

  10. Relationship between pineal cyst size and aqueductal CSF flow measured by phase contrast MRI.

    Science.gov (United States)

    Bezuidenhout, Abraham F; Kasper, Ekkehard M; Baledent, Olivier; Rojas, Rafael; Bhadelia, Rafeeque A

    2018-02-23

    Most patients with pineal cysts referred for neurosurgical consultation have no specific symptoms or objective findings except for pineal cyst size to help in management decisions. Our purpose was to assess the relationship between pineal cyst size and aqueductal CSF flow using PC-MRI. Eleven adult patients with pineal cysts (> 1-cm in size) referred for neurosurgical consultations were included. Cyst volume was calculated using 3D T1 images. PC-MRI in axial plane with velocity encoding of 5 cm/sec was used to quantitatively assess CSF flow through the cerebral aqueduct to determine the aqueductal stroke volume, which was then correlated to cyst size using Pearson's correlation. Pineal cysts were grouped by size into small (6/11) and large (5/11) using the median value to compare aqueductal stroke volume using Mann-Whitney test. Patients were 39 ± 13 years (mean ± SD) of age, and 10/11 (91%) were female. There was significant negative correlation between cyst volume and aqueductal stroke volume (r=0.74; p=0.009). Volume of small cysts (4954±2157 mm3) was significantly different compared to large cysts (13752±3738 mm3; p= 0.008). The aqueductal stroke volume of patients harboring large cysts 33±8 μL/cardiac cycle was significantly lower than that of patients with small cysts 96±29 μL/cardiac cycle (p=0.008). Aqueductal CSF flow appears to decrease with increasing pineal cyst size. Our preliminary results provide first evidence that even in the absence of objective neurological findings or hydrocephalus; larger pineal cysts already display decreased CSF flow through the cerebral aqueduct.

  11. Continuous positive airway pressure alters cranial blood flow and cerebrospinal fluid dynamics at the craniovertebral junction

    Directory of Open Access Journals (Sweden)

    Theresia I. Yiallourou

    2015-09-01

    Conclusion: Application of CPAP via a full-fitted mask at 15 cm H2O was found to have a significant effect on intracranial venous outflow and spinal CSF flow at the C2 vertebral level in healthy adult-age awake volunteers. CPAP can be used to non-invasively provoke changes in intracranial and CSF flow dynamics.

  12. Occult CSF flow disturbance of patients with Alzheimer type dementia and vascular dementia

    International Nuclear Information System (INIS)

    Kono, Kazuhiko; Sugita, Yasuko; Funaki, Chiaki

    1994-01-01

    We report results of Iotrolan CT-cisternography on 41 demented patients (13 males and 28 females) to find 'occult normal pressure hydrocephalus'. These patients were suspected to have CSF flow disturbance from clinical symptoms and simple brain CT scan findings. Their average age, duration of dementia, and score of Hasegawa's dementia scale (HDS) were 76.2 years, 5.9 years, 9.5/32.5,respectively. Before performing CT-cisternography, clinical diagnosis for their dementia were vascular dementia in 18 patients. Alzheimer type dementia in 12, suspect of NPH in 5, and other diagnoses in 6. From the results of cisternography, we found 13 patients with CSF flow disturbance (contrast material remained in the ventricle more than 48 hours after injection), and 17 patients with normal CSF flow. The former showed lower scores of HDS, higher urinary incontinence scores and smaller areas of the interhemispheric fissure on CT scan than the latter. But the former showed no significant difference from the latter in the average age, duration of dementia and width of the ventricles. (author)

  13. ICP curve morphology and intracranial flow-volume changes

    DEFF Research Database (Denmark)

    Unnerbäck, Mårten; Ottesen, Johnny T.; Reinstrup, Peter

    2018-01-01

    proposed to shape the ICP curve. This study tested the hypothesis that the ICP curve correlates to intracranial volume changes. METHODS: Cine phase contrast magnetic resonance imaging (MRI) examinations were performed in neuro-intensive care patients with simultaneous ICP monitoring. The MRI was set......BACKGROUND: The intracranial pressure (ICP) curve with its different peaks has been extensively studied, but the exact physiological mechanisms behind its morphology are still not fully understood. Both intracranial volume change (ΔICV) and transmission of the arterial blood pressure have been...

  14. Early Expansion of the Intracranial CSF Volume After Palliative Whole-Brain Radiotherapy: Results of a Longitudinal CT Segmentation Analysis

    International Nuclear Information System (INIS)

    Sanghera, Paul; Gardner, Sandra L.; Scora, Daryl; Davey, Phillip

    2010-01-01

    Purpose: To assess cerebral atrophy after radiotherapy, we measured intracranial cerebrospinal fluid volume (ICSFV) over time after whole-brain radiotherapy (WBRT) and compared it with published normal-population data. Methods and Materials: We identified 9 patients receiving a single course of WBRT (30 Gy in 10 fractions over 2 weeks) for ipsilateral brain metastases with at least 3 years of computed tomography follow-up. Segmentation analysis was confined to the tumor-free hemi-cranium. The technique was semiautomated by use of thresholds based on scanned image intensity. The ICSFV percentage (ratio of ICSFV to brain volume) was used for modeling purposes. Published normal-population ICSFV percentages as a function of age were used as a control. A repeated-measures model with cross-sectional (between individuals) and longitudinal (within individuals) quadratic components was fitted to the collected data. The influence of clinical factors including the use of subependymal plate shielding was studied. Results: The median imaging follow-up was 6.25 years. There was an immediate increase (p < 0.0001) in ICSFV percentage, which decelerated over time. The clinical factors studied had no significant effect on the model. Conclusions: WBRT immediately accelerates the rate of brain atrophy. This longitudinal study in patients with brain metastases provides a baseline against which the potential benefits of more localized radiotherapeutic techniques such as radiosurgery may be compared.

  15. Regional cerebral blood flow and CSF pressures during Cushing response induced by a supratentorial expanding mass

    International Nuclear Information System (INIS)

    Schrader, H.; Zwetnow, N.N.; Moerkrid, L.

    1985-01-01

    In order to delineate the critical blood flow pattern during the Cushing response in intracranial hypertension, regional cerebral blood flow was measured with radioactive microspheres in 12 anesthetized dogs at respiratory arrest caused either by expansion of an epidural supratentorial balloon or by cisternal infusion. Regional cerebrospinal fluid pressures were recorded and the local cerebral perfusion pressure calculated in various cerebrospinal compartments. In the 8 dogs of the balloon expansion group, the systemic arterial pressure was unmanipulated in 4, while it was kept at a constant low level (48 and 70 mm Hg) in 2 dogs and, in another 2 dogs, at a constant high level (150 and 160 mm Hg) induced by infusion of Aramine. At respiratory arrest, regional cerebral blood flow had a stereotyped pattern and was largely independent of the blood pressure level. In contrast, concomitant pressure gradients between the various cerebrospinal compartments varied markedly in the 3 animal groups increasing with higher arterial pressure. Flow decreased by 85-100% supratentorially and by 70-100% in the upper brain stem down to the level of the upper pons, while changes in the lower brain stem were minor, on the average 25%. When intracranial pressure was raised by cisternal infusion in 4 dogs, the supratentorial blood flow pattern at respiratory arrest was appriximately similar to the flow pattern in the balloon inflation group. However, blood flow decreased markedly (74-85%) also in the lower brain stem. The results constitute another argument in favour of the Cushing response in supratentorial expansion being caused by ischemia in the brain stem. The critical ischemic region seems to be located rostrally to the oblongate medulla, probably in the pons. (author)

  16. A whole-body mathematical model for intracranial pressure dynamics.

    Science.gov (United States)

    Lakin, William D; Stevens, Scott A; Tranmer, Bruce I; Penar, Paul L

    2003-04-01

    Most attempts to study intracranial pressure using lumped-parameter models have adopted the classical "Kellie-Monro Doctrine," which considers the intracranial space to be a closed system that is confined within the nearly-rigid skull, conserves mass, and has equal inflow and outflow. The present work revokes this Doctrine and develops a mathematical model for the dynamics of intracranial pressures, volumes, and flows that embeds the intracranial system in extensive whole-body physiology. The new model consistently introduces compartments representing the tissues and vasculature of the extradural portions of the body, including both the thoracic region and the lower extremities. In addition to vascular connections, a spinal-subarachnoid cerebrospinal fluid (CSF) compartment bridges intracranial and extracranial physiology allowing explict buffering of intracranial pressure fluctuations by the spinal theca. The model contains cerebrovascular autoregulation, regulation of systemic vascular pressures by the sympathetic nervous system, regulation of CSF production in the choroid plexus, a lymphatic system, colloid osmotic pressure effects, and realistic descriptions of cardiac output. To validate the model in situations involving normal physiology, the model's response to a realistic pulsatile cardiac output is examined. A well-known experimentally-derived intracranial pressure-volume relationship is recovered by using the model to simulate CSF infusion tests, and the effect on cerebral blood flow of a change in body position is also examined. Cardiac arrest and hemorrhagic shock are simulated to demonstrate the predictive capabilities of the model in pathological conditions.

  17. Phase-contrast cine MR imaging of normal aqueductal CSF flow. Effect of aging and relation to CSF void on modulus MR

    International Nuclear Information System (INIS)

    Barkhof, F.; Kouwenhoven, M.; Scheltens, P.; Sprenger, M.; Algra, P.; Valk, J.

    1994-01-01

    Cine phase-contrast MR imaging was used to study pulsatile CSF flow in the aqueduct in 11 young controls (mean age 30 years) and 9 old controls (mean age 69 years). A high-resolution gradient echo technique and an oblique imaging plane, perpendicular to the aqueduct, was used to avoid volume averaging. Phantom studies confirmed that the technique was accurate. Aqueductal velocity and flux in old controls was higher than in young controls, but the differences were not significant. For all controls together, the averaged peak velocity was 4.2 ± 1.5 cm/s in rostral and -7.8 ± 4.9 cm/s in caudal direction; for the flux it was 0.16 ± 0.10 cm 3 /s in rostral and -0.29 ± 0.19 cm 3 /s in caudal direction. Phase-contrast measurements were significantly related to flow-void on modulus MR images, but not with ventricular size or cortical atrophy. The present technique avoids underestimation of aqueductal flow, and therefore reveals higher aqueductal velocity and flux values than previous studies. Factors other than age or atrophy seem to determine aqueductal CSF flow. (orig.)

  18. Flow pattern in the ventricle of brain with cilia beating and CSF circulation

    Science.gov (United States)

    Wang, Yong; Westendorf, Christian; Faubel, Regina; Eichele, Gregor; Bodenschatz, Eberhard

    We recently discovered that cilia of the ventral third ventricle (v3V) of mammalian brain generate a complex flow network close to the wall. However, the flow pattern in the overall three dimensional v3V, especially under physiological condition, remains to be investigated. Computational fluid dynamics is arguably the best approach for such investigations. Several v3V geometries are reconstructed from different data for comparison study. The lattice Boltzmann method and immersed boundary method are used to reproduce the experimental set-up for an opened v3V firstly. The experimentally recorded cilia induced flow network is projected on the curved v3V wall. The flow maps obtained numerically at different heights from the v3V wall agree with the experimental data qualitatively. We then consider the entire v3V with ciliary flow network along the wall for boundary condition. Moreover, we add a time dependent flow rate to represent the CSF circulation, and study flow pattern in the ventricle. We thank the Max Planck Society (MPG) for financial support. This work is conducted within the Physics and Medicine Initiative at Goettingen Campus between MPG and University Medical Center.

  19. Traumatic orbital CSF leak

    Science.gov (United States)

    Borumandi, Farzad

    2013-01-01

    Compared to the cerebrospinalfluid (CSF) leak through the nose and ear, the orbital CSF leak is a rare and underreported condition following head trauma. We present the case of a 49-year-old woman with oedematous eyelid swelling and ecchymosis after a seemingly trivial fall onto the right orbit. Apart from the above, she was clinically unremarkable. The CT scan revealed a minimally displaced fracture of the orbital roof with no emphysema or intracranial bleeding. The fractured orbital roof in combination with the oedematous eyelid swelling raised the suspicion for orbital CSF leak. The MRI of the neurocranium demonstrated a small-sized CSF fistula extending from the anterior cranial fossa to the right orbit. The patient was treated conservatively and the lid swelling resolved completely after 5 days. Although rare, orbital CSF leak needs to be included in the differential diagnosis of periorbital swelling following orbital trauma. PMID:24323381

  20. Phase-contrast cerebrospinal fluid flow magnetic resonance imaging in qualitative evaluation of patency of CSF flow pathways prior to infusion of chemotherapeutic and other agents into the fourth ventricle.

    Science.gov (United States)

    Patel, Rajan P; Sitton, Clark W; Ketonen, Leena M; Hou, Ping; Johnson, Jason M; Romo, Seferino; Fletcher, Stephen; Shah, Manish N; Kerr, Marcia; Zaky, Wafik; Rytting, Michael E; Khatua, Soumen; Sandberg, David I

    2018-03-01

    Nuclear medicine studies have previously been utilized to assess for blockage of cerebrospinal fluid (CSF) flow prior to intraventricular chemotherapy infusions. To assess CSF flow without nuclear medicine studies, we obtained cine phase-contrast MRI sequences that assess CSF flow from the fourth ventricle down to the sacrum. In three clinical trials, 18 patients with recurrent malignant posterior fossa tumors underwent implantation of a ventricular access device (VAD) into the fourth ventricle, either with or without simultaneous tumor resection. Prior to infusing therapeutic agents into the VAD, cine MRI phase-contrast CSF flow sequences of the brain and total spine were performed. Velocity encoding (VENC) of 5 and 10 cm/s was used to confirm CSF flow from the fourth ventricular outlets to the cervical, thoracic, and lumbar spine. Qualitative CSF flow was characterized by neuroradiologists as present or absent. All 18 patients demonstrated CSF flow from the outlets of the fourth ventricle down to the sacrum with no evidence of obstruction. One of these patients, after disease progression, subsequently showed obstruction of CSF flow. No patient required a nuclear medicine study to assess CSF flow prior to initiation of infusions. Fourteen patients have received infusions to date, and none has had neurological toxicity. CSF flow including the fourth ventricle and the total spine can be assessed noninvasively with phase-contrast MRI sequences. Advantages over nuclear medicine studies include avoiding both an invasive procedure and radiation exposure.

  1. The use of novel flow diverting device Tubridge for the treatment of intracranial aneurysms: initial experience

    International Nuclear Information System (INIS)

    Yang Pengfei; Liu Jianmin; Huang Qinghai; Xu Yi; Hong Bo; Zhao Wenyuan; Li Qiang; Fang Yibin; Zhang Yuhui

    2011-01-01

    Objective: To preliminarily evaluate the feasibility, efficacy and safety of the novel flow diverting device, Tubridge, in treating intracranial aneurysms. Methods: The novel flow diverting device, Tubridge, was employed to treat intracranial aneurysms in 14 patients with a mean age of (52.4±10.2) years. A total of 14 intracranial aneurysms were detected in 14 patients, including 13 un-ruptured aneurysms and one ruptured aneurysms. The technical results and clinical data were analyzed. Results: A total of 18 flow diverters were implanted. The flow diverter was successfully conveyed and delivered in all patients, with a technical success rate of 100%. Six aneurysms were treated with the flow diverter together with the coils. Of the six aneurysms, complete obliteration of the aneurysm was obtained in 2 (Raymond grade Ⅰ), remnant of neck was seen in 1 (Raymond grade Ⅱ) and residual aneurysm sac was found in 3 (Raymond grade Ⅲ) cases. Eight aneurysms were treated with flow diverter implantation alone. After the procedure, marked decrease in contrast filling of the aneurysm sac was seen in 3 aneurysms, while the change in contrast filling pattern of the aneurysm sac as well as the obvious retention of contrast in the aneurysm sac could be detected in all cases. No procedure-related hemorrhagic or ischemic complications occurred. The mRS score at the time of discharge was 0 (n=13) or 1 (n=1). Conclusion: For the treatment of some special type intracranial aneurysms, the use of Tubridge flow diverter is clinically feasible, its effect is immediate and satisfactory with higher safety in short term. However, its long-term efficacy and safety need to be further evaluated. (authors)

  2. Angiographic CT with intravenous contrast agent application for monitoring of intracranial flow diverting stents

    International Nuclear Information System (INIS)

    Saake, Marc; Struffert, Tobias; Goelitz, Philipp; Ott, Sabine; Doerfler, Arnd; Seifert, Frank; Ganslandt, Oliver

    2012-01-01

    Intracranial flow diverting devices are increasingly used to treat cerebral aneurysms. A reliable, non-invasive follow-up modality would be desirable. Our aim was to compare intra-arterial digital subtraction angiography (ia DSA) to angiographic computed tomography with intravenous contrast agent application (iv ACT) in the visualisation of flow diverting devices and aneurysm lumina. Follow-up monitoring by iv ACT (n = 36) and ia DSA (n = 25) in 14 patients treated with flow diverting devices for intracranial aneurysms was evaluated retrospectively. Images were evaluated by two neuroradiologists in anonymous consensus reading regarding the device deployment, wall apposition, neck coverage of the aneurysm, opacification of the vessel and device lumen, as well as the degree of aneurysm occlusion. Corresponding ia DSA and iv ACT images were scored identically in all patients regarding the stent deployment, wall apposition and neck coverage, as well as the degree of aneurysm occlusion and patency status of the device and parent artery. Opacification of the parent vessel lumen and perfused parts of the aneurysm was considered slightly inferior for iv ACT in comparison with ia DSA (seven of 36 cases), without impact on diagnosis. We demonstrated the feasibility and diagnostic value of iv ACT in follow-up imaging of intracranial flow diverting devices. Due to its high spatial resolution and non-invasive character, this novel technique might become a valuable imaging modality in these patients. (orig.)

  3. Occult CSF flow disturbance of patients with Alzheimer type dementia and vascular dementia; Results from Iotrolan CT-cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Kono, Kazuhiko; Sugita, Yasuko; Funaki, Chiaki [Nagoya Univ. (Japan). Faculty of Medicine; and others

    1994-04-01

    We report results of Iotrolan CT-cisternography on 41 demented patients (13 males and 28 females) to find 'occult normal pressure hydrocephalus'. These patients were suspected to have CSF flow disturbance from clinical symptoms and simple brain CT scan findings. Their average age, duration of dementia, and score of Hasegawa's dementia scale (HDS) were 76.2 years, 5.9 years, 9.5/32.5,respectively. Before performing CT-cisternography, clinical diagnosis for their dementia were vascular dementia in 18 patients. Alzheimer type dementia in 12, suspect of NPH in 5, and other diagnoses in 6. From the results of cisternography, we found 13 patients with CSF flow disturbance (contrast material remained in the ventricle more than 48 hours after injection), and 17 patients with normal CSF flow. The former showed lower scores of HDS, higher urinary incontinence scores and smaller areas of the interhemispheric fissure on CT scan than the latter. But the former showed no significant difference from the latter in the average age, duration of dementia and width of the ventricles. (author).

  4. Regulation of cerebrospinal fluid (CSF) flow in neurodegenerative, neurovascular and neuroinflammatory disease.

    Science.gov (United States)

    Simon, Matthew J; Iliff, Jeffrey J

    2016-03-01

    Cerebrospinal fluid (CSF) circulation and turnover provides a sink for the elimination of solutes from the brain interstitium, serving an important homeostatic role for the function of the central nervous system. Disruption of normal CSF circulation and turnover is believed to contribute to the development of many diseases, including neurodegenerative conditions such as Alzheimer's disease, ischemic and traumatic brain injury, and neuroinflammatory conditions such as multiple sclerosis. Recent insights into CSF biology suggesting that CSF and interstitial fluid exchange along a brain-wide network of perivascular spaces termed the 'glymphatic' system suggest that CSF circulation may interact intimately with glial and vascular function to regulate basic aspects of brain function. Dysfunction within this glial vascular network, which is a feature of the aging and injured brain, is a potentially critical link between brain injury, neuroinflammation and the development of chronic neurodegeneration. Ongoing research within this field may provide a powerful new framework for understanding the common links between neurodegenerative, neurovascular and neuroinflammatory disease, in addition to providing potentially novel therapeutic targets for these conditions. This article is part of a Special Issue entitled: Neuro Inflammation edited by Helga E. de Vries and Markus Schwaninger. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension.

    Science.gov (United States)

    Oudeman, Eline A; Nandoe Tewarie, Rishi D S; Jöbsis, G Joost; Arts, Mark P; Kruyt, Nyika D

    2015-01-01

    Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula. We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior stenosis. The postoperative course was complicated by severe intracranial hypotension attributed to the erroneous placement of a low-pressure drain placed in the pleural cavity instead of a lumbar drain; this resulted in subdural hematoma's necessitating subsequent surgery. Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 3-5 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas.

  6. CSF smear

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003768.htm CSF smear To use the sharing features on this ... around the spinal cord and brain. Cerebrospinal fluid (CSF) protects the brain and spinal cord from injury. ...

  7. Analysis of cerebral blood flow and intracranial hypertension in critical patients with non-hepatic hyperammonemia.

    Science.gov (United States)

    Larangeira, Alexandre Sanches; Tanita, Marcos Toshiyuki; Dias, Marcos Antonio; Filho, Olavo Franco Ferreira; Delfino, Vinicius Daher Alvares; Cardoso, Lucienne Tibery Queiroz; Grion, Cintia Magalhães Carvalho

    2018-05-03

    Hyperammonemia in adults is generally associated with cerebral edema, decreased cerebral metabolism, and increased cerebral blood flow. The aim of this study was to evaluate the association between non-hepatic hyperammonemia and intracranial hypertension assessed by Doppler flowmetry and measurement of the optic nerve sheath. A prospective cohort study in critically ill patients hospitalized in intensive care units of a University Hospital between March 2015 and February 2016. Clinical data and severity scores were collected and the Glasgow coma scale was recorded. Serial serum ammonia dosages were performed in all study patients. Transcranial Doppler evaluation was carried out for the first 50 consecutive results of each stratum of ammonemia: normal (<35 μmol/L), mild hyperammonemia (≥35 μmol/L and < 50 μmol/L), moderate hyperammonemia (≥50 μmol/L and < 100 μmol/L), and severe hyperammonemia (≥100 μmol/L). The measurement of the optic nerve sheath was performed at the same time as the Doppler examination if the patient scored less than 8 on the Glasgow coma scale. There was no difference in flow velocity in the cerebral arteries between patients with and without hyperammonemia. Patients with hyperammonemia presented longer ICU stay. Optic nerve sheath thickness was higher in the group with severe hyperammonemia and this group presented an association with intracranial hypertension. Higher mortality was observed in the severe hyperammonemia group. There was an association between severe hyperammonemia and signs of intracranial hypertension. No correlation was found between ammonia levels and cerebral blood flow velocity through the Doppler examination.

  8. Spaceflight-Induced Intracranial Hypertension.

    Science.gov (United States)

    Michael, Alex P; Marshall-Bowman, Karina

    2015-06-01

    Although once a widely speculated about and largely theoretical topic, spaceflight-induced intracranial hypertension has gained acceptance as a distinct clinical phenomenon, yet the underlying physiological mechanisms are still poorly understood. In the past, many terms were used to describe the symptoms of malaise, nausea, vomiting, and vertigo, though longer duration spaceflights have increased the prevalence of overlapping symptoms of headache and visual disturbance. Spaceflight-induced visual pathology is thought to be a manifestation of increased intracranial pressure (ICP) because of its similar presentation to cases of known intracranial hypertension on Earth as well as the documentation of increased ICP by lumbar puncture in symptomatic astronauts upon return to gravity. The most likely mechanisms of spaceflight-induced increased ICP include a cephalad shift of body fluids, venous outflow obstruction, blood-brain barrier breakdown, and disruption to CSF flow. The relative contribution of increased ICP to the symptoms experienced during spaceflight is currently unknown, though other factors recently posited to contribute include local effects on ocular structures, individual differences in metabolism, and the vasodilator effects of carbon dioxide. This review article attempts to consolidate the literature regarding spaceflight-induced intracranial hypertension and distinguish it from other pathologies with similar symptomatology. It discusses the proposed physiological causes and the pathological manifestations of increased ICP in the spaceflight environment and provides considerations for future long-term space travel. In the future, it will be critical to develop countermeasures so that astronauts can participate at their peak potential and return safely to Earth.

  9. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension

    OpenAIRE

    Oudeman, Eline A.; Tewarie, Rishi D. S. Nandoe; J?bsis, G. Joost; Arts, Mark P.; Kruyt, Nyika D.

    2015-01-01

    Background: Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula. Case Description: We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior...

  10. PIV Measurement of Wall Shear Stress and Flow Structures within an Intracranial Aneurysm Model

    Science.gov (United States)

    Chow, Ricky; Sparrow, Eph; Campbell, Gary; Divani, Afshin; Sheng, Jian

    2012-11-01

    The formation and rupture of an intracranial aneurysm (IA) is a debilitating and often lethal event. Geometric features of the aneurysm bulb and upstream artery, such as bulb size, bulb shape, and curvature of the artery, are two groups of factors that define the flow and stresses within an IA. Abnormal flow stresses are related to rupture. This presentation discusses the development of a quasi-3D PIV technique and its application in various glass models at Re = 275 and 550 to experimentally assess at a preliminary level the impact of geometry and flow rate. Some conclusions are to be drawn linking geometry of the flow domain to rupture risk. The extracted results also serve as the baseline case and as a precursor to a companion presentation by the authors discussing the impact of flow diverters, a new class of medical devices. The PIV experiments were performed in a fully index-matched flow facility, allowing for unobstructed observations over complex geometry. A reconstruction and analysis method was devised to obtain 3D mean wall stress distributions and flow fields. The quasi 3D measurements were reconstructed from orthogonal planes encompassing the entire glass model, spaced 0.4mm apart. Wall shear stresses were evaluated from the near-wall flow viscous stresses.

  11. Relationship between intracranial hypertension and cerebral blood flow after craniotomy in cases with traumatic acute subdural hematoma

    International Nuclear Information System (INIS)

    Karibe, Hiroshi; Onuma, Takehide; Kameyama, Motonobu; Nimura, Taro; Hirano, Takayuki; Kubota, Keiichi

    2008-01-01

    The purpose of this study is to investigate relationship between the duration of initial intracranial hypertension and postoperative cerebral blood flow (CBF) changes in cases with traumatic acute subdural hematoma (ASDH). Intracerebral pressure (ICP) was monitored using ICP catheter in 17 cases with unilateral traumatic ASDH. ICP monitoring was started before craniotomy, and was continued for 7 days. CBF was quantitatively measured at 7 days after craniotomy with 123 I-infetamine (IMP) single photon emission computed tomography (SPECT). Clinical outcome was evaluated using Glasgow Outcome Scale (GOS) at the time of discharge. Patients were divided into 2 groups by the duration of intracranial hypertension: patients who presented with intracranial hypertension (>25 mmHg) and received surgical decompression within 6 hours after deterioration (group A, n=9), and patients who presented with intracranial hypertension and received surgical decompression more than 6 hours after deterioration (group B, n=6). In group A, 7 of 9 patients demonstrated ipsilateral hemispheric hyperperfusion, and the clinical outcome was relatively favorable: Good Recovery (GR) 4 cases, Moderately Disabled (MD) 4 cases, and Severely Disabled (SD) 1 case. In group B, 5 of 6 patients demonstrated ipsilateral hemispheric hypoperfusion, and the clinical outcome was unfavorable: SD 4 cases, and Dead 2 cases. These results suggest that the duration of intracranial hypertension affects on postoperative CBF changes. Duration of intracranial hypertension may also affect on clinical outcome directly, or secondary by altering postoperative CBF changes in patients with traumatic ASDH. (author)

  12. Inter-relationship between CSF dynamics and CSF to-and-fro movement in the cervical region as assessed by MR velocity imaging with phase encoding in hydrocephalic and normal patients

    International Nuclear Information System (INIS)

    Kudo, Sumio; Wachi, Akihiko; Sato, Kiyoshi; Sumie, Hirotoshi.

    1992-01-01

    The to-and-fro velocity of cerebrospinal fluid (CSF) at C-1 and C-2 spinal-cord levels was measured by means of MR velocity-imaging technique, and the correlation of changes in velocity and various biophysical factors influencing the intracranial pressure environment were analyzed. Eight hydrocephalic patients, male and female, of different ages (both infants and adults), and 11 normal volunteers with a similar age range were investigated. The to-and-fro CSF movement was measured by means of phase-shift techniques with a bipolar gradient pulse. The cerebrospinal opening pressure was also recorded in 6 of the 8 hydrocephalic patients, either through a ventricular catheter reservoir or a spinal catheter inserted in the lumbosacral subarachnoid space; the CSF pulse amplitude, the pressure volume index (PVI), and the CSF outflow resistance (Ro) were also evaluated during the procedure. CSF flowed towards caudally in the early systolic phase of a cardiac stroke, but the flow direction was reversed in the early diastolic phase when the maximum flow rate was reached. Although such a flow pattern was commonly observed in all normal and hydrocephalic subjects, whatever the age, there was a marked difference in flow rate between the infants and the pediatric-adults groups, -i.e., it was 5-10 mm/sec for the former and 10-20 mm/sec for the latter. An abnormally high flow rate (33.0 mm/sec) was observed in the hydrocephalic patients when there was a malfunction of the ventriculoperitoneal shunt. A close correlation was found to exist among the changes in the CSF flow velocity, the CSF pressure amplitude, and the CSF outflow resistance (Ro), but not in the PVI. The measurement of the CSF flow velocity by MR velocity imaging appears to have an important role not only in the investigation of CSF dynamics, but also in the diagnosis and treatment of such pathologies as hydrocephalus and ventriculoperitoneal shunt malfunction. (author)

  13. CSF analysis

    Science.gov (United States)

    Cerebrospinal fluid analysis ... Analysis of CSF can help detect certain conditions and diseases. All of the following can be, but ... An abnormal CSF analysis result may be due to many different causes, ... Encephalitis (such as West Nile and Eastern Equine) Hepatic ...

  14. Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Joash, Dr.

    2015-01-01

    Epidemiology is not only rare but an important cause of new daily persistent headaches among young & middle age individuals. The Etiology & Pathogenesis is generally caused by spinal CSF leak. Precise cause remains largely unknown, underlying structural weakness of spinal meninges is suspected. There are several MR Signs of Intracranial Hypotension that include:- diffuse pachymeningeal (dural) enhancement; bilateral subdural, effusion/hematomas; Downward displacement of brain; enlargement of pituitary gland; Engorgement of dural venous sinuses; prominence of spinal epidural venous plexus and Venous sinus thrombosis & isolated cortical vein thrombosis. The sum of volumes of intracranial blood, CSF & cerebral tissue must remain constant in an intact cranium. Treatment in Many cases can be resolved spontaneously or by use Conservative approach that include bed rest, oral hydration, caffeine intake and use of abdominal binder. Imaging Modalities for Detection of CSF leakage include CT myelography, Radioisotope cisternography, MR myelography, MR imaging and Intrathecal Gd-enhanced MR

  15. Predictors of residual flow in embolized intracranial ruptured aneurysms at early follow-up.

    Science.gov (United States)

    Serafin, Zbigniew; Strześniewski, Piotr; Beuth, Wojciech

    2014-01-01

    The possibility of recanalization and the need for retreatment are the most important drawbacks of intracranial aneurysm embolization. The purpose of the study was to prospectively analyze the results of early follow-up angiography of embolized ruptured aneurysms in an attempt to determine factors predicting the presence of residual flow. Evaluation included 72 patients with 72 aneurysms, which were followed-up 3 months after the treatment. Analysis of residual flow predictors included: age and gender, clinical state in Hunt-Hess scale, aneurysm localization, aneurysm three dimensions and volume, neck width, sac-to-neck ratio, initial result of embolization, number of coils used and the use of hydrogel coils and stents. Mean sac diameter was 6.5±3.9 mm, and mean neck width was 2.9±1.4 mm. Follow-up angiography presented residual flow in 26 aneurysms (36.1%): class 2 in 8 aneurysms (11.1%), and class 3 in 18 cases (25.0%). Stable aneurysm filling was observed in 45 cases (62.5%), progression of residual flow in 25 cases (34.7%), and regression in 2 cases (2.8%). According to ROC analysis independent predictors of residual flow were aneurysm neck diameter (AUC 0.857, 95% CI: 0.755-0.928, p<0.0001) and sac-to-neck ratio (AUC 0.817, 95% CI: 0.708-0.898, p<0.0001). Cut-off point of the ROC curve was established at 2.8 mm for neck diameter, and 1.73 for sac-to-neck ratio. Aneurysm neck diameter and sac-to-neck ratio are independently related to the residual flow in embolized ruptured aneurysms at early follow-up.

  16. Relationship between Cough-Associated Changes in CSF Flow and Disease Severity in Chiari I Malformation: An Exploratory Study Using Real-Time MRI.

    Science.gov (United States)

    Bezuidenhout, A F; Khatami, D; Heilman, C B; Kasper, E M; Patz, S; Madan, N; Zhao, Y; Bhadelia, R A

    2018-05-10

    Currently no quantitative objective test exists to determine disease severity in a patient with Chiari I malformation. Our aim was to correlate disease severity in symptomatic patients with Chiari I malformation with cough-associated changes in CSF flow as measured with real-time MR imaging. Thirteen symptomatic patients with Chiari I malformation (tonsillar herniation of ≥5 mm) were prospectively studied. A real-time, flow-sensitized pencil-beam MR imaging scan was used to measure CSF stroke volume during rest and immediately following coughing and relaxation periods (total scan time, 90 seconds). Multiple posterior fossa and craniocervical anatomic measurements were also obtained. Patients were classified into 2 groups by neurosurgeons blinded to MR imaging measurements: 1) nonspecific Chiari I malformation (5/13)-Chiari I malformation with nonspecific symptoms like non-cough-related or mild occasional cough-related headache, neck pain, dizziness, paresthesias, and/or trouble swallowing; 2) specific Chiari I malformation (8/13)-patients with Chiari I malformation with specific symptoms and/or objective findings like severe cough-related headache, myelopathy, syringomyelia, and muscle atrophy. The Spearman correlation was used to determine correlations between MR imaging measurements and disease severity, and both groups were also compared using a Mann-Whitney U test. There was a significant negative correlation between the percentage change in CSF stroke volume (resting to postcoughing) and Chiari I malformation disease severity ( R = 0.59; P = .03). Mann-Whitney comparisons showed the percentage change in CSF stroke volume (resting to postcoughing) to be significantly different between patient groups ( P = .04). No other CSF flow measurement or anatomic measure was significantly different between the groups. Our exploratory study suggests that assessment of CSF flow response to a coughing challenge has the potential to become a valuable objective noninvasive

  17. Experimental study on blood flow patterns through the phantoms of the intracranial arterial aneurysms using color Doppler imaging

    International Nuclear Information System (INIS)

    Chung, Tae Sub; Jeong, Eun Kee; Rhim, Yoon Chul; Kim, Sung Bin; Lee, Dong Hoon; Kim, Dae In

    1994-01-01

    The occurrence, growth, thrombosis, and rupture of intracranial saccular aneurysms can be directly related to the effect of hemodynamic forces. We developed the phantom flow models and compared with the computer simulation program to analyse the flow pattern and hemodynamics that might be responsible for the intracranial arterial aneurysms. We designed the arterial phantoms of three major sites of intracranial arterial aneurysm ; 1) basilar artery tip, 2) internal carotid artery bifurcation, 3) curved area of internal carotid artery. Flow patterns in the aneurysmal portion of phantoms were evaluated with color Doppler system on the connection with automatic closed type of circulation system. Then, we compared the results with computer simulation. The hemodynamic characteristics of the phantoms were identical with those obtained by computerisation's. Three distinct zones of flow were identified by color Doppler studies on the aneurysm of the curved area of an internal carotid artery : 1) an inflow zone entering the aneurysm at the distal aspect of its orifice, 2) an outflow zone exiting the aneurysm at the proximal aspect of its orifice, 3) a central slow vortex.However, the phantoms of basilar artery tip and artery bifurcation showed a direct inflow stream at the dome of an aneurysm. Flow dynamics in the various phantoms of the aneurysms can be successfully evaluated with color Doppler imaging, and were consistent with those predicted by computer simulations

  18. Cerebral blood flow changes in response to elevated intracranial pressure in rabbits and bluefish: a comparative study.

    Science.gov (United States)

    Beiner, J M; Olgivy, C S; DuBois, A B

    1997-03-01

    In mammals, the cerebrovascular response to increases in intracranial pressure may take the form of the Cushing response, which includes increased mean systemic arterial pressure, bradycardia and diminished respirations. The mechanism, effect and value of these responses are debated. Using laser-Doppler flowmetry to measure cerebral blood flow, we analyzed the cardiovascular responses to intracranial pressure raised by epidural infusion of mock cerebrospinal fluid in the bluefish and in the rabbit, and compare the results. A decline in cerebral blood flow preceding a rise in mean systemic arterial pressure was observed in both species. Unlike bluefish, rabbits exhibit a threshold of intracranial pressure below which cerebral blood flow was maintained and no cardiovascular changes were observed. The difference in response between the two species was due to the presence of an active autoregulatory system in the cerebral tissue of rabbits and its absence in bluefish. For both species studied, the stimulus for the Cushing response seems to be a decrement in cerebral blood flow. The resulting increase in the mean systemic arterial pressure restores cerebral blood flow to levels approaching controls.

  19. Cerebrospinal fluid flow. Pt. 3

    International Nuclear Information System (INIS)

    Schroth, G.; Klose, U.

    1992-01-01

    Cardiac- and respiration-related movements of the cerebrospinal fluid (CSF) were investigated by MRI in 71 patients. In most patients with arteriosclerotic occlusive vascular disease CSF pulsations are normal. Decreased pulsatile flow is detectable in those with arteriovenous malformations, intracranial air and following lumbar puncture and withdrawal of CSF. Increased pulsatile flow in the cerebral aqueduct was found in 2 patients with large aneurysms, idiopathic communicating syringomyelia and in most cases of normal pressure hydrocephalus (NPH). CSF flow in the cervical spinal canal is, however, reduced or normal in NPH, indicating reduction of the unfolding ability of the surface of the brain and/or inhibition of rapid CSF movements in the subrachnoid space over its convexity. (orig.)

  20. Blood flow in intracranial aneurysms treated with Pipeline embolization devices: computational simulation and verification with Doppler ultrasonography on phantom models

    Directory of Open Access Journals (Sweden)

    Anderson Chun On Tsang

    2015-04-01

    Full Text Available Purpose: The aim of this study was to validate a computational fluid dynamics (CFD simulation of flow-diverter treatment through Doppler ultrasonography measurements in patient-specific models of intracranial bifurcation and side-wall aneurysms. Methods: Computational and physical models of patient-specific bifurcation and sidewall aneurysms were constructed from computed tomography angiography with use of stereolithography, a three-dimensional printing technology. Flow dynamics parameters before and after flow-diverter treatment were measured with pulse-wave and color Doppler ultrasonography, and then compared with CFD simulations. Results: CFD simulations showed drastic flow reduction after flow-diverter treatment in both aneurysms. The mean volume flow rate decreased by 90% and 85% for the bifurcation aneurysm and the side-wall aneurysm, respectively. Velocity contour plots from computer simulations before and after flow diversion closely resembled the patterns obtained by color Doppler ultrasonography. Conclusion: The CFD estimation of flow reduction in aneurysms treated with a flow-diverting stent was verified by Doppler ultrasonography in patient-specific phantom models of bifurcation and side-wall aneurysms. The combination of CFD and ultrasonography may constitute a feasible and reliable technique in studying the treatment of intracranial aneurysms with flow-diverting stents.

  1. Intracranial arteriovenous malformation. Relationships between clinical and radiographic factors and cerebral blood flow

    Energy Technology Data Exchange (ETDEWEB)

    Batjer, H H; Devous, M D; Seibert, G B; Purdy, P D; Ajmani, A K; Delarosa, M; Bonte, F J [Texas Univ., Dallas, TX (USA). Southwestern Medical Center

    1989-05-01

    Arteriovenous malformations (AVMs) dramatically alter normal cerebral circulatory dynamics. Clinical and radiographic data from 62 patients were analyzed to determine their impact on total brain blood flow (TBF) measured by single-photon emission computed tomography. 48% of patients presented with hemorrhage and 34% with progressive deficits. 37% had angiographic steal and 21% developed postoperative hyperemic complications. 40% were under 30 years old, 45% were between 30 and 50 years of age, and 15% were over 50. TBF was less than 70 ml/100 gm/min in 32% of patients, between 70 and 84 ml/100 gm/min in 40%, and greater than 84 ml/100 gm/min in 27%. Female patients had higher TBF than males; 42% of females but only 17% of males had values greater than 84 ml/100 gm/min (p < 0.05). A trend toward decreased TBF with advancing age was noted. Intracranial hemorrhage was associated with lower TBF; 47% of patients with hemorrhage and 19% of those without had TBF of < 70 ml/100 gm/min (p < 0.05). 89% of patients with AVMs less than 5 cm in diameter had TBF of {le}84 ml/100 gm/min, and 65% of those with larger AVMs had similarly low flows (p < 0.05). A trend toward lower TBF was observed in patients with unfavorable outcomes. (author).

  2. IIH with normal CSF pressures?

    Directory of Open Access Journals (Sweden)

    Soh Youn Suh

    2013-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a condition of raised intracranial pressure (ICP in the absence of space occupying lesions. ICP is usually measured by lumbar puncture and a cerebrospinal fluid (CSF pressure above 250 mm H 2 O is one of the diagnostic criteria of IIH. Recently, we have encountered two patients who complained of headaches and exhibited disc swelling without an increased ICP. We prescribed acetazolamide and followed both patients frequently; because of the definite disc swelling with IIH related symptoms. Symptoms and signs resolved in both patients after they started taking acetazolamide. It is generally known that an elevated ICP, as measured by lumbar puncture, is the most important diagnostic sign of IIH. However, these cases caution even when CSF pressure is within the normal range, that suspicion should be raised when a patient has papilledema with related symptoms, since untreated papilledema may cause progressive and irreversible visual loss.

  3. Reduction of CSF flow artifact in fast fluid attenuated inversion recovery MR imaging. Study of excitation width in 180deg inversion pulse

    International Nuclear Information System (INIS)

    Tsuchihashi, Toshio; Yoshizawa, Satoshi; Maki, Toshio; Kitagawa, Matsuo; Suzuki, Ken; Fujita, Isao

    1998-01-01

    A technique that increases slice thickness so that it becomes wider than the excitation width of the 180deg inversion pulse and in which TR is partitioned twice has been investigated with regard to fast FLAIR. This is a technique that reduces the flow artifact of CSF. It is thought that, with this technique, the flow artifact is reduced because the CSF that flows onto the slice reaches the null point. The cross talk effect of the 180deg inversion pulse appears as a high CSF signal. As a result, the number of slices needs to be partitioned two or three times before imaging. Thus the imaging time is doubled or tripled. Considering the cross talk effect of the 180deg inversion pulse and the imaging time needed for this technique, the optimal imaging technique would be one that uses an inversion pulse that is four times slice thickness plus slice space and for which the number of slices is partitioned twice. Furthermore, the null point of CSF was dependent on dividing TR in half. (author)

  4. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    International Nuclear Information System (INIS)

    Briganti, Francesco; Napoli, Manuela; Leone, Giuseppe; Marseglia, Mariano; Mariniello, Giuseppe; Caranci, Ferdinando; Tortora, Fabio; Maiuri, Francesco

    2014-01-01

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  5. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, Francesco, E-mail: frabriga@unina.it [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: napoli.manuela@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: g.leonemd@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: mariano-marseglia@libero.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: giuseppe.mariniello@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: ferdinando.caranci@unina.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: fabiotor@libero.it [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: frmaiuri@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)

    2014-09-15

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (85.7%) had no previous hemorrhage. The procedures were performed in 5 patients (14.3%) with SILK and in 30 (85.7%) with PED. In 3 patients FDDs were used as a second treatment after failure of previous coiling (2 cases) or stenting (one case). The 39 aneurysms were in supraclinoid ICA in 26 (66.7%), cavernous ICA in 2 (5.1%), PCoA in 4 (10.2%), MCA in 5 (12.9%), SCA in 1 (2.6%) and PICA in 1 (2.6%). The aneurysms were small (<10 mm) in 32 cases (82%), large (11–25 mm) in 6 (15.3%) and giant in 1 (2.6%). The occlusion rate according to the aneurysm location, size and neck and the complications were evaluated. Results: Peri-procedural complications included transient dysarthria (2 patients), vasospasm with acute intra-stent aggregation (one), microwire rupture (one) and failure of the stent opening (one). The follow-up was made between 24 and 62 months (mean 41 months); clinical examination and CTA were performed at 1, 3, 6 and 12 months after the procedure. The complete occlusion was confirmed by CTA and DSA. MRI with angiographic-studies was taken every year. Complete occlusion was obtained in 35 aneurysms (92.1%) and subtotal in 3 (7.9%). Complete occlusion occurred at 3 months in 24 cases (68.6%), within 3 and 6 months in 9 (25.7%). The rate and

  6. Association between hemodynamic modifications and clinical outcome of intracranial aneurysms treated using flow diverters.

    Science.gov (United States)

    Paliwal, Nikhil; Damiano, Robert J; Davies, Jason M; Siddiqui, Adnan H; Meng, Hui

    2017-02-11

    Treatment of intracranial aneurysms (IAs) has been revolutionized by the advent of endovascular Flow Diverters (FDs), which disrupt blood flow within the aneurysm to induce pro-thrombotic conditions, and serves as a scaffold for endothelial ingrowth and arterial remodeling. Despite good clinical success of FDs, complications like incomplete occlusion and post-treatment rupture leading to subarachnoid hemorrhage have been reported. In silico computational fluid dynamic analysis of the pre- and post-treated geometries of IA patients can shed light on the contrasting blood hemodynamics associated with different clinical outcomes. In this study, we analyzed hemodynamic modifications in 15 IA patients treated using a single FD; 10 IAs were completely occluded (successful) and 5 were partially occluded (unsuccessful) at 12-month follow-up. An in-house virtual stenting workflow was used to recapitulate the clinical intervention on these cases, followed by CFD to obtain pre- and post-treatment hemodynamics. Bulk hemodynamic parameters showed comparable reductions in both groups with average inflow rate and aneurysmal velocity reduction of 40.3% and 52.4% in successful cases, and 34.4% and 49.2% in unsuccessful cases. There was a substantial reduction in localized parameter like vortex coreline length and Energy Loss for successful cases, 38.2% and 42.9% compared to 10.1% and 10.5% for unsuccessful cases. This suggest that for successfully treated IAs, the localized complex blood flow is disrupted more prominently by the FD as compared to unsuccessful cases. These localized hemodynamic parameters can be potentially used in prediction of treatment outcome, thus aiding the clinicians in a priori assessment of different treatment strategies.

  7. Penetrating Osseous Spicules Causing High-Flow Ventral CSF Leaks in the Setting of Relatively Low BMI : A Preliminary Study.

    Science.gov (United States)

    Rosebrock, Richard E; Diehn, Felix E; Luetmer, Patrick H; Wald, John T; Lane, John I; Morris, Jonathan M; Lehman, Vance T; Carr, Carrie M; Mokri, Bahram; Thielen, Kent R

    2017-05-16

    We have anecdotally observed patients with high-flow ventral cerebrospinal fluid (CSF) leaks resulting from penetrating osseous spicules or calcified discs to be relatively thin. The purpose of this study was to explore the validity of this observation and determine if a potential association exists between low body mass index (BMI) and high-flow spinal ventral CSF leaks resulting from such dura-penetrating lesions. Sixteen consecutive patients with precisely localized high-flow ventral spinal CSF leaks on dynamic myelography were identified. The cause of the CSF leak was determined. The BMI on the date nearest to and within 2 weeks of myelography was recorded. Utilizing exact sign test, the body mass index was compared to the average BMI from the National Health and Nutrition Examination Survey (Centers for Disease Control), matched to sex and age-range. The cohort consisted of 10 males (63%) and 6 females with a mean age of 54 years (range 37-72 years). In all patients, a spiculated osteophyte/calcified disc was identified at the site of the leak. Fourteen patients (88%) had a BMI below the matched national average, while only two patients (13%) had values above the national average (p = 0.004). Patients with high-flow ventral CSF leaks resulting from spiculated osteophyte or calcified disc as identified by dynamic myelography are more likely to have a BMI below the U.S. national average, matched for gender and age-range. This exploratory analysis requires confirmation as well as further characterization of potential pathophysiologic mechanisms and impact on radiographic and clinical assessments.

  8. Modelling of the CSF flow in the spinal canal in cervical stenosis

    Czech Academy of Sciences Publication Activity Database

    Kaczmarská, A.; Štěpáník, Z.; Vaněk, P.; Maršík, František; Převorovská, Světlana; Otáhal, J.

    2007-01-01

    Roč. 40, - (2007), s. 477-477 ISSN 0021-9290 Institutional research plan: CEZ:AV0Z20760514 Keywords : cerebrospinal fluid flow * spinal canal * cervical stenosis Subject RIV: BK - Fluid Dynamics Impact factor: 2.897, year: 2007

  9. Cardiac-driven Pulsatile Motion of Intracranial Cerebrospinal Fluid Visualized Based on a Correlation Mapping Technique.

    Science.gov (United States)

    Yatsushiro, Satoshi; Sunohara, Saeko; Hayashi, Naokazu; Hirayama, Akihiro; Matsumae, Mitsunori; Atsumi, Hideki; Kuroda, Kagayaki

    2018-04-10

    A correlation mapping technique delineating delay time and maximum correlation for characterizing pulsatile cerebrospinal fluid (CSF) propagation was proposed. After proofing its technical concept, this technique was applied to healthy volunteers and idiopathic normal pressure hydrocephalus (iNPH) patients. A time-resolved three dimensional-phase contrast (3D-PC) sampled the cardiac-driven CSF velocity at 32 temporal points per cardiac period at each spatial location using retrospective cardiac gating. The proposed technique visualized distributions of propagation delay and correlation coefficient of the PC-based CSF velocity waveform with reference to a waveform at a particular point in the CSF space. The delay time was obtained as the amount of time-shift, giving the maximum correlation for the velocity waveform at an arbitrary location with that at the reference location. The validity and accuracy of the technique were confirmed in a flow phantom equipped with a cardiovascular pump. The technique was then applied to evaluate the intracranial CSF motions in young, healthy (N = 13), and elderly, healthy (N = 13) volunteers and iNPH patients (N = 13). The phantom study demonstrated that root mean square error of the delay time was 2.27%, which was less than the temporal resolution of PC measurement used in this study (3.13% of a cardiac cycle). The human studies showed a significant difference (P correlation coefficient between the young, healthy group and the other two groups. A significant difference (P correlation coefficients in intracranial CSF space among all groups. The result suggests that the CSF space compliance of iNPH patients was lower than that of healthy volunteers. The correlation mapping technique allowed us to visualize pulsatile CSF velocity wave propagations as still images. The technique may help to classify diseases related to CSF dynamics, such as iNPH.

  10. Measurement of CSF volume with 3D-FASE MRI

    International Nuclear Information System (INIS)

    Kanayama, Shoichi; Calderon, A.; Makita, Jun-ichi; Ohara, Yukou; Tsunoda, Akira; Sato, Kiyoshi.

    1997-01-01

    A noninvasive and fast cerebrospinal fluid (CSF) volume measurement method has been developed using 3D-FASE MRI and a semi-automatic segmentation process. Images with a high CSF/(gray and white matter) ratio (about 10-20) were obtained with a heavily T 2 weighted 3D-FASE sequence. The CSF region was segmented with a region growing method and the volume was calculated from the number of segmented voxels with a signal intensity weighted summation. Total measurement time was about 30 minutes for each study. The errors of the measured volumes were within 10% for the phantom experiments. Intracranial CSF volumes of normal volunteers ranged between about 100 and 200 cc and the ventricle/intracranial CSF ratio was about 10%. 3D display of the segmented intracranial and ventricle CSF regions was also carried out and proved to be useful to understand the anatomy. Increased intracranial and/or ventricle CSF volumes were obtained for a hydrocephalic patient and one patient with probable cerebral atrophy. The results suggest that the developed method could be used for the diagnosis of patients with neurological diseases. (author)

  11. Cine phase-contrast MRI measurement of CSF flow in the cervical spine: a pilot study in patients with spinal cord injury

    Science.gov (United States)

    Negahdar, MJ; Shakeri, M.; McDowell, E.; Wells, J.; Vitaz, T.; Harkema, S.; Amini, A.

    2011-03-01

    MRI velocimetry (also known as phase-contrast MRI) is a powerful tool for quantification of cerebrospinal fluid (CSF) flow in various regions of the brain and craniospinal junction and has been accepted as a diagnostic tool to assist with the diagnosis of certain conditions such as hydrocephalus and chiari malformations. Cerebrospinal fluid is continually produced in the ventricles of the brain, flows through the ventricular system and then out and around the brain and spinal cord and is reabsorbed over the convexity of the brain. Any disease process which either impedes the normal pattern of flow or restricts the area where flow occurs can change the pattern of these waveforms with the direction and velocity of flow being determined by the pressure transmitted from the pulsation of the heart and circulation of blood within the central nervous system. Therefore, we hypothesized that phase-contrast MRI could eventually be used as a diagnostic aid in determining the degree of spinal cord compression following injury to the cervical or thoracic spine. In this study, we examined CSF flow in 3 normal subjects and 2 subjects with non-acute injuries in the cervical spine using Cine phasecontrast MRI. CSF flow analysis was performed using an in-house developed software. The flow waveform was calculated in both normal subjects (n=3) as well as subjects with spinal cord injury in the cervical spine (n=2). The bulk flow at C2 was measured to be 0.30 +/- 0.05 cc, at 5 cm distal to C2, it was 0.19+/- 0.07 cc, and at 10 cm distal to C2, it was 0.17+/- 0.05 cc. These results were in good agreement with previously published results. In patients with spinal cord injury, at the site of injury in the cervical spine, bulk flow was found to be 0.08 +/- 0.12 cc, at 5 cm proximal to the site of injury it was found to be 0.18 +/- 0.07 cc, and at 5 cm distal to the site of injury, it was found to be 0.12 +/- 0.01 cc.

  12. Endovascular treatment of intracranial aneurysms with the p64 flow diverter stent: mid-term results in 35 patients with 41 intracranial aneurysms.

    Science.gov (United States)

    Morais, Ricardo; Mine, Benjamin; Bruyère, Pierre Julien; Naeije, Gilles; Lubicz, Boris

    2017-03-01

    The p64 flow diverter (FD) device is a fully resheathable and detachable stent dedicated for endovascular treatment (EVT) of intracranial aneurysms (IAs). We report our mid-term experience with this device. Between January 2015 and February 2016, we retrospectively identified, in our prospectively maintained database, all patients treated with p64 FDs in two institutions. Independent clinical follow-up was performed by a vascular neurologist. Imaging follow-up included a digitalized subtraction angiography (DSA) at 3, 6, and 12 months and a magnetic resonance angiography (MRA) at 12 months. Thirty-nine patients (22 women/17 men; median age 54 years) with 48 IAs (median aneurysm size 6.2 mm; mean neck size 3.4 mm) were identified. All IAs were saccular and unruptured. Failure of safe stent delivery occurred in 15% of cases (7/48 IAs) which were excluded. Transient neurological morbidity occurred in 2/35 patients (5.7%) including one delayed thromboembolic complication. No permanent morbidity or mortality was encountered. Complete aneurysmal occlusion at 3, 6, and 12 months was 20/30 (66.6%), 18/27 (66.6%), and 24/28 (85.7%), respectively. Intra-stent stenosis was observed in 9/29 patients (31%) and classified as moderate in 4/29 (13.7%) and mild in 5/29 patients (17.2%). These stenoses gradually improved over time, with only mild stenoses being identified at 6 months and at 12 months. In our small case series, the p64 FD stent appears safe and effective for EVT of IAs. A high occlusion rate and a low morbidity rate were observed.

  13. Spaceflight-Induced Intracranial Hypertension: An Overview

    Science.gov (United States)

    Traver, William J.

    2011-01-01

    This slide presentation is an overview of the some of the known results of spaceflight induced intracranial hypertension. Historical information from Gemini 5, Apollo, and the space shuttle programs indicated that some vision impairment was reported and a comparison between these historical missions and present missions is included. Optic Disc Edema, Globe Flattening, Choroidal Folds, Hyperopic Shifts and Raised Intracranial Pressure has occurred in Astronauts During and After Long Duration Space Flight. Views illustrate the occurrence of Optic Disc Edema, Globe Flattening, and Choroidal Folds. There are views of the Arachnoid Granulations and Venous return, and the question of spinal or venous compliance issues is discussed. The question of increased blood flow and its relation to increased Cerebrospinal fluid (CSF) is raised. Most observed on-orbit papilledema does not progress, and this might be a function of plateau homeostasis for the higher level of intracranial pressure. There are seven cases of astronauts experiencing in flight and post flight symptoms, which are summarized and follow-up is reviewed along with a comparison of the treatment options. The question is "is there other involvement besides vision," and other Clinical implications are raised,

  14. CO2 Effects in Space: Relationship to Intracranial Hypertension

    Science.gov (United States)

    Alexander, David J.

    2011-01-01

    This slide presentation reviews the effects of enhanced exposure to CO2 on Earth and in space. The effects of enhanced exposure to CO2 are experienced in almost all bodily systems. In space some of the effects are heightened due to the fluid shifts to the thorax and head. This fluid shift results in increased intracranial pressure, congested cerebral circulation, increased Cerebral Blood Flow (CBF) and Intravenous dilatation. The mechanism of the effect of CO2 on CBF is diagrammed, as is the Cerebrospinal Fluid (CSF) production. A listing of Neuroendocrine targets is included.

  15. Organic electronics based pressure sensor towards intracranial pressure monitoring

    Science.gov (United States)

    Rai, Pratyush; Varadan, Vijay K.

    2010-04-01

    The intra-cranial space, which houses the brain, contains cerebrospinal fluid (CSF) that acts as a fluid suspension medium for the brain. The CSF is always in circulation, is secreted in the cranium and is drained out through ducts called epidural veins. The venous drainage system has inherent resistance to the flow. Pressure is developed inside the cranium, which is similar to a rigid compartment. Normally a pressure of 5-15 mm Hg, in excess of atmospheric pressure, is observed at different locations inside the cranium. Increase in Intra-Cranial Pressure (ICP) can be caused by change in CSF volume caused by cerebral tumors, meningitis, by edema of a head injury or diseases related to cerebral atrophy. Hence, efficient ways of monitoring ICP need to be developed. A sensor system and monitoring scheme has been discussed here. The system architecture consists of a membrane less piezoelectric pressure sensitive element, organic thin film transistor (OTFT) based signal transduction, and signal telemetry. The components were fabricated on flexible substrate and have been assembled using flip-chip packaging technology. Material science and fabrication processes, subjective to the device performance, have been discussed. Capability of the device in detecting pressure variation, within the ICP pressure range, is investigated and applicability of measurement scheme to medical conditions has been argued for. Also, applications of such a sensor-OTFT assembly for logic sensor switching and patient specific-secure monitoring system have been discussed.

  16. MRI measurements of intracranial pressure in the upright posture: The effect of the hydrostatic pressure gradient.

    Science.gov (United States)

    Alperin, Noam; Lee, Sang H; Bagci, Ahmet M

    2015-10-01

    To add the hydrostatic component of the cerebrospinal fluid (CSF) pressure to magnetic resonance imaging (MRI)-derived intracranial pressure (ICP) measurements in the upright posture for derivation of pressure value in a central cranial location often used in invasive ICP measurements. Additional analyses were performed using data previously collected from 10 healthy subjects scanned in supine and sitting positions with a 0.5T vertical gap MRI scanner (GE Medical). Pulsatile blood and CSF flows to and from the brain were quantified using cine phase-contrast. Intracranial compliance and pressure were calculated using a previously described method. The vertical distance between the location of the CSF flow measurement and a central cranial location was measured manually in the mid-sagittal T1 -weighted image obtained in the upright posture. The hydrostatic pressure gradient of a CSF column with similar height was then added to the MR-ICP value. After adjustment for the hydrostatic component, the mean ICP value was reduced by 7.6 mmHg. Mean ICP referenced to the central cranial level was -3.4 ± 1.7 mmHg compared to the unadjusted value of +4.3 ± 1.8 mmHg. In the upright posture, the hydrostatic pressure component needs to be added to the MRI-derived ICP values for compatibility with invasive ICP at a central cranial location. © 2015 Wiley Periodicals, Inc.

  17. Lack of causal association between spontaneous intracranial hypotension and cranial cerebrospinal fluid leaks.

    Science.gov (United States)

    Schievink, Wouter I; Schwartz, Marc S; Maya, M Marcel; Moser, Franklin G; Rozen, Todd D

    2012-04-01

    Spontaneous intracranial hypotension is an important cause of headaches and an underlying spinal CSF leak can be demonstrated in most patients. Whether CSF leaks at the level of the skull base can cause spontaneous intracranial hypotension remains a matter of controversy. The authors' aim was to examine the frequency of skull base CSF leaks as the cause of spontaneous intracranial hypotension. Demographic, clinical, and radiological data were collected from a consecutive group of patients evaluated for spontaneous intracranial hypotension during a 9-year period. Among 273 patients who met the diagnostic criteria for spontaneous intracranial hypotension and 42 who did not, not a single instance of CSF leak at the skull base was encountered. Clear nasal drainage was reported by 41 patients, but a diagnosis of CSF rhinorrhea could not be established. Four patients underwent exploratory surgery for presumed CSF rhinorrhea. In addition, the authors treated 3 patients who had a postoperative CSF leak at the skull base following the resection of a cerebellopontine angle tumor and developed orthostatic headaches; spinal imaging, however, demonstrated the presence of a spinal source of CSF leakage in all 3 patients. There is no evidence for an association between spontaneous intracranial hypotension and CSF leaks at the level of the skull base. Moreover, the authors' study suggests that a spinal source for CSF leakage should even be suspected in patients with orthostatic headaches who have a documented skull base CSF leak.

  18. Cerebrospinal fluid pulsation amplitude and its quantitative relationship to cerebral blood flow pulsations: a phase-contrast MR flow imaging study

    International Nuclear Information System (INIS)

    Bhadelia, R.A.; Bogdan, A.R.; Kaplan, R.F.; Wolpert, S.M.

    1997-01-01

    Our purpose in this investigation was to explain the heterogeneity in the cerebrospinal fluid (CSF) flow pulsation amplitudes. To this end, we determined the contributions of the cerebral arterial and jugular venous flow pulsations to the amplitude of the CSF pulsation. We examined 21 healthy subjects by cine phase-contrast MRI at the C2-3 disc level to demonstrate the CSF and vascular flows as waveforms. Multiple regression analysis was performed to calculate the contributions of (a) the arterial and venous waveform amplitudes and (b) the delay between the maximum systolic slopes of the arterial and venous waveforms (AV delay), in order to predict the amplitude of the CSF waveform. The contribution of the arterial waveform amplitude was positive (r = 0.61; p 0.003) to the CSF waveform amplitude and that of the venous waveform amplitude was negative (r = -0.50; p = 0.006). Both in combination accounted for 56 % of the variance in predicting the CSF waveform amplitude (p < 0.0006). The contribution of AV delay was not significant. The results show that the variance in the CSF flow pulsation amplitudes can be explained by concurrent evaluation of the CSF and vascular flows. Improvement in the techniques, and controlled experiments, may allow use of CSF flow pulsation amplitudes for clinical applications in the non-invasive assessment of intracranial dynamics by MRI. (orig.). With 3 figs., 2 tabs

  19. Decreased CSF-flow artefacts in T2 imaging of the cervical spine with periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER/BLADE)

    International Nuclear Information System (INIS)

    Ragoschke-Schumm, Andreas; Schmidt, Peter; Mayer, Thomas E.; Schumm, Julia; Reimann, Georg; Mentzel, Hans-Joachim; Kaiser, Werner A.

    2011-01-01

    The cervical spine is prone to artefacts in T2 MR-imaging due to patient movements and cerebrospinal fluid flow. The periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER/BLADE) acquisition method was developed to reduce motion artefacts. We sought to determine if T2-BLADE is superior to T2-TSE with conventional k-space reading. Twenty-five patients were examined using a 1.5 T MR-scanner. T2-weighted imaging of the cervical spine in sagittal and axial orientation using conventional or BLADE k-space reading was performed. Spinal cord, subarachnoid space, vertebrae and discs were evaluated by two independent observers using a scale from 0 (non-diagnostic) to 3 (excellent). Interobserver correlation was assessed as Cohen's kappa. Results of Mann-Whitney U test with p < 0.05 were regarded as significant. Furthermore, the investigators were asked for subjective evaluation in consensus. Overall interobserver accuracy of κ = 0.91 was obtained. Comparison of sagittal images showed better values for all investigated structures in T2-BLADE: spinal cord (TSE/BLADE: 1.52/2.04; p < 0.001), subarachnoid space (1.36/2.06; p < 0.001) and vertebrae/discs (1.66/2.86; p < 0.001). Comparison of axial images showed better values in T2-BLADE for spinal cord (1.68/1.86; p = 0.149) and vertebrae/discs (1.0/1.96: p < 0.001) while subarachnoid space was better to be evaluated in conventional T2-TSE (1.94/1.12; p < 0.001). In sagittal orientation, motion- and CSF-flow artefacts were reduced in T2-BLADE. In axial orientation, however, CSF-flow artefacts were pronounced in T2-BLADE. The image quality of the sagittal T2-BLADE sequences was significantly better than the T2-TSE and acquired in less time. In axial orientation, increased CSF-flow artefacts may reduce accuracy of structures in the subarachnoid space. (orig.)

  20. Long term evaluation of brain perfusion with magnetic resonance in high flow extracranial-intracranial saphenous graft bypass

    Energy Technology Data Exchange (ETDEWEB)

    Bozzao, Alessandro [University of Rome La Sapienza, Department of Neuroradiology, II Faculty of Medicine, Rome (Italy); Sant' Andrea Hospital, Rome (Italy); Fasoli, Fabrizio; Finocchi, Vanina; Romano, Andrea; Fantozzi, Luigi M. [University of Rome La Sapienza, Department of Neuroradiology, II Faculty of Medicine, Rome (Italy); Santoro, Giuseppe [University of Rome La Sapienza, Department of Neurosurgery, I Faculty of Medicine, Rome (Italy)

    2007-01-15

    Assessment was made of the cerebral vascular haemodynamic parameters in patients with a high-flow extra-intracranial (EC-IC) bypass performed for therapeutic occlusion of the internal carotid artery (ICA). Sixteen patients with ICA occlusion and EC-IC bypass (time interval from surgery 1-6 years) underwent MRI. Perfusion-weighted magnetic resonance imaging (PW-MRI) sequences were performed without the use of an arterial input function. The relative cerebral blood volume (rCBV), mean transit time (MTT) and relative cerebral blood flow (rCBF) were evaluated in all patients at the level of the basal ganglia, centrum semiovale and cortex in both hemispheres. Statistically significant differences (P<0.005) were observed in the haemodynamic parameters, indicating increased rCBV in the basal ganglia and decreased rCBF and rCBV in the cortex of the hemisphere supplied by the graft with respect to the contralateral. Patients with occlusion of the ICA and high flow EC-IC bypass do have altered vascular haemodynamic status between the hemispheres. In particular, rCBF is impaired in the surgical hemisphere at the level of the cortex. These patients should be followed-up to rule out chronic ischemia. (orig.)

  1. Fast CSF MRI for brain segmentation; Cross-validation by comparison with 3D T1-based brain segmentation methods

    NARCIS (Netherlands)

    van der Kleij, Lisa A; de Bresser, Jeroen; Hendrikse, Jeroen; Siero, Jeroen C W; Petersen, Esben T; De Vis, Jill B

    2018-01-01

    OBJECTIVE: In previous work we have developed a fast sequence that focusses on cerebrospinal fluid (CSF) based on the long T2 of CSF. By processing the data obtained with this CSF MRI sequence, brain parenchymal volume (BPV) and intracranial volume (ICV) can be automatically obtained. The aim of

  2. Steady-streaming effects on the motion of the cerebrospinal fluid (CSF) in the spinal canal

    Science.gov (United States)

    Lawrence, Jenna; Coenen, Wilfried; Sanchez, Antonio; Lasheras, Juan

    2017-11-01

    With each heart beat the oscillatory blood supply to the rigid cranial vault produces a time-periodic variation of the intracranial pressure that drives the cerebrospinal fluid (CSF) periodically in and out of the compliant spinal canal. We have recently conducted an analysis of this flow-structure interaction problem taking advantage of the small compliance of the dura membrane bounding externally the CSF and of the disparity of length scales associated with the geometry of the subarachnoid space. We have shown in an idealized geometry that the steady-streaming motion associated with this periodic flow, resulting from the nonlinear cumulative effects of convective acceleration, causes a bulk recirculation of CSF inside the spinal canal, which has been observed in many radiological studies. We extend here our study to investigate the possible contribution arising from the flow around the nerve roots protruding from the spinal cord, an effect that was neglected in our previous work. For this purpose, we consider the oscillatory motion around a cylindrical post confined between two parallel plates. For large values of the relevant Strouhal number we find at leading order a harmonic Stokes flow, whereas steady-streaming effects enter in the first-order corrections, which are computed for realistic values of the Womersley number and of the cylinder height-to-radius ratio.

  3. Cerebrospinal fluid flow waveforms: effect of altered cranial venous outflow. A phase-contrast MR flow imaging study

    International Nuclear Information System (INIS)

    Bhadelia, R.A.; Wolpert, S.M.

    1998-01-01

    Our purpose was to assess the effect of alterations in the cranial venous outflow on cerebrospinal fluid (CSF) flow waveforms using phase-contrast MRI. Thirteen healthy subjects were assessed for CSF flow and cerebral vascular flow at the C2-3 level, both before and after jugular venous compression (JVC). The flow waveforms were assessed both as an aggregate, and after dividing subjects in two groups based on percent jugular venous flow (PJVF) i. e. jugular outflow expressed as percent of cerebral arterial inflow. Group 1: 7 subjects with PJVF more than and including median (predominantly jugular outflow); Group 2: 6 subjects with PJVF less than median (predominantly extra-jugular outflow). CSF waveforms: JVC produced rounding of contours and flattening of dicrotic waves, with the effect being greater in group 1 than group 2. In group 1, systolic upslopes of the waveforms increased. No significant aggregate amplitude changes were noted; amplidutes increased in group 1 (P = 0.001), and decreased in group 2 (P = 0.03). Temporal interval to the maximum CSF systolic flow significantly increased in group 1. Vascular flow: Arterial flow significantly decreased in group 1. Jugular flow significantly decreased in both groups. The results suggest that CSF flow waveforms are sensitive to alterations in the cranial venous outflow. Changes in group 1 are most likely because of an elevation in intracranial pressure. Analysis of CSF flow waveforms appears a promising noninvasive tool for assessment of cranial compartment. (orig.)

  4. Measurement of Blood Flow in an Intracranial Artery Bypass From the Internal Maxillary Artery by Intraoperative Duplex Sonography.

    Science.gov (United States)

    Yu, Zaitao; Shi, Xiang'en; Brohi, Shams Raza; Qian, Hai; Liu, Fangjun; Yang, Yang

    2017-02-01

    This study explored the hemodynamic characteristics of a subcranial-intracranial bypass from the internal maxillary artery by measuring blood flow on intraoperative duplex sonography. The hemodynamic parameters of the internal maxillary artery (n = 20), radial artery (n = 20), internal maxillary artery-middle cerebral artery bypass (n = 42), and internal maxillary artery-posterior cerebral artery bypass (n = 9) were measured by intraoperative duplex sonography. There was no significant difference in the internal diameters of the internal maxillary and radial arteries (mean ± SD, 2.51 ± 0.34 versus 2.56 ± 0.22 mm; P = .648). The mean radial artery graft length for subcranial-intracranial bypasses was 88.5 ± 12.78 mm (95% confidence interval [CI], 80.8-90.2 mm). Internal maxillary artery-middle cerebral artery bypasses required a shorter radial artery graft than internal maxillary artery-posterior cerebral artery bypasses (77.8 ± 2.47 versus 104.8 ± 4.77 mm; P = .001). The mean flow volumes were 85.3 ± 18.5 mL/min (95% CI, 76.6-93.9 mL/min) for the internal maxillary artery, 72.6 ± 26.4 mL/min (95% CI, 64.3-80.9 mL/min) for internal maxillary artery-middle cerebral artery bypasses, and 45.4 ± 6.7 mL/min (95% CI, 40.7-50.0 mL/min) for internal maxillary artery-posterior cerebral artery bypasses. All grafts were opened after the success of the salvage procedures had been established, and the early patency rates (1 month after the operation) were 95% for internal maxillary artery-middle cerebral artery bypasses and 100% the internal maxillary artery-posterior cerebral artery bypasses. Measurement of blood flow by intraoperative sonography can be helpful in decision making and predicting graft patency and success after neurosurgical bypass procedures. © 2016 by the American Institute of Ultrasound in Medicine.

  5. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Cardwell, C.; Cox, I.; Baldey, A.

    2002-01-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  6. Spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Cardwell, C; Cox, I; Baldey, A [St. F.X. Cabrini Hospital, VIC (Australia). Departments of Nuclear Medicine and Magnetic Resonance Imaging

    2002-07-01

    Full text: A 49-year old female presented with severe postural headache with no history of trauma. A Computed Tomography (CT) study of the brain demonstrated abnormal meningeal enhancement raising the possibility of leptomeningeal metastases. The patient was then referred to Magnetic Resonance Imaging (MRI) which demonstrated diffuse smooth dural enhancement with ancillary findings characteristic of spontaneous intracranial hypotension. The patient was then referred to Nuclear Medicine to confirm the diagnosis and localise the presumed leak 400MBq of 99mTc DTPA was injected via lumbar puncture into the L3-L4 subarachnoid space Posterior images of the spine were taken with a GE XRT single head gamma camera at 1 and 4 hours post administration of radionuclide. Images demonstrated abnormal early arrival of radionuclide in the kidneys and bladder at 1 hour and abnormal leak of tracer was demonstrate at the level of the first thoracic vertebra on the right side at 4 hours. This confirmed CSF leak at this level. Consequently the patient underwent a blood patch and her symptoms resolved. Spontaneous Intracranial Hypotension is a syndrome often unrecognised presenting with symptoms including severe postural headache neck stiffness nausea vomiting tinnitus and vertigo. The diagnosis is frequently suspected from findings on MRI, but Nuclear Medicine CSF imaging provides a readily available and cost effective method for confirming the diagnosis, and for making the diagnosis in patients who are unsuitable for or do not have access to MRI. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc.

  7. CSF oligoclonal banding - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100145.htm CSF oligoclonal banding - series—Normal anatomy To use the ... 5 out of 5 Overview The cerebrospinal fluid (CSF) serves to supply nutrients to the central nervous ...

  8. CSF coccidioides complement fixation

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/003526.htm CSF coccidioides complement fixation test To use the sharing features on this page, please enable JavaScript. CSF coccidioides complement fixation is a test that checks ...

  9. MR imaging of cerebrospinal fluid dynamics in health and disease. On the vascular pathogenesis of communicating hydrocephalus and benign intracranial hypertension

    International Nuclear Information System (INIS)

    Greitz, D.; Hannerz, J.; Raehn, T.; Bolander, H.; Ericsson, A.

    1994-01-01

    The CSF flows in the aqueduct and at the foramen magnum were examined in 5 patients with communicating hydrocephalus (HC) and in 10 with benign intracranial hypertension (BIH) as well as in 5 healthy volunteers. As compared to normal individuals, the aqueductal flow in HC was about 10 times larger and the cervical flow was half as large. In BIH the CSF flows were not different from those of normal volunteers. The decreased arterial expansion as reflected in the reduced cervical flow in HC may be due to pathologic changes in the arteries and paravascular spaces. The large aqueductal flow in HC reflects a large brain expansion, causing increased transcerebral mantle pressure gradient and ventricular dilatation. In BIH there is a normal brain expansion (aqueductal flow) and consequently no ventricular dilatation. It is argued that BIH be caused by an obstruction on the venous side, as opposed to the vascular alterations in HC, which are on the arterial side. (orig.)

  10. Primary intracranial malignant lymphoma

    International Nuclear Information System (INIS)

    Matsumoto, Mikiro; Ohtsuka, Takatsugu; Kuroki, Takao; Shibata, Iekado; Terao, Hideo; Kudo, Motoshige

    1988-01-01

    Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3 % of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found. (author)

  11. A case of intracranial teratoma

    International Nuclear Information System (INIS)

    Shiota, Madoka; Ando, Yukinori; Takashima, Sachio; Hori, Tomokatsu; Hiramoto, Shinsuke.

    1985-01-01

    A case of neonatal intracranial teratoma was examined on ultrasonography (US), computed tomography (CT) and tumor markers in serum, CSF and tumor tissue. This 27-day-old male infant was pointed out a head enlargement by prenatal sonography at 39 weeks' gestation. He admitted to our hospital at the age of one day after cesarean section. His birth weight was 4430 g and head circumstance 47.5 cm. On admission, physical and neurological examinations reveled big head, weak crying, twiching and sun set phenomenon. The optic fundi were normal. The CT scan at 1 day demonstrated the marked enlargement of lateral ventricles and the supratentorial large polycystic mass with calcifications at midline area. Transfontanelle sonography also delineated the polycystic mass and enlarged ventricle. Ventricular tap showed bloody CSF. Alpha-Fetoprotein and carcinoembryonic antigen level in CSF was higher than those in serum. Postmortam tumor necropsy revealed a teratoma including mature squamous epithelium, muscle, cartilage, bone, lymphoid and nervous tissue. There were immature mesenchymal cells in some parts. The immune histochemical method showed positive staining to AFP in intestinal and respiratory epithelium, and to CEA in intestinal epithelium and immature mesenchymal cells. In summary, these characteristic findings of US, CT and tumor marker in CSF have a diagnostic value of intracranial teratoma. (author)

  12. Intracranial Pressure

    DEFF Research Database (Denmark)

    Hvedstrup, Jeppe; Radojicic, Aleksandra; Moudrous, Walid

    2018-01-01

    OBJECTIVE: To compare a new method of noninvasive intracranial pressure (nICP) measurement with conventional lumbar puncture (LP) opening pressure. METHODS: In a prospective multicenter study, patients undergoing LP for diagnostic purposes underwent intracranial pressure measurements with HeadSen...

  13. MR imaging of pulsatile CSF movement in hydrocephalus communicans before and after CSF shunt implantation

    International Nuclear Information System (INIS)

    Goldmann, A.; Kunz, U.; Rotermund, F.; Friedrich, J.M.; Schnarkowski, P.

    1992-01-01

    16 patients with hydrocephalus communicans and 5 healthy volunteers were examined to demonstrate the pattern of the pulsatile CSF flow. After implantation of a CSF shunt system the same patients were examined again to show the influence of the shunt on the CSF pulsations. We used a flow-sensitised, cardiac-gated 2D FLASH sequence and analysed the phase and magnitude images. It could be shown that most patients (n=12) had a hyerdynamic pulsatile flow preoperatively. After shunt implantation the pulsatile CSF motion and the clinical symptoms were improved in 8 of these patients. MRI of pulsatile CSF flow movement seems to be a helpful noninvasive tool to estimate the prognosis of a shunt implantation in patients with hydrocephalus communicans. (orig.) [de

  14. Safety and efficiency of flow diverters for treating small intracranial aneurysms: A systematic review and meta-analysis.

    Science.gov (United States)

    Yao, Xiyang; Ma, Junwei; Li, Haiying; Shen, Haitao; Lu, Xiaojun; Chen, Gang

    2017-02-01

    Background We evaluated the safety and efficiency of flow diverters (FDs) in treating small intracranial aneurysms (IAs). Materials and Methods We reviewed the literature published in PubMed and EMBASE. R for Project software was used to calculate the complete aneurysm occlusion rates, procedure-related neurologic mortality, procedure-related neurologic morbidity and procedure-related permanent morbidity. Results Ten observational studies were included in this analysis. The complete aneurysm occlusion rate was 84.23% (80.34%-87.76%), the procedure-related neurologic mortality was 0.87% (0.29%-1.74%), the procedure-related neurologic morbidity rate was 5.22% (3.62%-7.1%), the intracerebral haemorrhage rate was 1.42% (0.64%-2.49%), the ischemic rate was 2.35% (1.31%-3.68%), the subarachnoid haemorrhage rate was 0.03% (0%-0.32%) and the procedure-related permanent morbidity was 2.41% (0.81%-4.83%). Conclusions Treatment of small IAs with FDs may be correlated with high complete occlusion rates and low complication rates. Future long-term follow-up randomized trials will determine the optimal treatment for small IAs.

  15. Interest of Flow Diversion Prostheses in the Management of Unruptured Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    Xavier Armoiry

    2012-01-01

    Full Text Available Flow diversion prostheses represent a new endovascular approach aimed at treating patients with large wide-neck aneurysms. Our objective is to present this new technology, to review the clinical studies on efficacy, and to emphasize its current limits. Flow diversion prostheses consist of a cylinder made of a large number of braided microfilaments providing a large metallic surface when deployed and inducing a blood flow diversion outside the aneurysm. Two different brands are currently available. Clinical data supporting their efficacy are currently limited to six non comparative cohort studies that included between 18 and 107 patients. Procedural implantation was shown to be feasible in more than 90% and safe with a thirty-day mortality between 2.8 and 5.5%. Complete occlusion rates at twelve months varied between 85.7 and 100%. Even though promising, the current status of flow diversion prostheses needs further evaluation with randomized, prospective, clinical trials with comparison to conventional strategies including endovascular coiling or surgical clipping.

  16. The evaluation of cerebral hemodynamics in patients with intracranial tumors by stable xenon CT; The effect of glycerol administration on regional cerebral blood flow

    Energy Technology Data Exchange (ETDEWEB)

    Shimoda, Masami; Kawamata, Fumio; Yamamoto, Masahiro; Ohsuga, Hitoshi; Hidaka, Mitsuru; Oda, Shinri; Shibuya, Naoki; Yamamoto, Isao; Sato, Osamu (Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine)

    1989-04-01

    In evaluating cerebral regional blood flow (rCBF), stable xenon-enhanced tomography (XeCT) study associated with simultaneous blood sampling was applied in 15 cases of intracranial neoplasms. The effect of intravenous glycerol infusion on rCBF was also investigated. The results indicated that intratumoral rCBF values were not only variable and unrelated to their histological types and grades, but also were not correlated with the vascularity of the lesion as demonstrated by angiography. When a tumor mass was enhanced after the injection of iodinated contrast media, it proved to be useful in distinguishing tumor mass and its associated edema that the rCBF of the peritumoral edematous region was predominantly low (10{plus minus}5 ml/100 g/min). The regional cerebral blood flow in remote areas, both ipsilateral and contralateral to the lesion, was low in value, and there was no statistical significance between affected and sound sides. Following glycerol administration, rCBF was increased in the whole intracranial region, but not inside of the neoplasm, particularly when the intracranial pressure (ICP) was increased. It was assumed that the elevated rCBF after glycerol administration was due to the increase in the cerebral perfusion pressure resulting from the ICP reduction, the hemodilution effect, cerebral vessel dilatation after metabolic acidosis, and/or mechanically rectified microcirculation after edema reduction. (author).

  17. Volume changes of extremely large and giant intracranial aneurysms after treatment with flow diverter stents

    Energy Technology Data Exchange (ETDEWEB)

    Carneiro, Angelo; Byrne, James V. [ohn Radcliffe Hospital, Oxford Neurovascular and Neuroradiology Research Unit, Nuffield Department of Surgical Sciences, Oxford (United Kingdom); Rane, Neil; Kueker, Wilhelm; Cellerini, Martino; Corkill, Rufus [John Radcliffe Hospital, Department of Neuroradiology, Oxford (United Kingdom)

    2014-01-15

    This study assessed volume changes of unruptured large and giant aneurysms (greatest diameter >20 mm) after treatment with flow diverter (FD) stents. Clinical audit of the cases treated in a single institution, over a 5-year period. Demographic and clinical data were retrospectively collected from the hospital records. Aneurysm volumes were measured by manual outlining at sequential slices using computerised tomography (CT) or magnetic resonance (MR) angiography data. The audit included eight patients (seven females) with eight aneurysms. Four aneurysms involved the cavernous segment of the internal carotid artery (ICA), three the supraclinoid ICA and one the basilar artery. Seven patients presented with signs and symptoms of mass effect and one with seizures. All but one aneurysm was treated with a single FD stent; six aneurysms were also coiled (either before or simultaneously with FD placement). Minimum follow-up time was 6 months (mean 20 months). At follow-up, three aneurysms decreased in size, three were unchanged and two increased. Both aneurysms that increased in size showed persistent endosaccular flow at follow-up MR; in one case, failure was attributed to suboptimal position of the stent; in the other case, it was attributed to persistence of a side branch originating from the aneurysm (similar to the endoleak phenomenon of aortic aneurysms). At follow-up, five aneurysms were completely occluded; none of these increased in volume. Complete occlusion of the aneurysms leads, in most cases, to its shrinkage. In cases of late aneurysm growth or regrowth, consideration should be given to possible endoleak as the cause. (orig.)

  18. Flow-Diverting Devices versus Coil Embolization for Intracranial Aneurysms: A Systematic Literature Review and Meta-analysis.

    Science.gov (United States)

    Zhou, Geng; Zhu, Yue-Qi; Su, Ming; Gao, Kai-Di; Li, Ming-Hua

    2016-04-01

    To review the literature on flow-diverting device (FDD) treatments for intracranial aneurysms (IAs) and to compare the safety and efficacy of FDDs with coil embolization treatment (CET) for IAs using a meta-analysis of published studies. A systematic electronic search was conducted of PubMed, Springer Link, EBSCO, and the Cochrane Database on all accessible published articles through September 2015. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Studies that explicitly compared FDD and CET approaches to the treatment of IAs were included. Odds ratios (ORs) and 95% CIs were calculated for the complete occlusion rate and the morbidity rate using a random-effects model. Nine studies were included in the analysis, containing retrospectively collected data for 863 patients. FDD treatment showed a significantly higher complete occlusion rate than CET (OR = 3.13; 95% confidence interval [CI], 2.11-4.65) and the subgroup of stent-assisted coiling did (OR = 2.08; 95% CI, 1.34-3.24). FDDs did not achieve a significantly lower overall morbidity rate compared with CET (OR = 0.87; 95% CI, 0.45-1.69) or the SAC (stent-assisted coiling) subgroup (OR = 0.86; 95% CI, 0.33-2.26), and our results did not show a significant difference in mortality between the two techniques. FDD treatment of IAs yielded satisfactory results in complete occlusion rate compared with CET. The FDD procedure is feasible and has no significant difference in morbidity risk. Despite the findings reported herein, further validation with well-designed, multicenter randomized controlled trials is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Experimental and CFD flow studies in an intracranial aneurysm model with Newtonian and non-Newtonian fluids.

    Science.gov (United States)

    Frolov, S V; Sindeev, S V; Liepsch, D; Balasso, A

    2016-05-18

    According to the clinical data, flow conditions play a major role in the genesis of intracranial aneurysms. The disorder of the flow structure is the cause of damage of the inner layer of the vessel wall, which leads to the development of cerebral aneurysms. Knowledge of the alteration of the flow field in the aneurysm region is important for treatment. The aim is to study quantitatively the flow structure in an patient-specific aneurysm model of the internal carotid artery using both experimental and computational fluid dynamics (CFD) methods with Newtonian and non-Newtonian fluids. A patient-specific geometry of aneurysm of the internal carotid artery was used. Patient data was segmented and smoothed to obtain geometrical model. An elastic true-to-scale silicone model was created with stereolithography. For initial investigation of the blood flow, the flow was visualized by adding particles into the silicone model. The precise flow velocity measurements were done using 1D Laser Doppler Anemometer with a spatial resolution of 50 μ m and a temporal resolution of 1 ms. The local velocity measurements were done at a distance of 4 mm to each other. A fluid with non-Newtonian properties was used in the experiment. The CFD simulations for unsteady-state problem were done using constructed hexahedral mesh for Newtonian and non-Newtonian fluids. Using 1D laser Doppler Anemometer the minimum velocity magnitude at the end of systole -0.01 m/s was obtained in the aneurysm dome while the maximum velocity 1 m/s was at the center of the outlet segment. On central cross section of the aneurysm the maximum velocity value is only 20% of the average inlet velocity. The average velocity on the cross-section is only 11% of the inlet axial velocity. Using the CFD simulation the wall shear stresses for Newtonian and non-Newtonian fluid at the end of systolic phase (t= 0.25 s) were computed. The wall shear stress varies from 3.52 mPa (minimum value) to 10.21 Pa (maximum value) for the

  20. Diagnostic value of optical coherence tomography for intracranial pressure in idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Skau, M; Yri, H; Sander, B

    2013-01-01

    BACKGROUND: Idiopathic intracranial hypertension (IIH) is a condition of raised intracranial pressure (ICP) in the absence of space-occupying lesions or other known etiology. It primarily affects young obese females, and potentially causes permanent visual loss due to papilledema and secondary...... optic atrophy. The aim of this study was to evaluate the diagnostic value of optical coherence tomography (OCT) as a marker for CSF opening pressure in patients with idiopathic intracranial hypertension (IIH). METHODS: We conducted a case-control study of 20 newly diagnosed, 21 long-term IIH patients...

  1. CSF-VDRL test

    Science.gov (United States)

    ... test - CSF; Neurosyphilis - VDRL Images CSF test for syphilis References Chernecky CC, Berger BJ. Venereal disease research laboratory test (VDRL), test, cerebrospinal fluid – specimen. In: Chernecky CC, Berger BJ, eds. Laboratory Tests and Diagnostic Procedures . 6th ed. St Louis, MO: Elsevier Saunders; ...

  2. CSF total protein

    Science.gov (United States)

    CSF total protein is a test to determine the amount of protein in your spinal fluid, also called cerebrospinal fluid (CSF). ... The normal protein range varies from lab to lab, but is typically about 15 to 60 milligrams per deciliter (mg/dL) ...

  3. Cerebrospinal fluid (CSF) transient responses induced by hypercapnia

    International Nuclear Information System (INIS)

    Fisher, M.J.

    1984-01-01

    CSF transient responses to CO 2 inhalation were measured before and after facilitated perfusate flow through subarachnoid spaces of anesthetized cats during ventriculocisternal perfusion with artificial CSF containing 14 C-dextran. Convective mixing of perfusate in subarachnoid spaces was augmented while infusion constant, either by impeding cisternal efflux of perfusate by raising the cisternal outflow cannula (high CSF pressure), or by preventing CSF outflow by clamping the cisternal outflow cannula (stopflow; S-F). CSF transients were also measured before and after systemic administration of phenoxybenzamine (PBZ) in order to evaluate the contribution of sympatho-adrenergic activity to craniospinal CSF redistribution and mixing. Results from high CSF pressure and S-F experiments indicate that unequilibrated CSF contributes significantly to the reduced tracer concentration in CSF volume (Vd) since SCF effluent tracer concentration (Cd) was decreased after subarachnoid facilitated flow. Further, results from S-F studies indicate that at least 50% of Cd is due to craniospinal fluid redistribution, a process which, along with CSF outflow transients, was unaffected by PBZ. Conversely, PBZ administration decreased steady state SCF formation and absorption through alpha-mediated cerebrovascular responses and/or through beta-adrenoceptor inhibition of metabolism of CSF secretory epithelium

  4. Intracranial sarcoidosis

    International Nuclear Information System (INIS)

    Seltzer, S.; Mark, A.S.; Atlas, S.W.

    1989-01-01

    The appearance of intracranial sarcoidosis on Gd-DTPA-enhanced MR imaging has not been previously reported. The authors have studied five patients with T1-and T2-weighted pre-GD and T1-weighted post-GD sequences. Images showed diffuse meningeal involvement suspected on the unenhanced scans in only one patient, enhancing extraaxial masses mimicking meningiomas, and enhancing and nonenhancing intraaxial lesions. In four of five patients, the diagnosis of intracranial sarcoidosis was suggested only after Gd-DTPA administration. The addition of Gd-DTPA greatly enhanced the sensitivity of MR imaging to the extraaxial and meningeal manifestations of central nervous system sarcoidosis

  5. 2D time-of-flight MR angiography using concatenated saturation bands for determining direction of flow in the intracranial vessels

    International Nuclear Information System (INIS)

    Nesbit, G.M.; DeMarco, J.K.

    1997-01-01

    We prospectively studied 15 patients to assess 2D time-of-flight (TOF) magnetic resonance angiography (MRA) with concatenated saturation bands for determining the direction of intracranial blood flow. This MRA sequence was compared to T2-weighted spin-echo MRI, 3D-TOF MRA, and intra-arterial angiography (IAA) as regards demonstration of vessels and determination of the direction of flow in the circle of Willis and its branches. The 2D-TOF MRA sequence demonstrated flow in 98.5 % vessel segments identified on IAA, 3D-TOF demonstrating 92 % and spin-echo images 77 %. The direction of flow shown on the 2D-TOF sequence was correct in 94 % when compared to conventional angiography, the remaining six segments not demonstrating flow. In ten patients, the flow abnormalities demonstrated by this MRA technique provided clinical information similar to that of conventional angiography in nine, but it was incomplete in three, and misleading in one. Slow retrograde flow in ophthalmic artery collaterals and differentiation of arteries and veins presented some problems. 2D-TOF MRA with concatenated saturation bands provides flow direction information using widely available, easily applicable TOF techniques, and can be a useful adjunct to MRI and MRA if information on flow direction is needed. (orig.). With 5 figs., 3 tabs

  6. Intracranial Hemorrhage

    Science.gov (United States)

    2011-01-01

    Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Myocardial stunning and pulmonary edema related to neurological injury should be anticipated, and can usually be managed. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuromonitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy. PMID:22167847

  7. Raised intracranial pressure: What it is and how to recognise it

    African Journals Online (AJOL)

    This article presents an approach to raised intracranial pressure (ICP) constructed in a question-answer fashion. ... involves shifts of CSF and venous blood out .... by changes in posture, position and .... ICP can be measured by a number of.

  8. CSF LACTATE IN MENINGITIS

    Directory of Open Access Journals (Sweden)

    Anjampakuthikal Aboobekar Haris

    2017-05-01

    Full Text Available BACKGROUND Meningitis is an infection within the subarachnoid space characterised by a CNS inflammatory reaction. It is a serious condition requiring immediate diagnosis and appropriate treatment to be started at the earliest to prevent mortality as well as irreversible neurological deficits. CSF lactate has been found useful in differentiating bacterial meningitis from viral meningitis in many studies in the western population, but studies in Indian population are limited. The aim of the study is to study whether CSF lactate can be used to distinguish bacterial from viral meningitis and to study the levels of CSF lactate in tuberculosis meningitis. MATERIALS AND METHODS This was a descriptive study conducted in a tertiary care hospital. In this study, 78 cases of meningitis were selected. Cases are patients with bacterial, viral or tuberculosis meningitis admitted to the hospital under the Department of Medicine and Neurology. Cases are grouped into bacterial, viral and tuberculosis meningitis based on clinical picture, CSF analysis and imaging characteristics. CSF lactate estimation was done by dry chemistry method. Using appropriate statistical methods and SPSS software, CSF lactate levels were compared among these groups and analysed for any association with the final outcome. RESULTS The levels of CSF lactate in bacterial meningitis were higher than viral meningitis with a statistical significance of p 35 mg/dL for bacterial meningitis in this study was 95% and 100% respectively and the positive predictive value was 100% and the negative predictive value was 96%. The mean CSF lactate values in bacterial, viral and tuberculosis meningitis were 124.40 ± 35.85 mg/dL, 24.34 ± 6.05 mg/dL and 50.13 ± 9.89 mg/dL, respectively. CONCLUSION CSF lactate level was significantly elevated in bacterial meningitis than tuberculosis or viral meningitis and can be used as a marker for differentiating bacterial from viral meningitis.

  9. Large Intracranial Aneurysm after Transsphenoidal Surgery for Pituitary Macroadenoma

    OpenAIRE

    Yoon, Kyeong-Wook; Cho, Chun-Sung; Lee, Sang-Koo

    2014-01-01

    Uncontrolled cerebrospinal fluid (CSF) leakage after transsphenoidal surgery (TSS) for pituitary adenoma can lead to meningitis. Intracranial mycotic pseudoaneurysm is a rare complication in central nervous system infection. Large single pseudoaneurysm is more uncommon. Most mycotic aneurysms occur due to endocarditis. The present patient had no heart problem and was infected by CSF leakage after transsphenoidal surgery. We present a case of large ruptured mycotic pseudoaneurysm as a complica...

  10. Intracranial subdural hematoma coexisting with improvement in spontaneous intracranial hypotension after an epidural blood patch

    Directory of Open Access Journals (Sweden)

    Cheng-Hsi Chang

    2012-11-01

    Full Text Available A 36-year-old male had spontaneous intracranial hypotension (SIH presenting with refractory headache for 4 months. Multiple epidural blood patches (EBPs yielded relief of symptoms, but the course was complicated, with asymptomatic intracranial subdural hematoma (SDH. Except for SDH, other radiological diagnostic signs of SIH were resolved and the patient’s headaches improved after EBP. Owing to a mass effect and persistent cerebrospinal fluid (CSF leakage, surgical repair of the spinal leakage was performed, but no cranial procedures were carried out. Postoperatively, the SDH completely resolved, but there was still CSF leakage at the level where surgery was performed. The patient has remained free of headache or other events for 3 years. It was reduction rather than elimination of the spinal CSF leak that yielded remission of SIH. In summary, intracranial SDH can be a complication of inadequately treated SIH (i.e. persistent minor CSF leakage. Management of SDH should focus on correction of the underlying SIH rather than craniotomy for hematoma evacuation.

  11. Intracranial Hypertension Research Foundation

    Science.gov (United States)

    ... PARTNERSHIPS Meet our Fundraising Partners Tweet Welcome Intracranial hypertension (IH) is the general term for the neurological ... high. (Old names for IH include Benign Intracranial Hypertension and Pseudotumor Cerebri). The Intracranial Hypertension Research Foundation ...

  12. Intracranial pressure following complete removal of a small demarcated brain tumor

    DEFF Research Database (Denmark)

    Andresen, Morten; Juhler, Marianne

    2014-01-01

    OBJECTIVES: Current published normal values for intracranial pressure (ICP) are extrapolated from lumbar CSF pressure measurements and ICP measurements in patients treated for CSF pressure disorders. There is an emerging agreement that true normal ICP values are needed for diagnostic and therapeu...... and the ICP target range in hydrocephalus treatment....

  13. MRI evidence for preserved regulation of intracranial pressure in patients with cerebral arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Meinel, Felix G.; Fischer, Judith; Pomschar, Andreas; Wöhrle, Natalie; Koerte, Inga K.; Steffinger, Denise [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany); Laubender, Rüdiger P. [Institute of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich (Germany); Muacevic, Alexander [European Cyberknife Center Munich, 81377 Munich (Germany); Reiser, Maximilian F. [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany); Alperin, Noam [Department of Radiology, Miller School of Medicine, University of Miami, Miami, FL 33136 (United States); Ertl-Wagner, Birgit, E-mail: birgit.ertl-wagner@med.uni-muenchen.de [Institute for Clinical Radiology, Ludwig-Maximilians-University Hospital, Marchioninistr. 15, 81377 Munich (Germany)

    2014-08-15

    Purpose: The purpose of this study was to investigate intracranial pressure and associated hemo- and hydrodynamic parameters in patients with cerebral arteriovenous malformations AVMs. Methods: Thirty consecutive patients with arteriovenous malformations (median age 38.7 years, 27/30 previously treated with radiosurgery) and 30 age- and gender-matched healthy controls were investigated on a 3.0 T MR scanner. Nidus volume was quantified on dynamic MR angiography. Total arterial cerebral blood flow (tCBF), venous outflow as well as aqueductal and craniospinal stroke volumes were obtained using velocity-encoded cine-phase contrast MRI. Intracranial volume change during the cardiac cycle was calculated and intracranial pressure (ICP) was derived from systolic intracranial volume change (ICVC) and pulse pressure gradient. Results: TCBF was significantly higher in AVM patients as compared to healthy controls (median 799 vs. 692 mL/min, p = 0.007). There was a trend for venous flow to be increased in both the ipsilateral internal jugular vein (IJV, 282 vs. 225 mL/min, p = 0.16), and in the contralateral IJV (322 vs. 285 mL/min, p = 0.09), but not in secondary veins. There was no significant difference in median ICP between AVM patients and control subjects (6.9 vs. 8.6 mmHg, p = 0.30) and ICP did not correlate with nidus volume in AVM patients (ρ = −0.06, p = 0.74). There was a significant positive correlation between tCBF and craniospinal CSF stroke volume (ρ = 0.69, p = 0.02). Conclusions: The elevated cerebral blood flow in patients with AVMs is drained through an increased flow in IJVs but not secondary veins. ICP is maintained within ranges of normal and does not correlate with nidus volume.

  14. Spontaneous intracranial hypotension syndrome: magnetic resonance findings in two patients

    International Nuclear Information System (INIS)

    Ortega, R.; Pastor, J.; Escamilla, F.; Romero, M. I.

    1999-01-01

    The postural headache syndrome associated with a decrease in the cerebrospinal fluid (CSF) pressure is generally secondary to the CSF leakage that usually occurs after diagnostic lumbar puncture. Spontaneous intracranial hypotension can not be attributed to any known cause or previous diagnostic or therapeutic intervention. The syndrome is characterized by severe headache that is relieved by lying supine. During lumbar puncture, the CSF pressure is normally low. We present two patients in whom gadolinium-enhanced magnetic resonance imaging showed widespread thickening and enhancement of the dura mater and subdural fluid collections. (Author) 13 refs

  15. Osmolality of Cerebrospinal Fluid from Patients with Idiopathic Intracranial Hypertension (IIH)

    DEFF Research Database (Denmark)

    Wibroe, Elisabeth A; Yri, Hanne M; Jensen, Rigmor H

    2016-01-01

    INTRODUCTION: Idiopathic intracranial hypertension (IIH) is a disorder of increased intracranial fluid pressure (ICP) of unknown etiology. This study aims to investigate osmolality of cerebrospinal fluid (CSF) from patients with IIH. METHODS: We prospectively collected CSF from individuals referred...... significantly from patients with moderately elevated ICP from 26-45 cmH2O (n = 21) (p = 0.86) and patients with high ICP from 46-70 cmH2O (n = 4) (p = 0.32), respectively. There was no correlation between osmolality and ICP, BMI, age and body height, respectively. Mean CSF osmolality was 270 mmol/kg (± 1 SE, 95...

  16. CSF dynamics in children

    International Nuclear Information System (INIS)

    Oi, Shizuo; Shose, Yoshiteru; Yamada, Hiroshi; Ijichi, Akihiro; Matsumoto, Satoshi.

    1986-01-01

    Cerebrospinal fluid (CSF) dynamics in infants and children is still obscure. This paper aims to analyze the characteristics of CSF dynamics in the younger age group and to clarify the changes both in the acute/chronic hydrocephalic status and in the post-shunt condition on the basis of our experience with 118 cases of metrizamide CT cisternography. In order to pursue the CSF passive movements, the exact regional CT numbers were obtained by means of the ROI method in each case at 3, 6, and 24 hours after metrizamide injection. The results revealed that, in the normal CSF dynamics in both the major and minor pathways in children, it took more than 24 hours until the regional metrizamide was completely cleared up. In the acute hydrocephalic state, the ventricular reflux and stasis of the contrast was remarkable, and stagnation in the Sylvian fissure continued more than 24 hours. In the minor pathway, the contrast moved into the brain parenchyma, with there obviously being more in the subependymal layer and the adjacent white matter, and lasted more than 24 hours. On the other hand, these phenomena were very much less prominent in the chronic phase of hydrocephalus. This fact may suggest the hypothesis that a reconstituted active major or minor fluid pathway does not play an important role in the compensation of the acute high-pressure progressive hydrocephalic state. The CSF dynamics in a shunted hydrocephalus are obviously improved when in stasis or when stagnated inside or outside of the ventricular system. The timing of the metrizamide clear-up was within 24 hours after achieving a high accumulation of the contrast in the lateral ventricle where the shunt is placed. The contrast movement in the brain parenchyma as the minor pathway was significantly less in a shunted hydrocephalus, and there was almost none in cases of slit-like ventricles. (author)

  17. Normal ranges and test-retest reproducibility of flow and velocity parameters in intracranial arteries measured with phase-contrast magnetic resonance imaging

    International Nuclear Information System (INIS)

    Correia de Verdier, Maria; Wikstroem, Johan

    2016-01-01

    The purpose of the present study was to investigate normal ranges and test-retest reproducibility of phase-contrast MRI (PC-MRI)-measured flow and velocity parameters in intracranial arteries. Highest flow (HF), lowest flow (LF), peak systolic velocity (PSV), and end diastolic velocity (EDV) were measured at two dates in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries of 30 healthy volunteers using two-dimensional PC-MRI at 3 T. Least detectable difference (LDD) was calculated. In the left ACA, HF was (mean (range, LDD)) 126 ml/min (36-312, 59 %), LF 61 ml/min (0-156, 101 %), PSV 64 cm/s (32-141, 67 %), and EDV 35 cm/s (18-55, 42 %); in the right ACA, HF was 154 ml/min (42-246, 49 %), LF 77 ml/min (0-156, 131 %), PSV 75 cm/s (26-161, 82 %), and EDV 39 cm/s (7-59, 67 %). In the left MCA, HF was 235 ml/min (126-372, 35 %), LF 116 ml/min (42-186, 48 %), PSV 90 cm/s (55-183, 39 %), and EDV 46 cm/s (20-66, 28 %); in the right MCA, HF was 238 ml/min (162-342, 44 %), LF 120 ml/min (72-216, 48 %), PSV 88 cm/s (55-141, 35 %), and EDV 45 cm/s (26-67, 23 %). In the left PCA, HF was 108 ml/min (42-168, 54 %), LF 53 ml/min (18-108, 64 %), PSV 50 cm/s (24-77, 63 %), and EDV 28 cm/s (14-40, 45 %); in the right PCA, HF was 98 ml/min (30-162, 49 %), LF 49 ml/min (12-84, 55 %), PSV 47 cm/s (27-88, 59 %), and EDV 27 cm/s (16-41, 45 %). PC-MRI-measured flow and velocity parameters in the main intracranial arteries have large normal ranges. Reproducibility is highest in MCA. (orig.)

  18. Normal ranges and test-retest reproducibility of flow and velocity parameters in intracranial arteries measured with phase-contrast magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Correia de Verdier, Maria; Wikstroem, Johan [Uppsala University Hospital, Department of Radiology, Uppsala University, Uppsala (Sweden)

    2016-05-15

    The purpose of the present study was to investigate normal ranges and test-retest reproducibility of phase-contrast MRI (PC-MRI)-measured flow and velocity parameters in intracranial arteries. Highest flow (HF), lowest flow (LF), peak systolic velocity (PSV), and end diastolic velocity (EDV) were measured at two dates in the anterior (ACA), middle (MCA), and posterior (PCA) cerebral arteries of 30 healthy volunteers using two-dimensional PC-MRI at 3 T. Least detectable difference (LDD) was calculated. In the left ACA, HF was (mean (range, LDD)) 126 ml/min (36-312, 59 %), LF 61 ml/min (0-156, 101 %), PSV 64 cm/s (32-141, 67 %), and EDV 35 cm/s (18-55, 42 %); in the right ACA, HF was 154 ml/min (42-246, 49 %), LF 77 ml/min (0-156, 131 %), PSV 75 cm/s (26-161, 82 %), and EDV 39 cm/s (7-59, 67 %). In the left MCA, HF was 235 ml/min (126-372, 35 %), LF 116 ml/min (42-186, 48 %), PSV 90 cm/s (55-183, 39 %), and EDV 46 cm/s (20-66, 28 %); in the right MCA, HF was 238 ml/min (162-342, 44 %), LF 120 ml/min (72-216, 48 %), PSV 88 cm/s (55-141, 35 %), and EDV 45 cm/s (26-67, 23 %). In the left PCA, HF was 108 ml/min (42-168, 54 %), LF 53 ml/min (18-108, 64 %), PSV 50 cm/s (24-77, 63 %), and EDV 28 cm/s (14-40, 45 %); in the right PCA, HF was 98 ml/min (30-162, 49 %), LF 49 ml/min (12-84, 55 %), PSV 47 cm/s (27-88, 59 %), and EDV 27 cm/s (16-41, 45 %). PC-MRI-measured flow and velocity parameters in the main intracranial arteries have large normal ranges. Reproducibility is highest in MCA. (orig.)

  19. Flow diversion in vasculitic intracranial aneurysms? Repair of giant complex cavernous carotid aneurysm in polyarteritis nodosa using Pipeline embolization devices: first reported case.

    Science.gov (United States)

    Martinez Santos, Jaime; Kaderali, Zul; Spears, Julian; Rubin, Laurence A; Marotta, Thomas R

    2016-07-01

    Intracranial aneurysms in polyarteritis nodosa (PAN) are exceedingly rare lesions with unpredictable behavior that pose real challenges to microsurgical and endovascular interventions owing to their inflammatory nature. We introduce a safe and effective alternative for treating these aneurysms using Pipeline embolization devices (PEDs). A 20-year-old man presented with diplopia, headaches, chronic abdominal pain, and weight loss. Diagnostic evaluations confirmed PAN, including bilateral giant cavernous carotid aneurysms. Cyclophosphamide and steroids achieved significant and sustained clinical improvement, with a decision to follow the aneurysms serially. Seven years later the left unruptured aneurysm enlarged, causing a sudden severe headache and a cavernous sinus syndrome. Treatment of the symptomatic aneurysm was pursued using flow diversion (PED) and the internal carotid artery was successfully reconstructed with a total of four overlapping PEDs. At 6 months follow-up, complete exclusion of the aneurysm was demonstrated, with symptomatic recovery. This is the first description of using a flow-diverting technique in an inflammatory vasculitis. In this case, PEDs not only attained a definitive closure of the aneurysm but also reconstructed the damaged and fragile arterial segment affected with vasculitis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Brain MRI findings of spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Park, Won Kyu; Byun, Woo Mok; Cho, Jae Ho; Cho Kil Ho; Hwang, Mi Soo; Park, Bok Hwan [Yeungnam Univ. College of Medicine, Taegu (Korea, Republic of); Joo, Yang Gu [Keimyoung Univ. College of Medicine, Taegu (Korea, Republic of); Lee, Sang Jin [Soonchunhyang Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-09-01

    To evaluate brain MRI findings of spontaneous intracranial hypotension. A retrospective review of MRI findings was conducted on six patients with clinically proven spontaneous intracranial hypotension; no patient had a history of previous spinal puncture. Follow-up MRI was available in two patients, and to detect CSF leakage, radio-nuclide cisternography(n=3D5), myelography(n=3D1), and MR myelography(n=3D1) were performed. On contrast-enhanced T1WI, diffuse dural enhancement was seen in all cases, subdural hematoma or hygroma was seen in four cases, pituitary gland prominence in four, dural sinus dilatation in four, downward displacement of the cerebellar tonsil in two, downward displacement of the iter in one, and suprasellar and prepontine cistern effacement in two. In no patient was abnormal CSF leakage found. Although dural enhancement, as seen on MRI, is not specific, diffuse enhancement of the dura mater accompanied by subdural hematoma, hygroma, pituitary gland prominence, dural sinus dilatation, downward displacement of the cerebellar tonsil, or suprasellar and prepontine cistern effacement can strongly suggest intracranial hypotension.=20.

  1. MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury.

    Directory of Open Access Journals (Sweden)

    Andreas Pomschar

    Full Text Available To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI and age- and gender-matched controls.Thirty adult subjects (15 with mTBI and 15 age- and gender-matched controls were investigated using a 3T MR scanner. Time since trauma was 0.5 to 29 years (mean 11.4 years. A 2D-time-of-flight MR-venography of the upper neck was performed to visualize the cervical venous vasculature. Cerebral venous drainage through primary and secondary channels, and intracranial compliance index and pressure were derived using cine-phase contrast imaging of the cerebral arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial compliance index is the defined as the ratio of maximal intracranial volume and pressure changes during the cardiac cycle. MR estimated ICP was then obtained through the inverse relationship between compliance and ICP.Compared to the controls, subjects with mTBI demonstrated a significantly smaller percentage of venous outflow through internal jugular veins (60.9±21% vs. controls: 76.8±10%; p = 0.01 compensated by an increased drainage through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03. Mean intracranial compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls 8.4±1.9; p<0.0007. Consequently, MR estimate of intracranial pressure was significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg; p<0.0007.mTBI is associated with increased venous drainage through secondary pathways. This reflects higher outflow impedance, which may explain the finding of reduced intracranial compliance. These results suggest that hemodynamic and hydrodynamic changes following mTBI persist even in the absence of clinical symptoms and abnormal findings in conventional MR imaging.

  2. Understanding idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Markey, Keira A; Mollan, Susan P; Jensen, Rigmor H

    2016-01-01

    Idiopathic intracranial hypertension is a disorder characterised by raised intracranial pressure that predominantly affects young, obese women. Pathogenesis has not been fully elucidated, but several causal factors have been proposed. Symptoms can include headaches, visual loss, pulsatile tinnitus...

  3. Use of flow-diverting stents as salvage treatment following failed stent-assisted embolization of intracranial aneurysms.

    Science.gov (United States)

    Heiferman, Daniel M; Billingsley, Joshua T; Kasliwal, Manish K; Johnson, Andrew K; Keigher, Kiffon M; Frudit, Michel E; Moftakhar, Roham; Lopes, Demetrius K

    2016-07-01

    Flow-diverting stents, including the Pipeline embolization device (PED) and Silk, have been beneficial in the treatment of aneurysms previously unable to be approached via endovascular techniques. Recurrent aneurysms for which stent-assisted embolization has failed are a therapeutic challenge, given the existing intraluminal construct with continued blood flow into the aneurysm. We report our experience using flow-diverting stents in the repair of 25 aneurysms for which stent-assisted embolization had failed. Nineteen (76%) of these aneurysms at the 12-month follow-up showed improved Raymond class occlusion, with 38% being completely occluded, and all aneurysms demonstrated decreased filling. One patient developed a moderate permanent neurologic deficit. Appropriate stent sizing, proximal and distal construct coverage, and preventing flow diverter deployment between the previously deployed stent struts are important considerations to ensure wall apposition and prevention of endoleak. Flow diverters are shown to be a reasonable option for treating previously stented recurrent cerebral aneurysms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  4. Heavily T2-weighted MR myelography vs CT myelography in spontaneous intracranial hypotension.

    Science.gov (United States)

    Wang, Y-F; Lirng, J-F; Fuh, J-L; Hseu, S-S; Wang, S-J

    2009-12-01

    To assess the diagnostic accuracy of heavily T2-weighted magnetic resonance myelography (MRM) in patients with spontaneous intracranial hypotension (SIH). Patients with SIH were recruited prospectively, and first underwent MRM and then computed tomographic myelography (CTM). The results of MRM were validated with the gold standard, CTM, focusing on 1) CSF leaks along the nerve roots, 2) epidural CSF collections, and 3) high-cervical (C1-3) retrospinal CSF collections. Comparisons of these 3 findings between the 2 studies were made by kappa statistics and agreement rates. Targeted epidural blood patches (EBPs) were placed at the levels of CSF leaks if supportive treatment failed. Nineteen patients (6 men and 13 women, mean age 37.9 +/- 8.6 years) with SIH completed the study. MRM did not differ from CTM in the detection rates of CSF leaks along the nerve roots (84% vs 74%, p = 0.23), high-cervical retrospinal CSF collections (32% vs 16%, p = 0.13), and epidural CSF collections (89% vs 79%, p = 0.20). MRM demonstrated more spinal levels of CSF leaks (2.2 +/- 1.7 vs 1.5 +/- 1.5, p = 0.011) and epidural collections (12.2 +/- 5.9 vs 7.1 +/- 5.8, p localizing CSF leaks for patients with spontaneous intracranial hypotension. This noninvasive technique may be an alternative to computed tomographic myelography before targeted epidural blood patches.

  5. Spontaneous Cerebrospinal Fluid Rhinorrhea as the Presenting Symptom of Idiopathic Intracranial Hypertension: A Case Series

    Directory of Open Access Journals (Sweden)

    Hossein Ghalaenovi

    2018-05-01

    Full Text Available Although rare, Cerebrospinal Fluid (CSF Leakage can result in deadly complications such as meningitis and brain abscess. Previously, primary spontaneous CSF leakage was referred to leakages without any detectable causes. However, it has been found recently that it may be related to abnormal increased intracranial pressure (ICP. Here, we reported demographic, clinical, and therapeutic features in addition to the outcomes of five patients with Idiopathic Intracranial Hypertension (IIH presented with spontaneous CSF leakage as the initial symptom. Four of our patients were female. The mean age was 38 years old. Rhinorrhea was the first manifestation of the CSF leakage in our patients. Ethmoidal cells were the most common site of leakage. The mean opening pressures (OP was 31.3 cmH2O. The computed tomography (CT scan and magnetic resonance imaging (MRI of the brain was normal in all patients except one patient showing fullness in left ethmoidal cells. In all of the patients, cerebral CT cisternography was diagnostic to detect the site of leakage. CSF leak in two patients resolved with medical therapy but CSF diversion procedure was mandatory in other three patients. CSF leakage resolved in all of them. CSF leakage can be the first and only presenting symptom of abnormal increased ICP. The key point in patient treatment is controlling the elevated ICP, even though some patients may need to CSF diversion procedure eventually.

  6. Radionuclide cisternographic findings in patients with spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Jung, Dong Jin; Kim, Jae Seung; Ryu, Jin Sook; Shin, Jung Woo; Im, Joo Hyuk; Lee, Myoung Chong; Jung, Sung Joo; Moon, Dae Hyuk; Lee, Hee Kyung

    1998-01-01

    Radionuclide cisternography may be helpful in understanding pathophysiology of postural headache and low CSF pressure in patients with spontaneous intracranial hypotension. The purpose of this study was to characterize radionuclide cisternogrpahic findings of spontaneous intracranial hypotension. The study population consists of 15 patients with spontaneous intracranial hypotension. Diagnosis was based on their clinical symptoms and results of lumbar puncture. All patients underwent radionuclide cisternography following injection of 111 to 222 MBq of Tc-99m DTPA into the lumbar subarachnoid space. Sequential images were obtained between 1/2 hour and 24 hour after the injection of Tc-99m DTPA. Radioactivity of the bladder, soft tissue uptake, migration of radionuclide in the subarachnoid space, and extradural leakage of radionuclide were evaluated according to the scan time. Radionuclide cisternogram showed delayed migration of radionuclide into the cerebral convexity (14/15), increased soft tissue uptake (11/15), and early visualization of bladder activity at 30 min (6/10) and 2 hr (13/13). Cisternography also demonstrated leakage site of CSF in 4 cases and 2 of these were depicted at 30min. Epidural blood patch was done in 11 patients and headache was improved in all cases. The characteristics findings of spontaneous intracranial hypotension were delayed migration of radionuclide and early visualization of the soft tissue and bladder activity. These scintigraphic findings suggest that CSF leakage rather than increased CSF absorption or decreased production may be the main pathophysiology of spontaneous intracranial hypotension. Early and multiple imaging including the bladder and soft tissue is required to observe the entire dynamics of radionuclide migration

  7. Molecular CsF 5 and CsF 2 +

    KAUST Repository

    Rogachev, Andrey Yu.; Miao, Mao-sheng; Merino, Gabriel; Hoffmann, Roald

    2015-01-01

    D5h star-like CsF5, formally isoelectronic with known XeF5− ion, is computed to be a local minimum on the potential energy surface of CsF5, surrounded by reasonably large activation energies for its exothermic decomposition to CsF+2 F2, or to CsF3 (three isomeric forms)+F2, or for rearrangement to a significantly more stable isomer, a classical Cs+ complex of F5−. Similarly the CsF2+ ion is computed to be metastable in two isomeric forms. In the more symmetrical structures of these molecules there is definite involvement in bonding of the formally core 5p levels of Cs.

  8. Molecular CsF 5 and CsF 2 +

    KAUST Repository

    Rogachev, Andrey Yu.

    2015-06-03

    D5h star-like CsF5, formally isoelectronic with known XeF5− ion, is computed to be a local minimum on the potential energy surface of CsF5, surrounded by reasonably large activation energies for its exothermic decomposition to CsF+2 F2, or to CsF3 (three isomeric forms)+F2, or for rearrangement to a significantly more stable isomer, a classical Cs+ complex of F5−. Similarly the CsF2+ ion is computed to be metastable in two isomeric forms. In the more symmetrical structures of these molecules there is definite involvement in bonding of the formally core 5p levels of Cs.

  9. Monitoring of Intracranial Pressure During Intracranial Endoscopy

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar

    2013-08-01

    Full Text Available Background: Intracranial endoscopy is a minimum invasive procedure, which reduces trauma to the brain, is cost-effective, and carries a shortened hospital stay with an improved postoperative outcome. Objective: To monitor intracranial pressure changes during intracranial endoscopy among children and adults under general anesthesia/sedation, and to compare the intracranial pressure changes between children and adults receiving general anesthesia and among adults receiving general anesthesia and sedation. Methods: The present cross-sectional study was conducted in one of the tertiary care hospitals of Lucknow. This was carried out in the department of neurosurgery from January 2008 to December 2008. Patients who were not fit for general anesthesia received local anesthesia under sedation. Patients participating in the study were divided into three groups. Intracranial pressure was recorded at specific intervals. Parametric data were subjected to statistical analysis using a student\\s t test. Result: A total of 70 patients were undergoing intracranial endoscopy under general anesthesia during the study period. In both groups A and B, intracranial pressure increases the maximum during inflation of the balloon. In group C, all the variations in ICP were found to be statistically significant. In the comparison of intracranial pressure changes between groups A and B, no significant difference was found. All correlations in the comparison of groups B and C were found to be statistically significant (p< 0.001. Conclusion: There is a need for continuous intraoperative monitoring of ICP intracranial endoscopy, because ICP increases in various stages of the procedure, which can be detrimental to the perfusion of the brain. [Arch Clin Exp Surg 2013; 2(4.000: 240-245

  10. Rostrocaudal Dynamics of CSF Biomarkers

    NARCIS (Netherlands)

    Tarnaris, A.; Toma, A.K.; Chapman, M.D.; Petzold, A.F.S.; Keir, G.; Kitchen, N.D.; Watkins, L.D.

    2011-01-01

    The rostrocaudal gradient (RCG) of markers present in cerebrospinal fluid (CSF) has not been studied adequately due to lack of appropriate control populations and ethical restrictions. The aim of this study is to understand the rostrocaudal gradient of CSF biomarkers. We contacted a study comparing

  11. Intracranial neurenteric cyst: A rare cause of chemical meningitis

    Directory of Open Access Journals (Sweden)

    Naseer A Choh

    2013-01-01

    Full Text Available Intracranial neurenteric cysts are exceedingly rare congenital intracranial lesions that result from disorder of gastrulation. Still, more rarely, the cyst contents may leak into the CSF and give rise to recurrent episodes of chemical meningitis. We present a case of chemical meningitis due to a leaking posterior fossa neurenteric cyst in a young female, with emphasis on its imaging features. The final diagnosis was achieved by sufficiently characteristic imaging features; histopathologic documentation could not be achieved as the patient denied surgery.

  12. Association of benign intracranial hypertension and spontaneous encephalocele with cerebrospinal fluid leak.

    Science.gov (United States)

    Brainard, Laura; Chen, Douglas A; Aziz, Khaled M; Hillman, Todd A

    2012-12-01

    To determine the incidence of intracranial hypertension in patients with spontaneous encephalocele with cerebrospinal fluid (CSF) leak. Retrospective case review. Tertiary care neurotology practice. Patients presenting between 2008 and 2011 with spontaneous encephalocele and CSF leak in the temporal bone. Lumbar puncture with opening pressure measurement after encephalocele repair. Patient age, sex, postoperative course, body mass index, and postoperative intracranial pressure. Of the 26 patients identified with spontaneous encephalocele with CSF leak, 9 patients had postoperative lumbar puncture data. Of those 9, 89% were female subjects, and 11% were male, with a mean age of 57 and a mean BMI of 41 kg/m (morbidly obese). The mean opening pressure was 24.5 cm H(2)O. Approximately 33% had normal intracranial pressure (mean, 15 cm H(2)O; range, 10-17 cm H(2)O); 67% had elevated intracranial pressure (mean, 29 cm H(2)O; range, 23.5-40 cm H(2)O). The incidence of BIH in the general population is 0.001%. Of the 6 with intracranial hypertension, 3 (50%) were placed on acetazolamide for fundoscopic findings, postoperative headache, and/or visual changes. Mean time to LP after repair of encephalocele was 13 months (range, 4 days to 75 months). This study shows that benign intracranial hypertension is prevalent in a significant number of patients presenting with spontaneous encephalocele with CSF otorrhea at a rate much higher than is found in the general population. This finding has direct clinical implications and suggests that all patients with spontaneous encephalocele/CSF leak warrant evaluation for benign intracranial hypertension.

  13. Increased Intracranial Pressure in a Boy with Gorham-Stout Disease

    Directory of Open Access Journals (Sweden)

    Manisha K. Patel

    2016-04-01

    Full Text Available Gorham-Stout disease (GSD, also known as vanishing bone disease, is a rare disorder, which most commonly presents in children and young adults and is characterized by an excessive proliferation of lymphangiomatous tissue within the bones. This lymphangiomatous proliferation often affects the cranium and, due to the proximate location to the dura surrounding cerebrospinal fluid (CSF spaces, can result in CSF leaks manifesting as intracranial hypotension with clinical symptoms to include orthostatic headache, nausea, and vertigo. We present the case of a boy with GSD and a known history of migraine headaches who presented with persistent headaches due to increased intracranial pressure. Although migraine had initially been suspected, he was eventually diagnosed with intracranial hypertension after developing ophthalmoplegia and papilledema. We describe the first known instance of successful medical treatment of increased intracranial pressure in a patient with GSD.

  14. SPHENOID SINUS (SS ANTERIOR MEDIAL TEMPORAL LOBE ENCEPHALOCELE (AMTLE WITH SPONTANEOUS CSF RHINORRHOEA : A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Laveena

    2015-09-01

    Full Text Available Cranial encephaloceles are the herniation of intracranial meninges and brain tissue through a defect in the cranium or skull base. These are rare conditions with an incidence of approximately 1 in 35,000 people, and are more common in the anterior cranial fossa than those in the middle one . 1,2 Temporal lobe herniation through a mid dle fossa defect into the lateral recess of the Sphenoid Sinus is even rarer than its medial representation. Intrasphenoidal encephaloceles are extremely rare findings 3 . Spontaneous, or primary, CSF fistula is a separate entity with no underlying cause of the CSF leak. Spontaneous CSF leaks are usually associated with a co - existing encephalocele of variable size 4 . We present a case of spontaneous CSF rhinorrhoea in a sphenoid sinus Anterior Medial Temporal lobe encephalocele herniating through a clinically silent lateral Craniopharyngeal canal.

  15. Idiopathic intracranial hypertension: case report

    Directory of Open Access Journals (Sweden)

    Iacob G.

    2015-12-01

    Full Text Available Idiopathic intracranial hypertension - IIH (synonymous old terms: benign intracranial hypertension - BIH, pseudotumor-cerebri - PTC it’s a syndrome, related to elevated intracranial pressure, of unknown cause, sometimes cerebral emergency, occuring in all age groups, especially in children and young obese womans, in the absence of an underlying expansive intracranial lesion, despite extensive investigations. Although initial symptoms can resolve, IIH displays a high risk of recurrence several months or years later, even if initial symptoms resolved. Results: A 20-year-old male, obese since two years (body mass index 30, 9, was admitted for three months intense headache, vomiting, diplopia, progressive visual acuity loss. Neurologic examination confirmed diplopia by left abducens nerve palsy, papilledema right > left. At admission, cerebral CT scan and cerebral MRI with angio MRI 3DTOF and 2D venous TOF was normal. Despite treatment with acetazolamide (Diamox, corticosteroid, antidepressants (Amitriptyline, anticonvulsivants (Topiramate three weeks later headache, diplopia persist and vision become worse, confirmed by visual field assessment, visual evoked potential (VEP. A cerebral arteriography demonstrate filling defect of the superior sagittal sinus in the 1/3 proximal part and very week filling of the transverse right sinus on venous time. Trombophylic profile has revealed a heterozygote V factor Leyden mutation, a homozygote MTHFR and PAI mutation justifying an anticoagulant treatment initiated to the patient. The MRI showed a superior sagittal sinus, right transverse and sigmoid sinus thrombosis, dilatation and buckling of the optic nerve sheaths with increased perineural fluid especially retrobulbar, discrete flattening of the posterior segment of the eyeballs, spinal MRI showed posterior epidural space with dilated venous branches, with mass effect on the spinal cord, that occurs pushed anterior on sagittal T1/T2 sequences cervical and

  16. A case of multiple intracranial tuberculomas accompanied by tuberculous meningitis

    International Nuclear Information System (INIS)

    Fukabori, Takashi; Takamatsu, Hajime; Nakanishi, Yasuhiro

    1986-01-01

    A 63-year-old man was admitted for headache and progressive drowsiness. In spite of negative results from cerebrospinal fluid (CSF) stains and cultures of tuberculosis and other bacteria, CSF findings and tuberculosis-positive sputum culture led to a tentative diagnosis of tuberculous meningitis. Symptoms and neurological test results both improved remarkably during antituberculous chemotherapy. Although the brain CT scan taken on admission showed no abnormal findings, one taken two months later revealed multiple high-density areas after enhancement with a contrast medium, suggesting multiple intracranial tuberculomas accompanied by tuberculous meningitis. The size of the multiple high-density areas gradually decreased during antituberculous chemotherapy. The CT scan can clearly locate lesions, detect complications, and evaluate the effects of treatment in patients with intracranial tuberculosis. (author)

  17. Identification of Ambiguous Activities in Radionuclide Cisternography Using SPECT/CT: Aspirated and Ingested CSF Rhinorrhea

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Yun; Kim, Jae Seung [Univ. of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2014-03-15

    A 2 year-old little girl underwent Tc-99m diethylenthriamine pentaacetic acid (DTPA) radionuclide cisternography to evaluate CSF rhinorrhea (Fig. 1). Cisternography clearly showed consecutive tracer activity in the nasal cavity and nasal tip, reflecting cerebrospinal fluid (CSF) leakage. However, several unexpected activities appeared on the bilateral mid- and unilateral lower thorax on delayed images, respectively. We performed additional SPECT/CT to delineate the CSF leakage tract and identify the unexpected activities. Through SPECT/CT, we could confirm that the mid-thoracic activity was in the lung parenchyma, while the lower thoracic activity was in the stomach. Thus, we speculated that these unexpected activities were the result of aspirated and ingested CSF rhinorrhea. CSF rhinorrhea occurs when there is a fistula between the dura mater and the skull base and discharge of CSF from the nose. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection that could produce fulminant meningitis. Therefore, identification of the fistulous tract is helpful for patient management. Radionuclide cisternography is an important imaging modality to detect the site of leakage in patients with CSF rhinorrhea. The combination of radionuclide cistenography and SPECT/CT has led to a major improvement in the diagnostic accuracy for localization of CSF leakage. This case also shows an important role for SPECT/CT fusion imaging in radionuclide cisternography not only for localizing the primary CSF fistula tract, but also for evaluating ambiguous radiotracer activities in planar imaging; these ultimately turned out to be aspirated and ingested CSF rhinorrhea.

  18. Identification of Ambiguous Activities in Radionuclide Cisternography Using SPECT/CT: Aspirated and Ingested CSF Rhinorrhea

    International Nuclear Information System (INIS)

    Lee, Dong Yun; Kim, Jae Seung

    2014-01-01

    A 2 year-old little girl underwent Tc-99m diethylenthriamine pentaacetic acid (DTPA) radionuclide cisternography to evaluate CSF rhinorrhea (Fig. 1). Cisternography clearly showed consecutive tracer activity in the nasal cavity and nasal tip, reflecting cerebrospinal fluid (CSF) leakage. However, several unexpected activities appeared on the bilateral mid- and unilateral lower thorax on delayed images, respectively. We performed additional SPECT/CT to delineate the CSF leakage tract and identify the unexpected activities. Through SPECT/CT, we could confirm that the mid-thoracic activity was in the lung parenchyma, while the lower thoracic activity was in the stomach. Thus, we speculated that these unexpected activities were the result of aspirated and ingested CSF rhinorrhea. CSF rhinorrhea occurs when there is a fistula between the dura mater and the skull base and discharge of CSF from the nose. A spinal fluid leak from the intracranial space to the nasal respiratory tract is potentially very serious because of the risk of an ascending infection that could produce fulminant meningitis. Therefore, identification of the fistulous tract is helpful for patient management. Radionuclide cisternography is an important imaging modality to detect the site of leakage in patients with CSF rhinorrhea. The combination of radionuclide cistenography and SPECT/CT has led to a major improvement in the diagnostic accuracy for localization of CSF leakage. This case also shows an important role for SPECT/CT fusion imaging in radionuclide cisternography not only for localizing the primary CSF fistula tract, but also for evaluating ambiguous radiotracer activities in planar imaging; these ultimately turned out to be aspirated and ingested CSF rhinorrhea

  19. A clinical study on neonatal intracranial hemorrhage, 2

    International Nuclear Information System (INIS)

    Matsuda, Hiroo; Inoue, Takao; Shimura, Kohji

    1980-01-01

    Clinical pigns, laboratory data, CT findings, CSF spectrophotometric findings and CSF/blood glucose ratio were reviewed on thirty six newborns with intracranial hemorrhage confirmed by CT and/or autopsy and the following findings were obtained. The sites of hemorrhage were: intraventricular 14, intracerebral 4, subdural 2, subarachnoidal 16. 1) Convulsion (39%), hypotonia (58%), apnea (47%), and bradycardia (58%) were seen, but those were not regarded as specific for the intracranial hemorrhage. 2) Severe anemia of hemoglobin value less than 14 g/dl (17%), more than 10% fall of hematocrit (10%), and hyperglycemia of blood glucose more than 200 mg/gl (42%) were seen almost equally in every type of hemorrhage. 3) On CSF spectrophotometry, ajj twelve cases of intraventricular and four cases of intracerebral hemorrhage had the oxyhemoglobin peak absorbance. However, of fourteen cases of subarachnoidal hemorrhage, three had the oxyhemoglobin peak absorbance but the other eleven cases had the bilirubin peak absorbance. 4) Hypoglycorrachia, defined as CSF/blood glucose ratio less than 0.4, was recognized only in the intraventricular hemorrhage group (5/9, 56%). It was concluded that lumbar puncture should be done first of all when intracranial hemorrhage is suspected. If hypoglycorrachia or oxyhemoglobin peak absorbance is recognized, computed tomography should be performed immediately to know the accurate site and extent of hemorrhage. Although hypoglycorrachia is more specific for the intraventricular hemorrhage, it is usually found several days after the hemorrhage. On the other hand, oxyhemoglobin can be identified in CSF within a day after the episode of hemorrhage and this method is more benifical for the early diagnosis. (author)

  20. Magnetic resonance velocity mapping of 3D cerebrospinal fluid flow dynamics in hydrocephalus: preliminary results

    International Nuclear Information System (INIS)

    Stadlbauer, Andreas; Salomonowitz, Erich; Brenneis, Christian; Ungersboeck, Karl; Riet, Wilma van der; Buchfelder, Michael; Ganslandt, Oliver

    2012-01-01

    To investigate the detectability of CSF flow alterations in the ventricular system of patients with hydrocephalus using time-resolved 3D MR velocity mapping. MR velocity mapping was performed in 21 consecutive hydrocephalus patients and 21 age-matched volunteers using a 3D phase-contrast (PC) sequence. Velocity vectors and particle path lines were calculated for visualisation of flow dynamics. CSF flow was classified as ''hypomotile flow'' if it showed attenuated dynamics and as ''hypermotile flow'' if it showed increased dynamics compared with volunteers. Diagnostic efficacy was compared with routine 2D cine PC-MRI. Seven patients showed hypomotile CSF flow: six had non-communicating hydrocephalus due to aqueductal stenosis. One showed oscillating flow between the lateral ventricles after craniotomy for intracranial haemorrhage. Seven patients showed normal flow: six had hydrocephalus ex vacuo due to brain atrophy. One patient who underwent ventriculostomy 10 years ago showed a flow path through the opening. Seven patients showed hypermotile flow: three had normal pressure hydrocephalus, three had dementia, and in one the diagnosis remained unclear. The diagnostic efficacy of velocity mapping was significantly higher except for that of aqueductal stenosis. Our approach may be useful for diagnosis, therapy planning, and follow-up of different kinds of hydrocephalus. (orig.)

  1. Magnetic resonance velocity mapping of 3D cerebrospinal fluid flow dynamics in hydrocephalus: preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Stadlbauer, Andreas [Landesklinikum St. Poelten, MR Physics Group, Department of Radiology, St. Poelten (Austria); University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany); Salomonowitz, Erich [Landesklinikum St. Poelten, MR Physics Group, Department of Radiology, St. Poelten (Austria); Brenneis, Christian [Landesklinikum St. Poelten, Department of Neurology, St. Poelten (Austria); Ungersboeck, Karl [Landesklinikum St. Poelten, Department of Neurosurgery, St. Poelten (Austria); Riet, Wilma van der [European MRI Consultancy (EMRIC), Strasbourg (France); Buchfelder, Michael; Ganslandt, Oliver [University of Erlangen-Nuremberg, Department of Neurosurgery, Erlangen (Germany)

    2012-01-15

    To investigate the detectability of CSF flow alterations in the ventricular system of patients with hydrocephalus using time-resolved 3D MR velocity mapping. MR velocity mapping was performed in 21 consecutive hydrocephalus patients and 21 age-matched volunteers using a 3D phase-contrast (PC) sequence. Velocity vectors and particle path lines were calculated for visualisation of flow dynamics. CSF flow was classified as ''hypomotile flow'' if it showed attenuated dynamics and as ''hypermotile flow'' if it showed increased dynamics compared with volunteers. Diagnostic efficacy was compared with routine 2D cine PC-MRI. Seven patients showed hypomotile CSF flow: six had non-communicating hydrocephalus due to aqueductal stenosis. One showed oscillating flow between the lateral ventricles after craniotomy for intracranial haemorrhage. Seven patients showed normal flow: six had hydrocephalus ex vacuo due to brain atrophy. One patient who underwent ventriculostomy 10 years ago showed a flow path through the opening. Seven patients showed hypermotile flow: three had normal pressure hydrocephalus, three had dementia, and in one the diagnosis remained unclear. The diagnostic efficacy of velocity mapping was significantly higher except for that of aqueductal stenosis. Our approach may be useful for diagnosis, therapy planning, and follow-up of different kinds of hydrocephalus. (orig.)

  2. MR evaluation of CSF fistulae

    International Nuclear Information System (INIS)

    Gupta, V.; Goyal, M.; Mishra, N.; Gaikwad, S.; Sharma, A.

    1997-01-01

    Purpose: To evaluate the role of MR imaging in the localisation of cerebrospinal fluid (CSF) fistulae. Material and Methods: A total of 36 consecutive unselected patients with either clincally proven CSF leakage (n=26) or suspected CSF fistula (n=10) were prospectively evaluated by MR. All MR examinations included fast spin-echo T2-weighted images in the 3 orthogonal planes. Thin-section CT was performed following equivocal or negative MR examination. MR and CT findings were correlated with surgical results in 33 patients. Results: CSF fistula was visualised as a dural-bone defect with hyperintense fluid signal continuous with that in the basal cisterns on T2-weighted images. MR was positive in 26 cases, in 24 of which the fistula was confirmed surgically. In 2 patients the CSF leakage was directly demonstrated on MR. MR sensitivity of 80% compared favourably with the reported 46-81% of CT cisternography (CTC). No significant difference in MR sensitivity in detecting CSF fistula was found between active and inactive leaks. (orig.)

  3. Equal contribution of increased intracranial pressure and subarachnoid blood to cerebral blood flow reduction and receptor upregulation after subarachnoid hemorrhage. Laboratory investigation

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2009-01-01

    OBJECT: Cerebral ischemia remains the key cause of disability and death in the late phase after subarachnoid hemorrhage (SAH), and its pathogenesis is still poorly understood. The purpose of this study was to examine whether the change in intracranial pressure or the extravasated blood causes the...

  4. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  5. NOISY INTRACRANIAL TUMORS

    NARCIS (Netherlands)

    VANDOOREN, BTH; VANBRUGGEN, AC; MOOIJ, JJA; HEW, JM; JOURNEE, HL

    1994-01-01

    Transorbital sound recordings were obtained from 21 patients with intracranial tumours, 28 patients with intracranial aneurysms and 20 control patients. The group of patients with tumours consisted of 12 patients with gliomas, of whom 6 had low-grade gliomas and 6 had high-grade gliomas, and 9

  6. Intracranial hypotension - a look beyond “bilateral subdural hematomas”

    International Nuclear Information System (INIS)

    Penev, B.

    2015-01-01

    Full text: The intracranial hypotension (ICH) is a disorder due to spontaneous or iatrogenic CSF leak and a low intracranial pressure. The clinical presentation is characterized by drug resistant orthostatic headache, nausea, vomiting, dizziness, neck pain and etc. The intracranial hypotension is defined as a benign disorder and the treatment is predominantly conservative. Due to this fact it is very important to differentiate this entity from subdural hematomas and hygromas which are treated surgically. Magnetic resonance imaging has revolutionized the diagnosis of ICH. Nowadays there are a lot of clinical and imaging features of this disorder. Regardless of clinical varieties and atypical forms, MRI gives enough information for the correct or probable diagnosis in the vast majority of the cases. The initial imaging resemblance with posttraumatic subdural hematomas and hygromas can result in giving the wrong diagnosis and therefore performing unneeded surgical interventions. the aim of this presentation is to discuss the contemporary criteria, algorithm and imaging features of ICH

  7. Intracranial cerebrospinal fluid spaces imaging using a pulse-triggered three-dimensional turbo spin echo MR sequence with variable flip-angle distribution

    Energy Technology Data Exchange (ETDEWEB)

    Hodel, Jerome [Unite Analyse et Restauration du Mouvement, UMR-CNRS, 8005 LBM ParisTech Ensam, Paris (France); University Paris Est Creteil (UPEC), Creteil (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri Mondor, Department of Neuroradiology, Creteil (France); Hopital Henri Mondor, Creteil (France); Silvera, Jonathan [University Paris Est Creteil (UPEC), Creteil (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri Mondor, Department of Neuroradiology, Creteil (France); Bekaert, Olivier; Decq, Philippe [Unite Analyse et Restauration du Mouvement, UMR-CNRS, 8005 LBM ParisTech Ensam, Paris (France); University Paris Est Creteil (UPEC), Creteil (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri Mondor, Department of Neurosurgery, Creteil (France); Rahmouni, Alain [University Paris Est Creteil (UPEC), Creteil (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri Mondor, Department of Radiology, Creteil (France); Bastuji-Garin, Sylvie [University Paris Est Creteil (UPEC), Creteil (France); Assistance Publique-Hopitaux de Paris, Paris (France); Hopital Henri Mondor, Department of Public Health, Creteil (France); Vignaud, Alexandre [Siemens Healthcare, Saint Denis (France); Petit, Eric; Durning, Bruno [Laboratoire Images Signaux et Systemes Intelligents, UPEC, Creteil (France)

    2011-02-15

    To assess the three-dimensional turbo spin echo with variable flip-angle distribution magnetic resonance sequence (SPACE: Sampling Perfection with Application optimised Contrast using different flip-angle Evolution) for the imaging of intracranial cerebrospinal fluid (CSF) spaces. We prospectively investigated 18 healthy volunteers and 25 patients, 20 with communicating hydrocephalus (CH), five with non-communicating hydrocephalus (NCH), using the SPACE sequence at 1.5T. Volume rendering views of both intracranial and ventricular CSF were obtained for all patients and volunteers. The subarachnoid CSF distribution was qualitatively evaluated on volume rendering views using a four-point scale. The CSF volumes within total, ventricular and subarachnoid spaces were calculated as well as the ratio between ventricular and subarachnoid CSF volumes. Three different patterns of subarachnoid CSF distribution were observed. In healthy volunteers we found narrowed CSF spaces within the occipital aera. A diffuse narrowing of the subarachnoid CSF spaces was observed in patients with NCH whereas patients with CH exhibited narrowed CSF spaces within the high midline convexity. The ratios between ventricular and subarachnoid CSF volumes were significantly different among the volunteers, patients with CH and patients with NCH. The assessment of CSF spaces volume and distribution may help to characterise hydrocephalus. (orig.)

  8. Intracranial cerebrospinal fluid spaces imaging using a pulse-triggered three-dimensional turbo spin echo MR sequence with variable flip-angle distribution

    International Nuclear Information System (INIS)

    Hodel, Jerome; Silvera, Jonathan; Bekaert, Olivier; Decq, Philippe; Rahmouni, Alain; Bastuji-Garin, Sylvie; Vignaud, Alexandre; Petit, Eric; Durning, Bruno

    2011-01-01

    To assess the three-dimensional turbo spin echo with variable flip-angle distribution magnetic resonance sequence (SPACE: Sampling Perfection with Application optimised Contrast using different flip-angle Evolution) for the imaging of intracranial cerebrospinal fluid (CSF) spaces. We prospectively investigated 18 healthy volunteers and 25 patients, 20 with communicating hydrocephalus (CH), five with non-communicating hydrocephalus (NCH), using the SPACE sequence at 1.5T. Volume rendering views of both intracranial and ventricular CSF were obtained for all patients and volunteers. The subarachnoid CSF distribution was qualitatively evaluated on volume rendering views using a four-point scale. The CSF volumes within total, ventricular and subarachnoid spaces were calculated as well as the ratio between ventricular and subarachnoid CSF volumes. Three different patterns of subarachnoid CSF distribution were observed. In healthy volunteers we found narrowed CSF spaces within the occipital aera. A diffuse narrowing of the subarachnoid CSF spaces was observed in patients with NCH whereas patients with CH exhibited narrowed CSF spaces within the high midline convexity. The ratios between ventricular and subarachnoid CSF volumes were significantly different among the volunteers, patients with CH and patients with NCH. The assessment of CSF spaces volume and distribution may help to characterise hydrocephalus. (orig.)

  9. Intracranial atherosclerosis: current concepts.

    Science.gov (United States)

    Arenillas, Juan F

    2011-01-01

    The most relevant ideas discussed in this article are described here. Intracranial atherosclerotic disease (ICAD) represents the most common cause of ischemic stroke worldwide. Its importance in whites may have been underestimated. New technical developments, such as high-resolution MRI, allow direct assessment of the intracranial atherosclerotic plaque, which may have a profound impact on ICAD diagnosis and therapy in the near future. Early detection of ICAD may allow therapeutic intervention while the disease is still asymptomatic. The Barcelonès Nord and Maresme Asymptomatic Intracranial Atherosclerosis Study is presented here. The main prognostic factors that characterize the patients who are at a higher risk for ICAD recurrence are classified and discussed. The best treatment for ICAD remains to be established. The Stenting Versus Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis Study is currently ongoing to address this crucial issue. These and other topics will be discussed at the Fifth International Intracranial Atherosclerosis Conference (Valladolid, Spain, autumn 2011).

  10. Automated quantification of cerebral edema following hemispheric infarction: Application of a machine-learning algorithm to evaluate CSF shifts on serial head CTs

    OpenAIRE

    Chen, Yasheng; Dhar, Rajat; Heitsch, Laura; Ford, Andria; Fernandez-Cadenas, Israel; Carrera, Caty; Montaner, Joan; Lin, Weili; Shen, Dinggang; An, Hongyu; Lee, Jin-Moo

    2016-01-01

    Although cerebral edema is a major cause of death and deterioration following hemispheric stroke, there remains no validated biomarker that captures the full spectrum of this critical complication. We recently demonstrated that reduction in intracranial cerebrospinal fluid (CSF) volume (??CSF) on serial computed tomography (CT) scans provides an accurate measure of cerebral edema severity, which may aid in early triaging of stroke patients for craniectomy. However, application of such a volum...

  11. Increased intracranial pressure

    Science.gov (United States)

    ... the membranes covering the brain and spinal cord) Subdural hematoma (bleeding between the covering of the brain and ... intracranial pressure Patient Instructions Ventriculoperitoneal shunt - discharge Images Subdural hematoma Central nervous system and peripheral nervous system References ...

  12. Acute intracranial hematoma formation following excision of a cervical subdural tumor: a report of two cases and literature review.

    Science.gov (United States)

    Ma, Xuexiao; Zhang, Yan; Wang, Ting; Li, Guizhi; Zhang, Guoqing; Khan, Hassan; Xiang, Hongfei; Chen, Bohua

    2014-01-01

    An intracranial hematoma is a rare, yet significant, complication following spinal surgery. The authors describe two cases with acute intracranial hematoma formation after excision of a cervical subdural schwannoma. One was a 14-year-old girl who developed bilateral intracranial extradural hematomas immediately following excision of the C4 subdural schwannoma. The other was a 59-year-old woman who had an acute cerebellar hematoma after removal of the C2-C5 subdural schwannoma. During the surgeries of both cases, spinal dura was partially removed together with the tumor and the dural sac could not be repaired, resulting in large amounts of intraoperative CSF loss and persistent postoperative CSF leakage. Both patients failed to regain consciousness from anesthesia after surgery, and a cranial CT scan identified large intracranial hematomas. Urgent hematoma evacuation was ultimately performed to save the patients. Based on the authors' experience and literature review, a conclusion was drawn that considerable CSF leakage and a sharp decrease of CSF pressure are common features during the excision of a spinal subdural tumor, which may lead to acute intracranial hematomas. Continual postoperative monitoring in patients with this condition should be of a very high priority. A CT or MRI should be immediately investigated to exclude intracranial hematomas for any patient with delayed emergence from anesthesia following spinal surgery. Hematoma evacuation is indispensable once an intracranial hematoma is identified in the patient who fails to regain consciousness from anesthesia post surgery. Furthermore, the possible pathophysiological mechanisms responsible for the formation of an intracranial hematoma after spinal procedures, particularly after manipulations of a cervical subdural tumor, are discussed.

  13. Osmolality of Cerebrospinal Fluid from Patients with Idiopathic Intracranial Hypertension (IIH.

    Directory of Open Access Journals (Sweden)

    Elisabeth A Wibroe

    Full Text Available Idiopathic intracranial hypertension (IIH is a disorder of increased intracranial fluid pressure (ICP of unknown etiology. This study aims to investigate osmolality of cerebrospinal fluid (CSF from patients with IIH.We prospectively collected CSF from individuals referred on suspicion of IIH from 2011-2013. Subjects included as patients fulfilled Friedman and Jacobson's diagnostic criteria for IIH. Individuals in whom intracranial hypertension was refuted were included as controls. Lumbar puncture with ICP measurement was performed at inclusion and repeated for patients after three months of treatment. Osmolality was measured with a Vapor Pressure Osmometer.We collected 90 CSF samples from 38 newly diagnosed patients and 28 controls. At baseline 27 IIH-samples and at 3 months follow-up 35 IIH-samples were collected from patients. We found no significant differences in osmolality between 1 patients at baseline and controls (p = 0. 86, 2 patients at baseline and after 3 months treatment (p = 0.97, and 3 patients with normalized pressure after 3 months and their baseline values (p = 0.79. Osmolality in individuals with normal ICP from 6-25 cmH2O (n = 41 did not differ significantly from patients with moderately elevated ICP from 26-45 cmH2O (n = 21 (p = 0.86 and patients with high ICP from 46-70 cmH2O (n = 4 (p = 0.32, respectively. There was no correlation between osmolality and ICP, BMI, age and body height, respectively. Mean CSF osmolality was 270 mmol/kg (± 1 SE, 95% confidence interval 267-272 for both patients and controls.CSF osmolality was normal in patients with IIH, and there was no relation to treatment, ICP, BMI, age and body height. Mean CSF osmolality was 270 mmol/kg and constitutes a reference for future studies. Changes in CSF osmolality are not responsible for development of IIH. Other underlying pathophysiological mechanisms must be searched.

  14. Diagnosis and treatment of adult medulloblastoma seeding in the intracranial-spinal subarachnoid space

    Directory of Open Access Journals (Sweden)

    Ji-wei WANG

    2015-10-01

    Full Text Available Objective To investigate the clinical diagnosis and treatment of adult medulloblastoma seeding in the intracranial-spinal subarachnoid space. Methods Eleven cases of adult medulloblastoma seeding in the intracranial-spinal subarachnoid space were retrospectively analyzed on the clinical features, cerebrospinal fluid (CSF cytology, radiological characteristics and treatments. Results All patients underment neurosurgical procedures to remove medulloblastomas. In 10 patients, tumor was removed through suboccipital posterior midline approach and in one patient through post-sigmoid sinus approach. In 7 patients tumor cell seeding was found in the intracranial-spinal subarachnoid space before postoperative radiotherapy and disappeared after radiological and chemical treatment, while in other 4 patients tumor cell seeding was found in the intracranial-spinal subarachnoid space at 3 months to 3 years follow-up period (average 20 months after radiotherapy. In 2 of all the patients tumor cells were found by CSF cytology before operation. All the patients were treated with radiotherapy and adjuvant chemotherapy. Two patients were still alive, while 9 patients were dead. Conclusions Patients with adult medulloblastoma seeding in intracranial-spinal subarachnoid space have a poor prognosis. In the diagnosis of adult medulloblastomas seeding in the intracranial-spinal subarachnoid space, MRI is more sensitive than CSF cytology. Once the seeding in intracranial-spinal subarachnoid space was found, the patients should be treated with radiotherapy and adjuvant chemotherapy, which can prolong the survival time and improve the quality of life. DOI: 10.3969/j.issn.1672-6731.2015.10.012 

  15. Is there a relationship between obesity and intracranial hypertension?

    Science.gov (United States)

    Hannerz, J; Greitz, D; Ericson, K

    1995-04-01

    Intracranial hypertension and obesity have been reported in recent studies of patients with periorbital venous vasculitis. These findings indicate that obese patients should be investigated for signs of inflammation in serum and lumbar cerebrospinal fluid (CSF) pressure. Twenty obese females, aged 27-68 years participated in the study of associated symptoms, signs of inflammation in serum, intracranial hypertension and magnetic resonance imaging of the brain (MR). Twenty randomly selected age- and sex-matched females were also investigated for associated symptoms and MR as controls. There were no statistically significant differences in associated symptoms and diseases except for infertility (P rheumatic and antinuclear factors were significantly increased in the obese group compared with normal values at the hospital. The lumbar CSF pressure was increased above 20 cm water in 79% and above 25 cm water in 42% in the obese patients. MR showed that the subarachnoidal space in the obese patients were significantly smaller than in the controls. Signs of inflammation in serum, intracranial hypertension and decreased subarachnoidal space were statistically significantly more common in patients with obesity, than in controls.

  16. Acute hydrocephalus in nonaneurysmal perimesencephalic hemorrhage: evidence of CSF block at the tentorial hiatus

    NARCIS (Netherlands)

    Rinkel, G. J.; Wijdicks, E. F.; Vermeulen, M.; Tans, J. T.; Hasan, D.; van Gijn, J.

    1992-01-01

    The acute hydrocephalus in patients with nonaneurysmal perimesencephalic hemorrhage suggests an extraventricular obstruction of CSF flow. We studied the occurrence of acute hydrocephalus and the site of cisternal blood in 40 consecutive patients with perimesencephalic hemorrhage. In all 11 patients

  17. Autocrine CSF-1 and CSF-1 Receptor Co-expression Promotes Renal Cell Carcinoma Growth

    Science.gov (United States)

    Menke, Julia; Kriegsmann, Jörg; Schimanski, Carl Christoph; Schwartz, Melvin M.; Schwarting, Andreas; Kelley, Vicki R.

    2011-01-01

    Renal cell carcinoma is increasing in incidence but the molecular mechanisms regulating its growth remain elusive. Co-expression of the monocytic growth factor CSF-1 and its receptor CSF-1R on renal tubular epithelial cells (TEC) will promote proliferation and anti-apoptosis during regeneration of renal tubules. Here we show that a CSF-1-dependent autocrine pathway is also responsible for the growth of renal cell carcinoma (RCC). CSF-1 and CSF-1R were co-expressed in RCC and TEC proximally adjacent to RCC. CSF-1 engagement of CSF-1R promoted RCC survival and proliferation and reduced apoptosis, in support of the likelihood that CSF-1R effector signals mediate RCC growth. In vivo CSF-1R blockade using a CSF-1R tyrosine kinase inhibitor decreased RCC proliferation and macrophage infiltration in a manner associated with a dramatic reduction in tumor mass. Further mechanistic investigations linked CSF-1 and EGF signaling in RCC. Taken together, our results suggest that budding RCC stimulates the proximal adjacent microenvironment in the kidney to release mediators of CSF-1, CSF-1R and EGF expression in RCC. Further, our findings imply that targeting CSF-1/CSF-1R signaling may be therapeutically effective in RCC. PMID:22052465

  18. Suppurative intracranial processes in 15 domestic ruminants

    Directory of Open Access Journals (Sweden)

    Antônio Carlos Lopes Câmara

    2014-05-01

    Full Text Available In addition to listeriosis which is relatively common in ruminants, there are three other uncommon suppurative intracranial processes (SIP identifiable in adult ungulates as brain abscess, basilar empyema and suppurative meningitis. The present paper reports the epidemiological, clinical, laboratorial, pathological and microbiological findings of 15 domestic ruminants with SIP. A total of 15 animals were selected (eight sheep, four cattle and three goats; with the definitive diagnoses of basilar empyema (n=3, brain abscess (n=1, listeriosis (n=5 and suppurative meningitis (n=6. Hematology revealed leukocytosis with inversion of the lymphocyte/ neutrophil ratio in 4 cases. In the majority of animals, cerebrospinal fluid (CSF presented light yellow coloration and cloudy aspect due to neutrophilic pleocytosis (15 - 997 leukocytes/µL. Microbiological culture of CSF or central nervous system (CNS fragments resulted on isolation of Trueperella (Arcanobacterium pyogenes,Listeria monocytogenes,Escherichia coli and Stenotrophomonas sp. In a goat with thalamic abscess, microbiological assay was not performed, but Gram positive bacilli type bacteria were observed in histology. The diagnosis of these outbreaks was based on the association of epidemiological, clinical, pathological and bacteriological findings; reiterating that the infectious component remains an important cause of CNS disease in domestic ruminants and also shows the need for dissemination of information about the most effective preventive measures for the ranchers.

  19. MRI and CT findings of intracranial neurosyphilis

    International Nuclear Information System (INIS)

    Suh, Hong Kil; Shim, Ya Seong; Kim, Seon Bok; Kim, Uk Jung; Lee, Shin Ho; Jung, Hae Kyuong; Lee, Eil Seong; Kang, Ik Won; Cho, Hyeun Cha

    1999-01-01

    To evaluate the CT and MRI findings of neurosyphilis. We retrospectively reviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL, TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. The MRI and CT findings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy (n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershed zone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%), followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferior cerebellar artery territory (11.1%). The size of the lesion varied from 1cm to larger than one lobe. One patient showed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebral arterial territory

  20. MRI and CT findings of intracranial neurosyphilis

    Energy Technology Data Exchange (ETDEWEB)

    Suh, Hong Kil; Shim, Ya Seong; Kim, Seon Bok; Kim, Uk Jung; Lee, Shin Ho; Jung, Hae Kyuong; Lee, Eil Seong; Kang, Ik Won [Hallym University College of Medicine, Seoul (Korea, Republic of); Cho, Hyeun Cha [Sungkyunkwan University College of Medicine, Seoul (Korea, Republic of)

    1999-02-01

    To evaluate the CT and MRI findings of neurosyphilis. We retrospectively reviewed the CT and MR imaging findings in five patients with intracranial neurosyphilis confirmed by CSF, VDRL, TPHA, and clinical follow-up. MR imaging was performed in all five cases, and CT in two. The MRI and CT findings of intracranial neurosyphilis included infarction (n=3), focal inflammation (n=1) and encephalopathy (n=1). There was a total of ten infaretions : three of the basal ganglia, two each of the frontal lobe, watershed zone, and cerebellum, and one of the occipital lobe. Intaretion was most common in MCA territory (n=9; 50%), followed by the watershed zone (16.6%), posterior cerebral artery territory (16.6%), and posterior inferior cerebellar artery territory (11.1%). The size of the lesion varied from 1cm to larger than one lobe. One patient showed diffuse high signal intensity in the left temporal lobe, but on follow-up MRI, this had resolved. The most common finding of neurosyphilis, as seen on MRI and CT, was infarction in middle cerebral arterial territory.

  1. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    Science.gov (United States)

    ... cause is determined and is referred to as “secondary” intracranial hypertension. What are the risk factors for idiopathic intracranial ... clotting disorders, anemia and malnutrition. Can idiopathic intracranial ... to be “secondary” which affects males and females equally. The second ...

  2. Idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne M; Jensen, Rigmor H

    2015-01-01

    AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS: We included 44 patients with new-onset IIH. Thirty-four patients with suspected but u...... tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity....

  3. Radionuclide cisternography: a prudent investigation in diagnosing spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Sehgal, Aditi Khurana; Sethi, Ravinder Singh; Namgyal, Padma A.; Raghavan, Samudrala

    2013-01-01

    Spontaneous intracranial hypotension (SIH) is a cause of new persistent headache, which disappears on recumbence and reappears in sitting/standing position (orthostatic headache). We present a case of orthostatic headache, where the patient was suspected to have SIH and was subjected to radionuclide cisternography (RNC) using 99m Technetium Diethylenetriaminepenta acetic acid for confirmation of diagnosis. After due consent from the patient, the radiotracer was injected intra-thecally and serial images were acquired until 24 h. The direct and indirect evidences of Cerebrospinal fluid (CSF) leakage, which were revealed in our study, provided objective evidence to the clinical diagnosis. RNC is an important investigation in diagnosing SIH and also identifying the site of CSF leak, which may aid the management. (author)

  4. Raised intracranial pressure

    African Journals Online (AJOL)

    is article presents an approach to raised intracranial pressure (ICP) constructed in a question-answer fashion. ..... Given that raised ICP is a serious and potentially life-threatening emergency, fast and reliable referral and transfer mechanisms should be established to ensure patients with this condition are effectively treated.

  5. Intracranial Pressure Monitoring

    DEFF Research Database (Denmark)

    Raboel, P H; Bartek, J; Andresen, M

    2012-01-01

    Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods...

  6. Sinogenic intracranial complications

    DEFF Research Database (Denmark)

    Kofoed, Mikkel Seremet; Fisker, Niels; Christensen, Anne Estmann

    2018-01-01

    We present two 11-year-old girls with chronic recurrent multifocal osteomyelitis, treated with adalimumab. Both developed severe intracranial complications to sinusitis. Patient 1 had been treated with adalimumab for 15 months when she developed acute sinusitis complicated by an orbital abscess, ...

  7. Intracranial tuberculoma: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Salgado, P; Zenteno, M A; Rodriguez-Carbajal, J; Brutto, O.H. del; Talamas, O

    1989-09-01

    MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.).

  8. Intracranial tuberculoma: MR imaging

    International Nuclear Information System (INIS)

    Salgado, P.; Zenteno, M.A.; Rodriguez-Carbajal, J.; Brutto, O.H. del; Talamas, O.

    1989-01-01

    MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.)

  9. Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients.

    Science.gov (United States)

    Eide, Per K

    2008-11-01

    Data from intracranial pressure (ICP) recordings in patients with hydrocephalus were reviewed to determine whether intracranial pulsatility within the cerebrospinal fluid (CSF) of cerebral ventricles (ICP(LV)) may differ from that within the brain parenchyma (ICP(PAR)), and whether pulsatility may differ between noncommunicating ventricles. The authors retrieved data from recordings previously obtained in 7 patients with hydrocephalus (noncommunicating in 4 and communicating in 3) and shunt failure who received both an external ventricular drainage (EVD) and an ICP sensor as part of surveillance during intensive care. Simultaneous ICP(LV) and ICP(PAR) signals were available in 6 cases, and simultaneous signals from the lateral and fourth ventricles (ICP(LV) and ICP4V, respectively) were recorded in 1 case. The recordings with both signals were parsed into 6-second time windows. Pulsatility was characterized by the wave amplitude and rise time coefficient, and differences in pulsatility between the ICP(LV) and ICP(PAR) signals (6 cases) or ICP(LV) and ICP4V signals (1 case) were determined. There was uneven distribution of intracranial pulsatility in all 7 patients, shown as significantly elevated pulsatility (that is, higher wave amplitudes and rise time coefficients) within the ventricles (ICP(LV)) than within brain parenchyma (ICP(PAR)) in 6 patients, and significantly higher pulsatility in the fourth (ICP4V) than in the lateral (ICP(LV)) ventricles in 1 patient. Differences > or = 1 mm Hg in ICP wave amplitude were found in 0.5-100% (median 9.4%) of observations in the 7 patients (total number of 6-second time windows, 68,242). The present observations demonstrate uneven distribution of intracranial pulsatility in patients with hydrocephalus, higher pulse pressure amplitudes within the ventricular CSF (ICP(LV)) than within the brain parenchyma (ICP(PAR)). This may be one mechanism behind ventricular enlargement in hydrocephalus.

  10. Follow-up of intracranial aneurysms treated by a WEB flow disrupter: a comparative study of DSA and contrast-enhanced MR angiography.

    Science.gov (United States)

    Mine, Benjamin; Tancredi, Illario; Aljishi, Ali; Alghamdi, Faisal; Beltran, Margarita; Herchuelz, Maxime; Lubicz, Boris

    2016-06-01

    To compare contrast-enhanced MR angiography (CE-MRA) and DSA for the follow-up of intracranial aneurysms (IAs) treated with the Woven EndoBridge embolization system DL (WEB DL; Sequent Medical, Aliso Viejo, California, USA). We retrospectively identified all patients treated with a WEB DL between November 2010 and February 2013 in 2 hospitals. The IA occlusion was graded on follow-up CE-MRA and DSA by 4 independent readers and by 2 readers reaching a consensus, respectively. Interobserver agreement for MRA and intertechnique agreement was evaluated by calculating linear weighted κ. Fifteen patients with 16 IAs were included. Mean delay between MRA and DSA was 2 months (range 0-16 months). Interobserver agreement for MRA was substantial to almost perfect (κ=0.686-0.921; mean κ=0.809). Intertechnique agreement was moderate to substantial (κ=0.579-0.724; mean κ=0.669). Only three out of five inadequately occluded IAs were detected by MRA. CE-MRA is a useful tool for the follow-up of IAs treated with a WEB DL. However, early follow-up with DSA remains mandatory to detect inadequately occluded IAs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  11. Fast CSF MRI for brain segmentation; Cross-validation by comparison with 3D T1-based brain segmentation methods.

    Science.gov (United States)

    van der Kleij, Lisa A; de Bresser, Jeroen; Hendrikse, Jeroen; Siero, Jeroen C W; Petersen, Esben T; De Vis, Jill B

    2018-01-01

    In previous work we have developed a fast sequence that focusses on cerebrospinal fluid (CSF) based on the long T2 of CSF. By processing the data obtained with this CSF MRI sequence, brain parenchymal volume (BPV) and intracranial volume (ICV) can be automatically obtained. The aim of this study was to assess the precision of the BPV and ICV measurements of the CSF MRI sequence and to validate the CSF MRI sequence by comparison with 3D T1-based brain segmentation methods. Ten healthy volunteers (2 females; median age 28 years) were scanned (3T MRI) twice with repositioning in between. The scan protocol consisted of a low resolution (LR) CSF sequence (0:57min), a high resolution (HR) CSF sequence (3:21min) and a 3D T1-weighted sequence (6:47min). Data of the HR 3D-T1-weighted images were downsampled to obtain LR T1-weighted images (reconstructed imaging time: 1:59 min). Data of the CSF MRI sequences was automatically segmented using in-house software. The 3D T1-weighted images were segmented using FSL (5.0), SPM12 and FreeSurfer (5.3.0). The mean absolute differences for BPV and ICV between the first and second scan for CSF LR (BPV/ICV: 12±9/7±4cc) and CSF HR (5±5/4±2cc) were comparable to FSL HR (9±11/19±23cc), FSL LR (7±4, 6±5cc), FreeSurfer HR (5±3/14±8cc), FreeSurfer LR (9±8, 12±10cc), and SPM HR (5±3/4±7cc), and SPM LR (5±4, 5±3cc). The correlation between the measured volumes of the CSF sequences and that measured by FSL, FreeSurfer and SPM HR and LR was very good (all Pearson's correlation coefficients >0.83, R2 .67-.97). The results from the downsampled data and the high-resolution data were similar. Both CSF MRI sequences have a precision comparable to, and a very good correlation with established 3D T1-based automated segmentations methods for the segmentation of BPV and ICV. However, the short imaging time of the fast CSF MRI sequence is superior to the 3D T1 sequence on which segmentation with established methods is performed.

  12. Fast CSF MRI for brain segmentation; Cross-validation by comparison with 3D T1-based brain segmentation methods

    DEFF Research Database (Denmark)

    van der Kleij, Lisa A.; de Bresser, Jeroen; Hendrikse, Jeroen

    2018-01-01

    ObjectiveIn previous work we have developed a fast sequence that focusses on cerebrospinal fluid (CSF) based on the long T-2 of CSF. By processing the data obtained with this CSF MRI sequence, brain parenchymal volume (BPV) and intracranial volume (ICV) can be automatically obtained. The aim...... of this study was to assess the precision of the BPV and ICV measurements of the CSF MRI sequence and to validate the CSF MRI sequence by comparison with 3D T-1-based brain segmentation methods.Materials and methodsTen healthy volunteers (2 females; median age 28 years) were scanned (3T MRI) twice......cc) and CSF HR (5 +/- 5/4 +/- 2cc) were comparable to FSL HR (9 +/- 11/19 +/- 23cc), FSL LR (7 +/- 4,6 +/- 5cc),FreeSurfer HR (5 +/- 3/14 +/- 8cc), FreeSurfer LR (9 +/- 8,12 +/- 10cc), and SPM HR (5 +/- 3/4 +/- 7cc), and SPM LR (5 +/- 4,5 +/- 3cc). The correlation between the measured volumes...

  13. Reversal in the Diameter of the Superior Ophthalmic Vein after an Epidural Blood Patch in a Case of Spontaneous Intracranial Hypotension

    International Nuclear Information System (INIS)

    Hsiao, Chen Yu; Tsai, Yuh Feng

    2011-01-01

    Spontaneous intracranial hypotension (SIH) is caused by single or multiple cerebrospinal fluid (CSF) leaks in the spine with the prototypical symptom of postural headache. One of the characteristic MRI features in SIH is intracranial venous engorgement. This report presents a case of SIH with engorgement of the bilateral superior ophthalmic veins (SOVs) which resume their normal diameters by the third day of successful epidural blood patches (EBPs). We define this phenomenon as the 'reversal of the SOV' sign.

  14. Intracranial cavernous angioma

    International Nuclear Information System (INIS)

    Yuhi, Fumiaki; Gondou, Masazumi; Sasahira, Masahiro; Ichitsubo, Hidenori; Asakura, Tetsuhiko.

    1986-01-01

    The present authors have experienced 2 cases of intracranial cavernous angioma. Of these cases, one was admitted because of generalized convulsions, while the other was admitted because of headache. In both cases, neither plain X-ray films nor carotid angiography showed any abnormality, but computerized tomography (CT) revealed a slightly high-density area which was not enhanced with contrast media. Histologically, the tumors had many vascular cavities with walls lined with a single layer of endothelial cells and had no neural tissue between the vascular cavities; therefore, they were diagnosed as cases of cavernous angioma. The authors discussed the radiological findings of the intracranial cavernous angioma with a review of the literature and stressed the role of computerized tomography in the diagnosis of cavernous angioma. (author)

  15. An Unusual Case of Post-Traumatic Headache Complicated by Intracranial Hypotension

    Directory of Open Access Journals (Sweden)

    Sara Siavoshi

    2016-12-01

    Full Text Available We present a case of post-traumatic headache complicated by intracranial hypotension resulting in an acquired Chiari malformation and myelopathy with syringomyelia. This constellation of findings suggest a possible series of events that started with a traumatic cerebral spinal fluid (CSF leak, followed by descent of the cerebellar tonsils and disruption of CSF circulation that caused spinal cord swelling and syrinx. This unusual presentation of post-traumatic headache highlights the varying presentations and the potential sequelae of intracranial hypotension. In addition, the delayed onset of upper motor neuron symptoms along with initially normal head computerized tomography scan (CT findings, beg the question of whether or not a post-traumatic headache warrants earlier magnetic resonance imaging (MRI.

  16. Transethmoidal encephalocele after reduction of high intracranial pressure in aqueductal stenosis.

    Science.gov (United States)

    Sharifi, Guive; Alavi, Ehsan; Jalessi, Maryam; Haddadian, Karim; Faramarzi, Faezeh

    2014-01-01

    Acquired non-traumatic transethmoidal encephaloceles are very infrequent lesions that are generally caused by a tumor or hydrocephalus. As far as we know, there is no reported case of encephalocele after CSF diversion in the literature. We present a 25-year-old woman with hydrocephalus due to aquiductal stenosis who was treated with endoscopic third ventriculostomy. Nine months later, she had developed rhinorrhea and on imaging she had a transethmoidal encephalocele. She underwent endonasal endoscopic repair of the defect and removal of herniated parenchyma. CSF diversion to parasellar cisterns is not a known iatrogenic cause of basal encephalocele and is not noted elsewhere as a complication of third ventriculostomy. However, as third ventriculostomy is performed usually for intracranial hypertension treatment and intracranial hypertension itself is a known but rare cause of lacunar skull defect and encephalocele, this co-incidence may occur.

  17. Intracranial Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Maria Khan

    2011-01-01

    Full Text Available Intracranial atherosclerotic disease (ICAD is the most common proximate mechanism of ischemic stroke worldwide. Approximately half of those affected are Asians. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. However, noninvasive techniques including transcranial ultrasound and MRA are now emerging as reliable modalities to exclude moderate to severe (50%–99% stenosis. Little is known about measures for primary prevention of the disease. In terms of secondary prevention of stroke due to intracranial atherosclerotic stenosis, aspirin continues to be the preferred antiplatelet agent although clopidogrel along with aspirin has shown promise in the acute phase. Among Asians, cilostazol has shown a favorable effect on symptomatic stenosis and is of benefit in terms of fewer bleeds. Moreover, aggressive risk factor management alone and in combination with dual antiplatelets been shown to be most effective in this group of patients. Interventional trials on intracranial atherosclerotic stenosis have so far only been carried out among Caucasians and have not yielded consistent results. Since the Asian population is known to be preferentially effected, focused trials need to be performed to establish treatment modalities that are most effective in this population.

  18. Intracranial MR angiography

    International Nuclear Information System (INIS)

    Davis, W.L.; Blatter, D.D.; Parker, D.L.; Robison, R.O.; Harnsberger, H.R.

    1991-01-01

    This paper compares the more traditional three-dimensional (3D) time-of-flight MR angiography with a novel new technique, MOTSA, in the evaluation of both normal and abnormal intracranial anatomy. The authors performed sequential, location-matched 3D TOF and MOTSA MR angiography in 10 subjects with normal and 25 with abnormal intracranial anatomy. Images were evaluated for visualization of specific vessels and depiction of pathologic anatomy. All images were subjected to an objective scoring system. Digital angiography was available in 15 of 25 abnormal cases. In the normal cases, large- and small-vessel visualization was improved. Significant improvement in visualization of venous anatomy was also observed. In the abnormal cases, pathologic anatomy was better visualized, providing important diagnostic information. Multiple overlapping thin-slab-acquisition MR angiography demonstrates vessel visualization that is increased over that of 3D TOF MR angiography in both normal and abnormal cases. Because of the decrease in saturation effects and phase dispersion, MOTSA is especially useful in the evaluation of complex intracranial vascular abnormalities

  19. Intracranial chondroma: a rare entity.

    Science.gov (United States)

    Maheshwari, Veena; Mehdi, Ghazala; Varshney, Manoranjan; Jain, Anshu; Vashishtha, Sonal; Gaur, Kavita; Srivastava, Vinod Kumar

    2011-05-12

    Intracranial chondroma is a rare benign cartilaginous tumour with an incidence of less than 1% of all primary intracranial tumours. The authors are reporting here a case of intracranial chondroma in a 40-year-old man who presented with 5-month history of headache and gradual diminution of vision. A tentative diagnosis of chondroma was made on imprint cytology which was confirmed on histopathological examination.

  20. Three cases of intracranial lipoma

    Energy Technology Data Exchange (ETDEWEB)

    Kurokawa, Hiroyuki; Kikuchi, Kenji; Yanagida, Noritaka; Fujii, Satoshi; Watanabe, Kazuo; Miyauchi, Takaharu

    1987-12-01

    Intracranial lipoma is an uncommon lesion that can be found in both symptomatic and asymptomatic patients. Because of CT (computerized tomography), the tumors can now be easily diagnosed in asymptomatic individuals. Three cases of intracranial lipoma in asymptomatic patients are presented, along with a review of the literature, and the value of CT, especially coronal section, in the diagnosis of intracranial lipomas and associated anomalies, such as the agenesis of corpus callosum, is discussed.

  1. Study of cysticercosis in the fourth ventricle by CSF cinema MRI

    International Nuclear Information System (INIS)

    Wang Lianqing; Liu Lianxiang; Wu Jie; Wu Jing; Zhang Renshu; Wu Yujin

    1997-01-01

    Purpose: To evaluate the diagnostic value of cysticercosis in the fourth ventricle by CSF cinema MRI. Materials and methods: Nine patients with intraventricular cysticercosis in the fourth ventricle were studied. The diagnosis was confirmed by surgery in all cases. All of these patients were examined systematically before the operation and studied with CSF cinema MRI in mid sagittal section and finger-gated scan technique. Results: (1) The path of CSF flow was directly displayed. All cysticercosis presented as a filling defect, and a cyst with a smooth wall. (2) The ventricular compliance was normal in cysticercosis. (3) The cysticercosis in active stage was free in the fourth ventricle and could be rolled over, its shape might change slightly within a cardiac cycle. In the degenerative stage, its wall could adhere to the ependyma and obstruct the CSF flow. Conclusion: CSF cinema MRI can demonstrate the degree of obstruction and pattern of CSF flow in cysticercosis of the fourth ventricle, thereby providing useful information for proper management

  2. Intracranial hypertension: A rare presentation of lupus nephritis.

    Science.gov (United States)

    Yadav, Praveen; Nair, Anishkumar; Cherian, Ajith; Sibi, N S; Kumar, Ashwini

    2010-07-01

    A 14-year-old male presented with bilateral papilledema, growth retardation and absent secondary sexual characters. He had a past history of fever, headache and fatigue of 6 months duration. The diagnosis of intracranial hypertension (IH) was confirmed by an increased intracranial pressure and normal neuroimaging studies of the brain, except for partial empty sella, prominent perioptic cerebrospinal fluid (CSF) spaces and buckling of optic nerves. Evaluation showed erythrocyte sedimentation rate (ESR) of 150 mm/hr, positive antinuclear antibody (ANA), anti dsDNA and anti ribosomal P protein. Renal biopsy revealed diffuse segmental proliferative lupus nephritis (LN) class IV S (A) confirming the diagnosis of systemic lupus erythematosus (SLE). Treatment of LN with intravenous pulse methyl prednisolone and cyclophosphamide was effective in normalizing the CSF pressure, resulting in express and dramatic resolution of symptomatology. In a case of IH, SLE must be considered. IH, growth retardation and absence of sexual characters may be presenting manifestations of a chronic systemic inflammatory disease like SLE. These manifestations may act as a pointer to associated advanced grades of LN, which can be totally asymptomatic and missed without a renal biopsy.

  3. A case of idiopathic intracranial hypertension associated with PCOS.

    Science.gov (United States)

    Lee, Y J; Jeong, J E; Joo, J K; Lee, K S

    2015-01-01

    Idiopathic intracranial hypertension (IIH) is a rare neurologic disorder. It is also known as pseudotumor cerebri. The incidence of IIH is one to two per 100,000 population annually. The higher incidence is in obese women from 15 to 44 years. The main symptoms are headache and visual loss. It mostly affects women of childbearing age who are overweight or obese. There are many theories of pathogenesis of IIH, but precise pathogenesis is unknown. One of the causes of IIH is intracranial venous sinus thrombosis. It can cause increased cerebrospinal fluid (CSF) pressure by obstruction of venous outflow and blocking of CSF absorption. In polycystic ovary syndrome (PCOS) patients, thrombogenic tendency is increased due to increased aromatization of testosterone to estradiol which could induce estrogen-mediated thrombophilia. The authors present a 14-year-old girl with PCOS stigma who presented with a severe headache and papilledema. These symptoms were not improved by standard medical therapy of IIH and PCOS, but improved after laparoscopic ovarian drilling. The authors report it with a review of the literature.

  4. Non-invasive estimation of intracranial pressure. MR-based evaluation in children with hydrocephalus

    International Nuclear Information System (INIS)

    Muehlmann, M.; Steffinger, D.; Ertl-Wagner, B.; Koerte, I.K.; Peraud, A.; Lehner, M.; Heinen, F.; Alperin, N.

    2012-01-01

    The intracranial pressure (ICP) is a crucially important parameter for diagnostic and therapeutic decision-making in patients with hydrocephalus. So far there is no standard method to non-invasively assess the ICP. Various approaches to obtain the ICP semi-invasively or non-invasively are discussed and the clinical application of a magnetic resonance imaging (MRI)-based method to estimate ICP (MR-ICP) is demonstrated in a group of pediatric patients with hydrocephalus. Arterial inflow, venous drainage and craniospinal cerebrospinal fluid (CSF) flow were quantified using phase-contrast imaging to derive the MR-ICP. A total of 15 patients with hydrocephalus (n=9 treated with shunt placement or ventriculostomy) underwent MRI on a 3 T scanner applying retrospectively-gated cine phase contrast sequences. Of the patients six had clinical symptoms indicating increased ICP (age 2.5-14.61 years, mean 7.4 years) and nine patients had no clinical signs of elevated ICP (age 2.1-15.9 years; mean 9.8 years; all treated with shunt or ventriculostomy). Median MR-ICP in symptomatic patients was 24.5 mmHg (25th percentile 20.4 mmHg; 75th percentile 44.6 mmHg). Median MR-ICP in patients without acute signs of increased ICP was 9.8 mmHg (25th percentile 8.6 mmHg; 75th percentile 11.4 mmHg). Group differences were significant (p [de

  5. MR cisternography: a new method for the diagnosis of CSF fistulae

    International Nuclear Information System (INIS)

    Eberhardt, K.E.W.; Tomandl, B.F.; Huk, W.J.; Hollenbach, H.P.; Deimling, M.

    1997-01-01

    The aim of this study was to compare a new MRI method for detecting the existence of cerebrospinal fluid (CSF) fistulae, i. e. MR cisternography, with CT cisternography. In a prospective study, 30 patients with post-traumatic CSF fistulae were examined. The MR examinations were performed with a 1.0-T whole-body MR system, using two T2 * -weighted sequences, a 3D PSIF (time-inversed fast imaging with steady-state precession, FISP) and a 3D constructive interference steady-state (CISS) sequence. The results of MRI and CT cisternography were compared with the surgical findings. The sensitivity in detecting CSF fistulae with MR cisternography (PSIF: 89.9 %; CISS: 93.6 %) was higher than with CT cisternography (72.3 %). The sensitivity of CT cisternography at detecting CSF fistulae in patients with a size of dural lesion less than 2 mm or in patients with multiple dural lesions is significantly lower compared with the MR method. Although the localization of CSF fistulae always proved possible with MR cisternography, this could only be accomplished wih CT in 70 % of cases. The MR cisternography technique is a new examination method with a higher sensitivity for the detection of CSF fistulae than CT cisternography. The CISS technique is superior compared with PSIF and should be used in patients with high-flow CSF fistulas. (orig.)

  6. Spontaneous intracranial hypotension syndrome: magnetic resonance findings in two patients; Sindrome de hipotension intracraneal espontanea: hallazgos en resonancia magnetica en dos pacientes

    Energy Technology Data Exchange (ETDEWEB)

    Ortega, R.; Pastor, J.; Escamilla, F.; Romero, M. I. [Hospital de Traumatologia y Reabilitacion. Granada (Spain)

    1999-07-01

    The postural headache syndrome associated with a decrease in the cerebrospinal fluid (CSF) pressure is generally secondary to the CSF leakage that usually occurs after diagnostic lumbar puncture. Spontaneous intracranial hypotension can not be attributed to any known cause or previous diagnostic or therapeutic intervention. The syndrome is characterized by severe headache that is relieved by lying supine. During lumbar puncture, the CSF pressure is normally low. We present two patients in whom gadolinium-enhanced magnetic resonance imaging showed widespread thickening and enhancement of the dura mater and subdural fluid collections. (Author) 13 refs.

  7. Equal contribution of increased intracranial pressure and subarachnoid blood to cerebral blood flow reduction and receptor upregulation after subarachnoid hemorrhage. Laboratory investigation

    DEFF Research Database (Denmark)

    Ansar, Saema; Edvinsson, Lars

    2009-01-01

    chain reaction was used to determine the mRNA levels for ET(A), ET(B), and 5-HT(1) receptors. Regional and global cerebral blood flow (CBF) were quantified by means of an autoradiographic technique. RESULTS: Compared with the sham condition, both SAH and saline injection resulted in significantly...

  8. Primary intracranial malignant lymphoma. Report of nine cases

    Energy Technology Data Exchange (ETDEWEB)

    Matsumoto, Mikiro; Ohtsuka, Takatsugu; Kuroki, Takao; Shibata, Iekado; Terao, Hideo; Kudo, Motoshige

    1988-12-01

    Nine cases of primary intracranial malignant lymphoma, which accounts for 3.3 % of all intracranial tumors seen in the authors' institution, were studied in terms of diagnostic computed tomographic (CT) features, the tumors' histologic appearance, treatment, post-treatment blood immunologic and cerebrospinal fluid (CSF) characteristics, and outcome. The patients were seven males and two females aged 42 to 67 years. Their chief signs and symptoms on admission were intracranial hypertension, focal signs, and disturbance of consciousness. CT, which proved the most useful preoperative diagnostic technique, demonstrated multiple lesions in seven cases and, in all cases, regions of isodensity or slight high density that were enhanced by contrast medium. According to the patterns of enhancement, the tumors were classed as diffuse (three cases) or nodular (six cases). The former is considered typical of malignant lymphoma, whereas the latter type was sometimes indistinguishable from metastatic tumor and meningioma. At surgery, one patient underwent radical tumor excision, two partial removal, and six biopsy only. Histologic examination revealed one tumor to be of the diffuse small cell type, three of the medium cell type, and five of the large cell type (Lymphoma Study Group classification). Of seven tumors in which lymphocytes were examined by peroxidase-antiperoxidase staining, four were of the B cell type. Postoperatively, whole brain irradiation with 29 to 46 Gy was followed by local irradiation with 15 to 50 Gy. If the tumor persisted, one of three chemotherapies was administered. In one case, methotrexate was given intrathecally. Seven patients were divided into two groups: long remission (three) and recurrence (four). These two groups were compared in terms of serum immunoglobulin levels, T and B cell ratios, CSF characteristics, CT features, tumor cell type, and treatment. No clear differences were found.

  9. Intracranial Hemorrhage in Pregnancy

    Directory of Open Access Journals (Sweden)

    Afshan B. Hameed

    2012-11-01

    Full Text Available A pregnant woman with a mechanical prosthetic mitral valve was anticoagulated with low-molecular-weight heparin in the first trimester followed by warfarin until 36 weeks' gestation. She was then switched to intravenous unfractionated heparin infusion to allow for regional anesthesia in anticipation of vaginal delivery. She developed severe headache on hospital day 2 that was refractory to pain medications. Cranial imaging demonstrated a large subdural hematoma with midline shift. She delivered a healthy baby girl by cesarean section. Eventually, symptoms and intracranial abnormalities resolved over time. In conclusion, subdural hematoma is a relatively rare complication that requires multidisciplinary management plan.

  10. The calculation of CSF spaces in CT

    International Nuclear Information System (INIS)

    Hacker, H.; Artmann, H.

    1978-01-01

    Objective digital determination of CSF spaces is discussed, with ventricular and subarachnoid spaces handled separately. This method avoids the difficulty of visual definition of ventricular borders in planimetric measurements. The principle is to count automatically all pixels corresponding to CSF in a given region with a Hounsfield unit and to multiply this number by the pixel size. This will give the total surface area of CSF spaces in square millimeters. The calculation of pixel values for CSF spaces and brain tissue is experimentally formulated taking the intersection of the Gaussian curves for ventricular content and brain tissue. In practice, the determination of CSF spaces is done by first calculating a histogram of the total brain in a given slice defining all CSF spaces. Next a histogram of a region including ventricles with adjoining tissue is calculated and the ventricular size is calculated. By subtraction of the ventricle value from the total CSF space value, the subarachnoid space size is obtained. The advantages of this mehtod will be discussed. (orig.) [de

  11. CSF-1 Receptor Signaling in Myeloid Cells

    Science.gov (United States)

    Stanley, E. Richard; Chitu, Violeta

    2014-01-01

    The CSF-1 receptor (CSF-1R) is activated by the homodimeric growth factors colony-stimulating factor-1 (CSF-1) and interleukin-34 (IL-34). It plays important roles in development and in innate immunity by regulating the development of most tissue macrophages and osteoclasts, of Langerhans cells of the skin, of Paneth cells of the small intestine, and of brain microglia. It also regulates the differentiation of neural progenitor cells and controls functions of oocytes and trophoblastic cells in the female reproductive tract. Owing to this broad tissue expression pattern, it plays a central role in neoplastic, inflammatory, and neurological diseases. In this review we summarize the evolution, structure, and regulation of expression of the CSF-1R gene. We review, the structures of CSF-1, IL-34, and the CSF-1R and the mechanism of ligand binding to and activation of the receptor. We further describe the pathways regulating macrophage survival, proliferation, differentiation, and chemotaxis downstream from the CSF-1R. PMID:24890514

  12. Decompressive craniectomy and CSF disorders in children.

    Science.gov (United States)

    Manfiotto, Marie; Mottolese, Carmine; Szathmari, Alexandru; Beuriat, Pierre-Aurelien; Klein, Olivier; Vinchon, Matthieu; Gimbert, Edouard; Roujeau, Thomas; Scavarda, Didier; Zerah, Michel; Di Rocco, Federico

    2017-10-01

    Decompressive craniectomy (DC) is a lifesaving procedure but is associated to several post-operative complications, namely cerebrospinal fluid (CSF) dynamics impairment. The aim of this multicentric study was to evaluate the incidence of such CSF alterations after DC and review their impact on the overall outcome. We performed a retrospective multicentric study to analyze the CSF disorders occurring in children aged from 0 to 17 years who had undergone a DC for traumatic brain injury (TBI) in the major Departments of Pediatric Neurosurgery of France between January 2006 and August 2016. Out of 150 children, ranging in age between 7 months and 17 years, mean 10.75 years, who underwent a DC for TBI in 10 French pediatric neurosurgical centers. Sixteen (6 males, 10 females) (10.67%) developed CSF disorders following the surgical procedure and required an extrathecal CSF shunting. External ventricular drainage increased the risk of further complications, especially cranioplasty infection (p = 0.008). CSF disorders affect a minority of children after DC for TBI. They may develop early after the DC but they may develop several months after the cranioplasty (8 months), consequently indicating the necessity of clinical and radiological close follow-up after discharge from the neurosurgical unit. External ventricular drainage and permanent CSF shunt placement increase significantly the risk of cranioplasty infection.

  13. Calculation of CSF spaces in CT

    Energy Technology Data Exchange (ETDEWEB)

    Hacker, H; Artmann, H [Frankfurt Univ. (Germany, F.R.). Abt. fuer Neuroradiologie

    1978-01-01

    Objective digital determination of CSF spaces is discussed, with ventricular and subarachnoid spaces handled separately. This method avoids the difficulty of visual definition of ventricular borders in planimetric measurements. The principle is to count automatically all pixels corresponding to CSF in a given region with a Hounsfield unit and to multiply this number by the pixel size. This will give the total surface area of CSF spaces in square millimeters. The calculation of pixel values for CSF spaces and brain tissue is experimentally formulated taking the intersection of the Gaussian curves for ventricular content and brain tissue. In practice, the determination of CSF spaces is done by first calculating a histogram of the total brain in a given slice defining all CSF spaces. Next a histogram of a region including ventricles with adjoining tissue is calculated and the ventricular size is calculated. By subtraction of the ventricle value from the total CSF space value, the subarachnoid space size is obtained. The advantages of this mehtod will be discussed.

  14. Migration of an Intracranial Subdural Hematoma to the Spinal Subdural Space: A Case Report.

    Science.gov (United States)

    Kwon, O Ik; Son, Dong Wuk; Kim, Young Ha; Kim, Young Soo; Sung, Soon Ki; Lee, Sang Weon; Song, Geun Sung

    2015-09-01

    A 57-year-old man complained of severe lower back pain and radicular pain in both legs for 1 week after falling from a ladder. Magnetic resonance imaging (MRI) of the spine showed a subdural hematoma (SDH), which was surgically removed. The patient had no back pain or the radicular leg pain at 2 weeks post-surgery. However, he complained of diffuse headaches upon follow-up. Brain computed tomography (CT) and MRI revealed an intracranial SDH, which was immediately removed by surgery. During his 1-year follow-up, he reported that the pain had resolved without recurrence. Simultaneous spinal and intracranial SDH are rare and no standard treatment exists for this condition. This case suggests that it is possible that an intracranial SDH can migrate into the cerebrospinal fluid (CSF) space through an arachnoid tear. CSF circulation allows the intracranial SDH to enter subarachnoid spaces encasing the spinal cord. In order to prevent irreversible damage, surgical intervention should be considered for case of spinal SDH with progressive neurological deficits.

  15. Changes in Gene Expression during G-CSF-Induced Emergency Granulopoiesis in Humans

    DEFF Research Database (Denmark)

    Pedersen, Corinna C.; Borup, Rehannah; Fischer-Nielsen, Anne

    2016-01-01

    Emergency granulopoiesis refers to the increased production of neutrophils in bone marrow and their release into circulation induced by severe infection. Several studies point to a critical role for G-CSF as the main mediator of emergency granulopoiesis. However, the consequences of G-CSF...... stimulation on the transcriptome of neutrophils and their precursors have not yet been investigated in humans. In this work, we examine the changes in mRNA expression induced by administration of G-CSF in vivo, as a model of emergency granulopoiesis in humans. Blood samples were collected from healthy...... individuals after 5 d of G-CSF administration. Neutrophil precursors were sorted into discrete stages of maturation by flow cytometry, and RNA was subjected to microarray analysis. mRNA levels were compared with previously published expression levels in corresponding populations of neutrophil precursors...

  16. Intracranial tuberculosis in children : CT findings before and after treatment

    International Nuclear Information System (INIS)

    Jung, Hye Weon; Kim, In One; Kim, Woo Sun; Hwang, Yong Seong; Yeon, Kyung Mo

    1996-01-01

    To analyze the CT findings of intracranial tuberculosis in children at initial stage and during follow-up after treatment. We evaluated 25 patients who were diagnosed by CSF analysis or response to anti-tuberculous medication as suffering from intracranial tuberculosis. There were 13 boys and 12 girls aged between 4 months and 14 years. Twenty-five initial and sixty-three follow-up CT scans were retrospectively analyzed. We evaluated the pattern of cisternal enhancement, the locations of infarction, and the presence of calcification and parenchymal granuloma. The changes of hydrocephalus and related complications, as well as cisternal abnormality during anti-tuberculous medication were also evaluated. The initial findings on CT scan were hydrocephalus(75%), cisternal obliteration in precontrast study(64%), thick-line or ring-shaped cisternal enhancement on postcontrast study(44%), infarctions(32%), calcifications(32%), periventricular edema(28%), and parenchymal granulomas(16%). On follow-up CT scan, hydrocephalus and cisternal enhancement had decreased to 35% and 82%, respectively, and the granulomas had changed to calcified nodules(100%). Ventriculo-peritoneal shunt or external ventricular drainage was needed in nine patient, and ventriculitis or complication of shunt procedure developed in four. Intracranial tuberculosis in children presented predominantly as meningitis involving basal cisterns and was associated with hydrocephalus. Infarction and calcification may be seen as parenchymal lesion. In spite of medical treatment, drainage was needed in about half the patients. During this treatment, the resolution of hydrocephalus, decreased cisternal enhancement, and calcification of the granlomas were seen

  17. Headaches caused by decreased intracranial pressure: diagnosis and management.

    Science.gov (United States)

    Mokri, Bahram

    2003-06-01

    More patients with spontaneous intracranial hypotension are now being diagnosed, and it is realized that most cases result from spontaneous cerebrospinal fluid leaks. A broader clinical and imaging spectrum of the disorder is recognized. This paper reviews new insights into the variability of clinical manifestations, imaging features, etiological factors, anatomy of leaks, and implications of these in patient management. Spontaneous intracranial hypotension should not be equated with post-lumbar puncture headaches. In a substantial minority of patients, headaches are not orthostatic and may mimic other types of headache. Additional diverse neurological manifestations may dominate the clinical picture and patients may occasionally have no headache at all. Reports on unusual presentations of the disorder continue to appear in the literature. Furthermore, additional imaging features of cerebrospinal fluid leaks are recognized. High-flow and slow-flow leaks may present diagnostic challenges, and require modification of diagnostic studies aimed at locating the site of the leak. Stigmata of connective tissue abnormality, especially abnormalities of fibrillin and elastin, are seen in a notable minority of patients, pointing to weakness of the dural sac as one of the etiological factors. After treatment of spontaneous intracranial hypotension, surgically or by epidural blood patch, a rebound and self-limiting intracranial hypertension may sometimes develop. In the past decade, interest in spontaneous intracranial hypotension has been rekindled, with a substantial growth of knowledge on various aspects of the disorder. We are in the learning phase, and new information will probably appear in the future, with notable diagnostic and therapeutic implications.

  18. CSF Markers in Guillain-Barre Syndrome

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2007-01-01

    Full Text Available A positive 14-3-3 protein assay of CSF was observed in 29 of 38 patients with GBS and in 4 with motor neuron disease and other neuropathies studied at Universities of Milan and Verona, Italy.

  19. Intracranial epidural hemorrhage during lumbar spinal surgery.

    Science.gov (United States)

    Imajo, Yasuaki; Kanchiku, Tsukasa; Suzuki, Hidenori; Yoshida, Yuichiro; Nishida, Norihiro; Goto, Hisaharu; Suzuki, Michiyasu; Taguchi, Toshihiko

    2016-01-01

    The authors report a case of intracranial epidural hemorrhage (ICEH) during spinal surgery. We could not find ICEH, though we recorded transcranial electrical stimulation motor evoked potentials (TcMEPs). A 35-year-old man was referred for left anterior thigh pain and low back pain that hindered sleep. Sagittal T2-weighted magnetic resonance imaging revealed an intradural tumor at L3-L4 vertebral level. We performed osteoplastic laminectomy and en bloc tumor resection. TcMEPs were intraoperatively recorded at the bilateral abductor digiti minimi (ADM), quadriceps, tibialis anterior and abductor hallucis. When we closed a surgical incision, we were able to record normal TcMEPs in all muscles. The patient did not fully wake up from the anesthesia. He had right-sided unilateral positive ankle clonus 15 min after surgery in spite of bilateral negative of ankle clonus preoperatively. Emergent brain computed tomography scans revealed left epidural hemorrhage. The hematoma was evacuated immediately via a partial craniotomy. There was no restriction of the patient's daily activities 22 months postoperatively. We should pay attention to clinical signs such as headache and neurological findgings such as DTR and ankle clonus for patients with durotomy and cerebrospinal fluid (CSF) leakage. Spine surgeons should know that it was difficult to detect ICEH by monitoring with TcMEPs.

  20. CSF and plasma testosterone in attempted suicide.

    Science.gov (United States)

    Stefansson, Jon; Chatzittofis, Andreas; Nordström, Peter; Arver, Stefan; Åsberg, Marie; Jokinen, Jussi

    2016-12-01

    Very few studies have assessed testosterone levels in the cerebrospinal fluid in suicide attempters. Aggressiveness and impulsivity are common behavioural traits in suicide attempters. Dual-hormone serotonergic theory on human impulsive aggression implies high testosterone/cortisol ratio acting on the amygdala and low serotonin in the prefrontal cortex. Our aim was to examine the CSF and plasma testosterone levels in suicide attempters and in healthy volunteers. We also assessed the relationship between the testosterone/cortisol ratio, aggressiveness and impulsivity in suicide attempters. 28 medication-free suicide attempters and 19 healthy volunteers participated in the study. CSF and plasma testosterone sulfate and cortisol levels were assessed with specific radio-immunoassays. The Karolinska Scales of Personality was used to assess impulsivity and aggressiveness. All patients were followed up for cause of death. The mean follow-up period was 21 years. Male suicide attempters had higher CSF and plasma testosterone levels than age- matched male healthy volunteers. There were no significant differences in CSF testosterone levels in female suicide attempters and healthy female volunteers. Testosterone levels did not differ significantly in suicide victims compared to survivors. In male suicide attempters, the CSF testosterone/cortisol ratio showed a significant positive correlation with both impulsivity and aggressiveness. Higher CSF testosterone levels may be associated with attempted suicide in young men through association with both aggressiveness and impulsivity, a key endophenotype in young male suicide attempters. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique.

    Science.gov (United States)

    Tsunoda, A; Mitsuoka, H; Sato, K; Kanayama, S

    2000-06-01

    Our purpose was to quantify the intracranial cerebrospinal fluid (CSF) volume components using an original MRI-based segmentation technique and to investigate whether a CSF volume index is useful for diagnosis of normal pressure hydrocephalus (NPH). We studied 59 subjects: 16 patients with NPH, 14 young and 13 elderly normal volunteers, and 16 patients with cerebrovascular disease. Images were acquired on a 1.5-T system, using a 3D-fast asymmetrical spin-echo (FASE) method. A region-growing method (RGM) was used to extract the CSF spaces from the FASE images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured, and a VV/ICV ratio was calculated. Mean VV and VV/ICV ratio were higher in the NPH group than in the other groups, and the differences were statistically significant, whereas the mean ICV value in the NPH group was not significantly increased. Of the 16 patients in the NPH group, 13 had VV/ICV ratios above 30%. In contrast, no subject in the other groups had a VV/ICV ratios higher than 30%. We conclude that these CSF volume parameters, especially the VV/ICV ratio, are useful for the diagnosis of NPH.

  2. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique

    International Nuclear Information System (INIS)

    Tsunoda, A.; Mitsuoka, H.; Sato, K.; Kanayama, S.

    2000-01-01

    Our purpose was to quantify the intracranial cerebrospinal fluid (CSF) volume components using an original MRI-based segmentation technique and to investigate whether a CSF volume index is useful for diagnosis of normal pressure hydrocephalus (NPH). We studied 59 subjects: 16 patients with NPH, 14 young and 13 elderly normal volunteers, and 16 patients with cerebrovascular disease. Images were acquired on a 1.5-T system, using a 3D-fast asymmetrical spin- echo (FASE) method. A region-growing method (RGM) was used to extract the CSF spaces from the FASE images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured, and a VV/ICV ratio was calculated. Mean VV and VV/ICV ratio were higher in the NPH group than in the other groups, and the differences were statistically significant, whereas the mean ICV value in the NPH group was not significantly increased. Of the 16 patients in the NPH group, 13 had VV/ICV ratios above 30%. In contrast, no subject in the other groups had a VV/ICV ratios higher than 30%. We conclude that these CSF volume parameters, especially the VV/ICV ratio, are useful for the diagnosis of NPH. (orig.)

  3. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique

    Energy Technology Data Exchange (ETDEWEB)

    Tsunoda, A. [Department of Neurosurgery, Koshigaya Municipal Hospital, 10-47-1 Higashikoshigaya, Koshigaya City, Saitama 343-0023 (Japan); Mitsuoka, H.; Sato, K. [Department of Neurosurgery, Juntendo University (Japan); Kanayama, S. [Research and Development Centre, Toshiba Corporation (Japan)

    2000-06-01

    Our purpose was to quantify the intracranial cerebrospinal fluid (CSF) volume components using an original MRI-based segmentation technique and to investigate whether a CSF volume index is useful for diagnosis of normal pressure hydrocephalus (NPH). We studied 59 subjects: 16 patients with NPH, 14 young and 13 elderly normal volunteers, and 16 patients with cerebrovascular disease. Images were acquired on a 1.5-T system, using a 3D-fast asymmetrical spin- echo (FASE) method. A region-growing method (RGM) was used to extract the CSF spaces from the FASE images. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured, and a VV/ICV ratio was calculated. Mean VV and VV/ICV ratio were higher in the NPH group than in the other groups, and the differences were statistically significant, whereas the mean ICV value in the NPH group was not significantly increased. Of the 16 patients in the NPH group, 13 had VV/ICV ratios above 30%. In contrast, no subject in the other groups had a VV/ICV ratios higher than 30%. We conclude that these CSF volume parameters, especially the VV/ICV ratio, are useful for the diagnosis of NPH. (orig.)

  4. Spinal radiological findings in nine patients with spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Chiapparini, L.; Farina, L.; D' Incerti, L.; Erbetta, A.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milan (Italy); Pareyson, D.; Carriero, M.R. [Department of Neurology, Istituto Nazionale Neurologico, Milan (Italy)

    2002-02-01

    Cranial magnetic resonance imaging (MRI) findings in spontaneous intracranial hypotension (SIH) are well known, while spinal studies have received less attention. Radiological spinal findings in nine patients with SIH are presented, looking for possible characteristic features. Five of the nine patients had histories of previous minor trauma, one of previous surgery; in three patients possible relevant preceding events were completely absent. All nine patients had cervical, seven thoracic, and four lumbar spine MRI studies; post-contrast studies were obtained in seven cases, MRI myelograms in five. Radioisotope myelocisternography was performed in four patients and myelo-CT in four. Epidural fluid collections were found in seven patients. In six cases the dural sac had collapsed, with a festooned appearance; intense epidural enhancement on post-contrast studies demonstrated marked dilatation of the epidural venous plexus. In three cases an irregular root sleeve suggested a possible point of cerebrospinal fluid (CSF) leakage. Myelo-CT demonstrated the CSF fistula in two cases, radioisotope myelocisternography in three. The pattern of spinal abnormalities is different from that seen in cranial MRI for anatomical reasons: in the spinal canal the dura is not adherent to the bone; therefore, collapse of the dural sac and dilatation of epidural venous plexus occur, rather than subdural hematomas. In most cases the search for the dural tear is difficult. Radioisotope cisternography is probably the most sensitive examination for documenting the leakage of CSF out of the subarachnoid space; myelo-CT may precisely demonstrate the point of the CSF fistula, whereas MRI may only suggest it. (orig.)

  5. CXCL13 is the major determinant for B cell recruitment to the CSF during neuroinflammation

    Directory of Open Access Journals (Sweden)

    Kowarik Markus C

    2012-05-01

    Full Text Available Abstract Background The chemokines and cytokines CXCL13, CXCL12, CCL19, CCL21, BAFF and APRIL are believed to play a role in the recruitment of B cells to the central nervous system (CNS compartment during neuroinflammation. To determine which chemokines/cytokines show the strongest association with a humoral immune response in the cerebrospinal fluid (CSF, we measured their concentrations in the CSF and correlated them with immune cell subsets and antibody levels. Methods Cytokine/chemokine concentrations were measured in CSF and serum by ELISA in patients with non-inflammatory neurological diseases (NIND, n = 20, clinically isolated syndrome (CIS, n = 30, multiple sclerosis (MS, n = 20, Lyme neuroborreliosis (LNB, n = 8 and patients with other inflammatory neurological diseases (OIND, n = 30. Albumin, IgG, IgA and IgM were measured by nephelometry. CSF immune cell subsets were determined by seven-color flow cytometry. Results CXCL13 was significantly elevated in the CSF of all patient groups with inflammatory diseases. BAFF levels were significantly increased in patients with LNB and OIND. CXCL12 was significantly elevated in patients with LNB. B cells and plasmablasts were significantly elevated in the CSF of all patients with inflammatory diseases. CXCL13 showed the most consistent correlation with CSF B cells, plasmablasts and intrathecal Ig synthesis. Conclusions CXCL13 seems to be the major determinant for B cell recruitment to the CNS compartment in different neuroinflammatory diseases. Thus, elevated CSF CXCL13 levels rather reflect a strong humoral immune response in the CNS compartment than being specific for a particular disease entity.

  6. [Effect of G-CSF in vitro Stimulation on Distribution of Peripheral Lymphocyte Subsets in the Healthy Persons].

    Science.gov (United States)

    Zhao, Sha-Sha; Fang, Shu; Zhu, Cheng-Ying; Wang, Li-Li; Gao, Chun-Ji

    2018-02-01

    To investigate the effect of granulocyte-colony stimulating factor (G-CSF) in vitro stimulation on the distribution of lymphocyte subset in healthy human. Peripheral blood mononuclear cells (PBMNCs) were collected from 8 healthy volunteers by density gradient centrifugation on Ficoll-Paque TM . In vitro 200 ng/ml G-CSF or 200 ng/ml G-CSF plus 10 µg/ml ConA directly act on PBMNCs, then the colleted cells were cultivated for 3 days. Lymphocyte subsets were stained with the corresponding fluoresce labeled antibodies and detected by flow cytometry. The levels of T cells in G-CSF group and G-CSF+ConA group were both higher than that in the control group (PCSF on T cell subsets indicated that the levels of CD4 + T cells and CD8 + T cells in G-CSF group were both significantly higher than those in control group (PCSF and control group. Compared with the control group, the level of CD4 + T cells, CD8 + T cells and Treg cells in G-CSF+ConA group significantly increased (PCSF receptor (G-CSFR) expression showed that G-CSFR expression on T cells in G-CSF+ConA group dramatically increased, as compared with control group (PCSF stimulation. ConA can enhance the level of T cells and induce G-CSFR expression on T cells.

  7. Intracranial Hypertension: Medication and Surgery

    Science.gov (United States)

    ... fallen out of favor, unless there is a secondary inflammatory process caused by an underlying disease like ... have little effect on headaches caused by intracranial hypertension, they may temporarily affect the intensity of a ...

  8. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

    2011-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype or a...... antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH....

  9. Headache in Idiopathic Intracranial Hypertension: Findings From the Idiopathic Intracranial Hypertension Treatment Trial.

    Science.gov (United States)

    Friedman, Deborah I; Quiros, Peter A; Subramanian, Prem S; Mejico, Luis J; Gao, Shan; McDermott, Michael; Wall, Michael

    2017-09-01

    character, disabling, and associated with poorer quality of life in our cohort of patients with mild visual impairment. The lack of correlation between headache disability and cerebrospinal fluid (CSF) pressure at baseline and at the end of the randomized phase of the study implies that headache in IIH may be related to factors other than intracranial hypertension, and that specific headache treatment is needed in addition to therapies directed at lowering CSF pressure. © 2017 American Headache Society.

  10. CSF free light chain identification of demyelinating disease: comparison with oligoclonal banding and other CSF indexes.

    Science.gov (United States)

    Gurtner, Kari M; Shosha, Eslam; Bryant, Sandra C; Andreguetto, Bruna D; Murray, David L; Pittock, Sean J; Willrich, Maria Alice V

    2018-02-19

    Cerebrospinal fluid (CSF) used in immunoglobulin gamma (IgG) index testing and oligoclonal bands (OCBs) are common laboratory tests used in the diagnosis of multiple sclerosis. The measurement of CSF free light chains (FLC) could pose as an alternative to the labor-intensive isoelectric-focusing (IEF) gels used for OCBs. A total of 325 residual paired CSF and serum specimens were obtained after physician-ordered OCB IEF testing. CSF kappa (cKFLC) and lambda FLC (cLFLC), albumin and total IgG were measured. Calculations were performed based on combinations of analytes: CSF sum of kappa and lambda ([cKFLC+cLFLC]), kappa-index (K-index) ([cKFLC/sKFLC]/[CSF albumin/serum albumin]), kappa intrathecal fraction (KFLCIF) {([cKFLC/sKFLC]-[0.9358×CSF albumin/serum albumin]^[0.6687×sKFLC]/cKFLC)} and IgG-index ([CSF IgG/CSF albumin]/[serum IgG/serum albumin]). Patients were categorized as: demyelination (n=67), autoimmunity (n=53), non-inflammatory (n=50), inflammation (n=38), degeneration (n=28), peripheral neuropathy (n=24), infection (n=13), cancer (n=11), neuromyelitis optica (n=10) and others (n=31). cKFLC measurement used alone at a cutoff of 0.0611 mg/dL showed >90% agreement to OCBs, similar or better performance than all other calculations, reducing the number of analytes and variables. When cases of demyelinating disease were reviewed, cKFLC measurements showed 86% clinical sensitivity/77% specificity. cKFLC alone demonstrates comparable performance to OCBs along with increased sensitivity for demyelinating diseases. Replacing OCB with cKFLC would alleviate the need for serum and CSF IgG and albumin and calculated conversions. cKFLC can overcome challenges associated with performance, interpretation, and cost of traditional OCBs, reducing costs and maintaining sensitivity and specificity supporting MS diagnosis.

  11. Comparison of the sagittal sinus cross-sectional area between patients with multiple sclerosis, hydrocephalus, intracranial hypertension and spontaneous intracranial hypotension: a surrogate marker of venous transmural pressure?

    Science.gov (United States)

    Bateman, Grant A; Lechner-Scott, Jeannette; Copping, Ross; Moeskops, Christopher; Yap, Swee Leong

    2017-07-06

    There is evidence that patients with multiple sclerosis (MS) and hydrocephalus share some common pathophysiological mechanisms. Alterations in CSF pressure are known to affect cerebral venous sinus geometry. To further explore these mechanisms, we measured the superior sagittal sinus (SSS) cross-sectional area 3 cm above the torcular using T2 images in 20 MS, 10 spontaneous intracranial hypotension (SIH), 21 hydrocephalus and 20 idiopathic intracranial hypertension (IIH) patients and compared with 20 matched controls. The SSS area was reduced by 25% in hydrocephalus (p = 0.0008), increased by 22% (p = 0.037) in SIH and unchanged in IIH compared to matched controls. In MS there was a 16% increase in SSS area (p = 0.01).The findings suggest that changes in SSS cross-sectional are common between MS and SIH patients, while in hydrocephalus and IIH these are different.

  12. Nonlocal Intracranial Cavity Extraction

    Science.gov (United States)

    Manjón, José V.; Eskildsen, Simon F.; Coupé, Pierrick; Romero, José E.; Collins, D. Louis; Robles, Montserrat

    2014-01-01

    Automatic and accurate methods to estimate normalized regional brain volumes from MRI data are valuable tools which may help to obtain an objective diagnosis and followup of many neurological diseases. To estimate such regional brain volumes, the intracranial cavity volume (ICV) is often used for normalization. However, the high variability of brain shape and size due to normal intersubject variability, normal changes occurring over the lifespan, and abnormal changes due to disease makes the ICV estimation problem challenging. In this paper, we present a new approach to perform ICV extraction based on the use of a library of prelabeled brain images to capture the large variability of brain shapes. To this end, an improved nonlocal label fusion scheme based on BEaST technique is proposed to increase the accuracy of the ICV estimation. The proposed method is compared with recent state-of-the-art methods and the results demonstrate an improved performance both in terms of accuracy and reproducibility while maintaining a reduced computational burden. PMID:25328511

  13. Nonlocal Intracranial Cavity Extraction

    Directory of Open Access Journals (Sweden)

    José V. Manjón

    2014-01-01

    Full Text Available Automatic and accurate methods to estimate normalized regional brain volumes from MRI data are valuable tools which may help to obtain an objective diagnosis and followup of many neurological diseases. To estimate such regional brain volumes, the intracranial cavity volume (ICV is often used for normalization. However, the high variability of brain shape and size due to normal intersubject variability, normal changes occurring over the lifespan, and abnormal changes due to disease makes the ICV estimation problem challenging. In this paper, we present a new approach to perform ICV extraction based on the use of a library of prelabeled brain images to capture the large variability of brain shapes. To this end, an improved nonlocal label fusion scheme based on BEaST technique is proposed to increase the accuracy of the ICV estimation. The proposed method is compared with recent state-of-the-art methods and the results demonstrate an improved performance both in terms of accuracy and reproducibility while maintaining a reduced computational burden.

  14. Spontaneous intracranial hypotension

    International Nuclear Information System (INIS)

    Haritanti, A.; Karacostas, D.; Drevelengas, A.; Kanellopoulos, V.; Paraskevopoulou, E.; Lefkopoulos, A.; Economou, I.; Dimitriadis, A.S.

    2009-01-01

    Spontaneous intracranial hypotension (SIH) is an uncommon but increasingly recognized syndrome. Orthostatic headache with typical findings on magnetic resonance imaging (MRI) are the key to diagnosis. Delayed diagnosis of this condition may subject patients to unnecessary procedures and prolong morbidity. We describe six patients with SIH and outline the important clinical and neuroimaging findings. They were all relatively young, 20-54 years old, with clearly orthostatic headache, minimal neurological signs (only abducent nerve paresis in two) and diffuse pachymeningeal gadolinium enhancement on brain MRI, while two of them presented subdural hygromas. Spinal MRI was helpful in detecting a cervical cerebrospinal fluid leak in three patients and dilatation of the vertebral venous plexus with extradural fluid collection in another. Conservative management resulted in rapid resolution of symptoms in five patients (10 days-3 weeks) and in one who developed cerebral venous sinus thrombosis, the condition resolved in 2 months. However, this rapid clinical improvement was not accompanied by an analogous regression of the brain MR findings that persisted on a longer follow-up. Along with recent literature data, our patients further point out that SIH, to be correctly diagnosed, necessitates increased alertness by the attending physician, in the evaluation of headaches

  15. Single pulse analysis of intracranial pressure for a hydrocephalus implant.

    Science.gov (United States)

    Elixmann, I M; Hansinger, J; Goffin, C; Antes, S; Radermacher, K; Leonhardt, S

    2012-01-01

    The intracranial pressure (ICP) waveform contains important diagnostic information. Changes in ICP are associated with changes of the pulse waveform. This change has explicitly been observed in 13 infusion tests by analyzing 100 Hz ICP data. An algorithm is proposed which automatically extracts the pulse waves and categorizes them into predefined patterns. A developed algorithm determined 88 %±8 % (mean ±SD) of all classified pulse waves correctly on predefined patterns. This algorithm has low computational cost and is independent of a pressure drift in the sensor by using only the relationship between special waveform characteristics. Hence, it could be implemented on a microcontroller of a future electromechanic hydrocephalus shunt system to control the drainage of cerebrospinal fluid (CSF).

  16. Chronic hydrocephalus-induced changes in cerebral blood flow: mediation through cardiac effects.

    Science.gov (United States)

    Dombrowski, Stephen M; Schenk, Soren; Leichliter, Anna; Leibson, Zack; Fukamachi, Kiyotaka; Luciano, Mark G

    2006-10-01

    Decreased cerebral blood flow (CBF) in hydrocephalus is believed to be related to increased intracranial pressure (ICP), vascular compression as the result of enlarged ventricles, or impaired metabolic activity. Little attention has been given to the relationship between cardiac function and systemic blood flow in chronic hydrocephalus (CH). Using an experimental model of chronic obstructive hydrocephalus developed in our laboratory, we investigated the relationship between the duration and severity of hydrocephalus and cardiac output (CO), CBF, myocardial tissue perfusion (MTP), and peripheral blood flow (PBF). Blood flow measures were obtained using the microsphere injection method under controlled hemodynamic conditions in experimental CH (n=23) and surgical control (n=8) canines at baseline and at 2, 4, 8, 12, and 16 weeks. Cardiac output measures were made using the Swan-Ganz thermodilution method. Intracranial compliance (ICC) via cerebrospinal fluid (CSF) bolus removal and infusion, and oxygen delivery in CSF and prefrontal cortex (PFC) were also investigated. We observed an initial surgical effect relating to 30% CO reduction and approximately 50% decrease in CBF, MTP, and PBF in both groups 2 weeks postoperatively, which recovered in control animals but continued to decline further in CH animals at 16 weeks. Cerebral blood flow, which was positively correlated with CO (P=0.028), showed no significant relationship with either CSF volume or pressure. Decreased CBF correlated with oxygen deprivation in PFC (P=0.006). Cardiac output was inversely related with ventriculomegaly (P=0.019), but did not correlate with ICP. Decreased CO corresponded to increased ICC, as measured by CSF infusion (P=0.04). Our results suggest that CH may have more of an influence on CO and CBF in the chronic stage than in the early condition, which was dominated by surgical effect. The cause of this late deterioration of cardiac function in hydrocephalus is uncertain, but may reflect

  17. Cerebrospinal fluid corticosteroid levels and cortisol metabolism in patients with idiopathic intracranial hypertension: a link between 11beta-HSD1 and intracranial pressure regulation?

    Science.gov (United States)

    Sinclair, Alexandra J; Walker, Elizabeth A; Burdon, Michael A; van Beek, Andre P; Kema, Ido P; Hughes, Beverly A; Murray, Philip I; Nightingale, Peter G; Stewart, Paul M; Rauz, Saaeha; Tomlinson, Jeremy W

    2010-12-01

    The etiology of idiopathic intracranial hypertension (IIH) is unknown. We hypothesized that obesity and elevated intracranial pressure may be linked through increased 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1) activity. The aim was to characterize 11β-HSD1 in human cerebrospinal fluid (CSF) secretory [choroid plexus (CP)] and drainage [arachnoid granulation tissue (AGT)] structures, and to evaluate 11β-HSD1 activity after therapeutic weight loss in IIH. We conducted in vitro analysis of CP and AGT and a prospective in vivo cohort study set in two tertiary care centers. Twenty-five obese adult female patients with active IIH were studied, and 22 completed the study. Fasted serum, CSF, and 24-h urine samples were collected at baseline, after 3-month observation, and after a 3-month diet. Changes in urine, serum, and CSF glucocorticoids (measured by gas chromatography/mass spectrometry and liquid chromatography/tandem mass spectrometry) after weight loss were measured. 11β-HSD1 and key elements of the glucocorticoid signaling pathway were expressed in CP and AGT. After weight loss (14.2±7.8 kg; Plevels correlated with weight loss (r=-0.512; P=0.018). Therapeutic weight loss in IIH is associated with a reduction in global 11β-HSD1 activity. Elevated 11β-HSD1 may represent a pathogenic mechanism in IIH, potentially via manipulation of CSF dynamics at the CP and AGT. Although further clarification of the functional role of 11β-HSD1 in IIH is needed, our results suggest that 11β-HSD1 inhibition may have therapeutic potential in IIH.

  18. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  19. Colony-stimulating factor (CSF) radioimmunoassay: detection of a CSF subclass stimulating macrophage production

    International Nuclear Information System (INIS)

    Stanley, E.R.

    1979-01-01

    Colony-stimulating factors (CSFs) stimulate the differentiation of immature precursor cells to mature granulocytes and macrophages. Purified 125 I-labeled murine L cell CSF has been used to develop a radioimmunoassay (RIA) that detects a subclass of CSFs that stimulates macrophage production. Murine CSF preparations that contain this subclass of CSF compete for all of the CSF binding sites on anti-L cell CSF antibody. With the exception of mouse serum, which can contain inhibitors of the bioassay, there is complete correspondence between activities determined by RIA and those determined by bioassay. The RIA is slightly more sensitive than the bioassay, detecting approximately 0.3 fmol of purified L cell CSF. It can also detect this subclass of CSF in chickens, rats, and humans. In the mouse, the subclass is distinguished from other CSFs by a murine cell bioassay dose-response curve in which 90% of the response occurs over a 10-fold (rather than a 100-fold) increase in concentration, by stimulating the formations of colonies contaning a high proportion of mononuclear (rather than granulocytic) cells, and by certain physical characteristics

  20. Scinticisternography and scintiventriculography. A study of C.S.F. dynamics

    NARCIS (Netherlands)

    Front, Dov

    1971-01-01

    The problem of C.S.F. flow and absorption has attracted many different disciplines in medicine. The normal physiology and the pathology, which declares itself mainly by hydrocephalus, have been intensively studied by neurophysiologists, neurologists and neurosurgeons. The possibility of treating

  1. Disturbances of cerebrospinal fluid (CSF) circulation - neuro psychiatric symptoms and neuroradiological contribution

    International Nuclear Information System (INIS)

    Hofmann, E.; Becker, T.; Meixensberger, J.; Jackel, M.; Schneider, M.; Reichmann, H.

    1995-01-01

    The present study aims at relating dementia, pseudo-neurasthenic and affective organic brain syndromes to underlying types of CSF flow disorder and to the subsequent alteration of anatomy. T 2 * -weighted magnetic resonance imaging (MRI) in the mid sagittal plane permitted an analysis of aqueductal CSF flow phenomena and hydrocephalus-induced elevation, thinning and dorsal impingement of the corpus callosum. Furthermore, the width of the third ventricle was measured on the transverse scout images. 72 patients with communicating hydrocephalus (increased aqueductal CSF pulsations) and 26 patients with aqueductal stenosis (absence of aqueductal flow phenomena) were compared with 22 controls. Dementia and affective disorders were distributed equally among both CSF flow subgroups whereas pseudo-neurasthenic syndromes were observed more frequently in non-communicating hydrocephalus (p < 0.03). Alzheimer-type and multi infarct dementia syndromes were found more frequently in communicating hydrocephalus whereas non-classifiable dementia showed some predilection for non-communicating hydrocephalus. Callosal height, area and third ventricular width did not predict affective or pseudo neurasthenic disorder whereas third ventricular width (p < 0.01) and callosal area (p < 0.05) discriminated between demented and non-demented patients. Dorsal impingement of the corpus callosum by the falx was a non-specific finding. (author)

  2. Effects of Granulocyte-Macrophage Colony-Stimulating (GM-CSF Factor on Corneal Epithelial Cells in Corneal Wound Healing Model.

    Directory of Open Access Journals (Sweden)

    Chang Rae Rho

    Full Text Available Granulocyte-macrophage colony-stimulating factor (GM-CSF is a pleiotropic cytokine that activates granulocyte and macrophage cell lineages. It is also known to have an important function in wound healing. This study investigated the effect of GM-CSF in wound healing of human corneal epithelial cells (HCECs. We used human GM-CSF derived from rice cells (rice cell-derived recombinant human GM-CSF; rhGM-CSF. An in vitro migration assay was performed to investigate the migration rate of HCECs treated with various concentrations of rhGM-CSF (0.1, 1.0, and 10.0 μg/ml. MTT assay and flow cytometric analysis were used to evaluate the proliferative effect of rhGM-CSF. The protein level of p38MAPK was analyzed by western blotting. For in vivo analysis, 100 golden Syrian hamsters were divided into four groups, and their corneas were de-epithelialized with alcohol and a blade. The experimental groups were treated with 10, 20, or 50 μg/ml rhGM-CSF four times daily, and the control group was treated with phosphate-buffered saline. The corneal wound-healing rate was evaluated by fluorescein staining at the initial wounding and 12, 24, 36, and 48 hours after epithelial debridement. rhGM-CSF accelerated corneal epithelial wound healing both in vitro and in vivo. MTT assay and flow cytometric analysis revealed that rhGM-CSF treatment had no effects on HCEC proliferation. Western blot analysis demonstrated that the expression level of phosphorylated p38MAPK increased with rhGM-CSF treatment. These findings indicate that rhGM-CSF enhances corneal wound healing by accelerating cell migration.

  3. Evaluation of patients with headache due to spontaneous intracranial hypotension by RN cisternography

    International Nuclear Information System (INIS)

    Kim, Su Zy; Park, Chan Hee; Soo, Joo In; Pai, Moon Sun; Yoon, Suk Nam; Kim, Jang Sung

    1997-01-01

    Spontaneous intracranial hypotension (SIH) typically occurs without an obvious cause. However, it can be seen following the lumbar puncture, craniotomy, or spinal surgery. Also listed are contributing factors such as sneezing, coughing, intercourse or minor fall. Spontaneous spinal CSF leaks are not common, but are now increasingly recognized as a cause of postural headache associated with intracranial hypotension. The purpose of our study was to evaluate the role of RN cisternography in the diagnosis of SIH cuased by spinal CSF leakage. Four patients with clinical suspicion of SIH (Group I) and six patients as normal control (Group II) underwent RN cisternography. RN cisternography in Group II was done for various reasons, such as hydrocephalus, syringomyelia and memory loss. Group I consisted of the patients who presented with postural headache, as well as additional symptoms, such as nausea, vomiting, dizziness, tinnitus and eyeball pain. The age range of these patients was 27 - 67 years. Lumbar puncture and CSF examinations were performed in Group I more than once and showed typical findings of low CSF pressure and slightly elevated protein level. Brain MRI (4/4), Cervico-thoracic spine MRI (3/4) were also performed. On gadolinium-enhanced brain MRI, enhancement of the meninges which is the most characteristic radiographic finding in intracranial hypotension was found in all patients of Group I. But, cervico-thoracic spin MRI was nonspecific. None of Group I had contrast myelography because of the patient's refusal. Group I and Group II underwent radionuclide cisternography following lumbar subarachnoid injection of 99mTc-DTPA (1-2mCi). The scans were taken in 2, 5, 24 hours later using single head gamma camera equipped with LEAP. Entire spinal region in posterior view and head in frontal and lateral views were obtained. The cisternography of Group I showed the CSF leakage or diverticulum at the level of cervico-thoracic junction(3/4) and mid-thoracic level (1

  4. Evaluation of patients with headache due to spontaneous intracranial hypotension by RN cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Zy; Park, Chan Hee; Soo, Joo In; Pai, Moon Sun; Yoon, Suk Nam; Kim, Jang Sung [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    1997-07-01

    Spontaneous intracranial hypotension (SIH) typically occurs without an obvious cause. However, it can be seen following the lumbar puncture, craniotomy, or spinal surgery. Also listed are contributing factors such as sneezing, coughing, intercourse or minor fall. Spontaneous spinal CSF leaks are not common, but are now increasingly recognized as a cause of postural headache associated with intracranial hypotension. The purpose of our study was to evaluate the role of RN cisternography in the diagnosis of SIH cuased by spinal CSF leakage. Four patients with clinical suspicion of SIH (Group I) and six patients as normal control (Group II) underwent RN cisternography. RN cisternography in Group II was done for various reasons, such as hydrocephalus, syringomyelia and memory loss. Group I consisted of the patients who presented with postural headache, as well as additional symptoms, such as nausea, vomiting, dizziness, tinnitus and eyeball pain. The age range of these patients was 27 - 67 years. Lumbar puncture and CSF examinations were performed in Group I more than once and showed typical findings of low CSF pressure and slightly elevated protein level. Brain MRI (4/4), Cervico-thoracic spine MRI (3/4) were also performed. On gadolinium-enhanced brain MRI, enhancement of the meninges which is the most characteristic radiographic finding in intracranial hypotension was found in all patients of Group I. But, cervico-thoracic spin MRI was nonspecific. None of Group I had contrast myelography because of the patient's refusal. Group I and Group II underwent radionuclide cisternography following lumbar subarachnoid injection of 99mTc-DTPA (1-2mCi). The scans were taken in 2, 5, 24 hours later using single head gamma camera equipped with LEAP. Entire spinal region in posterior view and head in frontal and lateral views were obtained. The cisternography of Group I showed the CSF leakage or diverticulum at the level of cervico-thoracic junction(3/4) and mid

  5. Evaluation of patients with headache due to spontaneous intracranial hypotension by RN cisternography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Zy; Park, Chan Hee; Soo, Joo In; Pai, Moon Sun; Yoon, Suk Nam; Kim, Jang Sung [College of Medicine, Ajou Univ., Suwon (Korea, Republic of)

    1997-07-01

    Spontaneous intracranial hypotension (SIH) typically occurs without an obvious cause. However, it can be seen following the lumbar puncture, craniotomy, or spinal surgery. Also listed are contributing factors such as sneezing, coughing, intercourse or minor fall. Spontaneous spinal CSF leaks are not common, but are now increasingly recognized as a cause of postural headache associated with intracranial hypotension. The purpose of our study was to evaluate the role of RN cisternography in the diagnosis of SIH cuased by spinal CSF leakage. Four patients with clinical suspicion of SIH (Group I) and six patients as normal control (Group II) underwent RN cisternography. RN cisternography in Group II was done for various reasons, such as hydrocephalus, syringomyelia and memory loss. Group I consisted of the patients who presented with postural headache, as well as additional symptoms, such as nausea, vomiting, dizziness, tinnitus and eyeball pain. The age range of these patients was 27 - 67 years. Lumbar puncture and CSF examinations were performed in Group I more than once and showed typical findings of low CSF pressure and slightly elevated protein level. Brain MRI (4/4), Cervico-thoracic spine MRI (3/4) were also performed. On gadolinium-enhanced brain MRI, enhancement of the meninges which is the most characteristic radiographic finding in intracranial hypotension was found in all patients of Group I. But, cervico-thoracic spin MRI was nonspecific. None of Group I had contrast myelography because of the patient's refusal. Group I and Group II underwent radionuclide cisternography following lumbar subarachnoid injection of 99mTc-DTPA (1-2mCi). The scans were taken in 2, 5, 24 hours later using single head gamma camera equipped with LEAP. Entire spinal region in posterior view and head in frontal and lateral views were obtained. The cisternography of Group I showed the CSF leakage or diverticulum at the level of cervico-thoracic junction(3/4) and mid-thoracic level (1

  6. Intracranial Aneurysms of Neuro-Ophthalmologic Relevance.

    Science.gov (United States)

    Micieli, Jonathan A; Newman, Nancy J; Barrow, Daniel L; Biousse, Valérie

    2017-12-01

    Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases. Cavernous sinus aneurysms were not included in this review. Surgical clipping vs endovascular coiling for aneurysms causing third nerve palsies was compared in 13 retrospective studies representing 447 patients. Complete recovery was achieved in 78% of surgical patients compared with 44% of patients treated with endovascular coiling. However, the complication rate, hospital costs, and days spent in intensive care were reported as higher in surgically treated patients. Retrospective reviews of surgical clipping and endovascular coiling for all ocular motor nerve palsies (third, fourth, or sixth cranial nerves) revealed similar results of complete resolution in 76% and 49%, respectively. Improvement in visual deficits related to aneurysmal compression of the anterior visual pathways was also better among patients treated with clipping than with coiling. The time to treatment from onset of visual symptoms was a predictive factor of visual recovery in several studies. Few reports have specifically assessed the improvement of visual deficits after treatment with flow diverters. Decisions regarding the choice of therapy for intracranial aneurysms causing neuro-ophthalmologic signs ideally should be made at high-volume centers with access to both surgical and endovascular treatments. The status of the patient, location of the aneurysm, and experience of the treating physicians

  7. Stem Cell Mobilization with G-CSF versus Cyclophosphamide plus G-CSF in Mexican Children

    OpenAIRE

    Meraz, Jos? Eugenio V?zquez; Arellano-Galindo, Jos?; Avalos, Armando Mart?nez; Mendoza-Garc?a, Emma; Jim?nez-Hern?ndez, Elva

    2016-01-01

    Fifty-six aphaereses were performed in 23 pediatric patients with malignant hematological and solid tumors, following three different protocols for PBPC mobilization and distributed as follows: A: seventeen mobilized with 4?g/m2 of cyclophosphamide (CFA) and 10??g/kg/day of granulocyte colony stimulating factor (G-CSF), B: nineteen with CFA + G-CSF, and C: twenty only with G-CSF when the WBC count exceeded 10 ? 109/L. The average number of MNC/kg body weight (BW)/aphaeresis was 0.4 ? 108 (0.1...

  8. Intracranial arterial stenosis.

    Science.gov (United States)

    Carvalho, Marta; Oliveira, Ana; Azevedo, Elsa; Bastos-Leite, António J

    2014-04-01

    Intracranial arterial stenosis (IAS) is usually attributable to atherosclerosis and corresponds to the most common cause of stroke worldwide. It is very prevalent among African, Asian, and Hispanic populations. Advancing age, systolic hypertension, diabetes mellitus, high levels of low-density lipoprotein cholesterol, and metabolic syndrome are some of its major risk factors. IAS may be associated with transient or definite neurological symptoms or can be clinically asymptomatic. Transcranial Doppler and magnetic resonance angiography are the most frequently used ancillary examinations for screening and follow-up. Computed tomography angiography can either serve as a screening tool for the detection of IAS or increasingly as a confirmatory test approaching the diagnostic accuracy of catheter digital subtraction angiography, which is still considered the gold (confirmation) standard. The risk of stroke in patients with asymptomatic atherosclerotic IAS is low (up to 6% over a mean follow-up period of approximately 2 years), but the annual risk of stroke recurrence in the presence of a symptomatic stenosis may exceed 20% when the degree of luminal narrowing is 70% or more, recently after an ischemic event, and in women. It is a matter of controversy whether there is a specific type of treatment other than medical management (including aggressive control of vascular risk factors and antiplatelet therapy) that may alter the high risk of stroke recurrence among patients with symptomatic IAS. Endovascular treatment has been thought to be helpful in patients who fail to respond to medical treatment alone, but recent data contradict such expectation. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Multiple intracranial hydatid cysts: MR findings

    International Nuclear Information System (INIS)

    Pumar, J.; Alvarez, M.; Leira, R.; Prieto, J.M.; Arrojo, L.; Pereira, J.; Vidal, J.

    1992-01-01

    Multiple intracranial hydatid cysts are uncommon and usually localized in the supratentorial compartment. We report a case studied by CT and MR of multiple intracranial hydatid cysts scattered in various anatomic sites: supratentorial, infratentorial and also intraventricular. (orig.)

  10. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    . The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  11. Intrasphenoidal encephalocele and spontaneous CSF rhinorrhoea.

    Science.gov (United States)

    Daniilidis, J; Vlachtsis, K; Ferekidis, E; Dimitriadis, A

    1999-12-01

    Intrasphenoidal encephalocele is a rare clinical entity. In the international literature only 16 cases have been reported up today, with female predominance. Clinically they manifest at middle and advanced ages (40-67 years), when spontaneous CSF rhinorrhoea or recurrent meningitis occurs. We present our case, a 46 years old female, who had CSF rhinorrhoea from the right vestibule for 10 months. The diagnosis was based on the history and the high-resolution brain and skull base CT-scanning in conjunction with opaque fluid injection in the subarachnoidal space through a lumbar puncture. She was successfully treated with an operation, through an endonasal trans-ethmoid microendoscopic approach, using the Draf and Stammberger technique. We discuss the pathogenesis of the intrasphenoidal encephalocele, the existence of small occult defects in the skull base, which cause, at the middle and advanced ages, CSF fistula with spontaneous CSF rhinorrhoea and/or recurrent meningitis. Finally we emphasize the advantages of the endonasal surgical approach for the treatment of this condition.

  12. The inner CSF-brain barrier

    DEFF Research Database (Denmark)

    Whish, Sophie; Dziegielewska, Katarzyna M; Møllgård, Kjeld

    2015-01-01

    outlining the inner CSF-brain interface from E16; most of these markers were not present in the adult ependyma. Claudin-5 was present in the apical-most part of radial glial cells and in endothelial cells in embryos, but only in endothelial cells including plexus endothelial cells in adults. Claudin-11...

  13. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  14. Comparison between cerebrospinal fluid and serum lactate concentrations in neurologic dogs with and without structural intracranial disease.

    Science.gov (United States)

    Benedicenti, Leontine; Gianotti, Giacomo; Galban, Evelyn M

    2018-04-01

    The objectives of this study were to investigate the relationship between cerebrospinal fluid lactate and serum concentrations in dogs with clinical signs of central nervous system disease and to establish if cerebrospinal fluid lactate (CSF) concentrations are higher in dogs with structural intracranial disease (Group Pos-MRI) compared to dogs that have clinical signs of intracranial disease but no structural brain disease (Group Neg-MRI) based on magnetic resonance imaging (MRI) findings. Using a prospective study canine blood and cerebrospinal fluid were collected in 24 dogs with neurological signs after undergoing brain MRI. Dogs were divided in 2 groups. No significant difference between serum lactate (1.57 ± 0.9 mmol/L) and CSF lactate concentration (1.34 ± 0.3 mmol/L) was detected. There was a direct correlation between CSF and serum lactate concentration ( R = 0.731; P = 0.01). No significant difference was found in CSF lactate concentration between the 2 groups of dogs ( P = 0.13).

  15. Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces

    International Nuclear Information System (INIS)

    Shigematsu, Y.; Korogi, Y.; Hirai, T.; Okuda, T.; Ikushima, I.; Sugahara, T.; Liang, L.; Ge, Y.; Takahashi, M.

    1998-01-01

    We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure. (orig.)

  16. Virtual MRI endoscopy of the intracranial cerebrospinal fluid spaces

    Energy Technology Data Exchange (ETDEWEB)

    Shigematsu, Y.; Korogi, Y.; Hirai, T. [Kumamoto Univ. (Japan). Dept. of Radiology; Okuda, T.; Ikushima, I.; Sugahara, T.; Liang, L.; Ge, Y.; Takahashi, M.

    1998-10-01

    We used constructive interference in steady state (CISS) 3D Fourier transform (3DFT) MRI data sets to obtain three-dimensional (3D) virtual MRI endoscopic views of the intracranial cerebrospinal fluid (CSF) spaces, processing them with a commercially available perspective endoscopic algorithm. We investigated the potential of the intracranial virtual MRI endoscopy applied to visualisation of the pathology in 13 patients with surgically confirmed trigeminal neuralgia (3), hemifacial spasm (3), acoustic neuroma (3), suprasellar germinoma (1), Langerhans cell histiocytosis (1), lateral ventricle nodules (1) and pituitary dwarfism (1). All images were acquired using a 1.5-T imager employing a circular polarised head coil. The CISS-3DFT data sets were transferred to a workstation for processing with the perspective endoscopic algorithm. Postprocessing for virtual MRI endoscopy was possible for all data sets. The lesions in 12 patients, and their complex anatomical relationships with the surrounding structures, were well seen on the 3D images. A small acoustic neuroma in the internal auditory meatus was not seen using virtual endoscopy. Although virtual MRI endoscopy has limitations, it provides 3D images which cannot be acquired using any other procedure. (orig.) With 6 figs., 16 refs.

  17. Glymphatic distribution of CSF-derived apoE into brain is isoform specific and suppressed during sleep deprivation.

    Science.gov (United States)

    Achariyar, Thiyagaragan M; Li, Baoman; Peng, Weiguo; Verghese, Philip B; Shi, Yang; McConnell, Evan; Benraiss, Abdellatif; Kasper, Tristan; Song, Wei; Takano, Takahiro; Holtzman, David M; Nedergaard, Maiken; Deane, Rashid

    2016-12-08

    Apolipoprotein E (apoE) is a major carrier of cholesterol and essential for synaptic plasticity. In brain, it's expressed by many cells but highly expressed by the choroid plexus and the predominant apolipoprotein in cerebrospinal fluid (CSF). The role of apoE in the CSF is unclear. Recently, the glymphatic system was described as a clearance system whereby CSF and ISF (interstitial fluid) is exchanged via the peri-arterial space and convective flow of ISF clearance is mediated by aquaporin 4 (AQP4), a water channel. We reasoned that this system also serves to distribute essential molecules in CSF into brain. The aim was to establish whether apoE in CSF, secreted by the choroid plexus, is distributed into brain, and whether this distribution pattern was altered by sleep deprivation. We used fluorescently labeled lipidated apoE isoforms, lenti-apoE3 delivered to the choroid plexus, immunohistochemistry to map apoE brain distribution, immunolabeled cells and proteins in brain, Western blot analysis and ELISA to determine apoE levels and radiolabeled molecules to quantify CSF inflow into brain and brain clearance in mice. Data were statistically analyzed using ANOVA or Student's t- test. We show that the glymphatic fluid transporting system contributes to the delivery of choroid plexus/CSF-derived human apoE to neurons. CSF-delivered human apoE entered brain via the perivascular space of penetrating arteries and flows radially around arteries, but not veins, in an isoform specific manner (apoE2 > apoE3 > apoE4). Flow of apoE around arteries was facilitated by AQP4, a characteristic feature of the glymphatic system. ApoE3, delivered by lentivirus to the choroid plexus and ependymal layer but not to the parenchymal cells, was present in the CSF, penetrating arteries and neurons. The inflow of CSF, which contains apoE, into brain and its clearance from the interstitium were severely suppressed by sleep deprivation compared to the sleep state. Thus, choroid plexus/CSF

  18. Correlation of isotopic cisternographic patterns in multiple sclerosis with CSF IgG values

    International Nuclear Information System (INIS)

    Bartolini, S.; Inzitari, D.; Castagnoli, A.; Amaducci, L.

    1982-01-01

    Thirty-eight patients with multiple sclerosis (MS) were examined with isotopic cisternography (IC) in order to study cerebrospinal fluid (CSF) dynamics. Cisternography was also performed in 15 patients with amyotrophic lateral sclerosis and in 14 with senile dementia of the Alzheimer type as controls. IC pattern of ''mixed'' type was found in 18 MS patients and all those with Alzheimer senile dementia examined, while the IC examination did not show abnormality in any of 15 patients with amyotrophic lateral sclerosis. In MS patients, the abnormal IC picture proved to be significantly correlated with the CSF IgG values as calculated by Link's and Tourtelotte's formulas. The abnormal IC in MS may be due to altered CSF reabsorption or increased transependymal flow, or it may be related to the abnormal concentration of IgG

  19. The New PTB Caesium Fountain Clock CSF2

    National Research Council Canada - National Science Library

    Wynands, R; Bauch, A; Griebsch, D; Schroeder, R; Weyers, S

    2005-01-01

    At PTB a second caesium fountain clock, CSF2, is in the process of being set up. It differs from the first PTB caesium fountain standard CSF1 in a number of details, which are consecutively specified...

  20. CSF-1R Inhibitor Development: Current Clinical Status.

    Science.gov (United States)

    Peyraud, Florent; Cousin, Sophie; Italiano, Antoine

    2017-09-05

    Colony-stimulating factor 1 receptor (CSF-1R) and its ligands, CSF-1 and interleukin 34 (IL-34), regulate the function and survival of tumor-associated macrophages, which are involved in tumorigenesis and in the suppression of antitumor immunity. Moreover, the CSF-1R/CSF-1 axis has been implicated in the pathogenesis of pigmented villonodular synovitis (PVNS), a benign tumor of the synovium. As advanced or metastatic malignant solid tumors and relapsed/refractory PVNS remain unresolved therapeutic problems, new approaches are needed to improve the outcome of patients with these conditions. In solid tumors, targeting CSF-1R via either small molecules or antibodies has shown interesting results in vitro but limited antitumor activity in vivo. Concerning PVNS, clinical trials assessing CSF-1R inhibitors have revealed promising initial outcomes. Blocking CSF-1/CSF-1R signaling represents a promising immunotherapy approach and several new potential combination therapies for future clinical testing.

  1. Intracranial calcification in central diabetes insipidus

    International Nuclear Information System (INIS)

    Al-Kandari, Salwa R.; Pandey, Tarun; Badawi, Mona H.

    2008-01-01

    Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

  2. Intracranial calcification in central diabetes insipidus

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kandari, Salwa R. [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); Pandey, Tarun [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); University of Arkansas for Medical Sciences, Radiology Department, Little Rock, AR (United States); Badawi, Mona H. [Al-Adan Hospital, Department of Paediatrics, Kuwait (Kuwait)

    2008-01-15

    Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

  3. Intracranial Monitoring after Severe Traumatic Brain Injury

    OpenAIRE

    Donnelly, Joseph

    2018-01-01

    Intracranial monitoring after severe traumatic brain injury offers the possibility for early detection and amelioration of physiological insults. In this thesis, I explore cerebral insults due raised intracranial pressure, decreased cerebral perfusion pressure and impaired cerebral pressure reactivity after traumatic brain injury. In chapter 2, the importance of intracranial pressure, cerebral perfusion pressure and pressure reactivity in regulating the cerebral circulation is elucidated ...

  4. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

    2011-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...... or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant...

  5. Association of Cerebrospinal Fluid (CSF) Insulin with Cognitive Performance and CSF Biomarkers of Alzheimer's Disease.

    Science.gov (United States)

    Geijselaers, Stefan L C; Aalten, Pauline; Ramakers, Inez H G B; De Deyn, Peter Paul; Heijboer, Annemieke C; Koek, Huiberdina L; OldeRikkert, Marcel G M; Papma, Janne M; Reesink, Fransje E; Smits, Lieke L; Stehouwer, Coen D A; Teunissen, Charlotte E; Verhey, Frans R J; van der Flier, Wiesje M; Biessels, Geert Jan

    2018-01-01

    Abnormal insulin signaling in the brain has been linked to Alzheimer's disease (AD). To evaluate whether cerebrospinal fluid (CSF) insulin levels are associated with cognitive performance and CSF amyloid-β and Tau. Additionally, we explore whether any such association differs by sex or APOE ɛ4 genotype. From 258 individuals participating in the Parelsnoer Institute Neurodegenerative Diseases, a nationwide multicenter memory clinic population, we selected 138 individuals (mean age 66±9 years, 65.2% male) diagnosed with subjective cognitive impairment (n = 45), amnestic mild cognitive impairment (n = 44), or AD (n = 49), who completed a neuropsychological assessment, including tests of global cognition and memory performance, and who underwent lumbar puncture. We measured CSF levels of insulin, amyloid-β1-42, total (t-)Tau, and phosphorylated (p-)Tau. CSF insulin levels did not differ between the diagnostic groups (p = 0.136). Across the whole study population, CSF insulin was unrelated to cognitive performance and CSF biomarkers of AD, after adjustment for age, sex, body mass index, diabetes status, and clinic site (all p≥0.131). Importantly, however, we observed effect modification by sex and APOE ɛ4 genotype. Specifically, among women, higher insulin levels in the CSF were associated with worse global cognition (standardized regression coefficient -0.483; p = 0.008) and higher p-Tau levels (0.353; p = 0.040). Among non-carriers of the APOE ɛ4 allele, higher CSF insulin was associated with higher t-Tau (0.287; p = 0.008) and p-Tau (0.246; p = 0.029). Our findings provide further evidence for a relationship between brain insulin signaling and AD pathology. It also highlights the need to consider sex and APOE ɛ4 genotype when assessing the role of insulin.

  6. CSF HYPOCRETIN CONCENTRATION IN VARIOUS NEUROLOGICAL AND SLEEP DISORDERS

    OpenAIRE

    Tsutsui, Kou; Kanbayashi, Takashi; Sawaishi, Yukio; Tokunaga, Jun; Sato, Masahiro; Shimizu, Tetsuo

    2011-01-01

    Recent CSF and postmortem brain hypocretin measurements in human narcolepsy suggest that hypocretin deficiency is involved in the pathophysiology of the disease. Thus, it is important to study whether neurological disorders also have abnormal CSF hypocretin levels. We therefore measured hypocretins in the CSF of various neurological disorders and obstructive sleep apnea syndrome (OSAS) to identify altered hypocretin levels. CSF hypocretin levels in patients with OSAS and neurological diseases...

  7. [Effects of cell-mediated immunity induced by intramuscular chitosan-pJME/ GM-CSF nano-DNA vaccine in BAlb/c mice].

    Science.gov (United States)

    Zhai, Yong-Zhen; Zhou, Yan; Ma, Li; Feng, Guo-He

    2014-07-01

    This study aimed to investigate the immune adjuvant effect and mechanism induced by chitosan nanoparticles carrying pJME/GM-CSF. In this study, plasmid DNA (pJME/GM-CSF) was encapsulated in chitosan to prepare chitosan-pJME/GM-CSF nanoparticles using a complex coacervation process. Immunohistochemistry was used to detect the type of infiltrating cells at the site of intramuscular injection. The phenotype and functional changes of splenic DCs were measured by flow cytometry after different immunogens were injected intramuscularly. The killing activity of CTLs was assessed using the lactate dehydrogenase (LDH) release assay. The preparation of chitosan-pJME/GM-CSF nanoparticles matched the expected theoretical results. Our results also found that, after pJME/GM-CSF injection, the incoming cells were a mixture of macrophages, neutrophils, and immature DCs. Meanwhile, pJME/GM-CSF increased the expression of MHC class II molecules on splenic DCs, and enhanced their Ag capture and presentation functions. Cell-mediated immunity was induced by the vaccine. Furthermore, chitosan-pJME/GM-CSF nanoparticles outperformed the administration of standard pJME/GM-CSF in terms of DC recruitment, antigen processing and presentation, and vaccine enhancement. These findings reveal that chitosan could be used as delivery vector for DNA vaccine intramuscular immunizations, and enhance pJME/GM-CSF-induced cellular immune responses.

  8. Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Inês Correia

    2016-01-01

    Full Text Available Spontaneous intracranial hypotension (SIH is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.

  9. Primary intracranial leiomyoma: case report

    Energy Technology Data Exchange (ETDEWEB)

    Lai, P.H.; Yang, C.F.; Yeh, L.R.; Pan, H.B. [Department of Radiology, Veterans General Hospital-Kaohsiung, National Yang Ming University, National Defence Medical Centre, 386 Ta-Chung First Rd., Kaohsiung 813, Taiwan (Taiwan, Province of China); Huang, C.H. [Department of Neurosurgery, Veterans General Hospital-Kashsiung, National Yang Ming University, National Defence Medical Centre, Kashsiung, Taiwan (Taiwan, Province of China); Lin, S.L. [Department of Pathology, Veterans General Hospital-Kaohsiung, National Yang Ming University, National Defence Medical Centre, Taiwan (Taiwan, Province of China)

    1998-04-01

    We present a case of intracranial parenchymal leiomyoma in a 20-year-old woman with a chief complaint of numbness and a painful sensation over the right limbs for several years. CT and MRI revealed an intensely enhancing calcified mass. The patient was well, without recurrence, 2 years after surgery. (orig.) With 2 figs., 13 refs.

  10. Haemorrhage in intracranial tuber- culosis

    African Journals Online (AJOL)

    CASE REPORT. 16. SA JOURNAL OF RADIOLOGY • July 2005. Haemorrhage in intracranial tuber- culosis. M Modi. FCRad (SA), MMed. Department of Radiation Sciences ... wall where granulomatous inflamma- tion (Fig. 2, arrow) was present in the adventitia. A specific site of origin for the subarachnoid haemorrhage was.

  11. Canine Intracranial Meningioma: Case report

    Directory of Open Access Journals (Sweden)

    José Ricardo Gomes de Carvalho

    2016-11-01

    Full Text Available ABSTRACT. Carvalho J.R.G., Vasconcellos C.H.C., Bastos I. P.B., Trajano F.L.C., Costa T.S. & Fernandes J.I [Canine Intracranial Meningioma: Case report.] Meningioma intracraniano canino: Relato de caso. Revista Brasileira de Medicina Veterinária, 38(supl. 3:1- 7, 2016. Programa de Pós-Graduação em Ciências Veterinária, Universidade Federal Rural do Rio de Janeiro, BR 465 Km 7, Seropédica, RJ 23.897-000, Brasil, E-mail: vetjulio@yahoo.com.br Intracranial neoplasms usually show their signals in a moderate way, revealing a long background of nonspecific signs, making the diagnosis more difficult. The meningioma is the most common intracranial neoplasm in dogs and cats. Along the years, the Veterinary Medicine has experienced important technological improvements, making it possible the diagnosis of a lot of diseases. Therefore, diseases considered not common in the past, started being diagnosed more frequently, for instance, brain lesions. The objective of this research is to report a case of intracranial meningioma in a Boxer dog that arrived at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro, highlighting its clinical improvement, diagnosis and treatment.

  12. What Is IH (Intracranial Hypertension)?

    Science.gov (United States)

    ... Store What is IH? What is IH? Intracranial hypertension literally means that the pressure of cerebrospinal fluid ( ... is too high. “Intracranial” means “within the skull.” “Hypertension” means “high fluid pressure.” To understand how this ...

  13. MRI Diagnosis of Intracranial Hemorrhage : Experimental and Clinical Studies

    International Nuclear Information System (INIS)

    Alemany Ripoll, Montserrat

    2003-02-01

    The purpose of this work was to improve the diagnosis of intracranial hemorrhage with MRI, and add knowledge about the newer sequences increasing in use to depict intra parenchymal bleeds, especially T2*-w GE sequences. We also compared the effect of magnetic field strengths. The sequences and field strengths were tested in animals. Then, the most effective technique was applied to patients with hematomas of different ages and with hematoma residuals. Occurrence of residuals of earlier, clinically silent, haemorrhages in patients with acute spontaneous hematoma or with suspected ischemic stroke were compared. Experimental studies: The MR detectability of small experimental haematomas in the brain and of blood in the cerebrospinal fluid (CSF) spaces of 30 rabbits was evaluated. MRI examinations were performed at determined intervals using different pulse sequences at two field strengths. The last MR images were compared to the formalin fixed brain sections and, in 16 rabbits, also to the histological findings. T2*-weighted GE sequences revealed all the intra parenchymal haematomas at 1.5 T: they were strongly hypointense. Their sizes became smaller but the signal patterns remained unchanged during the follow-up. The haematoma sizes and shapes corresponded well to gross pathology at acute and subacute stages. At chronic stage, the signal changes were larger than iron deposits. Blood in the CSF spaces was best detected at 1.5T with T2*-weighted GE sequences during the first 2 days. The FLAIR sequence often revealed blood in CSF spaces but not in the brain. SE sequences were rather insensitive. Imaging at 0.5 T was less effective than at 1.5 T. Clinical studies: All MR examinations on patients were performed at 1.5T, including T1- and T2-w SE, FLAIR, T2*-w GE sequences, and, occasionally, diffusion-w sequences. Sixty-six intra parenchymal hematomas were examined in the first clinical study. The hematomas were of different sizes and the ages varied from 8 hours to 3

  14. A thin line between Meniere’s disease and spontaneous intracranial hypotension syndrome

    Directory of Open Access Journals (Sweden)

    Iva Botica

    2016-02-01

    Full Text Available Aim To point out the similarity of Meniere disease and spontaneous intracranial hypotension and difference of their treatment. Methods A case of a 54-year-old male patient with previously diagnosed Meniere’s disease and newly diagnosed spontaneous intracranial hypotension syndrome is presented. Additional neuroradiological examination, Brain contrast-enhanced MRI and MR myelography were used for diagnosis. Results Due to deterioration of vertigo, hearing loss and tinnitus in the right ear the patient was referred to the additional neuroradiological examination which confirmed the diagnosis of spontaneous intracranial hypotension syndrome. Brain contrast-enhanced MRI showed increased pachymeningeal contrast enhancement, and MR myelography identified the location of CSF leak. The patient was successfully treated conservatively. Conclusion According to our knowledge this is the fifth case report of Meniere’s disease and spontaneous intracranial hypotension coexistence. Both diseases have similar clinical presentation and initial treatment. We suggest procedures of additional examination when the treatment fails and initial diagnosis becomes questionable.

  15. Evidence that iron accelerates Alzheimer's pathology: a CSF biomarker study.

    Science.gov (United States)

    Ayton, Scott; Diouf, Ibrahima; Bush, Ashley Ian

    2018-05-01

    To investigate whether cerebrospinal fluid (CSF) ferritin (reporting brain iron) is associated with longitudinal changes in CSF β-amyloid (Aβ) and tau. Mixed-effects models of CSF Aβ 1-42 and tau were constructed using data from 296 participants who had baseline measurement of CSF ferritin and annual measurement of CSF tau and Aβ 1-42 for up to 5 years. In subjects with biomarker-confirmed Alzheimer's pathology, high CSF ferritin (>6.2 ng/mL) was associated with accelerated depreciation of CSF Aβ 1-42 (reporting increased plaque formation; p=0.0001). CSF ferritin was neither associated with changes in CSF tau in the same subjects, nor longitudinal changes in CSF tau or Aβ 1-42 in subjects with low baseline pathology. In simulation modelling of the natural history of Aβ deposition, which we estimated to occur over 31.4 years, we predicted that it would take 12.6 years to reach the pathology threshold value of CSF Aβ from healthy normal levels, and this interval is not affected by CSF ferritin. CSF ferritin influences the fall in CSF Aβ over the next phase, where high CSF ferritin accelerated the transition from threshold preclinical Aβ levels to the average level of Alzheimer's subjects from 18.8 to 10.8 years. Iron might facilitate Aβ deposition in Alzheimer's and accelerate the disease process. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  16. Magnetic resonance imaging of large and giant intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Matsumura, Kenichi; Saito, Akira; Nakasu, Yoko; Matsuda, Masayuki; Handa, Jyoji [Shiga University of Medical Science, Shiga (Japan); Todo, Giro

    1990-06-01

    Twelve large or giant intracranial aneurysms were studied with magnetic resonance (MR) imaging, and the findings were compared with those from computed tomographic (CT) scanning. Characteristic MR features of such aneurysms are: round, extra-axial mass with hypointensity rim; signal void, paradoxical enhancement, or even-echo rephasing due to blood flow; and laminated, eccentric thrombus with increased signal intensity when fresh, perianeurysmal hemorrhage occurs in the acute or subacute stage after aneurysmal rupture. MR imaging, however, often fails to identify or characterize the area of calcification. For the diagnosis of large or giant intracranial aneurysms, MR imaging is apparently superior to CT scanning in differentiating aneurysms from tumors, delineating the blood flow and intraluminal thrombus, and detecting the exact size of the aneurysm. It may also provide useful information concerning the growth mechanisms of aneurysms with or without thrombus formation. (author).

  17. A follow-up study by CT scan of intracranial hemorrhages in newborn children

    International Nuclear Information System (INIS)

    Shibata, Iekado; Kushida, Yoshimasa; Seiki, Yoshikatsu; Tsutsumi, Shunichiro; Kuramitsu, Toru

    1983-01-01

    Intracranial hemorrhages in perinatal babies and their sequelae are two of the targets of recent investigations. This study was designed to make clear the correlation between intracranial hemorrhage in perinates and the sequential widening of the cerebrospinal fluid space, including ventricles. 600 cases with moderate or severe clinical symptoms were treated in the Neonatal Intensive Care Unit of the Toho University Hospital from February, 1981, to October, 1982. Of these, 137 cases were suspected clinically to have had an intracranial hemorrhage at birth. In the CT study of these cases, intracranial hemorrhages of various types were confirmed in 55 cases. These included subarachnoid hemorrhages (29 cases), intraventricular hemorrhages (3 cases), intracerebral hemorrhages (3 cases), and combined hemorrhages (20 cases). A follow-up check of these cases by means of CT scan and neurological examinations was done for a period of from 40 days to 20 months. In 35 cases (63.5%) out of the 55, a temporary or persistent enlagement of the ventricle and/or widenings of the CSF space of various types were demonstrated. The latter included subdural effusion, the widening of the Sylvian fissure and/or interhemispheric fissure, and the widening of the basal cisterns. An enlargement of the ventricle occurred often following an intraventricular or intracerebral hemorrhage. On the other hand, subdural effusion was a common sequela after a subarachnoid hemorrhage. These changes in the ventricle or CSF space seem to be benign in nature and were improved in most cases during the period of the follow-up study. The ventricular enlargement disappeared substantially in 5 cases, and in the remaining 30 cases the abnormalities on the CT scans were much improved. Clinically, retarded physical development was evident in 3 cases, but the others showed no developmental retardation

  18. Advanced Imaging of Intracranial Atherosclerosis: Lessons from Interventional Cardiology

    Directory of Open Access Journals (Sweden)

    Davor Pavlin-Premrl

    2017-08-01

    Full Text Available Intracranial atherosclerosis is a major cause of ischemic stroke. Patients with a high degree of stenosis have a significant rate of stroke despite medical therapy. Two randomized trials of stenting have failed to show benefit. Improving periprocedural complication rates and patient selection may improve stenting outcomes. Fractional flow reserve (FFR, intravascular ultrasound (IVUS, and optical coherence tomography (OCT are intravascular imaging techniques employed to improve patient selection and stent placement in interventional cardiology. FFR has been shown to improve cardiovascular outcomes when used in patient selection for intervention. Studies of FFR in intracranial atherosclerosis show that the measure may predict which plaques lead to stroke. IVUS is used in cardiology to quantify stenosis and assist with stent placement. Comparisons with histology show that it can reliably characterize plaques. Several case reports of IVUS in intracranial arteries show the technique to be feasible and indicate it may improve stent placement. Plaque characteristics on IVUS may help identify vulnerable plaques. In interventional cardiology, OCT provides excellent visualization of vessel geometry and is useful periprocedurally. Images reliably identify thin-capped fibroatheromas and other plaque features. Case reports indicate that OCT is safe for use in intracranial arteries. OCT can be used to identify perforator vessels and so may be useful in avoiding perforator strokes, a common complication of stenting. Plaque characteristics on OCT may be useful in patient selection.

  19. Intracranial arteriovenous malformation. Contralateral steal phenomena

    Energy Technology Data Exchange (ETDEWEB)

    Batjer, H H; Devous, M D; Seibert, G B; Purdy, P D; Ajmani, A K; Delarosa, M; Bonte, F J [Texas Univ., Dallas, TX (USA). Southwestern Medical Center

    1989-05-01

    Sixty-two patients with radiographically proven intracranial arteriovenous malformations underwent preoperative regional cerebral blood flow measurement with {sup 133}Xe signal-photon emission computed tomography. Contralateral regions of hypoperfusion were deteceted in all cases. Steal severity was assessed according to the contralateral steal index (ISteal(c)). ISteal(c) was < 0.7 (severe) in 22 (35%), 0.7-0.8 (intermediate) in 18 (29%), and > 0.8 (mild) in 22 (35%). ISteal(c) was more frequently severe or mild in females and more often intermediate in males in males (p < 0.05). Hyperemic complications were encountered more frequently in patients with intermediate ISteal(c) (p = 0.086). An unfavorable outcome was associated with less severe contralateral steal (p = 0.12). A detailed clinical, radiographic, and hemodynamic profile may help to preperatively identify patients at high risk for a poor surgical outcome. (author).

  20. Automatic, accurate, and reproducible segmentation of the brain and cerebro-spinal fluid in T1-weighted volume MRI scans and its application to serial cerebral and intracranial volumetry

    Science.gov (United States)

    Lemieux, Louis

    2001-07-01

    A new fully automatic algorithm for the segmentation of the brain and cerebro-spinal fluid (CSF) from T1-weighted volume MRI scans of the head was specifically developed in the context of serial intra-cranial volumetry. The method is an extension of a previously published brain extraction algorithm. The brain mask is used as a basis for CSF segmentation based on morphological operations, automatic histogram analysis and thresholding. Brain segmentation is then obtained by iterative tracking of the brain-CSF interface. Grey matter (GM), white matter (WM) and CSF volumes are calculated based on a model of intensity probability distribution that includes partial volume effects. Accuracy was assessed using a digital phantom scan. Reproducibility was assessed by segmenting pairs of scans from 20 normal subjects scanned 8 months apart and 11 patients with epilepsy scanned 3.5 years apart. Segmentation accuracy as measured by overlap was 98% for the brain and 96% for the intra-cranial tissues. The volume errors were: total brain (TBV): -1.0%, intra-cranial (ICV):0.1%, CSF: +4.8%. For repeated scans, matching resulted in improved reproducibility. In the controls, the coefficient of reliability (CR) was 1.5% for the TVB and 1.0% for the ICV. In the patients, the Cr for the ICV was 1.2%.

  1. Impact of vessel wall lesions and vascular stenoses on cerebrovascular reactivity in patients with intracranial stenotic disease

    NARCIS (Netherlands)

    Cogswell, Petrice M; Davis, Taylor L; Strother, Megan K; Faraco, Carlos C; Scott, Allison O; Jordan, Lori C; Fusco, Matthew R; Frederick, Blaise deB; Hendrikse, Jeroen; Donahue, Manus J

    2017-01-01

    PURPOSE: To compare cerebrovascular reactivity (CVR) and CVR lagtimes in flow territories perfused by vessels with vs. without proximal arterial wall disease and/or stenosis, separately in patients with atherosclerotic and nonatherosclerotic (moyamoya) intracranial stenosis. MATERIALS AND METHODS:

  2. CSF in the ventricles of the brain behaves as a relay medium for arteriovenous pulse wave phase coupling.

    Directory of Open Access Journals (Sweden)

    William E Butler

    Full Text Available The ventricles of the brain remain perhaps the largest anatomic structure in the human body without established primary purpose, even though their existence has been known at least since described by Aristotle. We hypothesize that the ventricles help match a stroke volume of arterial blood that arrives into the rigid cranium with an equivalent volume of ejected venous blood by spatially configuring cerebrospinal fluid (CSF to act as a low viscosity relay medium for arteriovenous pulse wave (PW phase coupling. We probe the hypothesis by comparing the spatiotemporal behavior of vascular PW about the ventricular surfaces in piglets to internal observations of ventricle wall motions and adjacent CSF pressure variations in humans. With wavelet brain angiography data obtained from piglets, we map the travel relative to brain pulse motion of arterial and venous PWs over the ventricle surfaces. We find that arterial PWs differ in CF phase from venous PWs over the surfaces of the ventricles consistent with arteriovenous PW phase coupling. We find a spatiotemporal difference in vascular PW phase between the ventral and dorsal ventricular surfaces, with the PWs arriving slightly sooner to the ventral surfaces. In humans undergoing neuroendoscopic surgery for hydrocephalus, we measure directly ventricle wall motions and the adjacent internal CSF pressure variations. We find that CSF pressure peaks slightly earlier in the ventral Third Ventricle than the dorsal Lateral Ventricle. When matched anatomically, the peri-ventricular vascular PW phase distribution in piglets complements the endo-ventricular CSF PW phase distribution in humans. This is consistent with a role for the ventricles in arteriovenous PW coupling and may add a framework for understanding hydrocephalus and other disturbances of intracranial pressure.

  3. Specific Contributions of CSF-1 and GM-CSF to the Dynamics of the Mononuclear Phagocyte System.

    Science.gov (United States)

    Louis, Cynthia; Cook, Andrew D; Lacey, Derek; Fleetwood, Andrew J; Vlahos, Ross; Anderson, Gary P; Hamilton, John A

    2015-07-01

    M-CSF (or CSF-1) and GM-CSF can regulate the development and function of the mononuclear phagocyte system (MPS). To address some of the outstanding and sometimes conflicting issues surrounding this biology, we undertook a comparative analysis of the effects of neutralizing mAbs to these CSFs on murine MPS populations in the steady-state and during acute inflammatory reactions. CSF-1 neutralization, but not of GM-CSF, in normal mice rapidly reduced the numbers of more mature Ly6C(-) monocytes in blood and bone marrow, without any effect on proliferating precursors, and also the numbers of the resident peritoneal macrophages, observations consistent with CSF-1 signaling being essential only at a relatively late state in steady-state MPS development; in contrast, GM-CSF neutralization had no effect on the numbers of these particular populations. In Ag-induced peritonitis (AIP), thioglycolate-induced peritonitis, and LPS-induced lung inflammation, CSF-1 neutralization lowered inflammatory macrophage number; in the AIP model, this reduced number was not due to suppressed proliferation. More detailed studies with the convenient AIP model indicated that CSF-1 neutralization led to a relatively uniform reduction in all inflammatory cell populations; GM-CSF neutralization, in contrast, was more selective, resulting in the preferential loss among the MPS populations of a cycling, monocyte-derived inflammatory dendritic cell population. Some mechanistic options for the specific CSF-dependent biologies enumerated are discussed. Copyright © 2015 by The American Association of Immunologists, Inc.

  4. Decompressive craniectomy and hydrocephalus: proposal of a therapeutic flow chart.

    Science.gov (United States)

    Peraio, Simone; Calcagni, Maria Lucia; Mattoli, Maria Vittoria; Marziali, Giammaria; DE Bonis, Pasquale; Pompucci, Angelo; Anile, Carmelo; Mangiola, Annunziato

    2017-12-01

    Decompressive craniectomy (DC) may be necessary to save the lives of patients suffering from intracranial hypertension. However, this procedure is not complication-free. Its two main complications are hydrocephalus and the sinking skin-flap syndrome (SSFS). The radiological findings and the clinical evaluation may be not enough to decide when and/or how to treat hydrocephalus in a decompressed patient. SSFS and hydrocephalus may be not unrelated. In fact, a patient affected by hydrocephalus, after the ventriculo-peritoneal shunt, can develop SSFS; on the other hand, SSFS per se can cause hydrocephalus. Treating hydrocephalus in decompressed patients can be challenging. Radiological findings and clinical evaluation may not be enough to define the most appropriate therapeutic strategy. Cerebrospinal fluid (CSF) dynamics and metabolic evaluations can represent important diagnostic tools for assessing the need of a CSF shunt in patients with a poor baseline neurologic status. Based on our experience, we propose a flow chart for treating decompressed patients affected by ventriculomegaly.

  5. Distinct Properties of Human M-CSF and GM-CSF Monocyte-Derived Macrophages to Simulate Pathological Lung Conditions In Vitro: Application to Systemic and Inflammatory Disorders with Pulmonary Involvement.

    Science.gov (United States)

    Lescoat, Alain; Ballerie, Alice; Augagneur, Yu; Morzadec, Claudie; Vernhet, Laurent; Fardel, Olivier; Jégo, Patrick; Jouneau, Stéphane; Lecureur, Valérie

    2018-03-17

    Macrophages play a central role in the pathogenesis of inflammatory and fibrotic lung diseases. However, alveolar macrophages (AM) are poorly available in humans to perform in vitro studies due to a limited access to broncho-alveolar lavage (BAL). In this study, to identify the best alternative in vitro model for human AM, we compared the phenotype of AM obtained from BAL of patients suffering from three lung diseases (lung cancers, sarcoidosis and Systemic Sclerosis (SSc)-associated interstitial lung disease) to human blood monocyte-derived macrophages (MDMs) differentiated with M-CSF or GM-CSF. The expression of eight membrane markers was evaluated by flow cytometry. Globally, AM phenotype was closer to GM-CSF MDMs. However, the expression levels of CD163, CD169, CD204, CD64 and CD36 were significantly higher in SSc-ILD than in lung cancers. Considering the expression of CD204 and CD36, the phenotype of SSc-AM was closer to MDMs, from healthy donors or SSc patients, differentiated by M-CSF rather than GM-CSF. The comparative secretion of IL-6 by SSc-MDMs and SSc-AM is concordant with these phenotypic considerations. Altogether, these results support the M-CSF MDM model as a relevant in vitro alternative to simulate AM in fibrotic disorders such as SSc.

  6. Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI

    DEFF Research Database (Denmark)

    Gideon, P; Ståhlberg, F; Thomsen, C

    1994-01-01

    An interleaved velocity-sensitised fast low-angle shot pulse sequence was used to study cerebrospinal fluid (CSF) flow in the cerebral aqueduct, and supratentorial CSF production in 9 patients with normal pressure hydrocephalus (NPH) and 9 healthy volunteers. The peak aqueduct CSF flow, both caudal...

  7. Intracranial MR imaging of achondroplasia

    International Nuclear Information System (INIS)

    Ueno, Shinichi; Ootsuka, Ryouichi; Hayashi, Yoshinori; Nishitani, Hiromu; Shirakawa, Norihisa; Hashimoto, Toshiaki

    1992-01-01

    Intracranial MR imaging was performed in five patients with achondroplasia. All patients had narrowing of the subarachnoid space at the level of the formen magnum that was mainly due to protrusion of the posterior aspect. Three patients had compressive deformities of the brainstem and/or upper cervical spine. Among them, two patients had deformities of the pons. Relative upward displacement of the brainstem was seen in all patients. Hydrocephalus was seen in three patients. (author)

  8. Intracranial MR imaging of achondroplasia

    Energy Technology Data Exchange (ETDEWEB)

    Ueno, Shinichi; Ootsuka, Ryouichi; Hayashi, Yoshinori; Nishitani, Hiromu; Shirakawa, Norihisa; Hashimoto, Toshiaki (Tokushima Univ. (Japan). School of Medicine)

    1992-10-01

    Intracranial MR imaging was performed in five patients with achondroplasia. All patients had narrowing of the subarachnoid space at the level of the formen magnum that was mainly due to protrusion of the posterior aspect. Three patients had compressive deformities of the brainstem and/or upper cervical spine. Among them, two patients had deformities of the pons. Relative upward displacement of the brainstem was seen in all patients. Hydrocephalus was seen in three patients. (author).

  9. Computerized tomography of intracranial tumors

    International Nuclear Information System (INIS)

    Hungenberg, T.

    1982-01-01

    The author discusses the possibilities and limits of CT in the differential diagnosis of intracranial tumours. His discussion is based on a quantitative classification and a number of case studies selected under the following aspects: Misinterpretation of the CT image; specific diagnostic problems; uncommon CT image of the tumour; rare histological findings. 118 patients were examined between November 1976 and April 1979. (orig./MG) [de

  10. Neonatal intracranial hemorrhages (perinatal onset)

    International Nuclear Information System (INIS)

    Ban, Sadahiko; Ogata, Masahiro; Yamamoto, Toyoshiro; Nakao, Satoshi; Mizue, Hidenari; Kobayashi, Yutaka.

    1982-01-01

    1. We have reviewed 34 cases of neonatal intracranial hemorrhages (perinatal onset, 23 mature and 11 premature infants) experienced in 10-year period from 1971 to 1980, with special reference to gestational age, birth weight, type of delivery, presence or absence of asphyxia, symptoms and cause of death. 2. Regarding 9 autopsied cases and 7 cases diagnosed by CT-scan, 10 mature infants composed of 3 subarachnoid hemorrhages, 2 intraventricular hemorrhages, 2 subdural hematomas, 2 intracerebral and 1 subependymal hemorrhage; 6 premature infants consisted of 4 subependymal hemorrhages with ventricular rupture and 2 subarachnoid hemorrhages. Most of them presented with respiratory distress, vomiting and convulsive seizures which developed within 5 days after birth. 3. Poor outcome including death amounted 49% of mature and 63% of premature infants. Along with degree of intracranial hematoma, prematurity and pulmonary complication were felt to be important prognostic factors. 4. Introduction of CT-scan led to prompt diagnosis and treatment, thus lowering mortality rate of neonatal intracranial hemorrhages. (author)

  11. Research Upregulation of CD23 (FcεRII Expression in Human Airway Smooth Muscle Cells (huASMC in Response to IL-4, GM-CSF, and IL-4/GM-CSF

    Directory of Open Access Journals (Sweden)

    Lew D Betty

    2005-05-01

    Full Text Available Abstract Background Airway smooth muscle cells play a key role in remodeling that contributes to airway hyperreactivity. Airway smooth muscle remodeling includes hypertrophy and hyperplasia. It has been previously shown that the expression of CD23 on ASMC in rabbits can be induced by the IgE component of the atopic serum. We examined if other components of atopic serum are capable of inducing CD23 expression independent of IgE. Methods Serum starved huASMC were stimulated with either IL-4, GM-CSF, IL-13, IL-5, PGD2, LTD4, tryptase or a combination of IL-4, IL-5, IL-13 each with GM-CSF for a period of 24 h. CD23 expression was analyzed by flow cytometry, western blot, and indirect immunofluorescence. Results The CD23 protein expression was upregulated in huASMC in response to IL-4, GM-CSF, and IL-4/GM-CSF. The percentage of cells with increased fluorescence intensity above the control was 25.1 ± 4.2% (IL-4, 15.6 ± 2.7% (GM-CSF and 32.9 ± 13.9% (IL-4/GMCSF combination(n = 3. The protein content of IL-4/GMCSF stimulated cells was significantly elevated. Expression of CD23 in response to IL-4, GM-CSF, IL-4/GM-CSF was accompanied by changes in cell morphology including depolymerization of isoactin fibers, cell spreading, and membrane ruffling. Western blot revealed abundant expression of the IL-4Rα and a low level expression of IL-2Rγc in huASMC. Stimulation with IL-4 resulted in the phosphorylation of STAT-6 and an increase in the expression of the IL-2Rγc. Conclusion CD23 on huASMC is upregulated by IL-4, GM-CSF, and IL-4/GM-CSF. The expression of CD23 is accompanied by an increase in cell volume and an increase in protein content per cell, suggesting hypertrophy. Upregulation of CD23 by IL-4/GM-CSF results in phenotypic changes in huASMC that could play a role in cell migration or a change in the synthetic function of the cells. Upregulation of CD23 in huASMC by IL-4 and GM-CSF can contribute to changes in huASMC and may provide an avenue

  12. Prospective assessment of concomitant lumbar and chronic subdural hematoma: is migration from the intracranial space involved in their manifestation?

    Science.gov (United States)

    Kokubo, Rinko; Kim, Kyongsong; Mishina, Masahiro; Isu, Toyohiko; Kobayashi, Shiro; Yoshida, Daizo; Morita, Akio

    2014-02-01

    Spinal subdural hematomas (SDHs) are rare and some are concomitant with intracranial SDH. Their pathogenesis and etiology remain to be elucidated although their migration from the intracranial space has been suggested. The authors postulated that if migration plays a major role, patients with intracranial SDH may harbor asymptomatic lumbar SDH. The authors performed a prospective study on the incidence of spinal SDH in patients with intracranial SDH to determine whether migration is a key factor in their concomitance. The authors evaluated lumbar MR images obtained in 168 patients (125 males, 43 females, mean age 75.6 years) with intracranial chronic SDH to identify cases of concomitant lumbar SDH. In all cases, the lumbar MRI studies were performed within the 1st week after surgical irrigation of the intracranial SDH. Of the 168 patients, 2 (1.2%) harbored a concomitant lumbar SDH; both had a history of trauma to both the head and the hip and/or lumbar area. One was an 83-year-old man with prostate cancer and myelodysplastic syndrome who suffered trauma to his head and lumbar area in a fall from his bed. The other was a 70-year-old man who had hit his head and lumbar area in a fall. Neither patient manifested neurological deficits and their hematomas disappeared under observation. None of the patients with concomitant lumbar SDH had sustained head trauma only, indicating that trauma to the hip or lumbar region is significantly related to the concomitance of SDH (p < 0.05). As the incidence of concomitant lumbar and intracranial chronic SDH is rare and both patients in this study had sustained a direct impact to the head and hips, the authors suggest that the major mechanism underlying their concomitant SDH was double trauma. Another possible explanation is hemorrhagic diathesis and low CSF syndrome.

  13. Timing of CSF-1/CSF-1R signaling blockade is critical to improving responses to CTLA-4 based immunotherapy

    Science.gov (United States)

    Holmgaard, Rikke B.; Brachfeld, Alexandra; Gasmi, Billel; Jones, David R.; Mattar, Marissa; Doman, Thompson; Murphy, Mary; Schaer, David; Wolchok, Jedd D.; Merghoub, Taha

    2016-01-01

    ABSTRACT Colony stimulating factor-1 (CSF-1) is produced by a variety of cancers and recruits myeloid cells that suppress antitumor immunity, including myeloid-derived suppressor cells (MDSCs.) Here, we show that both CSF-1 and its receptor (CSF-1R) are frequently expressed in tumors from cancer patients, and that this expression correlates with tumor-infiltration of MDSCs. Furthermore, we demonstrate that these tumor-infiltrating MDSCs are highly immunosuppressive but can be reprogrammed toward an antitumor phenotype in vitro upon CSF-1/CSF-1R signaling blockade. Supporting these findings, we show that inhibition of CSF-1/CSF-1R signaling using an anti-CSF-1R antibody can regulate both the number and the function of MDSCs in murine tumors in vivo. We further find that treatment with anti-CSF-1R antibody induces antitumor T-cell responses and tumor regression in multiple tumor models when combined with CTLA-4 blockade therapy. However, this occurs only when administered after or concurrent with CTLA-4 blockade, indicating that timing of each therapeutic intervention is critical for optimal antitumor responses. Importantly, MDSCs present within murine tumors after CTLA-4 blockade showed increased expression of CSF-1R and were capable of suppressing T cell proliferation, and CSF-1/CSF-1R expression in the human tumors was not reduced after treatment with CTLA-4 blockade immunotherapy. Taken together, our findings suggest that CSF-1R-expressing MDSCs can be targeted to modulate the tumor microenvironment and that timing of CSF-1/CSF-1R signaling blockade is critical to improving responses to checkpoint based immunotherapy. Significance: Infiltration by immunosuppressive myeloid cells contributes to tumor immune escape and can render patients resistant or less responsive to therapeutic intervention with checkpoint blocking antibodies. Our data demonstrate that blocking CSF-1/CSF-1R signaling using a monoclonal antibody directed to CSF-1R can regulate both the number

  14. The influence of protein malnutrition on the production of GM-CSF and M-CSF by macrophages

    Directory of Open Access Journals (Sweden)

    Dalila Cunha de Oliveira

    Full Text Available ABSTRACT It is well established that protein malnutrition (PM impairs immune defenses and increases susceptibility to infection. Macrophages are cells that play a central role in innate immunity, constituting one of the first barriers against infections. Macrophages produce several soluble factors, including cytokines and growth factors, important to the immune response. Among those growth factors, granulocyte-macrophage colony-stimulating factor (GM-CSF and macrophage colony-stimulating factor (M-CSF. GM-CSF and M-CSF are important to monocyte and macrophage development and stimulation of the immune response process. Knowing the importance of GM-CSF and M-CSF, we sought to investigate the influence of PM on macrophage production of these growth factors. Two-month-old male BALB/c mice were subjected to PM with a low-protein diet (2% and compared to a control diet (12% mouse group. Nutritional status, hemogram and the number of peritoneal cells were evaluated. Additionally, peritoneal macrophages were cultured and the production of GM-CSF and M-CSF and mRNA expression were evaluated. To determine if PM altered macrophage production of GM-CSF and M-CSF, they were stimulated with TNF-α. The PM animals had anemia, leukopenia and a reduced number of peritoneal cells. The production of M-CSF was not different between groups; however, cells from PM animals, stimulated with or without TNF-α, presented reduced capability to produce GM-CSF. These data imply that PM interferes with the production of GM-CSF, and consequently would affect the production and maturation of hematopoietic cells and the immune response.

  15. Pivotal Roles of GM-CSF in Autoimmunity and Inflammation

    Science.gov (United States)

    Shiomi, Aoi; Usui, Takashi

    2015-01-01

    Granulocyte macrophage-colony stimulating factor (GM-CSF) is a hematopoietic growth factor, which stimulates the proliferation of granulocytes and macrophages from bone marrow precursor cells. In autoimmune and inflammatory diseases, Th17 cells have been considered as strong inducers of tissue inflammation. However, recent evidence indicates that GM-CSF has prominent proinflammatory functions and that this growth factor (not IL-17) is critical for the pathogenicity of CD4+ T cells. Therefore, the mechanism of GM-CSF-producing CD4+ T cell differentiation and the role of GM-CSF in the development of autoimmune and inflammatory diseases are gaining increasing attention. This review summarizes the latest knowledge of GM-CSF and its relationship with autoimmune and inflammatory diseases. The potential therapies targeting GM-CSF as well as their possible side effects have also been addressed in this review. PMID:25838639

  16. Endovascular treatment of intracranial aneurysms using liquid polymer injection

    International Nuclear Information System (INIS)

    Liu Jianmin; Huang Qinghai; Xu Yi; Hong Bo

    2004-01-01

    Objective: To report our preliminary clinical experience in embolization of intracranial aneurysms with liquid polymer (Onyx). Methods: One case of posterior communicating artery aneurysm was treated with Onyx and microcoils, while the other one with multiple basilar aneurysms was treated by Onyx combined with stent-coiling technique. Results: All the aneurysms were totally occluded with patency of parent arteries. There was no procedure-related complication. The patients recovered well during clinical follow-up for 3 months. The angiographic follow-up in one patient showed the result was stable and Onyx was totally apart from the flow in parent artery. Conclusions: Short-term result suggests that endovascular treatment of intracranial aneurysms with liquid polymer is safe and effective, however more experience is needed. (authors)

  17. Comparison of the Cerebrospinal Fluid (CSF) Toluidine Red Unheated Serum Test and the CSF Rapid Plasma Reagin Test with the CSF Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis among HIV-Negative Syphilis Patients in China

    Science.gov (United States)

    Zhu, Lin; Gu, Xin; Peng, Rui-Rui; Wang, Cuini; Gao, Zixiao; Gao, Ying; Shi, Mei; Guan, Zhifang; Seña, Arlene C.

    2014-01-01

    In this study, we aimed to investigate the performance of nontreponemal antibody tests in cerebrospinal fluid (CSF) specimens from syphilis patients. From September 2009 to September 2012, CSF specimens were collected at the Shanghai Skin Disease Hospital in Shanghai, China, from 1,132 syphilis patients without HIV infection, including 154 with symptomatic and 56 with asymptomatic neurosyphilis. All of the CSF specimens underwent testing with a rapid plasma reagin (RPR) test, an RPR-V (commercial RPR antigen diluted 1:2 in 10% saline) test, the toluidine red unheated serum test (TRUST), and the Venereal Disease Research Laboratory (VDRL) test. Specificities, sensitivities, positive predictive values (PPVs), negative predictive values (NPVs), and kappa values were calculated to determine the performances of the tests. We compared results of the CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST among patients with symptomatic and asymptomatic neurosyphilis who had reactive CSF-Treponema pallidum particle agglutination (TPPA) test results. Overall, the CSF-VDRL test was reactive in 261 patients (23.1%). There were no cases in which the CSF-VDRL was nonreactive and CSF-RPR, CSF-RPR-V, or CSF-TRUST was reactive. Agreement between the results of CSF-TRUST and CSF-RPR was almost perfect (κ = 0.861), with substantial agreement between the results of CSF-RPR and CSF-RPR-V (κ = 0.740). The sensitivities of CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST were 81.4%, 76.2%, 79.5%, and 76.2%, respectively. Compared to CSF-VDRL, CSF-RPR, CSF-RPR-V, and CSF-TRUST had comparable PPVs and NPVs. However, the specificity of CSF-VDRL (90.3%) was significantly lower than those of the other tests (92.7 to 93.4%). Therefore, CSF-RPR, CSF-RPR-V, and CSF-TRUST can be considered alternative tests for neurosyphilis diagnosis in HIV-negative populations, particularly when the CSF-VDRL is not available. PMID:24335955

  18. Characterization of lipoproteins in human and canine cerebrospinal fluid (CSF)

    International Nuclear Information System (INIS)

    Pitas, R.E.; Weisgraber, K.H.; Boyles, J.K.; Lee, S.; Mahley, R.W.

    1986-01-01

    Previously the authors demonstrated that rat brain astrocytes in vitro synthesize and secrete apo-E and possess apo-B,E(LDL) receptors. The apo-E secreted by astrocytes and apo-E in rat brain extracts differed from serum apo-E in two respects. Brain apo-E had a higher apparent molecular weight and a higher percentage of more acidic isoforms. To characterize further the apo-E within the central nervous system, apo-E in human and canine CSF was investigated. Compared to plasma apo-E, CSF apo-E had a higher apparent M/sub r/ and a higher percentage of acidic isoforms which were sialylated, as shown by neuraminidase digestion. The apo-E in human CSF was approx.5-10% of the plasma level. In CSF 60-80% of the apo-E was in lipoproteins with d = 1.09-1.15. The remainder of the apo-E was in the d > 1.21 fraction. Human CSF lipoproteins were primarily spherical (110-190 A) while canine CSF lipoproteins were a mixture of discs (205 x 65 A) while canine CSF lipoproteins were a mixture of discs (205 x 65 A) and spheres (100-150 A). The CSF also contained apo-AI in the d = 1.09-1.15 g/ml fraction. Human CSF lipoproteins containing both apo-E and apo-AI were isolated on an anti-apo-E affinity column, suggesting that apo-E and AI occurred in the same particles. The CSF apo-E-containing lipoproteins competed for binding of 125 I-LDL to the apo-B,E(LDL) receptor. There was no detectable apo-B in CSF. These data suggest that CSF lipoproteins might transport lipid and regulate lipid homeostasis within the brain

  19. Cilia driven flow networks in the brain

    Science.gov (United States)

    Wang, Yong; Faubel, Regina; Westendorf, Chrsitian; Eichele, Gregor; Bodenschatz, Eberhard

    Neurons exchange soluble substances via the cerebrospinal fluid (CSF) that fills the ventricular system. The walls of the ventricular cavities are covered with motile cilia that constantly beat and thereby induce a directional flow. We recently discovered that cilia in the third ventricle generate a complex flow pattern leading to partitioning of the ventricular volume and site-directed transport paths along the walls. Transient and daily recurrent alterations in the cilia beating direction lead to changes in the flow pattern. This has consequences for delivery of CSF components along the near wall flow. The contribution of this cilia-induced flow to overall CSF flow remains to be investigated. The state-of-art lattice Boltzmann method is adapted for studying the CFS flow. The 3D geometry of the third ventricle at high resolution was reconstructed. Simulation of CSF flow without cilia in this geometry confirmed that the previous idea about unidirectional flow does not explain how different components of CSF can be delivered to their various target sites. We study the contribution of the cilia-induced flow pattern to overall CSF flow and identify target areas for site-specific delivery of CSF-constituents with respect to the temporal changes.

  20. Epithelial GM-CSF induction by Candida glabrata.

    Science.gov (United States)

    Li, L; Dongari-Bagtzoglou, A

    2009-08-01

    The main cytokine induced by the interaction of oral epithelial cells with C. glabrata is granulocyte monocyte colony-stimulating factor (GM-CSF); however, the mechanisms regulating this response are unknown. Based on previously published information on the interactions of C. albicans with oral epithelial cells, we hypothesized that interaction with viable C. glabrata triggers GM-CSF synthesis via NF-kappaB activation. We found that C. glabrata-induced GM-CSF synthesis was adhesion-dependent, enhanced by endocytosis, and required fungal viability. NF-kappaB activation was noted during interaction of epithelial cells with C. glabrata, and pre-treatment with an NF-kappaB inhibitor partly inhibited GM-CSF synthesis. Blocking TLR4 with anti-TLR4 antibody did not inhibit GM-CSF production. In contrast, an anti-CDw17 antibody triggered significant inhibition of NF-kappaB activation and GM-CSF synthesis. beta-glucans did not stimulate GM-CSF synthesis, suggesting that the CDw17/NF-kappaB/GM-CSF pathway may be beta-glucan-independent. This study provides new insights into the mechanism of GM-CSF induction by C. glabrata.

  1. Occurrence of occult CSF leaks during standard FESS procedures.

    Science.gov (United States)

    Bucher, S; Kugler, A; Probst, E; Epprecht, L; Stadler, R S; Holzmann, D; Soyka, M B

    2018-03-18

    To determine the incidence of occult cerebrospinal fluid leaks (CSF) after functional endoscopic sinus surgery (FESS) and to evaluate the diagnostic performance of beta2-transferrin in blood-contaminated conditions. Prospective cohort study. An analysis of 57 intraoperative samples using hydrogel 6 beta2-transferrin assay after FESS was undertaken. In case of CSF positive samples and continuing rhinorrhea, reanalysis after more than 1 year was conducted. In-vivo analysis of a primary spontaneous CSF leak sample took place to verify difficulties in detecting beta2-transferrin in blood-contaminated settings. Own titrations were performed to evaluate detection limits of CSF by beta2-transferrin and beta-trace protein assays in these settings. An incidence of 13% for occult CSF leaks after FESS was found. In blood-contaminated conditions, routine beta2-transferrin assays showed low sensitivity. In over 1 year follow-up, all samples were negative for CSF and none of them developed clinical relevant CSF leaks or meningitis. Occult and clinically irrelevant CSF leaks do occur in a significant proportion of patients during and shortly after FESS. Intra- and postoperatively, routine beta2-transferrin assays show low sensitivity. They should not be used in these settings. The clinical course of patients with occult CSF leaks indicated possibility of an uneventful follow-up.

  2. Comparing the performance characteristics of CSF-TRUST and CSF-VDRL for syphilis: a cross-sectional study

    OpenAIRE

    Gu, Weiming; Yang, Yang; Wu, Lei; Yang, Sheng; Ng, Lai-King

    2013-01-01

    Objective In this study, we aimed to determine the performance characteristics of toluidine red unheated serum test on cerebrospinal fluids (CSF-TRUST) as compared to venereal disease research laboratory test on cerebrospinal fluids (CSF-VDRL) for laboratory the diagnosis of neurosyphilis. Design A cross-sectional study. Setting Sexually transmitted infections (STIs) clinics. Participants and methods CSF and serum samples were collected from 824 individual STD clinic patients who have syphili...

  3. PATHOGENESIS OF OPTIC DISC EDEMA IN RAISED INTRACRANIAL PRESSURE

    Science.gov (United States)

    Hayreh, Sohan Singh

    2015-01-01

    Optic disc edema in raised intracranial pressure was first described in 1853. Ever since, there has been a plethora of controversial hypotheses to explain its pathogenesis. I have explored the subject comprehensively by doing basic, experimental and clinical studies. My objective was to investigate the fundamentals of the subject, to test the validity of the previous theories, and finally, based on all these studies, to find a logical explanation for the pathogenesis. My studies included the following issues pertinent to the pathogenesis of optic disc edema in raised intracranial pressure: the anatomy and blood supply of the optic nerve, the roles of the sheath of the optic nerve, of the centripetal flow of fluids along the optic nerve, of compression of the central retinal vein, and of acute intracranial hypertension and its associated effects. I found that, contrary to some previous claims, an acute rise of intracranial pressure was not quickly followed by production of optic disc edema. Then, in rhesus monkeys, I produced experimentally chronic intracranial hypertension by slowly increasing in size space-occupying lesions, in different parts of the brain. Those produced raised cerebrospinal fluid pressure (CSFP) and optic disc edema, identical to those seen in patients with elevated CSFP. Having achieved that, I investigated various aspects of optic disc edema by ophthalmoscopy, stereoscopic color fundus photography and fluorescein fundus angiography, and light microscopic, electron microscopic, horseradish peroxidase and axoplasmic transport studies, and evaluated the effect of opening the sheath of the optic nerve on the optic disc edema. This latter study showed that opening the sheath resulted in resolution of optic disc edema on the side of the sheath fenestration, in spite of high intracranial CSFP, proving that a rise of CSFP in the sheath was the essential pre-requisite for the development of optic disc edema. I also investigated optic disc edema with

  4. Stereotactic intracranial radiotherapy: Dose prescription

    International Nuclear Information System (INIS)

    Schlienger, M.; Lartigau, E.; Nataf, F.; Mornex, F.; Latorzeff, I.; Lisbona, A.; Mahe, M.

    2012-01-01

    The aim of this article was the study of the successive steps permitting the prescription of dose in stereotactic intracranial radiotherapy, which includes radiosurgery and fractionated stereotactic radiotherapy. The successive steps studied are: the choice of stereotactic intracranial radiotherapy among the therapeutic options, based on curative or palliative treatment intent, then the selection of lesions according to size/volume, pathological type and their number permitting the choice between radiosurgery or fractionated stereotactic radiotherapy, which have the same methodological basis. Clinical experience has determined the level of dose to treat the lesions and limit the irradiation of healthy adjacent tissues and organs at risk structures. The last step is the optimization of the different parameters to obtain a safe compromise between the lesion dose and healthy adjacent structures. Study of dose-volume histograms, coverage indices and 3D imaging permit the optimization of irradiation. For lesions close to or included in a critical area, the prescribed dose is planned using the inverse planing method. Implementation of the successively described steps is mandatory to insure the prescription of an optimized dose. The whole procedure is based on the delineation of the lesion and adjacent healthy tissues. There are sometimes difficulties to assess the delineation and the volume of the target, however improvement of local control rates and reduction of secondary effects are the proof that the totality of the successive procedures are progressively improved. In practice, stereotactic intracranial radiotherapy is a continually improved treatment method, which constantly benefits from improvements in the choice of indications, imaging, techniques of irradiation, planing/optimization methodology and irradiation technique and from data collected from prolonged follow-up. (authors)

  5. Postoperative radiotherapy for intracranial meningioma

    International Nuclear Information System (INIS)

    Chun, Ha Chung; Lee, Myung Za

    2001-01-01

    To evaluate the effectiveness and tolerance of postoperative external radiotherapy for patients with intracranial meningiomas. The records of thirty three patients with intracranial meningiomas who were treated with postoperative external irradiation at our institution between Feb, 1988 and Nov, 1999 were retrospectively analyzed. Median age of patients at diagnosis was 53 years with range of 17 to 68 years. Sites of involvement were parasagital, cerebral convexity, sphenoid ridge, parasellar and tentorium cerebella. Of 33 evaluated patients, 15 transitional, 10 meningotheliomatous, 4 hemangiopericytic, 3 atypical and 1 malignant meningioma were identified. Four patients underwent biopsy alone and remaining 29 patients underwent total tumor resection. A dose of 50 to 60 Gy was delivered in 28-35 daily fractions over a period of 5 to 7 weeks. Follow-up period ranged from 12 months to 8 years. The actuarial survival rates at 5 and 7 years for entire group of patients were 78% and 67%, respectively. The corresponding disease free survival rates were 73% and 61 %, respectively. The overall local control rate at 5 years was 83%. One out of 25 patients in benign group developed local failure, while 4 out of 8 patients in malignant group did local failure (p <0.05), Of 4 patients who underwent biopsy alone, 2 developed local failure. There was no significant difference in 5 year actuarial survival between patients who underwent total tumor resection and those who did biopsy alone. Patients whose age is under 60 showed slightly better survival than those whose age is 60 or older, although this was not statistically significant. There was no documented late complications in any patients. Based on our study, we might conclude that postoperative external beam radiotherapy tends to improve survival of patients with intracranial meningiomas comparing with surgery alone

  6. Microoptomechanical sensor for intracranial pressure monitoring

    International Nuclear Information System (INIS)

    Andreeva, A V; Luchinin, V V; Lutetskiy, N A; Sergushichev, A N

    2014-01-01

    The main idea of this research is the development of microoptomechanical sensor for intracranial pressure monitoring. Currently, the authors studied the scientific and technical knowledge in this field, as well as develop and test a prototype of microoptomechanical sensor for intracranial pressure (ICP) monitoring

  7. MRI of intracranial meningeal malignant fibrous histiocytoma

    International Nuclear Information System (INIS)

    Ogino, A.; Ochi, M.; Hayashi, K.; Hirata, K.; Hayashi, T.; Yasunaga, A.; Shibata, S.

    1996-01-01

    We describe the CT and MRI findings in a patient with primary intracranial meningeal malignant fibrous histiocytoma (MFH). CT delineated the anatomical relations and MRI aided in tissue characterisation. To our knowledge, this is the first report describing the MRI findings in primary intracranial meningeal MFH. (orig.). With 1 fig

  8. Ultrasonographic Findings of Fetal Congenital Intracranial Teratoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hak Jong [Seoul National University College of Medicine, Seoul (Korea, Republic of); Lee, Young Ho; Song, Mi Jin; Cho, Jeong Yeon; Min, Jee Yeon; Moon, Min Hwan; Kim, Jeong Ah [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2005-06-15

    To evaluate the sonographic findings of fetal congenital intracranial teratoma. From 1994 to 2002, of the 11 fetuses which had been diagnosed with fetal intracranial tumors after second level fetal ultrasonography, the six that were confirmed after autopsy as congenital intracranial teratomas were included in our study. The sonographic findings, including size, homogeneity, echogenicity compared with surrounding normal brain tissues, cystic components, and tumor related calcification, were retrospectively evaluated. The incidence of fetal congenital intracranial teratoma out of all fetal intracranial tumors was 54.5% (6 of 11 cases) during the 8-year period. The mean mass size was 7.4 cm (3.0-15.0 cm). Two thirds of (4/6) of the teratoma cases showed high echogenicity compared with normal brain tissues, and two thirds (4/6) showed heterogeneous echogenicity. Four teratoma cases (67%) showed cysts in the mass with a mean size of 1.9cm. One third (2/6) showed calcifications within the tumor. Out of the six cases, two had oropharyngeal teratoma with extension into the intracranial portion (so called epignathus) and showed homogenous mass without any cysts or calcifications. The typical sonographic appearance of intracranial teratoma was a heterogeneous, hyperechoic mass with cysts. In the epignathus cases, the sonographic appearances differed somewhat from the others. An understanding of the sonographic findings of fetal intracranial teratoma will help in the timely counseling of the parents and in obstetric decision making

  9. Intracranial alveolar echinococcosis: CT and MRI

    Energy Technology Data Exchange (ETDEWEB)

    Bensaid, A.H. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Dietemann, J.L. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Filippi de la Palavesa, M.M. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Klinkert, A. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Kastler, B. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Gangi, A. (Dept. of Radiology B, Univ. Hospital, Strasbourg (France)); Jacquet, G. (Dept. of Neurosurgery, Univ. Hospital, Besancon (France)); Cattin, F. (Dept. of Radiology, Univ. Hospital, Besancon (France))

    1994-05-01

    Intracranial alveolar echinococcosis is uncommon. We report a patient with right frontal lobe and palpebral lesions secondary to a primary hepatic focus with secondary lesion in the lung. The intracranial and palpebral cystic masses were totally removed and both proved to be alveolar hydatid cysts. An unusual feature in this case is CT and MRI demonstration of dural and bony extension. (orig.)

  10. Acute surgical management in idiopathic intracranial hypertension.

    LENUS (Irish Health Repository)

    Zakaria, Zaitun

    2012-01-01

    Idiopathic intracranial hypertension is a headache syndrome with progressive symptoms of raised intracranial pressure. Most commonly, it is a slow process where surveillance and medical management are the main treatment modalities. We describe herein an acute presentation with bilateral sixth nerve palsies, papilloedema and visual deterioration, where acute surgical intervention was a vision-saving operation.

  11. Intracranial alveolar echinococcosis: CT and MRI

    International Nuclear Information System (INIS)

    Bensaid, A.H.; Dietemann, J.L.; Filippi de la Palavesa, M.M.; Klinkert, A.; Kastler, B.; Gangi, A.; Jacquet, G.; Cattin, F.

    1994-01-01

    Intracranial alveolar echinococcosis is uncommon. We report a patient with right frontal lobe and palpebral lesions secondary to a primary hepatic focus with secondary lesion in the lung. The intracranial and palpebral cystic masses were totally removed and both proved to be alveolar hydatid cysts. An unusual feature in this case is CT and MRI demonstration of dural and bony extension. (orig.)

  12. Traumatic and alternating delayed intracranial hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-11-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

  13. Traumatic and alternating delayed intracranial hematomas

    International Nuclear Information System (INIS)

    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-01-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma. (orig.)

  14. Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift

    Directory of Open Access Journals (Sweden)

    Joji Inamasu

    2015-04-01

    Full Text Available Spontaneous intracranial hypotension (SIH is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the characteristic radiographic findings in such cases is the presence of bilateral accumulation of subdural fluid (hematoma/hygroma. When SIH-related subdural hematoma is present only unilaterally with a concomitant midline shift, making an accurate diagnosis may be challenging, and inadvertent hematoma evacuation may result in further neurologic deterioration. We report a 58-year-old woman with an altered mental status who had visited a local hospital and in whom a brain CT showed a unilateral subdural hematoma with a marked midline shift. She was referred to our department because of her neurologic deterioration after hematoma evacuation. A CT myelography revealed a massive CSF leakage in the entire thoracic epidural space. She made a full neurologic recovery following blood patch therapy. Our case is unique and educational because the suspicion for SIH as an underlying cause of subdural hematoma is warranted in nongeriatric patients not only with bilateral but also unilateral lesions. An immediate search for CSF leakage may be important in cases with failed hematoma evacuation surgery.

  15. Intracranial metastases: spectrum of MR imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Kyoung; Lee, Eun Ja; Lee, Yong Seok [Department of Radiology, Dongguk University Ilsan Hospital, Goyang-shi (Korea, Republic of)], E-mail: ejl1048@hanmail.net; Kim, Mi Sung; Park, No Hyuck [Department of Radiology, Kwandong University, College of Medicine, Myongji Hospital, Goyang-shi (Korea, Republic of); Park, Hee-Jin [Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); II, Sung Park [Department of Diagnostic Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2012-12-15

    Intracranial metastatic lesions arise through a number of routes. Therefore, they can involve any part of the central nervous system and their imaging appearances vary. Magnetic resonance imaging (MRI) plays a key role in lesion detection, lesion delineation, and differentiation of metastases from other intracranial disease processes. This article is a reasoned pictorial review illustrating the many faces of intracranial metastatic lesions based on the location - intra-axial metastases, calvarial metastases, dural metastases, leptomeningeal metastases, secondary invasion of the meninges by metastatic disease involving the calvarium and skull base, direct or perineural intracranial extension of head and neck neoplasm, and other unusual manifestations of intracranial metastases. We also review the role of advanced MRI to distinguish metastases from high-grade gliomas, tumor-mimicking lesions such as brain abscesses, and delayed post-radiation changes in radiosurgically treated patients.

  16. The effect of CSF-1 administration on lung maturation in a mouse model of neonatal hyperoxia exposure.

    Science.gov (United States)

    Jones, Christina V; Alikhan, Maliha A; O'Reilly, Megan; Sozo, Foula; Williams, Timothy M; Harding, Richard; Jenkin, Graham; Ricardo, Sharon D

    2014-09-06

    Lung immaturity due to preterm birth is a significant complication affecting neonatal health. Despite the detrimental effects of supplemental oxygen on alveolar formation, it remains an important treatment for infants with respiratory distress. Macrophages are traditionally associated with the propagation of inflammatory insults, however increased appreciation of their diversity has revealed essential functions in development and regeneration. Macrophage regulatory cytokine Colony-Stimulating Factor-1 (CSF-1) was investigated in a model of neonatal hyperoxia exposure, with the aim of promoting macrophages associated with alveologenesis to protect/rescue lung development and function. Neonatal mice were exposed to normoxia (21% oxygen) or hyperoxia (Hyp; 65% oxygen); and administered CSF-1 (0.5 μg/g, daily × 5) or vehicle (PBS) in two treatment regimes; 1) after hyperoxia from postnatal day (P)7-11, or 2) concurrently with five days of hyperoxia from P1-5. Lung structure, function and macrophages were assessed using alveolar morphometry, barometric whole-body plethysmography and flow cytometry. Seven days of hyperoxia resulted in an 18% decrease in body weight and perturbation of lung structure and function. In regime 1, growth restriction persisted in the Hyp + PBS and Hyp + CSF-1 groups, although perturbations in respiratory function were resolved by P35. CSF-1 increased CSF-1R+/F4/80+ macrophage number by 34% at P11 compared to Hyp + PBS, but was not associated with growth or lung structural rescue. In regime 2, five days of hyperoxia did not cause initial growth restriction in the Hyp + PBS and Hyp + CSF-1 groups, although body weight was decreased at P35 with CSF-1. CSF-1 was not associated with increased macrophages, or with functional perturbation in the adult. Overall, CSF-1 did not rescue the growth and lung defects associated with hyperoxia in this model; however, an increase in CSF-1R+ macrophages was not associated with an

  17. Computed tomography in the CSF seeding of brain tumors

    International Nuclear Information System (INIS)

    Nakagawa, Yoshio; Fujimoto, Masahito; Naruse, Shoji; Ueda, Satoshi; Hirakawa, Kimiyoshi

    1981-01-01

    In the past three years nine cases of brain tumors with CSF seeding have been revealed by computed tomography (CT). We have been analyzing the CT pattern of CSF seeding, CSF cytology, and spinal metastasis. The brain tumors were classified as follows: five medulloblastomas, two glioblastomas, one germinoma, and one meningeal carcinomatosis. Their CT patterns were divided into three groups: 1) diffuse seeding of the basal cisterns. 2) invasion of the ventricular wall. 3) solitary metastasis in the ventricle. The subarachnoid seeding included four medulloblastomas and one meningeal carcinomatosis. The second type of seeding included two glioblastomas and one germinoma. One medulloblastoma had a single metastasis in the lateral ventricle. In the medulloblastomas, the diffuse seeding of the basal cisterns was more common than the invasion of the ventricular wall or solitary metastasis in the ventricle. Medulloblastomas were also accompanied by spinal metastasis. Because there were many cases of spinal metastasis in the first type of seeding, we concluded that there was a definite correlation between the CSF seeding of the basal cisterns and spinal metastasis. Needless to say, CT was the most important method for the diagnosis of the CSF seeding of brain tumors. However, because there was a case of CSF seeding which had not been demonstrated by CT, we also emphasized the importance of neurological examination and CSF cytology in the diagnosis of the CSF seeding of brain tumors. (author)

  18. MR phase imaging and cerebrospinal fluid flow in the head and spine

    International Nuclear Information System (INIS)

    Levy, L.M.; Di Chiro, G.

    1990-01-01

    Motion of the cerebrospinal fluid (CSF) in and around the brain spinal cord was examined in healthy subjects and in a number of patients with abnormalities of the CSF circulation. The pulsatile motion of the CSF was determined by spin echo phase (velocity) imaging, sometimes in combination with gradient echo phase contrast cine. Differences in flow patterns across CSF spaces were observed: Flow reversal in the cerebellomedullary cistern and lumbar area relative to cervical CSF, and in the posterior versus the anterior subarachnoid space in the spinal canal. Flow communication was demonstrated in known communicating cysts or cavities. Differences in flow were also noted across spinal narrowing or block, and across the walls of a variety of cystic lesions in the brain and spinal cord. MR phase imaging of CSF flow provides pathophysiological information of potential clinical importance for the assessment of diseases affecting the CSF circulation. (orig.)

  19. Desmopressin Acetate in Intracranial Haemorrhage

    Directory of Open Access Journals (Sweden)

    Thomas Kapapa

    2014-01-01

    Full Text Available Introduction. The secondary increase in the size of intracranial haematomas as a result of spontaneous haemorrhage or trauma is of particular relevance in the event of prior intake of platelet aggregation inhibitors. We describe the effect of desmopressin acetate as a means of temporarily stabilising the platelet function. Patients and Methods. The platelet function was analysed in 10 patients who had received single (N=4 or multiple (N=6 doses of acetylsalicylic acid and 3 patients (control group who had not taken acetylsalicylic acid. All subjects had suffered intracranial haemorrhage. Analysis was performed before, half an hour and three hours after administration of desmopressin acetate. Statistical analysis was performed by applying a level of significance of P≤0.05. Results. (1 Platelet function returned to normal 30 minutes after administration of desmopressin acetate. (2 The platelet function worsened again after three hours. (3 There were no complications related to electrolytes or fluid balance. Conclusion. Desmopressin acetate can stabilise the platelet function in neurosurgical patients who have received acetylsalicylic acid prior to surgery without causing transfusion-related side effects or a loss of time. The effect is, however, limited and influenced by the frequency of drug intake. Further controls are needed in neurosurgical patients.

  20. Management of intracranial arteriovenous malformations

    International Nuclear Information System (INIS)

    Miyamoto, Susumu; Takahashi, Jun C.

    2008-01-01

    Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into presurgical embolization in large AVMs to occlude deep arterial feeding vessels and embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon. (author)

  1. Management of intracranial arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Susumu; Takahashi, Jun C [National Cardiovascular Center, Suita, Osaka (Japan)

    2008-10-15

    Intracranial arteriovenous malformations (AVMs) are congenital lesions that can cause serious neurological deficits or even death. They can manifest as intracranial hemorrhage, epileptic seizure, or other symptoms such as headache or tinnitus. They are detected by computed tomography or magnetic resonance imaging. Recently there have been significant developments in the management of AVMs. In this paper, the authors represent an overview of the epidemiology of AVMs and the existing treatment strategies. AVMs are ideally excised by standard microsurgical techniques. The grading scale which was proposed by Spetzler and Martin is widely used to estimate the risk of direct surgery. Stereotactic radiosurgery such as that using a gamma knife is very useful for small lesions located in eloquent areas. Technological advances in endovascular surgery have provided new alternatives in the treatment of AVMs. Currently indications for embolization can be divided into presurgical embolization in large AVMs to occlude deep arterial feeding vessels and embolization before stereotactic radiosurgery to reduce the size of the nidus. Palliative embolization can be also applied for patients with large, inoperable AVMs who are suffering from progressive neurological deficits secondary to venous hypertension and/or arterial steal phenomenon. (author)

  2. [Therapeutic use of hematopoietic growth factors. II. GM-CSF and G-CSF].

    Science.gov (United States)

    Royer, B; Arock, M

    1998-01-01

    The second part of this review on haematopoietic growth factors is focused on the therapeutic use of GM-CSF and G-CSF. Such therapeutic applications have raised very great hopes for clinical haematology. However, it should not be forgotten that these haematopoietic growth factors, which are very costly, are powerful two-edged weapons capable of triggering a cascade of reactions, and have a field of activity that often goes beyond the single highly specific property which it is hoped they possess. The risks and costs of their use are currently being evaluated. Waited developments concerning these molecules focus on three axes: a best use of factors already commercialized, especially concerning adaptation of posologies and new indications, the development of hybrid molecules from already known haematopoietic growth factors, possessing the advantages of respective factors, but not their disadvantages, the discovery of new haematopoietic growth factors with potential therapeutic application.

  3. Non-invasive assessment of pulsatile intracranial pressure with phase-contrast magnetic resonance imaging.

    Directory of Open Access Journals (Sweden)

    Geir Ringstad

    Full Text Available Invasive monitoring of pulsatile intracranial pressure can accurately predict shunt response in patients with idiopathic normal pressure hydrocephalus, but may potentially cause complications such as bleeding and infection. We tested how a proposed surrogate parameter for pulsatile intracranial pressure, the phase-contrast magnetic resonance imaging derived pulse pressure gradient, compared with its invasive counterpart. In 22 patients with suspected idiopathic normal pressure hydrocephalus, preceding invasive intracranial pressure monitoring, and any surgical shunt procedure, we calculated the pulse pressure gradient from phase-contrast magnetic resonance imaging derived cerebrospinal fluid flow velocities obtained at the upper cervical spinal canal using a simplified Navier-Stokes equation. Repeated measurements of the pulse pressure gradient were also undertaken in four healthy controls. Of 17 shunted patients, 16 responded, indicating high proportion of "true" normal pressure hydrocephalus in the patient cohort. However, there was no correlation between the magnetic resonance imaging derived pulse pressure gradient and pulsatile intracranial pressure (R = -.18, P = .43. Pulse pressure gradients were also similar in patients and healthy controls (P = .26, and did not differ between individuals with pulsatile intracranial pressure above or below established thresholds for shunt treatment (P = .97. Assessment of pulse pressure gradient at level C2 was therefore not found feasible to replace invasive monitoring of pulsatile intracranial pressure in selection of patients with idiopathic normal pressure hydrocephalus for surgical shunting. Unlike invasive, overnight monitoring, the pulse pressure gradient from magnetic resonance imaging comprises short-term pressure fluctuations only. Moreover, complexity of cervical cerebrospinal fluid flow and -pulsatility at the upper cervical spinal canal may render the pulse pressure gradient a poor surrogate

  4. Human autologous in vitro models of glioma immunogene therapy using B7-2, GM-CSF, and IL12

    International Nuclear Information System (INIS)

    Parney, I.F.; Farr-Jones, M.A.; Kane, K.; Chang, L.-J.; Petruk, K.C.

    2002-01-01

    Cancer immunogene therapy is based on vaccination with radiated, autologous tumor cells transduced with immunostimulatory genes. To help determine an optimal glioma immunogene therapy strategy, we stimulated lymphocytes with autologous human glioma cells transduced with B7-2 (CD86), granulocyte-macrophage colony-stimulating factor (GM-CSF), and/or interleukin-12 (IL12). A human glioma-derived cell culture (Ed147.BT) was transduced with B7-2, GM-CSF, and/or IL12 using retroviral vectors. Autologous peripheral blood mononuclear cells (PBMC) were co-cultured with irradiated gene-transduced tumor alone or a combination of radiated wild type and gene-transduced cells. Peripheral blood mononuclear cells proliferation was determined by serial cell counts. Peripheral blood mononuclear cells phenotype was assessed by flow cytometry for CD4, CD8, and CD16. Anti-tumor cytotoxicity was determined by chromium-51 ( 51 Cr) release assay. Peripheral blood mononuclear cells cell numbers all decreased during primary stimulation but tumor cells expressing B7-2 or GM-CSF consistently caused secondary proliferation. Tumors expressing B7-2 and GM-CSF or B7-2,GM-CSF,and IL12 consistently increased PBMC CD8+ (cytotoxic T) and CD16+ (natural killer) percentages. Interestingly, anti-tumor cytotoxicity only exceeded that of PBMC stimulated with wild type tumor alone when peripheral blood mononuclear cells were stimulated with both wild type tumor and B7-2/GM-CSF- (but not IL12) transduced cells. PBMC proliferation and phenotype is altered as expected by exposure to immunostimulatory gene-transduced tumor. However, transduced tumor cells alone do not stimulate greater anti-tumor cytotoxicity than wild type tumor. Only B7-2/GM-CSF-transduced cells combined with wild type produced increased cytotoxicity. This may reflect selection of turnor subclones with limited antigenic spectra during retrovirus-mediated gene transfer. (author)

  5. The pathway of subarachnoid CSF moving into the spinal parenchyma and the role of astrocytic aquaporin-4 in this process.

    Science.gov (United States)

    Wei, Fang; Zhang, Cui; Xue, Rong; Shan, Lidong; Gong, Shan; Wang, Guoqing; Tao, Jin; Xu, Guangyin; Zhang, Guoxing; Wang, Linhui

    2017-08-01

    It has been proved that cerebrospinal fluid (CSF) in the subarachnoid space could reenter the brain parenchyma via the perivascular space. The present study was designed to explore the pathway of subarachnoid CSF flux into the spinal cord and the potential role of aquaporin-4 (AQP4) in this process. Fluorescently tagged cadaverine, for the first time, was used to study CSF movement in mice. Following intracisternal infusion of CSF tracers, the cervical spinal cord was sliced and prepared for fluorescence imaging. Some sections were subject with immunostaining in order to observe tracer distribution and AQP4 expression. Fluorescently tagged cadaverine rapidly entered the spinal cord. Tracer influx into the spinal parenchyma was time dependent. At 10min post-infusion, cadaverine was largely distributed in the superficial tissue adjacent to the pial surface. At 70min post-infusion, cadaverine was distributed in the whole cord and especially concentrated in the gray matter. Furthermore, fluorescent tracer could enter the spinal parenchyma either along the perivascular space or across the pial surface. AQP4 was observed highly expressed in the astrocytic endfeet surrounding blood vessels and the pial surface. Blocking AQP4 by its specific inhibitor TGN-020 strikingly reduced the inflow of CSF tracers into the spinal cord. Subarachnoid CSF could flow into the spinal cord along the perivascular space or across the pial surface, in which AQP4 is involved. Our observation provides a basis for the study on CSF movement in the spinal cord when some neurological diseases occur. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. G-CSF treatment after myocardial infarction: impact on bone marrow-derived vs cardiac progenitor cells.

    Science.gov (United States)

    Brunner, Stefan; Huber, Bruno C; Fischer, Rebekka; Groebner, Michael; Hacker, Marcus; David, Robert; Zaruba, Marc-Michael; Vallaster, Marcus; Rischpler, Christoph; Wilke, Andrea; Gerbitz, Armin; Franz, Wolfgang-Michael

    2008-06-01

    Besides its classical function in the field of autologous and allogenic stem cell transplantation, granulocyte colony-stimulating factor (G-CSF) was shown to have protective effects after myocardial infarction (MI) by mobilization of bone marrow-derived progenitor cells (BMCs) and in addition by activation of multiple signaling pathways. In the present study, we focused on the impact of G-CSF on migration of BMCs and the impact on resident cardiac cells after MI. Mice (C57BL/6J) were sublethally irradiated, and BM from green fluorescent protein (GFP)-transgenic mice was transplanted. Coronary artery ligation was performed 10 weeks later. G-CSF (100 microg/kg) was daily injected for 6 days. Subpopulations of enhanced GFP(+) cells in peripheral blood, bone marrow, and heart were characterized by flow cytometry. Growth factor expression in the heart was analyzed by quantitative real-time polymerase chain reaction. Perfusion was investigated in vivo by gated single photon emission computed tomography (SPECT). G-CSF-treated animals revealed a reduced migration of c-kit(+) and CXCR-4(+) BMCs associated with decreased expression levels of the corresponding growth factors, namely stem cell factor and stromal-derived factor-1 alpha in ischemic myocardium. In contrast, the number of resident cardiac Sca-1(+) cells was significantly increased. However, SPECT-perfusion showed no differences in infarct size between G-CSF-treated and control animals 6 days after MI. Our study shows that G-CSF treatment after MI reduces migration capacity of BMCs into ischemic tissue, but increases the number of resident cardiac cells. To optimize homing capacity a combination of G-CSF with other agents may optimize cytokine therapy after MI.

  7. Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

    NARCIS (Netherlands)

    Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C.; Khoury, Nabil; Hadi, Christiane M.; van der Ende, Arie; Wootton, Susan H.; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

    2013-01-01

    We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193)

  8. GM-CSF, IL-3 and G-CSF receptors on acute myeloid leukemia cells : function, regulation of expression, and ligand binding characteristics

    NARCIS (Netherlands)

    L.M. Budel (Leo)

    1993-01-01

    textabstractIL-3, GM-CSF and G-CSF stimulate proliferation of human acute myeloid leukemia in vitro, but patterns of response among clinical cases are diverse. As described in Chapters 2 and 3, numbers and affinity of IL-3, GM-CSF and G-CSF receptors on cells of patients with AML were assessed and

  9. Stem Cell Mobilization with G-CSF versus Cyclophosphamide plus G-CSF in Mexican Children.

    Science.gov (United States)

    Meraz, José Eugenio Vázquez; Arellano-Galindo, José; Avalos, Armando Martínez; Mendoza-García, Emma; Jiménez-Hernández, Elva

    2016-01-01

    Fifty-six aphaereses were performed in 23 pediatric patients with malignant hematological and solid tumors, following three different protocols for PBPC mobilization and distributed as follows: A: seventeen mobilized with 4 g/m(2) of cyclophosphamide (CFA) and 10 μg/kg/day of granulocyte colony stimulating factor (G-CSF), B: nineteen with CFA + G-CSF, and C: twenty only with G-CSF when the WBC count exceeded 10 × 10(9)/L. The average number of MNC/kg body weight (BW)/aphaeresis was 0.4 × 10(8) (0.1-1.4), 2.25 × 10(8) (0.56-6.28), and 1.02 × 10(8) (0.34-2.5) whereas the average number of CD34+ cells/kg BW/aphaeresis was 0.18 × 10(6)/kg (0.09-0.34), 1.04 × 10(6) (0.19-9.3), and 0.59 × 10(6) (0.17-0.87) and the count of CFU/kg BW/aphaeresis was 1.11 × 10(5) (0.31-2.12), 1.16 × 10(5) (0.64-2.97), and 1.12 × 10(5) (0.3-6.63) in groups A, B, and C, respectively. The collection was better in group B versus group A (p = 0.007 and p = 0.05, resp.) and in group C versus group A (p = 0.08 and p = 0.05, resp.). The collection of PBPCs was more effective in the group mobilized with CFM + G-CSF when the WBC exceeded 10 × 10(3)/μL in terms of MNC and CD34+ cells and there was no toxicity of the chemotherapy.

  10. Stem Cell Mobilization with G-CSF versus Cyclophosphamide plus G-CSF in Mexican Children

    Directory of Open Access Journals (Sweden)

    José Eugenio Vázquez Meraz

    2016-01-01

    Full Text Available Fifty-six aphaereses were performed in 23 pediatric patients with malignant hematological and solid tumors, following three different protocols for PBPC mobilization and distributed as follows: A: seventeen mobilized with 4 g/m2 of cyclophosphamide (CFA and 10 μg/kg/day of granulocyte colony stimulating factor (G-CSF, B: nineteen with CFA + G-CSF, and C: twenty only with G-CSF when the WBC count exceeded 10 × 109/L. The average number of MNC/kg body weight (BW/aphaeresis was 0.4 × 108 (0.1–1.4, 2.25 × 108 (0.56–6.28, and 1.02 × 108 (0.34–2.5 whereas the average number of CD34+ cells/kg BW/aphaeresis was 0.18 × 106/kg (0.09–0.34, 1.04 × 106 (0.19–9.3, and 0.59 × 106 (0.17–0.87 and the count of CFU/kg BW/aphaeresis was 1.11 × 105 (0.31–2.12, 1.16 × 105 (0.64–2.97, and 1.12 × 105 (0.3–6.63 in groups A, B, and C, respectively. The collection was better in group B versus group A (p=0.007 and p=0.05, resp. and in group C versus group A (p=0.08 and p=0.05, resp.. The collection of PBPCs was more effective in the group mobilized with CFM + G-CSF when the WBC exceeded 10 × 103/μL in terms of MNC and CD34+ cells and there was no toxicity of the chemotherapy.

  11. The circulation of the cerebrospinal fluid (CSF) in the spinal canal

    Science.gov (United States)

    Sanchez, Antonio L.; Martinez-Bazan, Carlos; Lasheras, Juan C.

    2016-11-01

    Cerebrospinal Fluid (CSF) is secreted in the choroid plexus in the lateral sinuses of the brain and fills the subarachnoid space bathing the external surfaces of the brain and the spinal canal. Absence of CSF circulation has been shown to impede its physiological function that includes, among others, supplying nutrients to neuronal and glial cells and removing the waste products of cellular metabolism. Radionuclide scanning images published by Di Chiro in 1964 showed upward migration of particle tracers from the lumbar region of the spinal canal, thereby suggesting the presence of an active bulk circulation responsible for bringing fresh CSF into the spinal canal and returning a portion of it to the cranial vault. However, the existence of this slow moving bulk circulation in the spinal canal has been a subject of dispute for the last 50 years. To date, there has been no physical explanation for the mechanism responsible for the establishment of such a bulk motion. We present a perturbation analysis of the flow in an idealized model of the spinal canal and show how steady streaming could be responsible for the establishment of such a circulation. The results of this analysis are compared to flow measurements conducted on in-vitro models of the spinal canal of adult humans.

  12. Variability of CSF Alzheimer's disease biomarkers: implications for clinical practice.

    Directory of Open Access Journals (Sweden)

    Stephanie J B Vos

    Full Text Available BACKGROUND: Cerebrospinal fluid (CSF biomarkers are increasingly being used for diagnosis of Alzheimer's disease (AD. OBJECTIVE: We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. METHODS: We measured CSF amyloid-β (Aβ 1-42, total tau (t-tau, and phosphorylated tau (p-tau by INNOTEST enzyme-linked-immunosorbent assays (ELISA in a memory clinic population (n = 126. Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. RESULTS: CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. CONCLUSIONS: Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.

  13. Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

    Science.gov (United States)

    ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

    2018-01-01

    A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

  14. Functional changes in CSF volume estimated using measurement of water T2 relaxation

    NARCIS (Netherlands)

    Piechnik, S.K.; Evans, J.; Bary, L.H.; Wise, R.G.; Jezzard, P.

    2009-01-01

    Cerebrospinal fluid (CSF) provides hydraulic suspension for the brain. The general concept of bulk CSF production, circulation, and reabsorption is well established, but the mechanisms of momentary CSF volume variation corresponding to vasoreactive changes are far less understood. Nine individuals

  15. Semi-quantiative RI cisternographic patterns in patients with chronic headache. A resemblance to those of intracranial hypotension syndrome

    International Nuclear Information System (INIS)

    Horikoshi, Toru; Uchida, Mikito; Watanabe, Arata; Umeda, Takako; Ikegawa, Hiroaki

    2006-01-01

    Semi-quantitative radionuclide cisternography was performed to evaluate cerebrospinal fluid (CSF) leakage for patients with long-lasting headache and/or neck pain or refractory dizziness which appeared to be related to posture as well as patients with spontaneous intracranial hypotension (SIH). Radioactivity in the whole CSF space was counted and was plotted against time. SIH cases showed rapid decrease of radioactivity in the CSF space. Chronic headache patients were divided into Group I (rapid decrease of activity similarly to those in patients with SIH, to less than 80% at 5 h and 40% at 24 h), Group II (gradual decrease to less than 40% at 24 h), and Group III (activity remained more than 80% at 5 h and 40% at 24 h). Of 16 patients in Group I, epidural blood patch was attempted in 14, and improvement of symptoms was obtained in 10. In 3 patients who underwent post-treatment RI study, tracer kinetics was normalized. These findings may indicate that some of patients with chronic headache actually have CSF leakage that can be treated with epidural blood patch. (author)

  16. Traumatic epistaxis: Skull base defects, intracranial complications and neurosurgical considerations.

    Science.gov (United States)

    Veeravagu, Anand; Joseph, Richard; Jiang, Bowen; Lober, Robert M; Ludwig, Cassie; Torres, Roland; Singh, Harminder

    2013-01-01

    Endonasal procedures may be necessary during management of craniofacial trauma. When a skull base fracture is present, these procedures carry a high risk of violating the cranial vault and causing brain injury or central nervous system infection. A 52-year-old bicyclist was hit by an automobile at high speed. He sustained extensive maxillofacial fractures, including frontal and sphenoid sinus fractures (Fig. 1). He presented to the emergency room with brisk nasopharyngeal hemorrhage, and was intubated for airway protection. He underwent emergent stabilization of his nasal epistaxis by placement of a Foley catheter in his left nare and tamponade with the Foley balloon. A six-vessel angiogram showed no evidence of arterial dissection or laceration. Imaging revealed inadvertent insertion of the Foley catheter and deployment of the balloon in the frontal lobe (Fig. 2). The balloon was subsequently deflated and the Foley catheter removed. The patient underwent bifrontal craniotomy for dural repair of CSF leak. He also had placement of a ventriculoperitoneal shunt for development of post-traumatic hydrocephalus. Although the hospital course was a prolonged one, he did make a good neurological recovery. The authors review the literature involving violation of the intracranial compartment with medical devices in the settings of craniofacial trauma. Caution should be exercised while performing any endonasal procedure in the settings of trauma where disruption of the anterior cranial base is possible. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  17. Spinal level of myelomeningocele lesion as a contributing factor in posterior fossa volume, intracranial cerebellar volume, and cerebellar ectopia.

    LENUS (Irish Health Repository)

    Sweeney, Kieron J

    2013-02-01

    McLone and Knepper\\'s unified theory of Chiari malformation Type II (CM-II) describes how the loss of CSF via the open posterior neuropore fails to create adequate distending pressure for the developing rhomboencephalic vesicle. The authors of the present article describe the relationship between the posterior fossa volume and intracranial cerebellar volume as being related to the distance from the obex of the fourth ventricle to the myelomeningocele lesion using a common mathematical model, the Hagen-Poiseuille law.

  18. An investigation into the regulation of intra-cranial pressure and its influence upon the surrounding cranial bones.

    Science.gov (United States)

    Gard, Graham

    2009-07-01

    The aim of this study is to present a rational coherent hypothesis to explain the palpable involuntary movements of the cranium. The arterial and venous anatomy inside and around the skull and spinal column presents a complete vascular system with the capacity to regulate intra-cranial pressure to a level of equilibrium slightly higher than atmospheric pressure. Variations in cerebrospinal fluid (csf) pressure control the volume of blood draining through the cavernous sinus and hence into the inter-vertebral venous plexus in relation to the jugular vein. Stable intra-cranial pressure is maintained by a controlled release of venous blood through the inter-vertebral venous plexus (slow) and the jugular vein (fast) in the cavernous sinus. Any distortion of the skull from its healthy state will lead to reduced intra-cranial volume. The process of release from the state of compression has been interpreted as "cranial rhythm" but may be a mechanical adjustment increasing the internal volume of the skull, aided by the continual maintenance of stable intracranial pressure. This involuntary movement is capable of being assisted manually.

  19. Indications for CSF shunting in normal pressure hydrocephalus following subarachnoid hemorrhage with lateral ventricular size change on cine-MR

    Energy Technology Data Exchange (ETDEWEB)

    Fujitsuka, Mitsuyuki [Kyorin Univ., Mitaka, Tokyo (Japan). School of Medicine

    2002-09-01

    To clarify the indications for cerebrospinal fluid (CSF) shunting in normal pressure hydrocephalus (NPH) following subarachnoid hemorrhage (SAH), the author investigated changes in the pulsatile brain motions during a cardiac cycle in 17 cases with ventriculomegaly following SAH on cardiac gated cine MR images comparing with those in 50 normal adults. In 15 of these seventeen cases, the lateral ventricles not only constricted immediately following the R-wave related to brain expansion but also expanded paradoxically over the initial size during a cardiac diastole. These patterns were different from those of normal adults, and eleven of them showed excellent response to CSF shunting. Theses findings in ventricular motion during a cardiac cycle indicate that the forceful intraventricular CSF flows and stagnancy expand the ventricular walls causing compression of the surrounding brain against the skull. In the remaining two, the lateral ventricles only constricted immediately following the R-wave and the ventricular size change was similar to those of normal adults, and they were diagnosed as not requiring CSF shunting. Assessing ventricular size change on cine-MR enables non-invasive differentiation of NPH from other form of ventriculomegaly, and evaluation of the benefit of CSF shunting is also possible by this technique preoperatively. (author)

  20. Intracranial stenosis in cognitive impairment and dementia.

    Science.gov (United States)

    Hilal, Saima; Xu, Xin; Ikram, M Kamran; Vrooman, Henri; Venketasubramanian, Narayanaswamy; Chen, Christopher

    2017-06-01

    Intracranial stenosis is a common vascular lesion observed in Asian and other non-Caucasian stroke populations. However, its role in cognitive impairment and dementia has been under-studied. We, therefore, examined the association of intracranial stenosis with cognitive impairment, dementia and their subtypes in a memory clinic case-control study, where all subjects underwent detailed neuropsychological assessment and 3 T neuroimaging including three-dimensional time-of-flight magnetic resonance angiography. Intracranial stenosis was defined as ≥50% narrowing in any of the intracranial arteries. A total of 424 subjects were recruited of whom 97 were classified as no cognitive impairment, 107 as cognitive impairment no dementia, 70 vascular cognitive impairment no dementia, 121 Alzheimer's Disease, and 30 vascular dementia. Intracranial stenosis was associated with dementia (age/gender/education - adjusted odds ratios (OR): 4.73, 95% confidence interval (CI): 1.93-11.60) and vascular cognitive impairment no dementia (OR: 3.98, 95% CI: 1.59-9.93). These associations were independent of cardiovascular risk factors and MRI markers. However, the association with Alzheimer's Disease and vascular dementia became attenuated in the presence of white matter hyperintensities. Intracranial stenosis is associated with vascular cognitive impairment no dementia independent of MRI markers. In Alzheimer's Disease and vascular dementia, this association is mediated by cerebrovascular disease. Future studies focusing on perfusion and functional markers are needed to determine the pathophysiological mechanism(s) linking intracranial stenosis and cognition so as to identify treatment strategies.

  1. Cloning and expression of porcine Colony Stimulating Factor-1 (CSF-1) and Colony Stimulating Factor-1 Receptor (CSF-1R) and analysis of the species specificity of stimulation by CSF-1 and Interleukin 34

    Science.gov (United States)

    Gow, Deborah J.; Garceau, Valerie; Kapetanovic, Ronan; Sester, David P.; Fici, Greg J.; Shelly, John A.; Wilson, Thomas L.; Hume, David A.

    2012-01-01

    Macrophage Colony Stimulating Factor (CSF-1) controls the survival, differentiation and proliferation of cells of the mononuclear phagocyte system. A second ligand for the CSF-1R, Interleukin 34 (IL-34), has been described, but its physiological role is not yet known. The domestic pig provides an alternative to traditional rodent models for evaluating potential therapeutic applications of CSF-1R agonists and antagonists. To enable such studies, we cloned and expressed active pig CSF-1. To provide a bioassay, pig CSF-1R was expressed in the factor-dependent Ba/F3 cell line. On this transfected cell line, recombinant porcine CSF-1 and human CSF-1 had identical activity. Mouse CSF-1 does not interact with the human CSF-1 receptor but was active on pig. By contrast, porcine CSF-1 was active on mouse, human, cat and dog cells. IL-34 was previously shown to be species-specific, with mouse and human proteins demonstrating limited cross-species activity. The pig CSF-1R was equally responsive to both mouse and human IL-34. Based upon the published crystal structures of CSF-1/CSF-1R and IL34/CSF-1R complexes, we discuss the molecular basis for the species specificity. PMID:22974529

  2. Intracranial germinomas: a case for low dose radiation therapy alone

    International Nuclear Information System (INIS)

    Harrigan, Patricia M.; Loeffler, Jay S.; Shrieve, Dennis; Tarbell, Nancy J.

    1995-01-01

    Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Materials and Methods: Between 1975 and 1995, 39 patients with a diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All but one pt received whole brain (WB) RT, (median dose: 3240 cGy range: 1500-4437 cGy) and a boost to the tumor volume (median total tumor volume dose: 5200 cGy, range: 3960-5950 cGy). Thirty-one pts received RT to the spine (median dose: 2500, range: 1875-3750). Eleven pts were treated with low dose RT and a tumor volume boost, (WB dose ≤ 2550 cGy, and spine dose ≤ 2160 cGy). Five pts were treated with cisplatin-based chemotherapy and low dose WB RT. Fifteen pts were biopsy-proven and 18 presented with multiple midline germinomas (MMG). Among all pts, 33% had serum or CSF positive for low levels of HCG and none of 19 (9 biopsy-proven) germinomas measured positive for AFP tumor marker. Six of 22 (27%) pts who had spine imaging or CSF cytology had evidence of tumor seeding. The male-to female-ratio was 1.4. Median age at diagnosis was 14 yrs for male pts and 9.5 yrs for females (p=.02, overall age range: 1-31 yrs). Median follow-up for survivors is 64 months (range: 1-226 months). Toxicity of treatment relative to dose was assessed. Results: The 5-yr. actuarial rate of disease-free survival (DFS) and overall survival for presumed germinomas was 97%. No pts died of germinoma. One pt died of a shunt infection who had received concurrent chemotherapy and low dose whole brain RT. Among the low dose RT alone group 6 pts received whole brain RT of ≤ 2550 cGy and 9 pts were treated with spinal RT of ≤ 2160 cGy without chemotherapy. Two of these pts had CSF cytology positive for tumor seeding. Additionally, 8 pts received a total dose to the tumor volume of ≤ 4800 cGy without chemotherapy. The 5-yr DFS was 100%. Five pts were treated with cisplatin-based chemotherapy followed

  3. Intracranial germinomas: a case for low dose radiation therapy alone

    Energy Technology Data Exchange (ETDEWEB)

    Harrigan, Patricia M; Loeffler, Jay S; Shrieve, Dennis; Tarbell, Nancy J

    1995-07-01

    Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Materials and Methods: Between 1975 and 1995, 39 patients with a diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All but one pt received whole brain (WB) RT, (median dose: 3240 cGy range: 1500-4437 cGy) and a boost to the tumor volume (median total tumor volume dose: 5200 cGy, range: 3960-5950 cGy). Thirty-one pts received RT to the spine (median dose: 2500, range: 1875-3750). Eleven pts were treated with low dose RT and a tumor volume boost, (WB dose {<=} 2550 cGy, and spine dose {<=} 2160 cGy). Five pts were treated with cisplatin-based chemotherapy and low dose WB RT. Fifteen pts were biopsy-proven and 18 presented with multiple midline germinomas (MMG). Among all pts, 33% had serum or CSF positive for low levels of HCG and none of 19 (9 biopsy-proven) germinomas measured positive for AFP tumor marker. Six of 22 (27%) pts who had spine imaging or CSF cytology had evidence of tumor seeding. The male-to female-ratio was 1.4. Median age at diagnosis was 14 yrs for male pts and 9.5 yrs for females (p=.02, overall age range: 1-31 yrs). Median follow-up for survivors is 64 months (range: 1-226 months). Toxicity of treatment relative to dose was assessed. Results: The 5-yr. actuarial rate of disease-free survival (DFS) and overall survival for presumed germinomas was 97%. No pts died of germinoma. One pt died of a shunt infection who had received concurrent chemotherapy and low dose whole brain RT. Among the low dose RT alone group 6 pts received whole brain RT of {<=} 2550 cGy and 9 pts were treated with spinal RT of {<=} 2160 cGy without chemotherapy. Two of these pts had CSF cytology positive for tumor seeding. Additionally, 8 pts received a total dose to the tumor volume of {<=} 4800 cGy without chemotherapy. The 5-yr DFS was 100%. Five pts were treated with cisplatin-based chemotherapy

  4. Stent-assisted angioplasty for intracranial atherosclerosis

    International Nuclear Information System (INIS)

    Nakahara, Toshinori; Sakamoto, Shigeyuki; Hamasaki, Osamu; Sakoda, Katsuaki

    2002-01-01

    We report on two patients with intracranial atherosclerosis of the carotid artery or vertebral artery treated with stent-assisted angioplasty. Both patients have severe intracranial atherosclerosis (>70%) with refractory symptoms despite optimal medical treatment. In both patients, a coronary balloon-expandable stent was successfully placed using a protective balloon technique without procedural complications. The patients were asymptomatic and neurologically intact at a mean clinical follow-up of 13 months. Follow-up angiograms did not show restenosis 3 or 4 months after procedure, respectively. Stent-assisted angioplasty for intracranial atherosclerosis in the elective patient has proven effective, with an acceptable low rate of morbidity and mortality. (orig.)

  5. Pleocytosis is not fully responsible for low CSF glucose in meningitis.

    Science.gov (United States)

    Baud, Maxime O; Vitt, Jeffrey R; Robbins, Nathaniel M; Wabl, Rafael; Wilson, Michael R; Chow, Felicia C; Gelfand, Jeffrey M; Josephson, S Andrew; Miller, Steve

    2018-01-01

    The mechanism of hypoglycorrhachia-low CSF glucose-in meningitis remains unknown. We sought to evaluate the relative contribution of CSF inflammation vs microorganisms (bacteria and fungi) in lowering CSF glucose levels. We retrospectively categorized CSF profiles into microbial and aseptic meningitis and analyzed CSF leukocyte count, glucose, and protein concentrations. We assessed the relationship between these markers using multivariate and stratified linear regression analysis for initial and repeated CSF sampling. We also calculated the receiver operating characteristics of CSF glucose and CSF-to-serum glucose ratios to presumptively diagnose microbial meningitis. We found that increasing levels of CSF inflammation were associated with decreased CSF glucose levels in the microbial but not aseptic category. Moreover, elevated CSF protein levels correlated more strongly than the leukocyte count with low CSF glucose levels on initial ( R 2 = 36%, p CSF sampling ( R 2 = 46%, p CSF glucose and CSF-to-serum glucose ratios had similar low sensitivity and moderate-to-high specificity in diagnosing microbial meningitis at thresholds commonly used. The main driver of hypoglycorrhachia appears to be a combination of microbial meningitis with moderate to high degrees of CSF inflammation and proteins, suggesting that the presence of microorganisms capable of catabolizing glucose is a determinant of hypoglycorrhachia in meningitis. A major notable exception is neurosarcoidosis. Low CSF glucose and CSF-to-serum glucose ratios are useful markers for the diagnosis of microbial meningitis.

  6. Time of flight MR angiography assessment casts doubt on the association between transient global amnesia and intracranial jugular venous reflux

    International Nuclear Information System (INIS)

    Kang, Yeonah; Kim, Eunhee; Kim, Jae Hyoung; Choi, Byung Se; Jung, Cheolkyu; Bae, Yun Jung; Lee, Kyung Mi; Lee, Dong Hoon

    2015-01-01

    Evidence of intracranial venous reflux flow due to jugular venous reflux (JVR) on time of flight (TOF) MR angiography (MRA) is thought to be highly associated with transient global amnesia (TGA) - evidence that supports the venous congestion theory of TGA pathophysiology. However, recent studies indicate that intracranial JVR on TOF MRA is occasionally observed in normal elderly. Therefore, the purpose of this study was to compare the prevalence of intracranial JVR on TOF MRA in patients with TGA and two control groups. Three age- and sex-matched groups of subjects that received MRI and MRA were enrolled. The groups comprised 167 patients with TGA, 167 visitors to the emergency room (ER) and 167 visitors to a health promotion centre (HPC). Intracranial JVR was defined as abnormal venous signals in the inferior petrosal, sigmoid and/or transverse sinuses on TOF MRA. The prevalence of intracranial JVR was assessed across the three groups. Intracranial JVR was seen in seven (4.2 %) TGA patients, eight (4.8 %) ER visitors and three (1.8 %) HPC visitors, respectively. No statistically significant differences were observed among the three groups. TGA patients showed a low prevalence of intracranial JVR on TOF MRA, and no statistical differences were found in comparison with control groups. (orig.)

  7. Time of flight MR angiography assessment casts doubt on the association between transient global amnesia and intracranial jugular venous reflux

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Yeonah; Kim, Eunhee; Kim, Jae Hyoung; Choi, Byung Se; Jung, Cheolkyu; Bae, Yun Jung; Lee, Kyung Mi [Seoul National University College of Medicine, Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeonggi-do (Korea, Republic of); Lee, Dong Hoon [Seoul Medical Center, Department of Radiology, Seoul (Korea, Republic of)

    2014-10-03

    Evidence of intracranial venous reflux flow due to jugular venous reflux (JVR) on time of flight (TOF) MR angiography (MRA) is thought to be highly associated with transient global amnesia (TGA) - evidence that supports the venous congestion theory of TGA pathophysiology. However, recent studies indicate that intracranial JVR on TOF MRA is occasionally observed in normal elderly. Therefore, the purpose of this study was to compare the prevalence of intracranial JVR on TOF MRA in patients with TGA and two control groups. Three age- and sex-matched groups of subjects that received MRI and MRA were enrolled. The groups comprised 167 patients with TGA, 167 visitors to the emergency room (ER) and 167 visitors to a health promotion centre (HPC). Intracranial JVR was defined as abnormal venous signals in the inferior petrosal, sigmoid and/or transverse sinuses on TOF MRA. The prevalence of intracranial JVR was assessed across the three groups. Intracranial JVR was seen in seven (4.2 %) TGA patients, eight (4.8 %) ER visitors and three (1.8 %) HPC visitors, respectively. No statistically significant differences were observed among the three groups. TGA patients showed a low prevalence of intracranial JVR on TOF MRA, and no statistical differences were found in comparison with control groups. (orig.)

  8. CSF circulation in subjects with the empty sella syndrome

    International Nuclear Information System (INIS)

    Brismar, K.; Bergstrand, G.

    1981-01-01

    In the present study the CSF circulation was analyzed in 48 subjects with ESS with gamma cisternography, pneumoencephalography (PEG) und computed tomography (CT). In 80% of the subjects the CSF circulation was retarded with convexity block which was combined with widened CSF transport pathways and basal cisterns. These findings were correlated with the clinical signs and symptoms. Headache, psychiatric symptoms, visual field defects and obesity, however, were not related to the impaired CSF circulation. It is concluded that impaired CSF dynamics leading to intermittent increase of ICP has a major impact on the development of the ESS and that most of the patients' complaints are related to this disturbance. Thus is is important to obtain information of the CSF dynamics concurrent with the diagnosis of ESS. For this purpose PEG or CT may be used as the first examination. Moreover, the patient should be examined at least every second year for symptoms and signs of progressive impairments of the CSF circulation. (orig./MG)

  9. Headache following intracranial neuroendovascular procedures.

    Science.gov (United States)

    Baron, Eric P; Moskowitz, Shaye I; Tepper, Stewart J; Gupta, Rishi; Novak, Eric; Hussain, Muhammad Shazam; Stillman, Mark J

    2012-05-01

    Predicting who will develop post-procedure headache (PPH) following intracranial endovascular procedures (IEPs) would be clinically useful and potentially could assist in reducing the excessive diagnostic testing so often obtained in these patients. Although limited safety data exist, the use of triptans or dihydroergotamine (DHE) often raise concern when used with pre/post-coiled aneurysms. We sought to determine risk factors for PPH following IEP, to evaluate the utility of diagnostic testing in patients with post-coil acute headache (HA), and to record whether triptans and DHE have been used safely in this clinical setting. We conducted a retrospective chart review of adult patients undergoing IEPs. Bivariate analyses were conducted to compare patients who did and did not develop PPH. We reviewed records pertaining to 372 patients, of whom 263 underwent intracranial coil embolizations, 21 acrylic glue embolizations, and 88 stent placements. PPH occurred in 72% of coil patients, 33% of glue patients, and 14% of stent patients. Significant risk factors for post-coil HA were female gender, any pre-coil HA history, smoking, and anxiety/depression. A pre-stent history of HA exceeding 1 year's duration, and smoking were risk factors for post-stent HA. A pre-glue history of HA exceeding 1 year was the only risk factor for post-glue HA. In the small subgroup available for study, treatment with triptans or DHE was not associated with adverse events in pre/post-coiled aneurysms. Diagnostic testing was low yield. Occurrence of PPH was common after IEPs and especially so with coiling and in women, smokers, and those with anxiety/depression, and was often of longer duration than allowed by current International Classification of Headache Disorders-II criteria. The yield of diagnostic testing was low, and in a small subgroup treatment with triptans or DHE did not cause adverse events in pre/post-coiled aneurysms. Prospective studies are needed to confirm these findings.

  10. CSF glial markers correlate with survival in amyotrophic lateral sclerosis.

    Science.gov (United States)

    Süssmuth, S D; Sperfeld, A D; Hinz, A; Brettschneider, J; Endruhn, S; Ludolph, A C; Tumani, H

    2010-03-23

    In neurodegenerative diseases such as amyotrophic lateral sclerosis (ALS), CSF biomarkers are increasingly studied to evaluate their relevance for differential diagnosis, disease progression, and understanding of pathophysiologic processes. To identify a biomarker profile of neuronal and glial CSF proteins to discriminate ALS from other motor neuron diseases (MND) and to assess whether baseline levels of CSF measures in ALS are associated with the course of the disease. A total of 122 consecutive subjects with MND were included in this cross-sectional study (ALS, n = 75; lower motor neuron syndrome, n = 39; upper motor neuron diseases, n = 8). Clinical follow-up included 76 patients. We determined baseline levels of protein tau and astroglial S100beta in CSF and microglial sCD14 in CSF and serum in relation to diagnosis, duration of disease, and survival. CSF tau was significantly elevated in ALS and upper motor neuron diseases as compared to lower motor neuron diseases and controls. CSF S100beta levels were significantly lower in lower motor neuron diseases as compared to other MND. CSF concentrations of S100beta and sCD14 correlated with the survival time in patients with ALS. In motor neuron diseases, CSF tau elevation indicates the degeneration of upper motor neurons, while S100 beta and sCD14 may indicate the activation of CNS glial cells. Because S100beta and sCD14 concentrations correlate with survival in amyotrophic lateral sclerosis (ALS), we suppose that the combination of both markers may be useful to obtain prognostic information in patients with ALS.

  11. MR angiography after coiling of intracranial aneurysms

    NARCIS (Netherlands)

    Schaafsma, J.D.

    2012-01-01

    Introduction Endovascular occlusion with detachable coils has become an alternative treatment to neurosurgical clipping of intracranial aneurysms over the last two decades. Its minimal invasiveness is the most important advantage of this treatment compared to clipping. The disadvantage of occlusion

  12. Atypical imaging appearances of intracranial meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    O' Leary, S. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Adams, W.M. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Parrish, R.W. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom); Mukonoweshuro, W. [Radiology Department, Derriford Hospital, Plymouth (United Kingdom)]. E-mail: William.mukonoweshuro@phnt.swest.nhs.uk

    2007-01-15

    Meningiomas are the commonest primary, non-glial intracranial tumours. The diagnosis is often correctly predicted from characteristic imaging appearances. This paper presents some examples of atypical imaging appearances that may cause diagnostic confusion.

  13. An Update on Idiopathic Intracranial Hypertension

    OpenAIRE

    Thurtell, Matthew J.; Bruce, Beau B.; Newman, Nancy J.; Biousse, Valérie

    2010-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of unknown etiology often encountered in neurologic practice. It produces non-localizing symptoms and signs of raised intracranial pressure and, when left untreated, can result in severe irreversible visual loss. It most commonly occurs in obese women of childbearing age, but it can also occur in children, men, non-obese adults, and older adults. While it is frequently associated with obesity, it can be associated with other conditions...

  14. Spontaneous Intracranial Hypotension without Orthostatic Headache

    Directory of Open Access Journals (Sweden)

    Tülay Kansu

    2009-03-01

    Full Text Available We report 2 cases of spontaneous intracranial hypotension that presented with unilateral abducens nerve palsy, without orthostatic headache. While sixth nerve palsies improved without any intervention, subdural hematoma was detected with magnetic resonance imaging. We conclude that headache may be absent in spontaneous intracranial hypotension and spontaneous improvement of sixth nerve palsy can occur, even after the development of a subdural hematoma

  15. Spontaneous intracranial epidural hematoma during rivaroxaban treatment

    Energy Technology Data Exchange (ETDEWEB)

    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jeronimo Buzetti; Jung, Gustavo Simiano; Silva Junior, Luis Fernando; Ramina, Ricardo, E-mail: leonardoruschel@yahoo.com.br [Instituto de Neurologia de Curitiba (INC), Curitiba, PR (Brazil)

    2016-11-15

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xarelto®. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban. (author)

  16. "Negative symptoms"secondary to intracranial tumor

    Directory of Open Access Journals (Sweden)

    Natasha Kate

    2014-01-01

    Full Text Available Intracranial tumors are increasingly common in the elderly population. They may present with varied symptoms, some of which may be psychiatric in nature. In patients with known psychiatric disorders, these symptoms may be misattributed resulting in a delay in diagnosis and management. We present a case of an elderly female with paranoid schizophrenia and new onset symptoms secondary to intracranial tumor, which were initially misdiagnosed.

  17. Graves' disease and idiopathic intracranial hypertension

    OpenAIRE

    Manish Gutch; Annesh Bhattacharjee; Sukriti Kumar; Durgesh Pushkar

    2017-01-01

    Idiopathic intracranial hypertension (IIH) is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in assoc...

  18. Increased intracranial pressure: evaluation by computerized tomography

    International Nuclear Information System (INIS)

    Lightfoote, W.E.; Pressman, B.D.

    1975-01-01

    Computerized tomography is clearly very useful in the evaluation of patients with increased intracranial pressure and suspected pseudotumor cerebri. It provides an index of ventricular size and configuration and has the capability of demonstrating intracranial lesions. Moreover, this new technique is rapid and non-invasive, and is without attendant risks. Examinations may be performed serially as the clinical process evolves, thereby giving roentgenographic correlation to the clinical features. (U.S.)

  19. Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report

    Directory of Open Access Journals (Sweden)

    Hideki Kanamaru

    2016-04-01

    Full Text Available Simultaneous spinal and intracranial chronic subdural hematoma (CSDH is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT and magnetic resonance imaging (MRI revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.

  20. Inhibiting the Ca2+ Influx Induced by Human CSF

    Directory of Open Access Journals (Sweden)

    Anna Drews

    2017-12-01

    Full Text Available One potential therapeutic strategy for Alzheimer’s disease (AD is to use antibodies that bind to small soluble protein aggregates to reduce their toxic effects. However, these therapies are rarely tested in human CSF before clinical trials because of the lack of sensitive methods that enable the measurement of aggregate-induced toxicity at low concentrations. We have developed highly sensitive single vesicle and single-cell-based assays that detect the Ca2+ influx caused by the CSF of individuals affected with AD and healthy controls, and we have found comparable effects for both types of samples. We also show that an extracellular chaperone clusterin; a nanobody specific to the amyloid-β peptide (Aβ; and bapineuzumab, a humanized monoclonal antibody raised against Aβ, could all reduce the Ca2+ influx caused by synthetic Aβ oligomers but are less effective in CSF. These assays could be used to characterize potential therapeutic agents in CSF before clinical trials.

  1. Chemical meningitis related to intra-CSF liposomal cytarabine.

    Science.gov (United States)

    Durand, Bénédicte; Zairi, Fahed; Boulanger, Thomas; Bonneterre, Jacques; Mortier, Laurent; Le Rhun, Emilie

    2017-10-01

    Therapeutic options of leptomeningeal metastases include intra-cerebrospinal fluid (CSF) chemotherapy. Among intra-CSF agents, liposomal cytarabine has advantages but can induce specific toxicities. A BRAF-V600E-mutated melanoma leptomeningeal metastases patient, treated by dabrafenib and liposomal cytarabine, presented after the first injection of liposomal cytarabine with hyperthermia and headaches. Despite sterile CSF/blood analyses, extended intravenous antibiotics were given and the second injection was delayed. The diagnosis of chemical meningitis was finally made. Dose reduction and appropriate symptomatic treatment permitted the administration of 15 injections of liposomal cytarabine combined with dabrafenib. A confirmation of the diagnosis of chemical meningitis is essential in order (1) not to delay intra-CSF or systemic chemotherapy or (2) to limit the administration of unnecessary but potentially toxic antibiotics.

  2. Application of RI-counting method for posttraumatic CSF rhinorrhea

    International Nuclear Information System (INIS)

    Itoh, Takahiko; Terai, Yoshinori; Fujimoto, Shunichiro; Kawauchi, Masamitsu.

    1987-01-01

    Numerous techniques and procedures have been reported for the evaluation of CSF fistulas. Especially metrizamide CT cisternography and radioisotope (RI) cisternography have been reported to be reliable for localizing the site of CSF leakage, however, it has been difficult to diagnose the existence and the site of CSF leakages in some cases. RI-counting method, measuring RI-count of intranasal cotton pledgets after the intrathecal injection of RI ( 111 In-DTPA) is thought to be the most reliable method for detecting the presence of CSF leakage in these cases. We used six cotton pledgets which were inserted into upper, middle, and lower meatuses on both side. Because the site of pledgets with ghest RI-count has anatomical relationship to the opening of the paranasal sinus, we can surmise the leakage of dural defect and CSF leakage. RI counting method was applied to two patients in whom it was difficult to diagnose the presence of CSF leakage with other procedures. The patients were free in position for four hours after the intrathecal injection of RI, and in the prone position for 30 minutes before RI-counting of intranasal cotton pledgets. After measuring the RI-counts of six pledgets, the counts were compared with each other. The cotton pledget inserted into left middle meatus showed the highest count in both cases. From this result and finding of conventional skull tomography we speculated the site of CSF leakage to be frontal sinus or ethmoid sinus. Operation demonstrated the opening of dura into the frontal sinus in one case, and ethmoid sinus in another case. As mentioned above, RI-counting method has the advantages of detecting the existence and the site of CSF leakage. (author)

  3. The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus

    DEFF Research Database (Denmark)

    Wikkelsø, Carsten; Hellström, Per; Klinge, Petra Margarete

    2013-01-01

    The objective was to determine the sensitivity, specificity, and positive and negative predictive values of the CSF Tap Test (CSF TT) and resistance to CSF outflow (Rout) for the outcome of shunting in a sample of patients with idiopathic normal pressure hydrocephalus (iNPH).......The objective was to determine the sensitivity, specificity, and positive and negative predictive values of the CSF Tap Test (CSF TT) and resistance to CSF outflow (Rout) for the outcome of shunting in a sample of patients with idiopathic normal pressure hydrocephalus (iNPH)....

  4. Delivery of GM-CSF to Protect against Influenza Pneumonia

    Science.gov (United States)

    Subramaniam, Renuka; Hillberry, Zachary; Chen, Han; Feng, Yan; Fletcher, Kalyn; Neuenschwander, Pierre; Shams, Homayoun

    2015-01-01

    Background Since adaptive immunity is thought to be central to immunity against influenza A virus (IAV) pneumonias, preventive strategies have focused primarily on vaccines. However, vaccine efficacy has been variable, in part because of antigenic shift and drift in circulating influenza viruses. Recent studies have highlighted the importance of innate immunity in protecting against influenza. Methods Granulocyte-macrophage colony stimulating factor (GM-CSF) contributes to maturation of mononuclear phagocytes, enhancing their capacity for phagocytosis and cytokine production. Results Overexpression of granulocyte macrophage-colony stimulating factor (GM-CSF) in the lung of transgenic mice provides remarkable protection against IAV, which depends on alveolar macrophages (AM). In this study, we report that pulmonary delivery of GM-CSF to wild type young and aged mice abrogated mortality from IAV. Conclusion We also demonstrate that protection is species specific and human GM-CSF do not protect the mice nor stimulates mouse immunity. We also show that IAV-induced lung injury is the culprit for side-effects of GM-CSF in treating mice after IAV infection, and introduce a novel strategy to deliver the GM-CSF to and retain it in the alveolar space even after IAV infection. PMID:25923215

  5. Delivery of GM-CSF to Protect against Influenza Pneumonia.

    Directory of Open Access Journals (Sweden)

    Renuka Subramaniam

    Full Text Available Since adaptive immunity is thought to be central to immunity against influenza A virus (IAV pneumonias, preventive strategies have focused primarily on vaccines. However, vaccine efficacy has been variable, in part because of antigenic shift and drift in circulating influenza viruses. Recent studies have highlighted the importance of innate immunity in protecting against influenza.Granulocyte-macrophage colony stimulating factor (GM-CSF contributes to maturation of mononuclear phagocytes, enhancing their capacity for phagocytosis and cytokine production.Overexpression of granulocyte macrophage-colony stimulating factor (GM-CSF in the lung of transgenic mice provides remarkable protection against IAV, which depends on alveolar macrophages (AM. In this study, we report that pulmonary delivery of GM-CSF to wild type young and aged mice abrogated mortality from IAV.We also demonstrate that protection is species specific and human GM-CSF do not protect the mice nor stimulates mouse immunity. We also show that IAV-induced lung injury is the culprit for side-effects of GM-CSF in treating mice after IAV infection, and introduce a novel strategy to deliver the GM-CSF to and retain it in the alveolar space even after IAV infection.

  6. Upfront plerixafor plus G-CSF versus cyclophosphamide plus G-CSF for stem cell mobilization in multiple myeloma: efficacy and cost analysis study.

    Science.gov (United States)

    Afifi, S; Adel, N G; Devlin, S; Duck, E; Vanak, J; Landau, H; Chung, D J; Lendvai, N; Lesokhin, A; Korde, N; Reich, L; Landgren, O; Giralt, S; Hassoun, H

    2016-04-01

    Cyclophosphamide plus G-CSF (C+G-CSF) is one of the most widely used stem cell (SC) mobilization regimens for patients with multiple myeloma (MM). Plerixafor plus G-CSF (P+G-CSF) has demonstrated superior SC mobilization efficacy when compared with G-CSF alone and has been shown to rescue patients who fail mobilization with G-CSF or C+G-CSF. Despite the proven efficacy of P+G-CSF in upfront SC mobilization, its use has been limited, mostly due to concerns of high price of the drug. However, a comprehensive comparison of the efficacy and cost effectiveness of SC mobilization using C+G-CSF versus P+G-CSF is not available. In this study, we compared 111 patients receiving C+G-CSF to 112 patients receiving P+G-CSF. The use of P+G-CSF was associated with a higher success rate of SC collection defined as ⩾5 × 10(6) CD34+ cells/kg (94 versus 83%, P=0.013) and less toxicities. Thirteen patients in the C+G-CSF arm were hospitalized owing to complications while none in the P+G-CSF group. C+G-CSF was associated with higher financial burden as assessed using institutional-specific costs and charges (P<0.001) as well as using Medicare reimbursement rates (P=0.27). Higher rate of hospitalization, increased need for salvage mobilization, and increased G-CSF use account for these differences.

  7. Csf1r-mApple Transgene Expression and Ligand Binding In Vivo Reveal Dynamics of CSF1R Expression within the Mononuclear Phagocyte System.

    Science.gov (United States)

    Hawley, Catherine A; Rojo, Rocio; Raper, Anna; Sauter, Kristin A; Lisowski, Zofia M; Grabert, Kathleen; Bain, Calum C; Davis, Gemma M; Louwe, Pieter A; Ostrowski, Michael C; Hume, David A; Pridans, Clare; Jenkins, Stephen J

    2018-03-15

    CSF1 is the primary growth factor controlling macrophage numbers, but whether expression of the CSF1 receptor differs between discrete populations of mononuclear phagocytes remains unclear. We have generated a Csf1r -mApple transgenic fluorescent reporter mouse that, in combination with lineage tracing, Alexa Fluor 647-labeled CSF1-Fc and CSF1, and a modified Δ Csf1- enhanced cyan fluorescent protein (ECFP) transgene that lacks a 150 bp segment of the distal promoter, we have used to dissect the differentiation and CSF1 responsiveness of mononuclear phagocyte populations in situ. Consistent with previous Csf1r- driven reporter lines, Csf1r -mApple was expressed in blood monocytes and at higher levels in tissue macrophages, and was readily detectable in whole mounts or with multiphoton microscopy. In the liver and peritoneal cavity, uptake of labeled CSF1 largely reflected transgene expression, with greater receptor activity in mature macrophages than monocytes and tissue-specific expression in conventional dendritic cells. However, CSF1 uptake also differed between subsets of monocytes and discrete populations of tissue macrophages, which in macrophages correlated with their level of dependence on CSF1 receptor signaling for survival rather than degree of transgene expression. A double Δ Csf1r -ECFP- Csf1r -mApple transgenic mouse distinguished subpopulations of microglia in the brain, and permitted imaging of interstitial macrophages distinct from alveolar macrophages, and pulmonary monocytes and conventional dendritic cells. The Csf1r- mApple mice and fluorescently labeled CSF1 will be valuable resources for the study of macrophage and CSF1 biology, which are compatible with existing EGFP-based reporter lines. Copyright © 2018 The Authors.

  8. Occurrence studies of intracranial tumours

    Energy Technology Data Exchange (ETDEWEB)

    Larjavaara, S.

    2011-07-01

    Intracranial tumours are a histopathologically heterogeneous group of tumours. This thesis focused on three types of intracranial tumours; gliomas, meningiomas and vestibular schwannomas (VS). The main objectives of the dissertation were to estimate the occurrence of intracranial tumours by different subtypes, and to assess the validity and completeness of the cancer registry data. The specific aims of the publications were to evaluate the validity of reported incidence rates of meningioma cases, to describe the trends of VS incidence in four Nordic countries, and to define the anatomic distribution of gliomas and to investigate their location in relation to mobile phone use. Completeness of meningioma registration was examined by comparing five separate sources of information, and by defining the frequencies of cases reported to the Finnish Cancer Registry (FCR). Incidence trends of VS were assessed in the four Nordic countries over a twenty-one-year period (1987 - 2007) using cancer registry data. The anatomic site of gliomas was evaluated using both crude locations in the cerebral lobes and, in more detail, a three-dimensional (3D) distribution in the brain. In addition, a study on specific locations of gliomas in relation to the typical position of mobile phones was conducted using two separate approaches: a case-case and a case-specular analysis. The thesis was based on four sets of materials. Data from the international Interphone study were used for the studies on gliomas, while the two other studies were register-based. The dataset for meningiomas included meningioma cases from the FCR and four clinical data sources in Tampere University Hospital (neurosurgical clinic, pathology database, hospital discharge register and autopsy register). The data on VS were obtained from the national cancer registries of Denmark, Finland, Norway and Sweden. The coverage of meningiomas was not comprehensive in any of the data sources. The completeness of FCR was

  9. Automated intracranial pressure-controlled cerebrospinal fluid external drainage with LiquoGuard.

    Science.gov (United States)

    Linsler, Stefan; Schmidtke, Mareike; Steudel, Wolf Ingo; Kiefer, Michael; Oertel, Joachim

    2013-08-01

    LiquoGuard is a new device for intracranial pressure (ICP)-controlled drainage of cerebrospinal fluid (CSF). This present study evaluates the accuracy of ICP measurement via the LiquoGuard device in comparison with Spiegelberg. Thus, we compared data ascertained from simultaneous measurement of ICP using tip-transducer and tip-sensor devices. A total of 1,764 monitoring hours in 15 patients (range, 52-219 h) were analysed. All patients received an intraventricular Spiegelberg III probe with the drainage catheter connected to the LiquoGuard system. ICP reading of both devices was performed on an hourly basis. Statistical analysis was done by applying Pearson correlation and Wilcoxon-matched pair test (p drainage. However, LiquoGuard tends to provide misleading results in slit ventricles. Thus, before these drawbacks are further analysed, the authors recommend additional ICP measurement with internal tip-sensor devices to avoid dangerous erroneous interpretation of ICP data.

  10. Relevance and therapy of intracranial arachnoidal cysts; Relevanz und Therapie intrakranieller Arachnoidalzysten

    Energy Technology Data Exchange (ETDEWEB)

    Eymann, R. [Universitaetsklinikum des Saarlandes, Klinik fuer Neurochirurgie, Homburg/Saar (Germany); Kiefer, M. [Universitaet des Saarlandes, Homburg/Saar (Germany)

    2018-02-15

    Intracranial arachnoidal cysts (AC) are relevant due to their space-demanding character. The pathophysiological sequelae are dependent on the size and location of the cyst and the patient's age. Direct pressure on surrounding tissue causes headaches (meninges) or rarely seizures (brain tissue). Cerebrospinal fluid (CSF) circulation disturbances resulting from brain mass displacement with occlusion of, for example, the foramen monroi or the aqueduct cause occlusive hydrocephalus, which can lead to an increase in intracranial pressure. Depending on age, the typical primary clinical symptoms or findings differ. In adults and older children, headaches are usually the first clinical symptom. Children, in whom skull growth is not yet complete, present with a head circumference above the 97th percentile. An abnormal one-sided deflection of the calotte in the region of the underlying AC may also be present. Cranial magnetic resonance imaging (cMRI), the first-line diagnostic tool of choice to demonstrate size and location of the cysts and the surrounding intracranial structures, is of utmost importance for therapy planning. In addition, further malformations can be detected. Moreover, cMRI may also be useful for a rough assessment of increased intracranial pressure (ICP). In most symptomatic AC, surgical treatment is unavoidable. The primarily goal is to establish communication between the CSF and the cysts' content in order to effect pressure equalization. If the CSF reabsorption capacity is insufficient, it may also be necessary to implant a CSF shunt. Asymptomatic arachnoidal cysts should be strictly followed clinically and by cMRI over time. The reasonable frequency for follow-up depends on the size and location of the cyst. (orig.) [German] Die Relevanz intrakranieller Arachnoidalzysten (AC) ergibt sich aus ihrem raumfordernden Charakter. Die pathophysiologischen Folgen ergeben sich aus der Groesse und Lage der Zyste sowie dem Alter des Patienten. Durch den

  11. Temporal lobe epilepsy due to meningoencephaloceles into the greater sphenoid wing. A consequence of idiopathic intracranial hypertension?

    Energy Technology Data Exchange (ETDEWEB)

    Urbach, H.; Jamneala, G.; Mader, I.; Egger, K.; Yang, S. [Medical Center - Freiburg Univ. (Germany). Dept. of Neuroradiology; Altenmueller, D. [Medical Center - Freiburg Univ. (Germany). Dept. of Epileptology

    2018-01-15

    Antero-inferior temporal lobe meningoencephaloceles are a rare, but increasingly recognized cause of drug-resistant temporal lobe epilepsy (TLE). In order to evaluate whether these lesions are related to idiopathic intracranial hypertension (IIH), we analyzed clinical and MRI findings of a cohort of patients undergoing presurgical work-up. Seizure onset in the anterior temporal lobe was proven by EEG electrodes in 22 patients, and in 21 patients, anterior temporal lobectomy (mostly with sparing of the hippocampus) was performed. MRI signs of IIH (in particular empty sella) and the volumes of the ventricles and external CSF spaces were determined and related to the body mass index (BMI) and clinical outcome. Six of seven obese (BMI > 30 kg/m{sup 2}) compared to four of 15 non-obese patients had partial empty or empty sella (p = 0.007). Bilateral lesions were found in all obese and 11 patients. Seizure freedom (Engel class 1A) was achieved in 12 of 21 patients (5 obese compared to 7 non-obese patients). BMI was related to the volume of the external CSF spaces (r = 0.467), and age at seizure onset was higher in obese patients. Roughly a third of patients with temporal lobe epilepsy due to antero-inferior meningoencephaloceles is obese and has MRI signs of idiopathic intracranial hypertension. (orig.)

  12. Measurement of blood flow in the superior sagittal sinus in healthy volunteers, and in patients with normal pressure hydrocephalus and idiopathic intracranial hypertension with phase-contrast cine MR imaging

    DEFF Research Database (Denmark)

    Gideon, P; Thomsen, C; Gjerris, F

    1996-01-01

    PURPOSE: To measure blood flow and velocity in the superior sagittal ++sinus. MATERIAL AND METHODS: MR velocity mapping was used to examine 14 healthy volunteers, 15 patients with normal pressure hydrocephalus (NPH), 3 patients with high pressure hydrocephalus (HPH), and 11 patients with idiopathic...

  13. Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery.

    Science.gov (United States)

    Schneider, Christian; Ramaswamy, Vijay; Kulkarni, Abhaya V; Rutka, James T; Remke, Marc; Tabori, Uri; Hawkins, Cynthia; Bouffet, Eric; Taylor, Michael D

    2015-03-01

    While medulloblastoma was initially thought to comprise a single homogeneous entity, it is now accepted that it in fact comprises 4 discrete subgroups, each with its own distinct demographics, clinical presentation, transcriptomics, genetics, and outcome. Hydrocephalus is a common complication of medulloblastoma and not infrequently requires CSF diversion. The authors report the incidence of CSF diversion surgery in each of the subgroups of medulloblastoma (Wnt, Shh, Group 3, and Group 4). The medical and imaging records for patients who underwent surgery for medulloblastoma at The Hospital for Sick Children were retrospectively reviewed. The primary outcome was the requirement for CSF diversion surgery either before or within 60 days of tumor resection. The modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) was compared among subgroups. Of 143 medulloblastoma patients, treated from 1991 to 2013, sufficient data were available for 130 patients (15 with Wnt, 30 with Shh, 30 with Group 3, and 55 with Group 4 medulloblastomas). Of these, 28 patients (22%) ultimately underwent CSF diversion surgery: 0% with Wnt, 29% with Shh, 29% with Group 3, and 43% with Group 4 tumors. Patients in the Wnt subgroup had a lower incidence of CSF diversion than all other patients combined (p = 0.04). Wnt patients had a lower mCPPRH score (lower risk of CSF diversion, p = 0.045), were older, had smaller ventricles at diagnosis, and had no leptomeningeal metastases. The overall rate of CSF diversion surgery for Shh, Group 3, and Group 4 medulloblastomas is around 30%, but no patients in the present series with a Wnt medulloblastoma required shunting. The low incidence of hydrocephalus in patients with Wnt medulloblastoma likely reflects both host factors (age) and disease factors (lack of metastases). The absence of hydrocephalus in patients with Wnt medulloblastomas likely contributes to their excellent rate of survival and may also contribute to a higher quality

  14. Genetic study of intracranial aneurysms.

    Science.gov (United States)

    Yan, Junxia; Hitomi, Toshiaki; Takenaka, Katsunobu; Kato, Masayasu; Kobayashi, Hatasu; Okuda, Hiroko; Harada, Kouji H; Koizumi, Akio

    2015-03-01

    Rupture of intracranial aneurysms (IAs) causes subarachnoid hemorrhage, leading to immediate death or severe disability. Identification of the genetic factors involved is critical for disease prevention and treatment. We aimed to identify the susceptibility genes for IAs. Exome sequencing was performed in 12 families with histories of multiple cases of IA (number of cases per family ≥3), with a total of 42 cases. Various filtering strategies were used to select the candidate variants. Replicate association studies of several candidate variants were performed in probands of 24 additional IA families and 426 sporadic IA cases. Functional analysis for the mutations was conducted. After sequencing and filtering, 78 variants were selected for the following reasons: allele frequencies of variants in 42 patients was significantly (PIA within ≥1 family; variants predicted damage to the structure or function of the protein by PolyPhen-2 (Polymorphism Phenotyping V2) and SIFT (Sorting Intolerance From Tolerant). We selected 10 variants from 9 genes (GPR63, ADAMST15, MLL2, IL10RA, PAFAH2, THBD, IL11RA, FILIP1L, and ZNF222) to form 78 candidate variants by considering commonness in families, known disease genes, or ontology association with angiogenesis. Replicate association studies revealed that only p.E133Q in ADAMTS15 was aggregated in the familial IA cases (odds ratio, 5.96; 95% confidence interval, 2.40-14.82; P=0.0001; significant after the Bonferroni correction [P=0.05/78=0.0006]). Silencing ADAMTS15 and overexpression of ADAMTS15 p.E133Q accelerated endothelial cell migration, suggesting that ADAMTS15 may have antiangiogenic activity. ADAMTS15 is a candidate gene for IAs. © 2015 American Heart Association, Inc.

  15. Idiopathic intracranial hypertension, hormones, and 11β-hydroxysteroid dehydrogenases

    DEFF Research Database (Denmark)

    Markey, Keira A; Uldall, Maria; Botfield, Hannah

    2016-01-01

    Idiopathic intracranial hypertension (IIH) results in raised intracranial pressure (ICP) leading to papilledema, visual dysfunction, and headaches. Obese females of reproductive age are predominantly affected, but the underlying pathological mechanisms behind IIH remain unknown. This review provi...

  16. Predictors of severe complications in intracranial meningioma surgery

    DEFF Research Database (Denmark)

    Bartek, Jiri; Sjåvik, Kristin; Förander, Petter

    2015-01-01

    OBJECTIVE: To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events. METHODS: A retrospective review was conducted in a Scandinavian population-based cohort of 979 adult operations for intracranial meningioma perfo...

  17. 3D steady-state MR cisternography in CSF rhinorrhoea

    International Nuclear Information System (INIS)

    Jayakumar, P.N.; Kovoor, J.M.E.; Srikanth, S.G.; Praharaj, S.S.

    2001-01-01

    Purpose: To determine the utility of 3D steady-state MR cisternography in the demonstration and localisation of cerebrospinal fluid (CSF) leak in patients with clinically suspected CSF rhinorrhoea. Material and Methods: Six consecutive patients with clinically suspected CSF rhinorrhoea were examined with routine MR evaluation and MR cisternography (MRC). All MR examinations included fast spin-echo (SE) T1WI in axial and sagittal planes, fast SE T2WI in axial and coronal planes and fluid attenuated inversion recovery (FLAIR) images in the axial plane. 3D evaluation was done using the CISS technique with 0.7-mm thickness in the sagittal and coronal planes. The site and extent of the defect, and any brain herniation detected on MRC were correlated with surgical findings. Results: In the 6 patients who underwent surgical exploration and repair, intraoperative findings correlated with the defect revealed by MRC in all cases. Conclusion: In clinically suspected CSF rhinorrhoea, MRC is highly accurate in localising the site and extent of CSF fistula and may be used as the first investigation due to its efficacy and non-invasive nature

  18. CSF N-glycoproteomics for early diagnosis in Alzheimer's disease.

    Science.gov (United States)

    Palmigiano, Angelo; Barone, Rita; Sturiale, Luisa; Sanfilippo, Cristina; Bua, Rosaria Ornella; Romeo, Donata Agata; Messina, Angela; Capuana, Maria Luisa; Maci, Tiziana; Le Pira, Francesco; Zappia, Mario; Garozzo, Domenico

    2016-01-10

    This work aims at exploring the human CSF (Cerebrospinal fluid) N-glycome by MALDI MS techniques, in order to assess specific glycosylation pattern(s) in patients with Alzheimer's disease (n:24) and in subjects with mild cognitive impairment (MCI) (n:11), these last as potential AD patients at a pre-dementia stage. For comparison, 21 healthy controls were studied. We identified a group of AD and MCI subjects (about 40-50% of the studied sample) showing significant alteration of CSF N-glycome profiling, consisting of a decrease in the overall sialylation degree and an increase in species bearing bisecting GlcNAc. Noteworthy, all the MCI patients that converted to AD within the clinical follow-up, had an abnormal CSF glycosylation profile. Based on the studied cohort, CSF glycosylation changes may occur before an AD clinical onset. Previous studies specifically focused on the key role of glycosyltransferase GnT-III on AD-pathogenesis, addressing the patho-mechanism to specific sugar modification of BACE-1 glycoprotein with bisecting GlcNAc. Our patients addressed protein N-glycosylation changes at an early phase of the whole biomolecular misregulation on AD, pointing to CSF N-glycome analyses as promising tool to enhance early detection of AD and also suggesting alternative therapeutics target molecules, such as specific glyco-enzymes. Copyright © 2015 Elsevier B.V. All rights reserved.

  19. MRI findings of primary intracranial lymphoma on immunologically normal patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ho Chul; Chang, Kee Hyun; Han, Moon Hee; Choi, Choong Gon [Seoul National University College of Medicine, Seoul (Korea, Republic of); Cha, Sang Hoon [Chonbuk National University College of Medicine, Chungju (Korea, Republic of)

    1993-07-15

    Magnetic resonance (MR) images of 14 consecutive patients with pathologically proven primary intracranial lymphoma were reviewed. All patients had a brain MR imaging before any treatment and were immunologically competent. MR images were acquired using 2.0 T (n=6) or 0.5 T (n=8) machine. The MR images were reviewed regarding the location, multiplicity, size, signal intensity, margin, shape, and the extent of surrounding edema of the lesions. Seven patients had multi lesions, 2 to 4 in number. A total of 26 lesions was found; 25 were parenchymal lesions and one was dural lesion. The location of tumor was either central (n=11) or peripheral (n=14). The size of tumor was variable raging from 0.6 cm to 6.0 cm in its maximal diameter. The tumors were isointense (n=19) or hypointense (n=7) relative to gray matter om T1-weighted images, isointense (n=24) or hypointense (n=2) on proton-density weighted images, and isointense (n=21) or hypointense (n=5) on T2-weighted images. On gadolinium-enhanced T1- weighted images of 13 patients, strong enhancement was seen in 22 of 23 lesion. Nineteen lesions showed smooth, well-defined margin, whereas remaining 7 lesions showed irregular, ill-defined margin. The shape of the tumor was diverse; round of ovoid (n=15), lobulated (n=9), or short linear (n=2). These results suggest that one should consider the diagnosis of CNS lymphoma in case with single or multiple masses that abut CSF space and show iso- or similar intensity to gray matter with strong enhancement on MR images.

  20. EFFECTS OF L-LYSINE AESCINAT ON INTRACRANIAL PRESSURE IN CRITICALLY ILL PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

    Directory of Open Access Journals (Sweden)

    S. S. Petrikov

    2016-01-01

    Full Text Available Abstract. Increased intracranial pressure results in cerebral blood flow decrease and cerebral edema formation. Correction of intracranial hypertension is one of the most important goals of intensive care in patients with severe traumatic brain injury. Objectives To determine the effects of L-lysine aescinat on ICP in patients with severe TBI.Material and methods. Twenty patients with TBI and Glasgow coma scale below 9 enrolled in the study. All patients were operated: 6 patients underwent craniotomy and intracranial hematoma removing; 11 — decompressive craniotomy and intracranial hematoma removing. In 3 patients only ICP-sensor was implanted. ICP-monitoring was used in all patients. Ten patients were randomized to L-lysine aescinat treatment (daily dose of 20 ml for 7 days after surgery (study group, 10 — to standard therapy (control group. We perfomed a comparative analysis of the mean ICP and the incidence of ICH within 7 days after surgery in the study and control groups.Results. The length of ICP monitoring was 6.4±3.7 days: in the control group — 7.6±4.9 days, in the study group — 5.2±1.4 days. Mean intracranial pressure was less in the study group as compared to patients in the control group. The number of intracranial hypertension episodes was higher in the control group compared with patients who received L-lysine aescinat.Conclusion. L-lysine aescinat treatment in patients with severe traumatic brain injury is accompanied by reduction of mean intracranial pressure and the number of intracranial hypertension episodes.

  1. Parapharyngeal meningioma extending from the intracranial space

    International Nuclear Information System (INIS)

    Uchibori, M.; Odake, G.; Ueda, S.; Yasuda, N.; Hisa, I.

    1990-01-01

    A 50-year old woman with a giant parapharyngeal meningioma extending from the intracranial cavity was admitted to our hospital. The parapharyngeal tumor was biopsied using the transoral approach, and a histological section diagnosis suggested meningioma. Thereafter, further examination by magnetic resonance images (MRI) and contrast enhanced CT scans revealed a diffuse meningioma en plaque in the posterior fossa. Invasion extended from the clival dura to the right sigmoid sinus. The extracranial extension of a meningioma is very rare but a few cases have been reported. In almost all of the reported cases, a large intracranial meningioma was simultaneously or previously verified by CT scans. Our case was special in that the intracranial mass was not voluminous but showed en plaque extension, and also because the pathway of the extracranial extension through the jugular foramen was clearly visualized by CT and MRI. Obliteration and invasion of the right sigmoid sinus and the internal jugular vein by tumor were also demonstrated. (orig.)

  2. Germinoma with Involvement of Midline and Off-Midline Intracranial Structures

    Directory of Open Access Journals (Sweden)

    Monica Graciela Loto

    2014-01-01

    Full Text Available Germinomas are malignant intracranial germ tumors, usually found in suprasellar regions. Less than 10% are localized in off-middle structures, and synchronous involvement of both structures has only exceptionally been published. A case of an 18-year-old male patient with progressive right-sided hemiparesis and panhypopituitarism was reviewed. Brain MRI showed a solid mass involving pituitary and hypothalamus with thickening of pituitary stalk, high intensity lesions on T2-weighted imaging in left internal capsule, caudate nucleus, globus pallidus, and mild atrophy of the left internal capsule and cerebral peduncle. Nonadenomatous lesions were considered in the differential diagnosis. Alfa-fetoprotein (AFP levels were negative in both serum and cerebrospinal fluid (CSF, while β-human chorionic gonadotrophin (β-HCG levels were slightly increased in CSF. A transsphenoidal biopsy identified a germinoma. Four cycles of chemotherapy with bleomicine, etoposide, and cysplatin were given, followed by radiotherapy, but patients died due to a recidiva. Conclusion. Germinoma must be considered in patients with insipidus diabetes with a sellar mass with thickening of pituitary stalk; and ectopic germinoma must be suspected in patients with slowly progressive hemiparesis with cerebral hemiatrophy. Even with a rare condition, colocalization of midline and off-midline germinoma must be suspected in the presence of these typical signs of both localizations.

  3. Controversies: Optic nerve sheath fenestration versus shunt placement for the treatment of idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Arielle Spitze

    2014-01-01

    Full Text Available Background: Idiopathic intracranial hypertension (IIH has been increasing in prevalence in the past decade, following the obesity epidemic. When medical treatment fails, surgical treatment options must be considered. However, controversy remains as to which surgical procedure is the preferred surgical option - optic nerve sheath fenestration (ONSF or cerebrospinal fluid (CSF shunting - for the long-term treatment of this syndrome. Purpose: To provide a clinical update of the pros and cons of ONSF versus shunt placement for the treatment of IIH. Design: This was a retrospective review of the current literature in the English language indexed in PubMed. Methods: The authors conducted a PubMed search using the following terms: Idiopathic IIH, pseudotumor cerebri, ONSF, CSF shunts, vetriculo-peritoneal shunting, and lumbo-peritoneal shunting. The authors included pertinent and significant original articles, review articles, and case reports, which revealed the new aspects and updates in these topics. Results: The treatment of IIH remains controversial and lacks randomized controlled clinical trial data. Treatment of IIH rests with the determination of the severity of IIH-related visual loss and headache. Conclusion: The decision for ONSF versus shunting is somewhat institution and surgeon dependent. ONSF is preferred for patients with visual symptoms whereas shunting is reserved for patients with headache. There are positive and negative aspects of both procedures, and a prospective, randomized, controlled trial is needed (currently underway. This article will hopefully be helpful in allowing the reader to make a more informed decision until that time.

  4. The MRI appearance of the optic nerve sheath following fenestration for benign intracranial hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Sallomi, D.; Taylor, H.; Hibbert, J.; Sanders, M.D.; Spalton, D.J.; Tonge, K. [Guys and St. Thomas` Hospitals, London (United Kingdom)

    1998-09-01

    Optic nerve fenestration is carried out in cases of severe benign intracranial hypertension. This study aimed to monitor the optic nerve sheath appearances and orbital changes that occur following this procedure. The eight patients were all female with an average age of 37.3 years and a range of 20-58 years. The duration of symptoms was 2-6 years. Symptoms included headaches, diplopia and visual obscurations. Examination revealed severe papilledema. All investigations, including MRI, biochemical and immunological tests, were negative. Patients had fenestration of a 2 mm x 3 mm segment of the medial aspect of the optic nerve sheath. Imaging was obtained with a 1 T MRI machine using a head coil. Coronal, axial and sagittal 3 mm contiguous sections using STIR sequences with TR 4900 ms, IT 150 ms and TE 60 ms were obtained. Five patients showed clinical improvement. The post-operative MRI findings in four of these included a decreased volume of cerebrospinal fluid (CSF) around the optic nerve sheaths and a localized collection of fluid within the orbit. There were no MRI changes in the three patients with no clinical improvement. Decreased CSF volume around the optic nerve and a fluid collection within the orbit may indicate a favorable outcome in optic nerve fenestration. (orig.) With 3 figs., 12 refs.

  5. Telemetric implantable pressure sensor for short- and long-term monitoring of intracranial pressure.

    Science.gov (United States)

    Frischholz, M; Sarmento, L; Wenzel, M; Aquilina, K; Edwards, R; Coakham, H B

    2007-01-01

    Patients with hydrocephalus, idiopathic intracranial hypertension and head injury frequently require monitoring of intracranial pressure (ICP) and may need repeated episodes of monitoring months or years apart. The gold standard for measurement of ICP remains the external ventricular catheter. This is a fluid-filled catheter transducer system that allows regular recalibration and correction of zero drift by its position relative to a fixed anatomical reference. It also allows drainage of cerebrospinal fluid (CSF), providing a means of lowering the ICP. Several catheter tip transducer systems are currently in clinical use, including using strain gauges or fiber-optical pressure sensing techniques. In these devices, zero drift and calibration cannot be checked in vivo. All the ICP monitoring devices in current clinical use require a physical connection between the brain and the external environment. This is a source of infection and limits the duration of monitoring. A number of telemetric monitoring devices, in which data is in some way transmitted transcutaneously, have been developed over the last twenty years, but significant technical problems have precluded their use in routine clinical practice. All current ICP monitors are temporary percutaneous implanted devices. Placement of these devices carries significant morbidity, particularly infection. Patients undergoing repeated monitoring require multiple surgical procedures. Apart from decreasing the risk of infection in patients with severe head injury, the clinical value of an accurate telemetric ICP monitoring system which maintains its reliability over a long period of implantation is high.

  6. Fast FLAIR MR images of intracranial hemorrhage

    International Nuclear Information System (INIS)

    Chun, Eun Ju; Choi, Hye Young; Cho, Young A; Kim, Wha Young

    1998-01-01

    The purpose of this study is to evaluate the signal characteristics of intracranial hemorrhage, as seen on fluid attenuated inversion recovery (FLAIR) MR imaging according to various stages, and to compare FLAIR imaging with spin-echo T1- and T2-weighted MR imaging. We retrospectively evaluated fast FLAIR images along with spin-echo T1- and T2 weighted MR images of 32 lesions in 25 patients (12 males and 14 females, aged 3 - 84 yrs) with intracranial hemorrhagic lesions. For imaging, 1.5 T unit was used, and the nature of the lesions was found to be as follows : intracranial hemorrhage (n=15); tumor (n=9); infarction (n=4); arteriovenous malformation (n=3); and arachnoid cyst with hemorrhage (n=1). On the basis of spin-echo MR imaging, lesions were classified as acute, early subacute, late subacute, early chronic, or late chronic stage. The signal characteristics of intracranial hemorrhage were analysed in accordance with each staging, as seen on MR FLAIR imaging, and compared to the staging seen on spin-echo T1- and T-2 weighted MR imaging. The signal intensity of intracranial hemorrhage, as seen on FLAIR imaging, was not characteristic; it was similar to that of T2WI during the acute and subacute stages, and similiar to that of T1WI during the chronic stage. When used together with spin-echo T1- and T2-weighted MR imaging, however, FLAIR imaging may be useful for the classification of chronic intracranial hemorrhage as either early or late stage. (author). 20 refs., 2 tabs., 6 figs

  7. Spontaneous intracranial hemorrhage and multiple intracranial aneurysms in a patient with Roberts/SC phocomelia syndrome.

    Science.gov (United States)

    Wang, Anthony C; Gemmete, Joseph J; Keegan, Catherine E; Witt, Cordelie E; Muraszko, Karin M; Than, Khoi D; Maher, Cormac O

    2011-11-01

    Roberts/SC phocomelia syndrome (RBS) is a rare but distinct genetic disorder with an autosomal recessive inheritance pattern. It has been associated with microcephaly, craniofacial malformation, cavernous hemangioma, encephalocele, and hydrocephalus. There are no previously reported cases of RBS with intracranial aneurysms. The authors report on a patient with a history of RBS who presented with a spontaneous posterior fossa hemorrhage. Multiple small intracranial aneurysms were noted on a preoperative CT angiogram. The patient underwent emergency craniotomy for evacuation of the hemorrhage. A postoperative angiogram confirmed the presence of multiple, distal small intracranial aneurysms.

  8. Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome

    DEFF Research Database (Denmark)

    Bartek, Jiri; Abedi-Valugerdi, Golbarg; Liska, Jan

    2013-01-01

    We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have...... an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led...

  9. Flow cytometric characterization of cerebrospinal fluid cells.

    Science.gov (United States)

    de Graaf, Marieke T; de Jongste, Arjen H C; Kraan, Jaco; Boonstra, Joke G; Sillevis Smitt, Peter A E; Gratama, Jan W

    2011-09-01

    Flow cytometry facilitates the detection of a large spectrum of cellular characteristics on a per cell basis, determination of absolute cell numbers and detection of rare events with high sensitivity and specificity. White blood cell (WBC) counts in cerebrospinal fluid (CSF) are important for the diagnosis of many neurological disorders. WBC counting and differential can be performed by microscopy, hematology analyzers, or flow cytometry. Flow cytometry of CSF is increasingly being considered as the method of choice in patients suspected of leptomeningeal localization of hematological malignancies. Additionally, in several neuroinflammatory diseases such as multiple sclerosis and paraneoplastic neurological syndromes, flow cytometry is commonly performed to obtain insight into the immunopathogenesis of these diseases. Technically, the low cellularity of CSF samples, combined with the rapidly declining WBC viability, makes CSF flow cytometry challenging. Comparison of flow cytometry with microscopic and molecular techniques shows that each technique has its own advantages and is ideally combined. We expect that increasing the number of flow cytometric parameters that can be simultaneously studied within one sample, will further refine the information on CSF cell subsets in low-cellular CSF samples and enable to define cell populations more accurately. Copyright © 2011 International Clinical Cytometry Society.

  10. Identification of the soluble form of tyrosine kinase receptor Axl as a potential biomarker for intracranial aneurysm rupture.

    Science.gov (United States)

    Xu, Jing; Ma, Feiqiang; Yan, Wei; Qiao, Sen; Xu, Shengquan; Li, Yi; Luo, Jianhong; Zhang, Jianmin; Jin, Jinghua

    2015-03-05

    Subarachnoid hemorrhage caused by a ruptured intracranial aneurysm (RIA) is a devastating condition with significant morbidity and mortality. Despite the fact that RIAs can be prevented by microsurgical clipping or endovascular coiling, there are no reliable means of effectively predicting IA patients at risk for rupture. The purpose of our study was to discover differentially-expressed glycoproteins in IAs with or without rupture as potential biomarkers to predict rupture. Forty age/gender-matched patients with RIA, unruptured IA (UIA), healthy controls (HCs) and disease controls (DCs) (discovery cohort, n = 10 per group) were recruited and a multiplex quantitative proteomic method, iTRAQ (isobaric Tagging for Relative and Absolute protein Quantification), was used to quantify relative changes in the lectin-purified glycoproteins in CSF from RIAs and UIAs compared to HCs and DCs. Then we verified the proteomic results in an independent set of samples (validation cohort, n = 20 per group) by enzyme-linked immunosorbent assay. Finally, we evaluated the specificity and sensitivity of the candidate marker with receiver operating characteristic (ROC) curve methods. The proteomic findings identified 294 proteins, 40 of which displayed quantitative changes unique to RIA, 13 to UIA, and 20 to IA. One of these proteins, receptor tyrosine kinase Axl, was significantly increased in RIA, as confirmed in CSF from the discovery cohort as well as in CSF and plasma from the validation cohort (p IA.

  11. Development of intracranial hypertension after surgical management of intracranial arachnoid cyst: report of three cases and review of the literature.

    LENUS (Irish Health Repository)

    Kaliaperumal, Chandrasekaran

    2013-11-12

    To describe three cases of delayed development of intracranial hypertension (IH) after surgical treatment of intracranial arachnoid cyst, including the pathogenesis of IH and a review of the literature.

  12. Fast fluid-attenuated inversion-recovery MR image in the intracranial tumors: comparison with fast spin-echo image

    International Nuclear Information System (INIS)

    Choi, Hye Young; Kwang, Hyoen Joo; Baek, Seoung Yeon; Lee, Sun Wha

    1997-01-01

    To evaluate the significance of fluid-attenuated inversion recovery(FLAIR) magnetic resonance(MR) images for the diagnosis of intracranial tumors. MR imaging was used to study 15 patients with various intracranial tumors and were compared the findings according to fast spin echo and fast FLAIR images. In 12 of 15 patients, tumor signal intensities on FLAIR images were consistent with those shown on T2-weighted(T2W) images. In seven of eight patients who had cystic or necrotic components within the mass, FLAIR images showed isosignal intensity and in the other patient, high signal intensity was seen. There was variation in the signal intensity from cerebrospinal fluid(CSF). In 12 of 13 patients in whom edema was associated with tumor, FLAIR images were clearer than T2W images as their signal intensity was brighter. In eight patients, however, FLAIR and T2W images provided a similar definition of the margin between edema and tumor. In six patients with intratumoral hemorrhage except the chronic cystic stage. We concluded that in the diagnosis of intracranial tumors, FLAIR images can supplement conventional spin-echo images

  13. Intracranial meningiomas in the present era of modern neuroimaging

    African Journals Online (AJOL)

    Background: Intracranial meningioma is the most common primary, intracranial, extra-axial neoplasm. It is mesenchymal in origin and arises from meningothelial cells of arachnoid villi of meninges. Objectives: To re-emphasize the regional anatomic localisation and diagnostic radiological features of intracranial ...

  14. Idiopathic Intracranial Hypertension – Pathophysiology Based on Case Series

    Directory of Open Access Journals (Sweden)

    Ljubisavljević Srdjan

    2016-09-01

    Full Text Available According to the definition, idiopathic intracranial hypertension (IIH is a pathological state characterized by an increase in intracranial pressure; however, there are no obvious intracranial pathological processes. The pathophysiology of this disorder is not clear, although there are many reports related to it.

  15. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)

    2009-02-15

    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

  16. Primary intracranial leiomyoma in renal transplant recipient

    Directory of Open Access Journals (Sweden)

    Upasana Patel

    2017-01-01

    Full Text Available Leiomyoma, the benign tumor of smooth muscle cell origin, is commonly seen in genitourinary and gastrointestinal tracts. Primary intracranial leiomyoma, however, is extremely rare occurrence. We hereby report a case of Epstein-Barr negative primary intracranial leiomyoma in a middle-aged renal transplant recipient, which mimicked left frontal parasagittal meningioma on neuroimaging. The tumor was completely excised and diagnosis of leiomyoma was clinched on pathological analysis with immunohistochemistry. The patient improved after tumor removal, and no evidence of tumor recurrence was noted on follow-up study after 10 months postsurgically.

  17. Intracranial osteosarcoma after radiosurgery. Case report

    International Nuclear Information System (INIS)

    Sanno, Naoko; Hayashi, Shinkichi; Shimura, Toshiro; Maeda, Shotaro; Teramoto, Akira

    2004-01-01

    A 56-year-old woman presented with an intracranial osteosarcoma at the site of previous radiosurgery, manifesting as sudden onset of headache and left hemiparesis with aphasia. She had a previous history of stereotactic radiosurgery for an intracranial tumor under a diagnosis of falx meningioma. Computed tomography showed intratumoral and peritumoral hemorrhage at the right parietofrontal region. Gross total resection of the tumor with hematoma was performed. The histological diagnosis was osteosarcoma. Sarcomatous change is a rare complication of radiotherapy. This case illustrates that osteosarcoma may develop years after radiosurgery for benign brain neoplasm. (author)

  18. Increased intracranial volume in Parkinson's disease

    DEFF Research Database (Denmark)

    Krabbe, Katja; Karlsborg, Merete; Hansen, Andreas

    2005-01-01

    segmentation and outlining of regions in order to identify regional volume changes that might be useful in the diagnosis of the two diseases. RESULTS: Patients with PD had significantly larger intracranial volumes (ICVs) and significantly smaller putaminal and sustantia nigra volumes than controls. MSA...... patients had significantly smaller substantia nigra and caudate volumes than controls but normal intracranial volume. In both patient groups there was a further trend towards smaller amygdala volumes. DISCUSSION: Increased ICV in PD patients is a new finding that may be explained by genetic factors...

  19. Traumatic rupture of an intracranial dermoid cyst

    Directory of Open Access Journals (Sweden)

    Raksha Ramlakhan, BMedSc, MBBCh

    2015-01-01

    Full Text Available Intracranial dermoid cysts are congenital tumors of ectodermal origin. Rupture of these cysts can occur spontaneously, but rupture in association with trauma is reported infrequently. The diagnosis of rupture is made by the presence of lipid (cholesterol droplets in the subarachnoid spaces and ventricles. Nonenhanced CT of the head demonstrates multiple foci of low attenuation that correspond with hyperintense signal on T1-weighted MRI. We present a case of an adult patient with rupture of an intracranial dermoid cyst, precipitated by minor trauma.

  20. Graves' disease and idiopathic intracranial hypertension

    Directory of Open Access Journals (Sweden)

    Manish Gutch

    2017-01-01

    Full Text Available Idiopathic intracranial hypertension (IIH is a central nervous system disorder characterized by raised intracranial pressure with normal cerebrospinal fluid composition and absence of any structural anomaly on neuroimaging. Among all endocrine disorders associated with the development of IIH, the association of hyperthyroidism and IIH is very rare with few cases reported till date. Thyroid disturbances have a unique association with IIH. Hypo- and hyper-thyroidism have been reported in association with this disorder. We present a rare case of a 25-year-old man with Graves' disease with intractable headache that was later investigated and attributed to development of IIH.

  1. Analysis of petrous apex meningocele associated with meningioma. Is there any relation with chronic intracranial hypertension?

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Wan-Qun; Huang, Biao; Liang, Chang-Hong [Southern Medical University, The Second School of Clinical Medicine, Guangzhou (China); Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong (China); Feng, Jie-Ying [Nanhai Hospital Affiliated Southern Medical University, Department of Radiology, Foshan, Guangdong (China); Liu, Hong-Jun [Guangdong Academy of Medical Sciences, Department of Radiology, Guangdong General Hospital, Guangzhou, Guangdong (China)

    2018-02-15

    Petrous apex meningocele (PAM) is an uncommon cystic lesion involving the petrous apex. The underlying cause of PAM may be related to chronic elevated intracranial pressure. The aim of the study was to explore the relationship between PAM and meningioma and between PAM and other intracranial hypertension findings. Two hundred seventy-eight consecutive patients with meningiomas were retrospectively studied. Fifty age- and gender-matched controls were also enrolled in this study. The incidence of PAM, empty sella, tortuosity of the optic nerve, and hydrops of optic nerve sheath was evaluated. The maximum width, area, volume of each PAM, or Meckel's cave and volume of meningioma were measured in controls and patients, separately. One hundred fifty-nine (57.19%) patients were detected with coexistent PAMs. One hundred twenty-five patients had bilateral PAMs, 34 had unilateral lesions, and the remaining 119 did not have PAM. Two subjects (4/50) had unilateral PAMs in normal controls. The maximum width, area, volume of PAM, or Meckel's cave were significantly larger in the patients with bilateral PAM group than those in the unilateral PAM group, in the group without PAM, and those in control group (p = 0.000). The volume of meningioma was positively correlated with the PAM volume (r = 0.48). There was a positive correlation for the incidence between PAM and (1) empty sella (r = 0.901) and (2) tortuosity of the optic nerves and hydrops of the optic sheath (r = 0.825). Coexistence of PAMs with meningiomas is not rare in incidence, and it suggests a potential role for chronically elevated intracranial pressure and disturbance of CSF circulation in their pathophysiology. (orig.)

  2. Analysis of petrous apex meningocele associated with meningioma. Is there any relation with chronic intracranial hypertension?

    International Nuclear Information System (INIS)

    Yang, Wan-Qun; Huang, Biao; Liang, Chang-Hong; Feng, Jie-Ying; Liu, Hong-Jun

    2018-01-01

    Petrous apex meningocele (PAM) is an uncommon cystic lesion involving the petrous apex. The underlying cause of PAM may be related to chronic elevated intracranial pressure. The aim of the study was to explore the relationship between PAM and meningioma and between PAM and other intracranial hypertension findings. Two hundred seventy-eight consecutive patients with meningiomas were retrospectively studied. Fifty age- and gender-matched controls were also enrolled in this study. The incidence of PAM, empty sella, tortuosity of the optic nerve, and hydrops of optic nerve sheath was evaluated. The maximum width, area, volume of each PAM, or Meckel's cave and volume of meningioma were measured in controls and patients, separately. One hundred fifty-nine (57.19%) patients were detected with coexistent PAMs. One hundred twenty-five patients had bilateral PAMs, 34 had unilateral lesions, and the remaining 119 did not have PAM. Two subjects (4/50) had unilateral PAMs in normal controls. The maximum width, area, volume of PAM, or Meckel's cave were significantly larger in the patients with bilateral PAM group than those in the unilateral PAM group, in the group without PAM, and those in control group (p = 0.000). The volume of meningioma was positively correlated with the PAM volume (r = 0.48). There was a positive correlation for the incidence between PAM and (1) empty sella (r = 0.901) and (2) tortuosity of the optic nerves and hydrops of the optic sheath (r = 0.825). Coexistence of PAMs with meningiomas is not rare in incidence, and it suggests a potential role for chronically elevated intracranial pressure and disturbance of CSF circulation in their pathophysiology. (orig.)

  3. Herpes Simplex Encephalitis Presenting with Normal CSF Analysis

    International Nuclear Information System (INIS)

    Ahmed, R.; Kiani, I. G.; Shah, F.; Rehman, R. N.; Haq, M. E.

    2013-01-01

    A 28 years old female presented with headache, fever, altered sensorium and right side weakness for one week. She was febrile and drowsy with right sided hemiplegia and papilledema. Tuberculous or bacterial meningitis, tuberculoma and abscess were at the top of the diagnosis list followed by Herpes simplex meningo-encephalitis (HSE). MRI showed abnormal signal intensity of left temporal lobe without significant post-contrast enhancement and midline shift. CSF examination was normal, gram stain and Ziehl-Neelsen stain showed no micro-organism, or acid fast bacilli. CSF for MTB PCR was negative. PCR DNA for Herpes simplex 1 on CSF was detected. Acyclovir was started and the patient was discharged after full recovery. A high index of suspicion is required for HSE diagnosis in Pakistan where other infections predominantly affect the brain and HSE may be overlooked as a potential diagnosis. (author)

  4. ATYPICAL CSF PICTURE IN VIRAL MENINGITIS HSV- TYPE-2

    Directory of Open Access Journals (Sweden)

    Vikram

    2016-05-01

    Full Text Available INTRODUCTION Acute infections of nervous system are among the most important problems in medicine because early recognition, efficient decision making and rapid institution of therapy can be lifesaving. Making a clinical diagnosis of acute meningitis depends on the cornerstone of cerebrospinal fluid (CSF examination. We present a case with the above-mentioned difficulty and the approach involved in establishing the exact diagnosis and institution of appropriate treatment. CONCLUSION About findings in viral meningitis one should be careful while evaluating a CSF report so as to not make a mistaken diagnosis and delay treatment. The most important analysis in patients whose symptoms are consistent with herpes simplex meningitis is the detection of Herpes simplex Virus deoxy-ribo-nucleic acid (HSV-DNA in CSF with Polymerase Chain Reaction (PCR.

  5. Recent Advances of Colony-Stimulating Factor-1 Receptor (CSF-1R) Kinase and Its Inhibitors.

    Science.gov (United States)

    El-Gamal, Mohammed I; Al-Ameen, Shahad K; Al-Koumi, Dania M; Hamad, Mawadda G; Jalal, Nouran A; Oh, Chang-Hyun

    2018-01-17

    Colony stimulation factor-1 receptor (CSF-1R), which is also known as FMS kinase, plays an important role in initiating inflammatory, cancer, and bone disorders when it is overstimulated by its ligand, CSF-1. Innate immunity, as well as macrophage differentiation and survival, are regulated by the stimulation of the CSF-1R. Another ligand, interlukin-34 (IL-34), was recently reported to activate the CSF-1R receptor in a different manner. The relationship between CSF-1R and microglia has been reviewed. Both CSF-1 antibodies and small molecule CSF-1R kinase inhibitors have now been tested in animal models and in humans. In this Perspective, we discuss the role of CSF-1 and IL-34 in producing cancer, bone disorders, and inflammation. We also review the newly discovered and improved small molecule kinase inhibitors and monoclonal antibodies that have shown potent activity toward CSF-1R, reported from 2012 until 2017.

  6. Delivery of CSF-1R to the lumen of macropinosomes promotes its destruction in macrophages

    Science.gov (United States)

    Lou, Jieqiong; Low-Nam, Shalini T.; Kerkvliet, Jason G.; Hoppe, Adam D.

    2014-01-01

    ABSTRACT Activation of the macrophage colony stimulating factor-1 receptor (CSF-1R) by CSF-1 stimulates pronounced macropinocytosis and drives proliferation of macrophages. Although the role of macropinocytosis in CSF-1R signaling remains unknown, we show here that, despite internalizing large quantities of plasma membrane, macropinosomes contribute little to the internalization of the CSF-1–CSF-1R complex. Rather, internalization of the CSF-1R in small endocytic vesicles that are sensitive to clathrin disruption, outcompetes macropinosomes for CSF-1R endocytosis. Following internalization, small vesicles carrying the CSF-1R underwent homotypic fusion and then trafficked to newly formed macropinosomes bearing Rab5. As these macropinosomes matured, acquiring Rab7, the CSF-1R was transported into their lumen and degraded. Inhibition of macropinocytosis delayed receptor degradation despite no disruption to CSF-1R endocytosis. These data indicate that CSF-1-stimulated macropinosomes are sites of multivesicular body formation and accelerate CSF-1R degradation. Furthermore, we demonstrate that macropinocytosis and cell growth have a matching dose dependence on CSF-1, suggesting that macropinosomes might be a central mechanism coupling CSF-1R signaling and macrophage growth. PMID:25335894

  7. Application of smart differential pressure transmitters (DPTS) for containment studies facility (CSF)

    International Nuclear Information System (INIS)

    Shanware, V.M.; Gole, N.V.; Sebastian, A.; Subramaniam, K.

    2001-01-01

    Containment Studies Facility (CSF) is being set up in BARC for studying various containment related thermal hydraulic and other processes during simulated conditions of pipe rupture. The set up consists of a model reactor containment vessel with a model primary heat transport system. Besides, provisions exist to introduce aerosols and hydrogen also in the containment model. The instrumentation includes measurement of the process temperatures, pressures, levels, flows, humidity, etc. Differential Pressure Transmitters (DPT) will be used for measurement of levels and flows in the CSF. The procured DPTs for this facility are smart. Conventional transmitters have a rangeability specification of 5 or 6. But the smart transmitters have rangeability varying between 40-100. Smart transmitters have facility to change its operating range online. This enables the provision of zooming in on the selected range and narrowing the range around the point of measurement. This facility can be exploited to realise the maximum possible accuracy at the smallest possible range around the point of measurement. This paper describes how the smart DPTs function, how the Highway Addressable Remote Transmitter (HART) protocol works and how we propose to use the on-line rangeability of these DPTs get the highest resolution in our measurements. (author)

  8. Contribution of isotopic data in cerebrospinal fluid (CSF) studies

    International Nuclear Information System (INIS)

    Askienazy, S.; Ducassou, D.

    The growing interest in isotopic CSF studies is explained by the fact that the mechanism and classification of hydrocephalus cases are based not only on anatomoclinical data but also on physiological information inaccessible by static image methods. This article shows the full importance of dynamic CSF research (ideal tracer: 111 In-DTPA); the possibilities of myeloscintigraphy to study the permeability of the medullary sub-arachnoid spaces (tracers used: sup(99m)Tc-DTPA in the liquid phase or xenon bubble technique in the gas phase); ventricular morphology; existence of meningeal gaps [fr

  9. Clinical studies of cerebral blood flows using single photon emission computed tomography (SPECT), 1; The remote effects of tumors and the adverse effects of radiochemotherapy in the non-affected brain of patients with intracranial tumors

    Energy Technology Data Exchange (ETDEWEB)

    Araki, Yuzo (Gifu Univ. (Japan). Faculty of Medicine)

    1991-01-01

    To examine remote effects of tumors on cerebral blood flow (CBF) and adverse effects of radiochemotherapy on cerebral and cerebellar blood flow (CeBF), mean CBF (mCBF) and mean CeBF (mCeBF) have been studied by single photon emission computed tomography (SPECT) with Xe-133. The subjects were 78 patients with brain tumor, whose ages ranged from 9 to 74 years. Forty normal volunteers served as controls. In the control group, both mCBF and mCeBF were significantly decreased with advancing age. Both ipsilateral and contralateral mCeBFs were significantly decreased in adult patients with bilateral cerebral tumor, as compared with the control group, which was dependent on tumor volume. mCeBF was significantly decreased on the contralataral side than on the ipsilataral side. Similarly, ipsilateral mCBF was significantly lower than that in the control group. Crossed cerebellar diaschisis occurred frequently associated with extensive involvement of tumor into the frontal, parietal, and temporal lobes. In adult patients, a decreased mCBF on the non-affected side before surgery was improved postoperatively. One month after irradiation, it transiently increased and decreased again. Three months after irradiation, mCBF was significantly decreased, as compared with that in the control group. The degree of atrophy and tumor volume influenced mCBF on the non-affected side. These factors were responsible for mCBF in younger patients for the adult group, and in older patients for the child group. For adult patients, radiation dose was also a contributing factor for mCBF. In the group given chemotherapy, mCBF was significantly decreased, as compared with the group without chemotherapy. (N.K.) 102 refs.

  10. Giant serpentine intracranial aneurysm: a case report

    International Nuclear Information System (INIS)

    Park, Jae Seong; Lee, Myeong Sub; Kim, Myung Soon; Kim, Dong Jin; Park, Joong Wha; Whang, Kum

    2001-01-01

    The authors present a case of giant serpentine aneurysm (a partially thrombosed aneurysm containing tortuous vascular channels with a separate entrance and outflow pathway). Giant serpentine aneurysms form a subgroup of giant intracranial aneurysms, distinct from saccular and fusiform varieties, and in this case, too, the clinical presentation and radiographic features of CT, MR imaging and angiography were distinct

  11. Idiopathic intracranial hypertension and transverse sinus stenoses

    DEFF Research Database (Denmark)

    Skyrman, Simon; Fytagoridis, Anders; Andresen, Morten

    2013-01-01

    An 18-year-old woman was diagnosed with idiopathic intracranial hypertension (IIH) and bilateral transverse sinus stenoses (TSS), after presenting with papilledema and decreased visual acuity. Lumbar puncture revealed an opening pressure of >60 cm H2O. MRI showed bilateral TSS believed to be asso...

  12. Endovascular treatment of intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Xu Shubin; Liang Zhihui; Cui Jinguo; Tian Huiqin; Li Liang; Chen Feng

    2009-01-01

    Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

  13. [Intracranial plasmocytomas: biology, diagnosis, and treatment].

    Science.gov (United States)

    Belov, A I; Gol'bin, D A

    2006-01-01

    Intracranial plasmocytomas are a rare abnormality in a neurosurgeon's practice. The plasmocytomas may originate from the skull bones or soft tissue intracranial structures; they may be solitary or occur as a manifestation of multiple myeloma, this type being typical of most intracranial plasmocytomas. Progression of solitary plasmocytoma to multiple myeloma is observed in a number of cases. Preoperative diagnosis involves computed tomography or magnetic resonance imaging; angiography is desirable. The final diagnosis of plasmocytoma is chiefly based on a morphological study. Special immunohistochemical studies yield very promising results; these are likely to be of high prognostic value. Intracranial plasmocytomas require a differential approach and a meticulous examination since the presence or absence of multiple myeloma radically affects prognosis. There are well-defined predictors; however, it is appropriate that craniobasal plasmocytomas show a worse prognosis than plasmocytomas of the skull vault and more commonly progress to multiple myeloma. Plasmocytomas respond to radiotherapy very well. The gold standard of treatment for plasmocytoma is its total removal and adjuvant radiation therapy; however, there is evidence for good results when it is partially removed and undergoes radiotherapy or after radical surgery without subsequent radiation. The role of chemotherapy has not been defined today.

  14. Genetics of intracranial aneurysms and related diseases

    NARCIS (Netherlands)

    van 't Hof, F.N.G.

    2017-01-01

    Intracranial aneurysms (IA) are dilatations of the vessel walls of cerebral arteries. Some can rupture and result in a subarachnoid hemorrhage (SAH), a severe subtype of stroke. This thesis is set out to elucidate the pathophysiology of IA from a genetic perspective. The main conclusions are: 1.

  15. Computed tomography in intracranial malignant lymphoma

    Energy Technology Data Exchange (ETDEWEB)

    Naruse, S; Odake, G; Fujimoto, M; Yamaki, T; Mizukawa, N [Kyoto Prefectural Univ. of Medicine (Japan)

    1978-09-01

    Malignant lymphoma of the central nervous system has been found more and more often in recent years, partly because of the increased use of radiation and such drugs as steroids and antibiotics. However, the definite diagnosis of this disease is difficult until histological verification has been done by operation or autopsy. Since the revolutionary development of computed tomography, however, several reports have been presented, on the computed tomography of malignant lymphoma of the thorax and abdomen. Nevertheless, only a few cases of intracranial malignant lymphoma have been reported. The purpose of this paper, using four patients, is to emphasize the value of computed tomography in the diagnosis of intracranial malignant lymphoma. The characteristic CT findings of intracranial malignant lymphoma may be summarized follows: (1) the tumors are demonstrated to be well-defined, nodular-shaped, and homogenous isodensity - or slightly high-density - lesions in plain scans, and the tumors homogenously increase in density upon contrast enhancement; (2) the disease always has multifocal intracranial lesions, which are shown simultaneously or one after another, and (3) perifocal edema is prominent around the tumors in the cerebral hemisphere.

  16. Whole-brain intracranial vessel wall imaging at 3 Tesla using cerebrospinal fluid-attenuated T1-weighted 3D turbo spin echo.

    Science.gov (United States)

    Fan, Zhaoyang; Yang, Qi; Deng, Zixin; Li, Yuxia; Bi, Xiaoming; Song, Shlee; Li, Debiao

    2017-03-01

    Although three-dimensional (3D) turbo spin echo (TSE) with variable flip angles has proven to be useful for intracranial vessel wall imaging, it is associated with inadequate suppression of cerebrospinal fluid (CSF) signals and limited spatial coverage at 3 Tesla (T). This work aimed to modify the sequence and develop a protocol to achieve whole-brain, CSF-attenuated T 1 -weighted vessel wall imaging. Nonselective excitation and a flip-down radiofrequency pulse module were incorporated into a commercial 3D TSE sequence. A protocol based on the sequence was designed to achieve T 1 -weighted vessel wall imaging with whole-brain spatial coverage, enhanced CSF-signal suppression, and isotropic 0.5-mm resolution. Human volunteer and pilot patient studies were performed to qualitatively and quantitatively demonstrate the advantages of the sequence. Compared with the original sequence, the modified sequence significantly improved the T 1 -weighted image contrast score (2.07 ± 0.19 versus 3.00 ± 0.00, P = 0.011), vessel wall-to-CSF contrast ratio (0.14 ± 0.16 versus 0.52 ± 0.30, P = 0.007) and contrast-to-noise ratio (1.69 ± 2.18 versus 4.26 ± 2.30, P = 0.022). Significant improvement in vessel wall outer boundary sharpness was observed in several major arterial segments. The new 3D TSE sequence allows for high-quality T 1 -weighted intracranial vessel wall imaging at 3 T. It may potentially aid in depicting small arteries and revealing T 1 -mediated high-signal wall abnormalities. Magn Reson Med 77:1142-1150, 2017. © 2016 International Society for Magnetic Resonance in Medicine. © 2016 International Society for Magnetic Resonance in Medicine.

  17. [Experimental study of acute brain swelling under acute intracranial hypertension (author's transl)].

    Science.gov (United States)

    Shigemori, M; Watanabe, M; Kuramoto, S

    1976-12-01

    There are many problems about the cause, pathophysiology and treatment of acute brain swelling under intracranial hypertension frequently encountered in the neurosurgical clinics. Generally, rapid increase of the cerebral vasoparesis caused by unknown etiology is thought to be the main cause of acute brain swelling under intracranial hypertension. Moreover, disturbance of the cerebral venous circulatory system is discussed recently by many authors. But, research from the point of systemic respiration and hemodynamics is necessary for resolving these problems. This experiment was designed to study the effects of respiration and hemodynamics on the cerebral vasoparesis. Using 22 adult dogs, acute intracranial hypertension was produced by epidural balloon inflation sustained at the level of 300 - 400 mmH2O. Simultaneously with measurement of intracranial pressure at the epidural space, superior sagittal sinus pressure, respirogram, systemic blood pressure (femoral artery), central venous pressure, common carotid blood flow, EKG and bipolar lead EEG were monitored continuously. The experimental group was divided by the respiratory loading into 5 groups as follows: control (6 cases), 10% CO2 hypercapnia (4 cases), 10% O2 hypoxia (4 cases), stenosis of airway (5 cases), 100% O2-controled respiration (3 cases). 1) Cerebral vasoparesis under acute intracranial hypertension took place earlier and showed more rapid progression in groups of stenosis of airway, hypercapnia and hypoxia than control group of spontaneous respiration in room air. No occurrence of cerebral vasoparesis was found out in a group of 100% O2 controlled respiration. It is proved that increased airway resistance or asphyxia, hypercapnia and hypoxia have strictly reference to the occurrence and progression of cerebral vasoparesis and for the prevention of cerebral vasoparesis, correct 100% O2 cont rolled respiration is effective. 2) From the hemodynamic change, the progression of rapid increase of cerebral

  18. The Effect of Inlet Waveforms on Computational Hemodynamics of Patient-Specific Intracranial Aneurysms

    OpenAIRE

    Xiang, J.; Siddiqui, A.H.; Meng, H.

    2014-01-01

    Due to the lack of patient-specific inlet flow waveform measurements, most computational fluid dynamics (CFD) simulations of intracranial aneurysms usually employ waveforms that are not patient-specific as inlet boundary conditions for the computational model. The current study examined how this assumption affects the predicted hemodynamics in patient-specific aneurysm geometries. We examined wall shear stress (WSS) and oscillatory shear index (OSI), the two most widely studied hemodynamic qu...

  19. Cerebral venous dynamics in newborn mice with intracranial hemorrhage studied using wavelets

    Science.gov (United States)

    Pavlov, A. N.; Semyachkina-Glushkovskaya, O. V.; Sindeeva, O. A.; Pavlova, O. N.; Shuvalova, E. P.; Huang, Q.; Zhu, D.; Li, P.; Tuchin, V. V.; Luo, Q.

    2015-03-01

    We investigate the stress-induced development of the intracranial hemorrhage in newborn mice with the main attention to its latent stage. Our study is based on the laser speckle contrast imaging of the cerebral venous blood flow and the wavelet-based analysis of experimental data. We study responses of the sagittal sinus in different frequency ranges associated with distinct regulatory mechanisms and discuss significant changes of the spectral power in the frequency area associated with the NO-related endothelial function.

  20. Synovial CD4+ T-cell-derived GM-CSF supports the differentiation of an inflammatory dendritic cell population in rheumatoid arthritis

    Science.gov (United States)

    Reynolds, G; Gibbon, J R; Pratt, A G; Wood, M J; Coady, D; Raftery, G; Lorenzi, A R; Gray, A; Filer, A; Buckley, C D; Haniffa, M A; Isaacs, J D; Hilkens, C M U

    2016-01-01

    Objective A population of synovial inflammatory dendritic cells (infDCs) has recently been identified in rheumatoid arthritis (RA) and is thought to be monocyte-derived. Here, we investigated the role and source of granulocyte macrophage-colony-stimulating factor (GM-CSF) in the differentiation of synovial infDC in RA. Methods Production of GM-CSF by peripheral blood (PB) and synovial fluid (SF) CD4+ T cells was assessed by ELISA and flow cytometry. In vitro CD4+ T-cell polarisation experiments were performed with T-cell activating CD2/CD3/CD28-coated beads in the absence or presence of pro-Th1 or pro-Th17 cytokines. CD1c+ DC and CD16+ macrophage subsets were flow-sorted and analysed morphologically and functionally (T-cell stimulatory/polarising capacity). Results RA-SF CD4+ T cells produced abundant GM-CSF upon stimulation and significantly more than RA-SF mononuclear cells depleted of CD4+ T cells. GM-CSF-producing T cells were significantly increased in RA-SF compared with non-RA inflammatory arthritis SF, active RA PB and healthy donor PB. GM-CSF-producing CD4+ T cells were expanded by Th1-promoting but not Th17-promoting conditions. Following coculture with RA-SF CD4+ T cells, but not healthy donor PB CD4+ T cells, a subpopulation of monocytes differentiated into CD1c+ infDC; a process dependent on GM-CSF. These infDC displayed potent alloproliferative capacity and enhanced GM-CSF, interleukin-17 and interferon-γ production by CD4+ T cells. InfDC with an identical phenotype to in vitro generated cells were significantly enriched in RA-SF compared with non-RA-SF/tissue/PB. Conclusions We demonstrate a therapeutically tractable feedback loop of GM-CSF secreted by RA synovial CD4+ T cells promoting the differentiation of infDC with potent capacity to induce GM-CSF-producing CD4+ T cells. PMID:25923217

  1. A dimensionless parameter for classifying hemodynamics in intracranial

    Science.gov (United States)

    Asgharzadeh, Hafez; Borazjani, Iman

    2015-11-01

    Rupture of an intracranial aneurysm (IA) is a disease with high rates of mortality. Given the risk associated with the aneurysm surgery, quantifying the likelihood of aneurysm rupture is essential. There are many risk factors that could be implicated in the rupture of an aneurysm. However, the most important factors correlated to the IA rupture are hemodynamic factors such as wall shear stress (WSS) and oscillatory shear index (OSI) which are affected by the IA flows. Here, we carry out three-dimensional high resolution simulations on representative IA models with simple geometries to test a dimensionless number (first proposed by Le et al., ASME J Biomech Eng, 2010), denoted as An number, to classify the flow mode. An number is defined as the ratio of the time takes the parent artery flow transports across the IA neck to the time required for vortex ring formation. Based on the definition, the flow mode is vortex if An>1 and it is cavity if AnOSI on the human subject IA. This work was supported partly by the NIH grant R03EB014860, and the computational resources were partly provided by CCR at UB. We thank Prof. Hui Meng and Dr. Jianping Xiang for providing us the database of aneurysms and helpful discussions.

  2. Automated quantification of cerebral edema following hemispheric infarction: Application of a machine-learning algorithm to evaluate CSF shifts on serial head CTs

    Directory of Open Access Journals (Sweden)

    Yasheng Chen

    2016-01-01

    Full Text Available Although cerebral edema is a major cause of death and deterioration following hemispheric stroke, there remains no validated biomarker that captures the full spectrum of this critical complication. We recently demonstrated that reduction in intracranial cerebrospinal fluid (CSF volume (∆CSF on serial computed tomography (CT scans provides an accurate measure of cerebral edema severity, which may aid in early triaging of stroke patients for craniectomy. However, application of such a volumetric approach would be too cumbersome to perform manually on serial scans in a real-world setting. We developed and validated an automated technique for CSF segmentation via integration of random forest (RF based machine learning with geodesic active contour (GAC segmentation. The proposed RF + GAC approach was compared to conventional Hounsfield Unit (HU thresholding and RF segmentation methods using Dice similarity coefficient (DSC and the correlation of volumetric measurements, with manual delineation serving as the ground truth. CSF spaces were outlined on scans performed at baseline (<6 h after stroke onset and early follow-up (FU (closest to 24 h in 38 acute ischemic stroke patients. RF performed significantly better than optimized HU thresholding (p < 10−4 in baseline and p < 10−5 in FU and RF + GAC performed significantly better than RF (p < 10−3 in baseline and p < 10−5 in FU. Pearson correlation coefficients between the automatically detected ∆CSF and the ground truth were r = 0.178 (p = 0.285, r = 0.876 (p < 10−6 and r = 0.879 (p < 10−6 for thresholding, RF and RF + GAC, respectively, with a slope closer to the line of identity in RF + GAC. When we applied the algorithm trained from images of one stroke center to segment CTs from another center, similar findings held. In conclusion, we have developed and validated an accurate automated approach to segment CSF and calculate its shifts on serial CT scans

  3. Bacterial Isolates from Cerebrospinal Fluid (CSF) of Patients In a ...

    African Journals Online (AJOL)

    The presence of bacteria in cerebrospinal fluid (CSF) results in the inflammation of the meninges, a condition known as meningitis. The aim of the study is to determine the prevalence of bacteria, which causes meningitis and their susceptibility pattern. This study, which was prospective and cross sectional involved patients ...

  4. CSF biomarker variability in the Alzheimer's Association quality control program

    NARCIS (Netherlands)

    Mattsson, N.; Andreasson, U.; Persson, S.; Carrillo, M.C.; Collins, S.; Chalbot, S.; Cutler, N.; Dufour-Rainfray, D.; Fagan, A.M.; Heegaard, N.H.H.; Robin Hsiung, G.Y.; Hyman, B.; Iqbal, K.; Lachno, D.R.; Lleo, A.; Lewczuk, P.; Molinuevo, J.L.; Parchi, P.; Regeniter, A.; Rissman, R.; Rosenmann, H.; Sancesario, G.; Schroder, J.; Shaw, L.M.; Teunissen, C.E.; Trojanowski, J.Q.; Vanderstichele, H.; Vandijck, M.; Verbeek, M.M.; Zetterberg, H.; Blennow, K.; Kaser, S.A.; et al.,

    2013-01-01

    BACKGROUND: The cerebrospinal fluid (CSF) biomarkers amyloid beta 1-42, total tau, and phosphorylated tau are used increasingly for Alzheimer's disease (AD) research and patient management. However, there are large variations in biomarker measurements among and within laboratories. METHODS: Data

  5. CSF biomarker variability in the Alzheimer's Association quality control program

    NARCIS (Netherlands)

    Mattsson, N.; Andreasson, U.; Persson, S.; Carrillo, M.C.; Collins, S.; Chalbot, S.; Cutler, N.; Dufour-Rainfray, D.; Fagan, A.M.; Heegaard, N.H.H.; Hsiung, G.Y.R.; Hyman, B.; Iqbal, K.; Lachno, D.R.; Lleo, A.; Lewczuk, P.; Molinuevo, J.L.; Parchi, P.; Regeniter, A.; Rissman, R.; Rosenmann, H.; Sancesario, G.; Schroder, J.; Shaw, L.M.; Teunissen, C.E.; Trojanowski, J.Q.; Vanderstichele, H.; Vandijck, M.; Verbeek, M.M.; Zetterberg, H.; Blennow, K.; Kaser, S.A.

    2013-01-01

    Background: The cerebrospinal fluid (CSF) biomarkers amyloid beta 1-42, total tau, and phosphorylated tau are used increasingly for Alzheimer's disease (AD) research and patient management. However, there are large variations in biomarker measurements among and within laboratories. Methods: Data

  6. The diagnosis of CSF fistulas with rhinorrhea by isotope cisternography

    International Nuclear Information System (INIS)

    Salar, G.; Carteri, A.; Zampieri, P.

    1978-01-01

    The experience with the use of RIHSA cisternography in cases of spontaneous of post-traumatic CSF rhinorrhea is reported. The utility of this method for identifying the fistulous tract so that the neurosurgeon can, as far as he is able, carry out a direct and not solely exploratory operation is pointed out. (orig.) [de

  7. Fatal cerebral edema associated with serine deficiency in CSF

    NARCIS (Netherlands)

    Keularts, Irene M. L. W.; Leroy, Piet L. J. M.; Rubio-Gozalbo, Estela M.; Spaapen, Leo J. M.; Weber, Biene; Dorland, Bert; de Koning, Tom J.; Verhoeven-Duif, Nanda M.

    2010-01-01

    Two young girls without a notable medical history except for asthma presented with an acute toxic encephalopathy with very low serine concentrations both in plasma and cerebrospinal fluid (CSF) comparable to patients with 3-phosphoglycerate dehydrogenase (3-PGDH) deficiency. Clinical symptoms and

  8. G-CSF Intrauterine for Thin Endometrium, and Pregnancy Outcome

    Directory of Open Access Journals (Sweden)

    Ensieh Tehraninejad

    2015-10-01

    Full Text Available Objective:To evaluate effects ofG-CSF on a cancelled ART cycle due to thin endometrium.Materials and methods:In a nonrandomized clinical trial from January 2011 to January 2013 in two tertiary university based hospitals fifteen patients undergoing embryo transfer and with the history of cycle cancellation due to thin endometrium were studied. Intrauterine infusion of G-CSF was done on the day of oocyte pick-up or 5 days before embryo transfer. The primary outcome to be measured was an endometrium thickened to at least 6 mm and the secondary outcome was clinical pregnancy rate and consequently take-home baby. All previous cycles were considered as control for each patient.Results:The G-CSF was infused at the day of oocyte retrieval or 5 days before embryo transfer. The endometrial thickness reached from3.593±0.251 mm to 7.120±0.84 mm. The mean age, gravidity, parity, and FSH were 35.13± 9.531 years,3, 1 and32.78± 31.10 mIU/ml, respectively. The clinical pregnancy rate was 20%, and there was one missed abortion, a mother death at 34 weeks, and a preterm labor at 30 weeks due to PROM.Conclusion:G-CSF may increase endometrial thickness in the small group of patients who had no choice except cycle cancellation or surrogacy.

  9. Increased CSF Homocysteine in Pathological Gamblers Compared with Healthy Controls

    Science.gov (United States)

    Nordin, Conny; Sjodin, Ingemar

    2009-01-01

    Neurocognitive disturbances suggesting a frontal lobe dysfunction have been observed in pathological gamblers and alcohol dependents. Given that a high homocysteine level has been suggested to be a mediating factor in alcohol-related cognitive decline, we have determined homocysteine and cobalamine in cerebrospinal fluid (CSF) obtained from 11…

  10. Inherited biallelic CSF3R mutations in severe congenital neutropenia.

    Science.gov (United States)

    Triot, Alexa; Järvinen, Päivi M; Arostegui, Juan I; Murugan, Dhaarini; Kohistani, Naschla; Dapena Díaz, José Luis; Racek, Tomas; Puchałka, Jacek; Gertz, E Michael; Schäffer, Alejandro A; Kotlarz, Daniel; Pfeifer, Dietmar; Díaz de Heredia Rubio, Cristina; Ozdemir, Mehmet Akif; Patiroglu, Turkan; Karakukcu, Musa; Sánchez de Toledo Codina, José; Yagüe, Jordi; Touw, Ivo P; Unal, Ekrem; Klein, Christoph

    2014-06-12

    Severe congenital neutropenia (SCN) is characterized by low numbers of peripheral neutrophil granulocytes and a predisposition to life-threatening bacterial infections. We describe a novel genetic SCN type in 2 unrelated families associated with recessively inherited loss-of-function mutations in CSF3R, encoding the granulocyte colony-stimulating factor (G-CSF) receptor. Family A, with 3 affected children, carried a homozygous missense mutation (NM_000760.3:c.922C>T, NP_000751.1:p.Arg308Cys), which resulted in perturbed N-glycosylation and aberrant localization to the cell surface. Family B, with 1 affected infant, carried compound heterozygous deletions provoking frameshifts and premature stop codons (NM_000760.3:c.948_963del, NP_000751.1:p.Gly316fsTer322 and NM_000760.3:c.1245del, NP_000751.1:p.Gly415fsTer432). Despite peripheral SCN, all patients had morphologic evidence of full myeloid cell maturation in bone marrow. None of the patients responded to treatment with recombinant human G-CSF. Our study highlights the genetic and morphologic SCN variability and provides evidence both for functional importance and redundancy of G-CSF receptor-mediated signaling in human granulopoiesis. © 2014 by The American Society of Hematology.

  11. CSF Amino Acids, Pterins and Mechanism of the Ketogenic Diet

    Directory of Open Access Journals (Sweden)

    J. Gordon Millichap

    2015-11-01

    Full Text Available Investigators from Hospital Sant Joan de Deu, Barcelona, Spain, studied the relationship between the etiology of refractory childhood epilepsy, CSF neurotransmitters, pterins, and amino acids, and response to a ketogenic diet in 60 patients with refractory epilepsy, 83% focal and 52% idiopathic.

  12. Using CSF biomarkers to replicate genetic associations in Alzheimer's disease

    NARCIS (Netherlands)

    Schott, Jonathan M.; Abdi, Hervé; Abdul Hadi, Normi; Abdulkadir, Ahmed; Abdullah, Afnizanfaizal; Achuthan, Anusha; Adluru, Nagesh; Aggarwal, Namita; Aghajanian, Jania; Agyemang, Alex; Ahdidan, Jamila; Ahmad, Duaa; Ahmed, Fayeza; Ahmed, Shiek; Ahmed, Fareed; Akbarifar, Roshanak; Akhondi-Asl, Alireza; Aksu, Yaman; Alcauter, Sarael; Alexander, Daniel; Alin, Aylin; Alshuft, Hamza; Alvarez-Linera, Juan; Amin-Mansour, Ali; Anderson, Jeff; Anderson, Dallas; Andorn, Anne; Andrews, K. Abigail; Ang, Amma; Angersbach, Steve; Ansarian, Reza; Abhishek, Appaji M.; Appannah, Arti; Arfanakis, Konstantinos; Arif, Muhammad; Armentrout, Steven; Arrighi, Michael; Arumughababu, S. Vethanayaki; Arunagiri, Vidhya; Ashe-McNalley, Cody; Ashford, Wes; Le Page, Aurelie; Avants, Brian; Aviv, Richard; Avula, Ramesh; Ayache, Nicholas; Ayan-Oshodi, Mosun; Ayhan, Murat; Richard, Edo; Schmand, Ben

    2012-01-01

    Defining cases and controls on the basis of biomarkers rather than clinical diagnosis may reduce sample sizes required for genetic studies. The aim of this study was to assess whether characterizing case/control status on the basis of cerebrospinal fluid (CSF) profile would increase power to

  13. Comparison of the Cerebrospinal Fluid (CSF) Toluidine Red Unheated Serum Test and the CSF Rapid Plasma Reagin Test with the CSF Venereal Disease Research Laboratory Test for Diagnosis of Neurosyphilis among HIV-Negative Syphilis Patients in China

    OpenAIRE

    Zhu, Lin; Gu, Xin; Peng, Rui-Rui; Wang, Cuini; Gao, Zixiao; Zhou, Pingyu; Gao, Ying; Shi, Mei; Guan, Zhifang; Seña, Arlene C.

    2014-01-01

    In this study, we aimed to investigate the performance of nontreponemal antibody tests in cerebrospinal fluid (CSF) specimens from syphilis patients. From September 2009 to September 2012, CSF specimens were collected at the Shanghai Skin Disease Hospital in Shanghai, China, from 1,132 syphilis patients without HIV infection, including 154 with symptomatic and 56 with asymptomatic neurosyphilis. All of the CSF specimens underwent testing with a rapid plasma reagin (RPR) test, an RPR-V (commer...

  14. Biological role of granulocyte macrophage colony-stimulating factor (GM-CSF) and macrophage colony-stimulating factor (M-CSF) on cells of the myeloid lineage

    Science.gov (United States)

    Ushach, Irina; Zlotnik, Albert

    2016-01-01

    M-CSF and GM-CSF are 2 important cytokines that regulate macrophage numbers and function. Here, we review their known effects on cells of the macrophage-monocyte lineage. Important clues to their function come from their expression patterns. M-CSF exhibits a mostly homeostatic expression pattern, whereas GM-CSF is a product of cells activated during inflammatory or pathologic conditions. Accordingly, M-CSF regulates the numbers of various tissue macrophage and monocyte populations without altering their "activation" status. Conversely, GM-CSF induces activation of monocytes/macrophages and also mediates differentiation to other states that participate in immune responses [i.e., dendritic cells (DCs)]. Further insights into their function have come from analyses of mice deficient in either cytokine. M-CSF signals through its receptor (CSF-1R). Interestingly, mice deficient in CSF-1R expression exhibit a more significant phenotype than mice deficient in M-CSF. This observation was explained by the discovery of a novel cytokine (IL-34) that represents a second ligand of CSF-1R. Information about the function of these ligands/receptor system is still developing, but its complexity is intriguing and strongly suggests that more interesting biology remains to be elucidated. Based on our current knowledge, several therapeutic molecules targeting either the M-CSF or the GM-CSF pathways have been developed and are currently being tested in clinical trials targeting either autoimmune diseases or cancer. It is intriguing to consider how evolution has directed these pathways to develop; their complexity likely mirrors the multiple functions in which cells of the monocyte/macrophage system are involved. PMID:27354413

  15. Emerging Roles for CSF-1 Receptor and its Ligands in the Nervous System

    Science.gov (United States)

    Chitu, Violeta; Gokhan, Solen; Nandi, Sayan; Mehler, Mark F.; Stanley, E. Richard

    2016-01-01

    The colony stimulating factor-1 receptor (CSF-1R) kinase regulates tissue macrophage homeostasis, osteoclastogenesis, and Paneth cell development. However, recent studies in mice have revealed that CSF-1R signaling directly controls the development and maintenance of microglia, and cell autonomously regulates neuronal differentiation and survival. While the CSF-1R-cognate ligands, CSF-1 and interleukin-34 (IL-34), compete for binding to the CSF-1R, they are expressed in a largely non-overlapping manner by mature neurons. The recent identification of a dominantly inherited, adult-onset, progressive dementia associated with inactivating mutations in the CSF-1R highlights the importance of CSF-1R signaling in the brain. We review the roles of the CSF-1R and its ligands in microglial and neural development and function, and their relevance to our understanding of neurodegenerative disease. PMID:27083478

  16. Epidemiology and genetics of intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Caranci, F., E-mail: ferdinandocaranci@libero.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Briganti, F., E-mail: frabriga@unina.it [Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples (Italy); Cirillo, L.; Leonardi, M. [Neuroradiology service, Bellaria Hospital, Bologna (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service Cardarelli Hospital Naples (Italy)

    2013-10-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  17. Epidemiology and genetics of intracranial aneurysms

    International Nuclear Information System (INIS)

    Caranci, F.; Briganti, F.; Cirillo, L.; Leonardi, M.; Muto, M.

    2013-01-01

    Intracranial aneurysms are acquired lesions (5–10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3–p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3–p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2

  18. The Clinical Importance of Perforator Preservation in Intracranial Aneurysm Surgery: An Overview with a Review of the Literature.

    Science.gov (United States)

    Joo, Sung-Pil; Kim, Tae-Sun

    2017-01-01

    Clipping for intracranial aneurysms is done to achieve complete occlusion of the aneurysm without a remnant sac. Despite modern advancements of neurosurgical techniques, morbidity related to the clipping of intracranial aneurysms still exists. Clip occlusion of a parent artery or small hidden perforators commonly leads to permanent neurological deficits, and is a serious and unwanted complication. Thus, preserving blood flow in the branches and perforators of a parent artery is very important for successful surgery without postoperative morbidity and mortality. The aim of this review article is to discuss the consequences of perforator injury and how to avoid this phenomenon in aneurysm surgeries using intraoperative monitoring devices.

  19. IL-34 and CSF-1 display an equivalent macrophage differentiation ability but a different polarization potential

    OpenAIRE

    Boulakirba, Sonia; Pfeifer, Anja; Mhaidly, Rana; Obba, Sandrine; Goulard, Michael; Schmitt, Thomas; Chaintreuil, Paul; Calleja, Anne; Furstoss, Nathan; Orange, François; Lacas-Gervais, Sandra; Boyer, Laurent; Marchetti, Sandrine; Verhoeyen, Els; Luciano, Frederic

    2018-01-01

    CSF-1 and IL-34 share the CSF-1 receptor and no differences have been reported in the signaling pathways triggered by both ligands in human monocytes. IL-34 promotes the differentiation and survival of monocytes, macrophages and osteoclasts, as CSF-1 does. However, IL-34 binds other receptors, suggesting that differences exist in the effect of both cytokines. In the present study, we compared the differentiation and polarization abilities of human primary monocytes in response to CSF-1 or IL-...

  20. Heterogeneous effects of M-CSF isoforms on the progression of MLL-AF9 leukemia.

    Science.gov (United States)

    Wang, Rong; Feng, Wenli; Yang, Feifei; Yang, Xiao; Wang, Lina; Chen, Chong; Hu, Yuting; Ren, Qian; Zheng, Guoguang

    2018-02-01

    Macrophage colony-stimulating factor (M-CSF) regulates both malignant cells and microenvironmental cells. Its splicing isoforms show functional heterogeneity. However, their roles on leukemia have not been well established. Here, the expression of total M-CSF in patients with hematopoietic malignancies was analyzed. The roles of M-CSF isoforms on the progression of acute myeloid leukemia (AML) were studied by establishing MLL-AF9-induced mouse AML models with high level membrane-bound M-CSF (mM-CSF) or soluble M-CSF (sM-CSF). Total M-CSF was highly expressed in myeloid leukemia patients. Furthermore, mM-CSF but not sM-CSF prolonged the survival of leukemia mice. While sM-CSF was more potent to promote proliferation and self-renew, mM-CSF was more potent to promote differentiation. Moreover, isoforms had different effects on leukemia-associated macrophages (LAMs) though they both increase monocytes/macrophages by growth-promoting and recruitment effects. In addition, mM-CSF promoted specific phagocytosis of leukemia cells by LAMs. RNA-seq analysis revealed that mM-CSF enhanced phagocytosis-associated genes and activated oxidative phosphorylation and metabolism pathway. These results highlight heterogeneous effects of M-CSF isoforms on AML progression and the mechanisms of mM-CSF, that is, intrinsically promoting AML cell differentiation and extrinsically enhancing infiltration of macrophages and phagocytosis by macrophages, which may provide potential clues for clinical diagnosis and therapy. © 2017 Australasian Society for Immunology Inc.

  1. DMPD: CSF-1 and cell cycle control in macrophages. [Dynamic Macrophage Pathway CSML Database

    Lifescience Database Archive (English)

    Full Text Available 8981359 CSF-1 and cell cycle control in macrophages. Hamilton JA. Mol Reprod Dev. 1...997 Jan;46(1):19-23. (.png) (.svg) (.html) (.csml) Show CSF-1 and cell cycle control in macrophages. PubmedI...D 8981359 Title CSF-1 and cell cycle control in macrophages. Authors Hamilton JA. Publication Mol Reprod Dev

  2. The 100 most cited articles in the endovascular management of intracranial aneurysms.

    Science.gov (United States)

    Maingard, Julian; Phan, Kevin; Ren, Yifan; Kok, Hong Kuan; Thijs, Vincent; Hirsch, Joshua A; Lee, Michael J; Chandra, Ronil V; Brooks, Duncan Mark; Asadi, Hamed

    2018-01-19

    Endovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms. We performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms ('intracranial aneurysm', 'aneurysm', 'aneurysmal subarachnoid', 'endovascular', 'coiling', 'stent-assisted', 'balloon-assisted', 'flow-diversion') yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication. Citations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level-II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA. This study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Ultrasound Imaging of Mouse Fetal Intracranial Hemorrhage Due to Ischemia/Reperfusion

    Directory of Open Access Journals (Sweden)

    Kenichi Funamoto

    2017-05-01

    Full Text Available Despite vast improvement in perinatal care during the 30 years, the incidence rate of neonatal encephalopathy remains unchanged without any further Progress towards preventive strategies for the clinical impasse. Antenatal brain injury including fetal intracranial hemorrhage caused by ischemia/reperfusion is known as one of the primary triggers of neonatal injury. However, the mechanisms of antenatal brain injury are poorly understood unless better predictive models of the disease are developed. Here we show a mouse model for fetal intracranial hemorrhage in vivo developed to investigate the actual timing of hypoxia-ischemic events and their related mechanisms of injury. Intrauterine growth restriction mouse fetuses were exposed to ischemia/reperfusion cycles by occluding and opening the uterine and ovarian arteries in the mother. The presence and timing of fetal intracranial hemorrhage caused by the ischemia/reperfusion were measured with histological observation and ultrasound imaging. Protein-restricted diet increased the risk of fetal intracranial hemorrhage. The monitoring of fetal brains by ultrasound B-mode imaging clarified that cerebral hemorrhage in the fetal brain occurred after the second ischemic period. Three-dimensional ultrasound power Doppler imaging visualized the disappearance of main blood flows in the fetal brain. These indicate a breakdown of cerebrovascular autoregulation which causes the fetal intracranial hemorrhage. This study supports the fact that the ischemia/reperfusion triggers cerebral hemorrhage in the fetal brain. The present method enables us to noninvasively create the cerebral hemorrhage in a fetus without directly touching the body but with repeated occlusion and opening of the uterine and ovarian arteries in the mother.

  4. A coil placement technique to treat intracranial aneurysm with incorporated artery.

    Science.gov (United States)

    Luo, Chao-Bao; Chang, Feng-Chi; Lin, Chung-Jung; Guo, Wan-Yuo

    2018-03-01

    Endovascular coil embolization is an accepted treatment option for intracranial aneurysms. However, the coiling of aneurysms with an incorporated artery (IA) poses a high risk of IA occlusion. Here we report our experience of endovascular coil placement using a technique that avoids IA occlusion in aneurysms with IAs. Over a 6-year period, 185 patients harboring 206 intracranial aneurysms underwent endosaccular coiling. Forty-two of these patients with 45 aneurysms were treated by coil placement to avoid IAs occlusion. We assessed the anatomy of the aneurysms and IAs, technical feasibility of the procedure, and degree of aneurysm occlusion. Clinical and angiographic outcomes were assessed as well. Aneurysms were located in the supra-clinoid intracranial internal carotid artery (n = 24), anterior cerebral artery (n = 6), middle cerebral artery (n = 7), and vertebrobasilar artery (n = 8). The IA was at the aneurysm neck in 34 patients, body in 10, and dome in 1. Immediate post-coiling angiogram showed preservation of blood flow through the IA in all aneurysms. Coil compaction with aneurysmal regrowth was found in 7 of 36 patients having follow-up conventional angiography. One patient had an IA territory infarction after embolization. All 42 patients were followed up (mean: 21 months) and showed no re-bleeding. This technique is effective and safe in managing intracranial aneurysms with IAs. Although aneurysmal recurrence may occur in some aneurysms because of insufficient coiling, this technique is simpler to perform and requires less skill than other techniques. It can be an alternative option for treating some selected intracranial aneurysms with IAs. Copyright © 2017. Published by Elsevier Taiwan LLC.

  5. Headache attributed to intracranial pressure alterations: applicability of the International Classification of Headache Disorders ICHD-3 beta version versus ICHD-2.

    Science.gov (United States)

    Curone, M; Peccarisi, C; Bussone, G

    2015-05-01

    The association between headache and changes in intracranial pressure is strong in clinical practice. Syndromes associated with abnormalities of cerebrospinal fluid (CSF) pressure include spontaneous intracranial hypotension (SIH) and idiopathic intracranial hypertension (IIH). In 2013, the Headache Classification Committee of the International Headache Society (IHS) published the third International Classification of Headache Disorders (ICHD-3 beta version). The aim of this study was to investigate applicability of the new ICHD-3 versus ICHD-2 criteria in a clinical sample of patients with intracranial pressure (ICP) alterations. Patients admitted at our Headache Center for headache evaluation in whom a diagnosis of ICP alterations was performed were reviewed. 71 consecutive patients were studied. 40 patients (Group A) were diagnosed as IIH, 22 (Group B) as SIH, 7 (Group C) and 2 (Group D), respectively, as symptomatic intracranial hypertension and symptomatic intracranial hypotension. Main headache features were: in Group A, daily or nearly-daily headache (100 %) with diffuse/non-pulsating pain (73 %), aggravated by coughing/straining (54 %) and migrainous-associated symptoms (43 %). In Group B, an orthostatic headache (100 %) with nausea (29 %), vomiting (24 %), hearing disturbance (33 %), neck pain (48 %), hypacusia (24 %), photophobia (22 %) was reported. In Group C, a diffuse non-pulsating headache was present in 95 % with vomiting (25 %), sixth nerve palsy (14 %) and tinnitus (29 %). In Group D, an orthostatic headache with neck stiffness was reported by 100 %. Regarding applicability of ICHD-2 criteria in Group A, 73 % of the patients fitted criterion A; 100 %, criterion B; 100 %, criterion C; and 75 %, criterion D; while applying ICHD-3 beta version criteria, 100 % fitted criterion A; 97.5 %, criterion B; 100 %, criterion C; and 100 %, criterion D. In Group B, application of ICHD-2 showed 91 % patients fitting criterion A; 100 %, criterion B; 100

  6. Intracranial MRA: single volume vs. multiple thin slab 3D time-of-flight acquisition.

    Science.gov (United States)

    Davis, W L; Warnock, S H; Harnsberger, H R; Parker, D L; Chen, C X

    1993-01-01

    Single volume three-dimensional (3D) time-of-flight (TOF) MR angiography is the most commonly used noninvasive method for evaluating the intracranial vasculature. The sensitivity of this technique to signal loss from flow saturation limits its utility. A recently developed multislab 3D TOF technique, MOTSA, is less affected by flow saturation and would therefore be expected to yield improved vessel visualization. To study this hypothesis, intracranial MR angiograms were obtained on 10 volunteers using three techniques: MOTSA, single volume 3D TOF using a standard 4.9 ms TE (3D TOFA), and single volume 3D TOF using a 6.8 ms TE (3D TOFB). All three sets of axial source images and maximum intensity projection (MIP) images were reviewed. Each exam was evaluated for the number of intracranial vessels visualized. A total of 502 vessel segments were studied with each technique. With use of the MIP images, 86% of selected vessels were visualized with MOTSA, 64% with 3D TOFA (TE = 4.9 ms), and 67% with TOFB (TE = 6.8 ms). Similarly, with the axial source images, 91% of selected vessels were visualized with MOTSA, 77% with 3D TOFA (TE = 4.9 ms), and 82% with 3D TOFB (TE = 6.8 ms). There is improved visualization of selected intracranial vessels in normal volunteers with MOTSA as compared with single volume 3D TOF. These improvements are believed to be primarily a result of decreased sensitivity to flow saturation seen with the MOTSA technique. No difference in overall vessel visualization was noted for the two single volume 3D TOF techniques.

  7. Computed tomographic findings of intracranial pyogenic abscess

    International Nuclear Information System (INIS)

    Kim, S. J.; Suh, J. H.; Park, C. Y.; Lee, K. C.; Chung, S. S.

    1982-01-01

    The early diagnosis and effective treatment of brain abscess pose a difficult clinical problem. With the advent of computed tomography, however, it appears that mortality due to intracranial abscess has significantly diminished. 54 cases of intracranial pyogenic abscess are presented. Etiologic factors and computed tomographic findings are analyzed and following result are obtained. 1. The common etiologic factors are otitis media, post operation, and head trauma, in order of frequency. 2. The most common initial computed tomographic findings of brain abscess is ring contrast enhancement with surrounding brain edema. 3. The most characteristic computed tomographic finding of ring contrast enhancement is smooth thin walled ring contrast enhancement. 4. Most of thick irregular ring contrast enhancement are abscess associated with cyanotic heart disease or poor operation. 5. The most common findings of epidural and subdural empyema is crescentic radiolucent area with thin wall contrast enhancement without surrounding brain edema in convexity of brain

  8. Intracranial neurenteric cyst traversing the brainstem

    Directory of Open Access Journals (Sweden)

    Jasmit Singh

    2015-01-01

    Full Text Available Neurenteric cysts (NECs, also called enterogenous cysts, are rare benign endodermal lesions of the central nervous system that probably result from separation failure of the notochord and upper gastrointestinal tract. Most frequently they are found in the lower cervical spine or the upper thoracic spine. Intracranial occurrence is rare and mostly confined to infratentorial compartment, in prepontine region [51%]. Other common locations are fourth ventricle and cerebellopontine angle. There are few reports of NEC in medulla or the cerebellum. Because of the rarity of the disease and common radiological findings, they are misinterpreted as arachnoid or simple cysts until the histopathological confirmation, unless suspected preoperatively. We herein report a rare yet interesting case of intracranial NEC traversing across the brainstem.

  9. The contemporary management of intracranial atherosclerotic disease.

    Science.gov (United States)

    Leng, Xinyi; Wong, Ka Sing; Leung, Thomas W

    2016-06-01

    Intracranial atherosclerotic disease is the most common cause of cerebral vasculopathy and an important stroke etiology worldwide, with a higher prevalence in Asian, Hispanic and African ethnicities. Symptomatic intracranial atherosclerotic disease portends a recurrent stroke risk as high as 18% at one year. The key to secondary prevention is an understanding of the underlying stroke mechanism and aggressive control of conventional cardiovascular risks. Contemporary treatment includes antiplatelet therapy, optimal glycemic and blood pressure control, statin therapy and lifestyle modifications. For patients with high-grade (70-99%) symptomatic steno-occlusion, short-term dual antiplatelet therapy with aspirin and clopidogrel followed by life-long single antiplatelet therapy may reduce the recurrent risk. Current evidence does not advocate percutaneous transluminal angioplasty and stenting as an initial treatment. External counterpulsation, encephaloduroarteriosynangiosis and remote limb ischemic preconditioning are treatments under investigation. Future studies should aim at predicting patients prone to recurrence despite of medical therapies and testing the efficacy of emerging therapies.

  10. Intracranial Infections: Clinical and Imaging Characteristics

    Energy Technology Data Exchange (ETDEWEB)

    Foerster, B.R.; Thurnher, M.M.; Malani, P.N.; Petrou, M.; Carets-Zumelzu, F.; Sundgren, P.C. [Dept. of Radiology, and Divisions of Infectious Diseases and G eriatric Medicine, Dept. of Internal Medicine, Univ. of Michigan Medical Center, Ann Arbor, MI (United States)

    2007-10-15

    The radiologist plays a crucial role in identifying and narrowing the differential diagnosis of intracranial infections. A thorough understanding of the intracranial compartment anatomy and characteristic imaging findings of specific pathogens, as well incorporation of the clinical information, is essential to establish correct diagnosis. Specific types of infections have certain propensities for different anatomical regions within the brain. In addition, the imaging findings must be placed in the context of the clinical setting, particularly in immunocompromised and human immunodeficiency virus (HIV)-positive patients. This paper describes and depicts infections within the different compartments of the brain. Pathology-proven infectious cases are presented in both immunocompetent and immunocompromised patients, with a discussion of the characteristic findings of each pathogen. Magnetic resonance spectroscopy (MRS) characteristics for several infections are also discussed.

  11. Prognostic factors in childhood intracranial neoplasms

    International Nuclear Information System (INIS)

    Ampil, F.L.

    1987-01-01

    Thirty-six cases of primary intracranial neoplasm in children (over 1 year but under 13 years of age) seen at the university medical center between 1951 and 1982 were reviewed because of concern as to the results and after-effects of applied therapy. The overall 5-year actuarial survival rate was 17 %. Several factors of possible prognostic relevance, such as patient's age, intracranial location of the tumor, application or nonapplication of therapy, single or multiple modes of therapy, and extent of surgery, were analyzed. Completeness of surgical removal of the tumor proved to be the only statistically significant factor that correlated with survival. There was only one recorded case of severe learning disability and abnormal neuropsychologic development among the 12 living patients. The influence of patient's age (and technical factors) at the time of irradiation in correlation with the child's subsequent posttreatment functional performance, as reported in the literature, is reviewed. (author)

  12. Intracranial hemorrhage of the mature newborn infant

    International Nuclear Information System (INIS)

    Takemine, Hisao

    1983-01-01

    Concerning four mature newborn infants with intracranial hemorrhage diagnosed by CT, the labour course, treatment, and prognoses were discussed. Of intracranial hemorrhage, 70.7% was small hemorrhage along the cerebellar tentorium and the falx cerebri, 12.2% subdural hemorrhage in the posterior cranial fossa, and 9.8% subdural hemorrhage in the fornex. Intraventricular or extradural hemorrhage was rarely found. The prognosis is determined by severeness of neurotic symptoms due to cerebral hypoxia. Subdural hemorrhage of the posterior cranial fossa resulted in cerebral palsy in one fifth of the cases, and in slight enlargement of the ventricle in three fifths. Subdural hematoma left porencephaly in one fourth of the patients, but the remaining recovered to normal. (Ueda, J.)

  13. Therapeutic use of recombinant human G-CSF (rhG-CSF) in a canine model of sublethal and lethal whole-body irradiation

    International Nuclear Information System (INIS)

    MacVittie, T.J.; Monroy, R.L.; Patchen, M.L.; Souza, L.M.

    1990-01-01

    Recombinant human G-CSF (rhG-CSF) was studied for its ability to modulate haemopoiesis in normal dogs as well as to decrease therapeutically the severity and duration of neutropenia in sublethally and lethally irradiated dogs. Data indicate that in the lethally irradiated dog, effective cytokine therapy with rhG-CSF will increase survival through the induction of earlier recovery of neutrophils and platelets. (author)

  14. Impact of whole brain radiation therapy on CSF penetration ability of Icotinib in EGFR-mutated non-small cell lung cancer patients with brain metastases: Results of phase I dose-escalation study.

    Science.gov (United States)

    Zhou, Lin; He, Jiazhuo; Xiong, Weijie; Liu, Yongmei; Xiang, Jing; Yu, Qin; Liang, Maozhi; Zhou, Xiaojuan; Ding, Zhenyu; Huang, Meijuan; Ren, Li; Zhu, Jiang; Li, Lu; Hou, Mei; Ding, Lieming; Tan, Fenlai; Lu, You

    2016-06-01

    Whole-brain radiation therapy (WBRT) and epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are both treatment options for EGFR-mutated non-small cell lung cancer (NSCLC) patients with brain metastases. However, the dose-escalation toxicity and efficacy of combination therapy, and the effect of WBRT on cerebrospinal fluid (CSF) penetration of EGFR-TKIs are still unclear. EGFR-mutated NSCLC patients with brain metastases were enrolled in this study, and the cohorts were constructed with a 3+3 design. The patients received icotinib with escalating doses (125-625mg, tid), and the concurrent WBRT (37.5Gy/15f/3weeks) started a week later. The CSF penetration rates of icotinib were tested before, immediately after, and 4 weeks after WBRT, respectively. Potential toxicities and benefits from dose-escalation treatment were analyzed. Fifteen patients were included in this study, 3 at each dose level from 125mg-375mg and 6 at 500mg with 3 occurred dose-limiting toxicities. The maximal tolerated dose of icotinib was 375mg tid in this combination therapy. There was a significant correlation between icotinib concentration in the CSF and plasma (R(2)=0.599, Picotinib, from 1.2% to 9.7%, reached a maximum at 375mg (median, 6.1%). There was no significant difference for CSF penetration rates among the three test points (median, 4.1% vs. 2.8% vs. 2.8%, P=0.16). The intracranial objective response rate and median intracranial progression free survival are 80% and 18.9 months. WBRT plus concurrent icotinib is well tolerated in EGFR-mutated NSCLC patients with brain metastases, up to an icotinib dose of 375mg tid. The icotinib CSF concentration seemed to have a potential ceiling effect with the dose escalation, and WBRT seemed to have no significant impact on CSF penetration of icotinib till 4 weeks after the treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  15. Computed tomographic findings of traumatic intracranial lesions

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Seong Wook; Kim, Il Young; Lee, Byung Ho; Kim, Ki Jeoung; Yoon, Il Gyu [Soonchunhyang University College of Medicine, Seoul (Korea, Republic of)

    1985-10-15

    Traumatic intracranial lesion has been one of the most frequent and serious problem in neurosurgical pathology. Computed tomography made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospital for 15 months from October 1983 to December 1984. We have reviewed the computed tomographic scans of 264 patients which showed traumatic intracranial lesion. The result were as follows: 1. Head trauma was the most frequent diagnosed disease using computed tomographic scans (57.8%) and among 264 cases the most frequent mode of injury was traffic accident (73.9%). 2. Skull fracture was accompanied in frequency of 69.7% and it was detected in CT in 38.6%: depression fracture was more easily detected in 81%. 3. Conutercoup lesion (9.5%) was usually accompanied with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling (24.6%), subdural hematoma (22.3%), epidural hematoma (20.8%), intracerebral hematoma (6.1%), and subarachnoid hemorrhage (3.0%). 5. The shape of hematoma was usually biconvex (92.7%) in acute epidural hematoma and cresentic (100%) in acute subdural hematoma, but the most chronic the case became, they showed planoconvex and bicconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin level as single factor.

  16. Natural history of intracranial meningioma after radiotherapy

    International Nuclear Information System (INIS)

    Monzen, Yoshio

    1999-01-01

    The author examined the natural history of intracranial meningioma after radiotherapy using CT or MR imaging. Twenty patients with intracranial meningioma received radiotherapy from a high-energy linear accelerator (4-10 MV X rays) from 1980 to 1996. The total doses were 50 Gy to the tumor bed in single doses of 2 Gy in 5 weekly fractions. Meningiomas in 10 of 20 patients were reduced within 1 to 38 months after radiotherapy, the average being 11 months. The tumors were controlled for a median of 60 months after radiotherapy (range 19-126 months). Four other patients have shown no change in tumor size after radiotherapy. The tumors were controlled for a median of 70 months after radiotherapy (range 37-127 months). The other six patients have shown tumor growth within 3 to 25 months after radiotherapy, after which the tumors stopped growing for a median of 71 months (range 2-181 months). Neither tumor size nor histological type was related to response. The growth of tumors was controlled by radiotherapy for a median duration of 43 months in the meningothelial type, 52 months in the fibroblastic type, and 61 months in the transitional type. The median duration for all benign tumors was 52 months. A moderate correlation was noted between tumor response and functional outcome after radiotherapy in 9 patients with neurological deficits. The natural histories of intracranial meningiomas after radiotherapy were grouped into three categories. Some tumors showed no change in size over a long period. This was a characteristic response after radiotherapy that differed from that of other brain tumors. The results of this study provide important information for the follow-up of intracranial meningiomas after radiotherapy. (author)

  17. Intracranial capillary hemangioma mimicking a dissociative disorder

    Directory of Open Access Journals (Sweden)

    Alexander Lacasse

    2012-01-01

    Full Text Available Capillary hemangiomas, hamartomatous proliferation of vascular endothelial cells, are rare in the central nervous system (CNS. Intracranial capillary hemangiomas presenting with reversible behavioral abnormalities and focal neurological deficits have rarely been reported. We report a case of CNS capillary hemangioma presenting with transient focal neurological deficits and behavioral abnormalities mimicking Ganser’s syndrome. Patient underwent total excision of the vascular malformation, resulting in complete resolution of his symptoms.

  18. Computed tomographic findings of traumatic intracranial lesions

    International Nuclear Information System (INIS)

    Jeong, Seong Wook; Kim, Il Young; Lee, Byung Ho; Kim, Ki Jeoung; Yoon, Il Gyu

    1985-01-01

    Traumatic intracranial lesion has been one of the most frequent and serious problem in neurosurgical pathology. Computed tomography made it possible to get prompt diagnosis and surgical intervention of intracranial lesions by its safety, fastness and accuracy. Computed tomographic scan was carried out on 1309 cases at Soonchunhyang Chunan Hospital for 15 months from October 1983 to December 1984. We have reviewed the computed tomographic scans of 264 patients which showed traumatic intracranial lesion. The result were as follows: 1. Head trauma was the most frequent diagnosed disease using computed tomographic scans (57.8%) and among 264 cases the most frequent mode of injury was traffic accident (73.9%). 2. Skull fracture was accompanied in frequency of 69.7% and it was detected in CT in 38.6%: depression fracture was more easily detected in 81%. 3. Conutercoup lesion (9.5%) was usually accompanied with temporal and occipital fracture, and it appeared in lower incidence among pediatric group. 4. Intracranial lesions of all 264 cases were generalized cerebral swelling (24.6%), subdural hematoma (22.3%), epidural hematoma (20.8%), intracerebral hematoma (6.1%), and subarachnoid hemorrhage (3.0%). 5. The shape of hematoma was usually biconvex (92.7%) in acute epidural hematoma and cresentic (100%) in acute subdural hematoma, but the most chronic the case became, they showed planoconvex and bicconvex shapes. 6. Extra-axial hematoma was getting decreased in density as time gone by. 7. Hematoma density was not in direct proportion to serum hemoglobin level as single factor

  19. A Case of Rivaroxaban Associated Intracranial Hemorrhage

    Directory of Open Access Journals (Sweden)

    Jean Chin-Yu Lo

    2014-07-01

    Full Text Available Rivaroxaban is a newer anticoagulant initially approved by the Food and Drug Administration to treat nonvalvular atrial fibrillation. Rivaroxaban has several characteristics that are more favorable than warfarin. One of the characteristics is decreased risk of hemorrhage. We report one of the first case reports of severe intracranial hemorrhage associated with rivaroxaban in an elderly patient with decreased renal function. We aim to alert emergency medicine providers regarding the likelihood of encountering these patient as newer anticoagulants rise in popularity.

  20. Computed tomography in intracranial hemorrhage in leukemia

    International Nuclear Information System (INIS)

    Hanyu, Haruo; Katsunuma, Hideyo; Yoshimura, Masahiro; Tomonaga, Masanori.

    1984-01-01

    In tracranial hemorrhage in leukemia was clinicopathologically studied in 62 cases of autopsy materials, with special attention paid to a morphological comparison of CT images with pathological findings. Intracranial hemorrhage was found in 32 of the 62 leukemic patients (51.6%), and in 13 of these patients (21.0%) it was responsible for death. Leukemic intracranial hemorrhage occurred more often in the acute leukemic type than in the chronic type, and even more often in younger leukemic patinents; it was pathologically characterized by multiple lesions in the white matter of the cerebral hemisphere, prone to combination with SAH or SDH. The hemorrhages could be divided into five types: (1) scattered small hemorrhagic type, (2) hematoma type, (3) fusion type (large hemorrhage composed of assembled small hemorrhages), (4) SAH type, and (5) SDH type. Among these types, the fusion type was considered to be characteristic of leukemia. CT was undertaken in 5 pathologically proven cases, with findings of the scattered small hemorrhagic type in 1, of the SDH type in 3, and of the fusion type in 1. Yet, one case with scattered small hemorrhages and two cases with SDH failed to be detected by CT. However, one case with a typical fusion hemorrhage was found to have multiple, irregular, high-density areas with surrounding edema and a mass effect as well as pathological findings. Therefore, a large-fusion hemorrhage, which is one of the most characteristic types of leukemic intracranial hemorrhage, could be demonstrated as distinctive CT images which reflected neuropathological findings. On the other hand, small parenchymal hemorrhages and relatively thin subdural hemorrhages could not be detected by CT. In conclusion, it seems that CT has value in the diagnosis of intracranial hemorrhage in leukemia. (J.P.N.)

  1. GM-CSF enhances tumor invasion by elevated MMP-2, -9, and -26 expression

    International Nuclear Information System (INIS)

    Gutschalk, Claudia M; Yanamandra, Archana K; Linde, Nina; Meides, Alice; Depner, Sofia; Mueller, Margareta M

    2013-01-01

    Granulocyte–macrophage colony-stimulating factor (GM-CSF) promotes tumor progression in different tumor models in an autocrine and paracrine manner. However, at the same time GM-CSF is used in cancer therapies to ameliorate neutropenia. We have previously shown in GM-CSF and G-CSF expressing or negative skin or head and neck squamous cell carcinoma that GM-CSF expression is associated with a highly angiogenic and invasive tumor phenotype. To determine the functional contribution of GM-CSF to tumor invasion, we stably transfected a GM-CSF negative colon adenocarcinoma cell line HT-29 with GM-CSF or treated the same cell line with exogenous GM-CSF. While GM-CSF overexpression and treatment reduced tumor cell proliferation and tumor growth in vitro and in vivo, respectively, it contributed to tumor progression. Together with an enhanced migratory capacity in vitro, we observed a striking increase in tumor cell invasion into the surrounding tissue concomitant with the induction of an activated tumor stroma in GM-CSF overexpressing or GM-CSF treated tumors. In a complex 3D in vitro model, enhanced GM-CSF expression was associated with a discontinued basement membrane deposition that might be mediated by the increased expression and activation of MMP-2, -9, and -26. Treatment with GM-CSF blocking antibodies reversed this effect. The increased presence and activity of these tumor cell derived proteases was confirmed in vivo. Here, expression of MMP-26 protein was predominantly located in pre- and early-invasive areas suggesting MMP-26 expression as an early event in promoting GM-CSF dependent tumor invasion

  2. A rare cause of fatal intracranial haemorrhage.

    LENUS (Irish Health Repository)

    Neligan, A

    2012-01-31

    INTRODUCTION: We report the case of a 53-year-old farmer with a 5-day history of severe headache, photophobia and neck stiffness. Full blood count (platelets 173), coagulation screen were normal throughout. Liver function tests remained normal apart from an elevated gamma-GT (156). CT Brain was normal. CSF analysis showed a WCC of 454\\/mm(3) (60% lymphocytes), elevated CSF protein (1.42 g\\/l) and a normal CSF glucose. He was commenced on IV antibiotics and IV acyclivor and improved. On day 3 of admission, he complained of a sudden severe headache, became unresponsive (GCS 3\\/15). INVESTIGATIONS: CT Brain showed a massive left intraventricular haemorrhage. He died 4 days later. Subsequent serum serology for leptospirosis was positive. A repeat sample taken 4 days post-admission, showed a rising IgM indicating active leptospirosis. Detailed pathological examination confirmed intracerebral haemorrhage with normal cerebral vasculature. CONCLUSION: Leptospirosis is a rare cause of intracerebral haemorrhage even in the absence of coagulopathy.

  3. Nucleolin Mediates MicroRNA-directed CSF-1 mRNA Deadenylation but Increases Translation of CSF-1 mRNA*

    Science.gov (United States)

    Woo, Ho-Hyung; Baker, Terri; Laszlo, Csaba; Chambers, Setsuko K.

    2013-01-01

    CSF-1 mRNA 3′UTR contains multiple unique motifs, including a common microRNA (miRNA) target in close proximity to a noncanonical G-quadruplex and AU-rich elements (AREs). Using a luciferase reporter system fused to CSF-1 mRNA 3′UTR, disruption of the miRNA target region, G-quadruplex, and AREs together dramatically increased reporter RNA levels, suggesting important roles for these cis-acting regulatory elements in the down-regulation of CSF-1 mRNA. We find that nucleolin, which binds both G-quadruplex and AREs, enhances deadenylation of CSF-1 mRNA, promoting CSF-1 mRNA decay, while having the capacity to increase translation of CSF-1 mRNA. Through interaction with the CSF-1 3′UTR miRNA common target, we find that miR-130a and miR-301a inhibit CSF-1 expression by enhancing mRNA decay. Silencing of nucleolin prevents the miRNA-directed mRNA decay, indicating a requirement for nucleolin in miRNA activity on CSF-1 mRNA. Downstream effects followed by miR-130a and miR-301a inhibition of directed cellular motility of ovarian cancer cells were found to be dependent on nucleolin. The paradoxical effects of nucleolin on miRNA-directed CSF-1 mRNA deadenylation and on translational activation were explored further. The nucleolin protein contains four acidic stretches, four RNA recognition motifs (RRMs), and nine RGG repeats. All three domains in nucleolin regulate CSF-1 mRNA and protein levels. RRMs increase CSF-1 mRNA, whereas the acidic and RGG domains decrease CSF-1 protein levels. This suggests that nucleolin has the capacity to differentially regulate both CSF-1 RNA and protein levels. Our finding that nucleolin interacts with Ago2 indirectly via RNA and with poly(A)-binding protein C (PABPC) directly suggests a nucleolin-Ago2-PABPC complex formation on mRNA. This complex is in keeping with our suggestion that nucleolin may work with PABPC as a double-edged sword on both mRNA deadenylation and translational activation. Our findings underscore the complexity of

  4. Endovascular treatment for pediatric intracranial aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lv, Xianli; Jiang, Chuhan; Li, Youxiang; Yang, Xinjian; Wu, Zhongxue [Capital Medical University, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, Hebei (China)

    2009-11-15

    The purpose of this study is to report the characteristics and outcomes of pediatric patients with intracranial aneurysms. From 1998 to 2005, 25 pediatric patients (aged {<=}17 years) with intracranial aneurysm were treated at our institute. Eleven of 25 patients had subarachnoid hemorrhage. In ten patients, the aneurysm was an incidental finding. One patient presented with cranial nerves dysfunction and three with neurological deficits. The locations of the aneurysms were as follows: vertebral artery (VA; n = 9), middle cerebral artery (MCA; n = 5), posterior cerebral artery (PCA; n = 4), basilar artery (BA; n = 2), anterior communicating artery (n = 2), anterior cerebral artery (n = 2), and internal carotid artery (n = 1). Five patients were treated with selective embolization with coils. Sixteen patients were treated with parent vessel occlusion (PVO). Eight PVOs were performed with balloons and eight were performed with coils. One patient with a VA aneurysm was spontaneously thrombosed 4 days after the initial diagnostic angiogram. In three patients treated with stent alone or stent-assisted coiling, one with BA trunk aneurysm died. One aneurismal recurrence occurred and was retreated. At a mean follow-up duration of 23.5 months, 96% of patients had a Glasgow Outcome Scale score of 4 or 5. Pediatric intracranial aneurysms occur more commonly in male patients and have a predilection for the VA, PCA, and MCA. PVO is an effective and safe treatment for fusiform aneurysms. Basilar trunk fusiform aneurysms were difficult to treat and were associated with a high mortality rate. (orig.)

  5. The Technique of Endovascular Intracranial Revascularization

    Directory of Open Access Journals (Sweden)

    John J. Connors

    2014-11-01

    Full Text Available Intracranial atherosclerosis was traditionally believed to carry a risk of stroke of 8% to 22% per annum. The annualized stroke rate in the recent Stenting and Aggressive Medical Management for Preventing Stroke in Intracranial Stenosis trial medical management arm was 12.2%. This trial was halted due to excessive periprocedural events in the stent arm. This stroke rate Is still Unacceptably high and a treatment strategy is still needed. SAMMPRIS has no bearing on angioplasty alone. Angioplasty alone has always been our primary intervention for intracranial atherosclerosis and remains so to this day due to its relative simplicity, low complication rate, and efficacy. We have, however, made adjustments to our patient management regimen based on the results of SAMMPRIS. This paper outlines our current patient selection, procedural technique, and post-procedure management. The complications we have encountered while developing our technique are described along with how to avoid them and how to manage them. Our most recent results (since previous publications are also discussed.

  6. Abciximab for thrombolysis during intracranial aneurysm coiling

    International Nuclear Information System (INIS)

    Gralla, Jan; Rennie, Adam T.M.; Corkill, Rufus A.; Lalloo, Shivendra T.; Molyneux, Andrew; Byrne, James V.; Kuker, Wilhem

    2008-01-01

    Thrombotic events are a common and severe complication of endovascular aneurysm treatment with significant impact on patients' outcome. This study evaluates risk factors for thrombus formation and assesses the efficacy and safety of abciximab for clot dissolution. All patients treated with abciximab during (41 patients) or shortly after (22 patients) intracranial aneurysm coil embolisation were retrieved from the institutional database (2000 to 2007, 1,250 patients). Sixty-three patients (mean age, 55.3 years, ±12.8) had received either intra-arterial or intravenous abciximab. Risk factors for clot formation were assessed and the angiographic and clinical outcome evaluated. No aneurysm rupture occurred during or after abciximab application. The intra-procedural rate of total recanalisation was 68.3%. Thromboembolic complications were frequently found in aneurysms of the Acom complex and of the basilar artery, whilst internal carotid artery aneurysms were underrepresented. Two patients died of treatment-related intracranial haemorrhages into preexisting cerebral infarcts. Two patients developed a symptomatic groin haematoma. Abciximab is efficacious and safe for thrombolysis during and after endovascular intracranial aneurysm treatment in the absence of preexisting ischaemic stroke. (orig.)

  7. CT and MRI diagnosis of intracranial chondroma

    International Nuclear Information System (INIS)

    Liu Xuejun; Sui Qinglan

    2006-01-01

    Objective: To summarize and study the features of intracranial chondroma on CT and MRI imaging. Methods: CT and MRI findings of ten cases of intracranial chondroma proved by surgery and pathology from 1994. 1 to 2004.9 were retrospectively analyzed. Results: Among 10 cases, 4 cases were located at the skull base, 4 cases at convexity, 1 case at the region of falx cerebri, and 1 case within the brain parenchyma. CT scans showed obvious calcification and clear border of the tumors in 10 cases, mixed attenuation in 9 eases, and adjacent bone invasion in 5 cases. 4 cases of MRI scans showed hypointense signal on T 1 and T 2 -weighted images in calcified element of the tumor, intermediate to hypointense signal intensity on T 1 -weighted image, and hyperintense signal intensity on T 2 -weighted image in parenchyma of the tumor. 4 cases of CT scans showed slightly enhancement. Conclusion: Intracranial chondroma are often originated from synchondrosis of the skull base, convexity of brain and region of falx cerebri. Obvious calcification may be seen in most cases. Slightly enhancement and marked delayed contrast enhancement were characteristic. The accurate diagnosis still depends on pathology. (authors)

  8. Idiopathic intracranial hypertension in pediatric patients

    Directory of Open Access Journals (Sweden)

    Nada Jirásková

    2008-11-01

    Full Text Available Nada Jirásková, Pavel RozsívalDepartment of Ophthalmology, University Hospital, Hradec Králové, Czech RepublicPurpose: To evaluate retrospectively the features, treatment, and outcome of idiopathic intracranial hypertension (IIH in children.Methods: Nine patients, 15 years and younger, diagnosed with IIH. Inclusion criteria were papilledema, normal brain computer tomography or magnetic resonance imaging, cerebrospinal fluid pressure greater than 250 mm H2O, normal cerebrospinal fluid content, and a nonfocal neurologic examination except for sixth nerve palsy.Results: Of the nine patients, eight were girls. Five girls were overweight and one boy was obese. The most common presenting symptom was headache (5 patients. Diplopia or strabismus did not occur in our group. Visual field abnormalities were present in all eyes, and severe visual loss resulting in light perception vision occurred in both eyes of one patient. Eight patients were treated medically with acetazolamide alone, and one girl needed a combination of acetazolamide and corticosteroids. This girl also required optic nerve sheath decompression surgery. Resolution of papilledema and recovery of visual function occurred in all patients.Conclusions: Idiopathic intracranial hypertension in prepubertal children is rather uncommon. Prompt diagnosis and management are important to prevent permanent visual loss.Keywords: idiopathic intracranial hypertension, pediatric, treatment

  9. Eleven cases of neonatal intracranial hemorrhage

    International Nuclear Information System (INIS)

    Matsuda, Tadashi; Asao, Toyohiko; Shibata, Takeo

    1981-01-01

    Eleven cases of neonatal intracranial hemorrhage were diagnosed and followed up by CT scanning. By CT, hemorrhagic lesions were shown as high density areas in an acute stage and imaged as low density areas after the hemorrhage was absorbed. The time of absorption varies depending upon the site and the severity of hemorrhage. Intraventricular hemorrhage, petechial hemorrhage and subdural hematoma were absorbed rapidly in more than 70% of the exanimed cases, CT scanning 1 - 2 weeks after the onset revealed absorption of hemorrhage. However, the absorption delayed in intracerebral hematoma; CT scan taken after one month showed hemorrhagic lesions remaining in 75% of the cases. In nine cases who survived, following the absorption of the hemorrhagic lesions, cerebral atrophy was observed in 4 cases (44%), ventricular enlargement in 3 cases (33%), and complete recovery in 2 cases (22%). From these results, CT scanning for diagnosis of neonatal intracranial hemorrhage should be done before the hemorrhagic lesion is absorbed (within 7 days of the onset). Follow-up study by CT is important for observing changes and predicting prognosis of intracranial hemorrhage. (Ueda, J.)

  10. Primary brain tumor presenting as intracranial hemorrhage

    International Nuclear Information System (INIS)

    Tsunoda, Shigeru; Sakaki, Toshisuke; Miyamoto, Seiji; Kyoi, Kikuo; Utsumi, Shozaburo; Kamada, Kitaro; Inui, Shoji; Masuda, Akio.

    1989-01-01

    Ten cases of primary brain tumor presenting as intracranial hemorrhage were studied in terms of the radiological and histological findings. The cases having hemorrhage in the tumor, as established through CT or histologically, were excluded if their onsets were not sudden due to intracranial hemorrhages. The results obtained may be summarized as follows: 1) From an anatomical point of view, cerebral subcortical hemorrhages account for 80%; hemorrhages in the cerebellopontine angle, 10%, and hemorrhages in the basal ganglia, 10%. 2) Plain CT findings showed perifocal low-density areas within 24 hours after onset in all 10 cases. 3) Enhanced CT findings showed enhanced areas in 4 or 6 cases. 4) Angiographic findings revealed abnormalities besides the mass effect in 5 of the 10 cases. 4) Angiographic findings revealed abnormalities besides the mass effect in 5 of the 10 cases. 5) From a histological point of view, glioblastomas account for 30%; malignant astrocytomas, 20%; astrocytomas, 20%; malignant ependymomas, 10%; hemangioblastoma, 10%, and transitional meningiomas, 10%. In conclusion, a perifocal low-density area on CT within 24 hours after onset is the most meaningful indication of intracranial hemorrhage originating from a brain tumor. A histological 'perinuclear halo' in an astrocytoma as an artifact due to hemorrhage may often be misleading in diagnosing mixed oligo-astrocytomas. (author)

  11. Developmental and functional significance of the CSF-1 proteoglycan chondroitin sulfate chain

    OpenAIRE

    Nandi, Sayan; Akhter, Mohammed P.; Seifert, Mark F.; Dai, Xu-Ming; Stanley, E. Richard

    2006-01-01

    The primary macrophage growth factor, colony-stimulating factor-1 (CSF-1), is homodimeric and exists in 3 biologically active isoforms: a membrane-spanning, cell-surface glycoprotein (csCSF-1) and secreted glycoprotein (sgCSF-1) and proteoglycan (spCSF-1) isoforms. To investigate the in vivo role of the chondroitin sulfate glycosaminoglycan (GAG) chain of spCSF-1, we created mice that exclusively express, in a normal tissue-specific and developmental manner, either the secreted precursor of s...

  12. G-CSF-primed BM for allogeneic SCT: revisited.

    Science.gov (United States)

    Pessach, I; Resnick, I; Shimoni, A; Nagler, A

    2015-07-01

    G-SCF-mobilized PBSC (GPB) grafts have a higher cell dose and somewhat more committed progenitor cells than steady-state BM (SBM), resulting in faster engraftment and faster immunological reconstitution. On the other hand, transplant related mortality (TRM), disease-free survival (DFS) and overall survival (OS) are similar both for PB and for BM. In contrast to SBM, G-CSF-primed BM (GBM) grafts stimulate HSC proliferation, increasing cell dose and thus resulting in faster engraftment because of higher cell dose infused, or because of treatment with G-CSF. Furthermore, GBM may induce tolerance and functional modulations in donor hematopoiesis and immunity, further reducing GVHD incidence, which is already lower with SBM compared with GPB grafts. Overall, a growing body of clinical evidence suggests that GBM transplants may share the advantages of GPB transplantations, without the associated increased risk of GVHD, and might be an attractive graft source for allogeneic SCTs.

  13. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    primary effect parameter was total headache burden defined as area under the curve (AUC: intensity × duration) and as secondary effect parameters we identified: intensity (VAS 0-10), frequency (days per month), duration in hours (total hours/month) and also medication days (days on medication...... of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...

  14. Epidural blood patch for refractory low CSF pressure headache

    DEFF Research Database (Denmark)

    Madsen, Søren Aalbæk; Fomsgaard, Jonna Storm; Jensen, Rigmor

    2011-01-01

    of non-invasive/conservative measures and invasive measures with epidural blood patch providing the cornerstone of the invasive measures. In the present pilot study we therefore aimed to evaluate the treatment efficacy of epidural blood patch (EBP) in treatment-refractory low-pressure headache. Our......Once believed an exceedingly rare disorder, recent evidence suggests that low cerebrospinal fluid (CSF) pressure headache has to be considered an important cause of new daily persistent headaches, particularly among young and middle-aged individuals. Treatment of low CSF pressure headache consists...... primary effect parameter was total headache burden defined as area under the curve (AUC: intensity × duration) and as secondary effect parameters we identified: intensity (VAS 0-10), frequency (days per month), duration in hours (total hours/month) and also medication days (days on medication...

  15. Intracranial germinoma: the case for lower dose radiation therapy

    International Nuclear Information System (INIS)

    Hardenbergh, Patricia Harrigan; Golden, Jeffrey; Billet, Amy; Scott, R. Michael; Shrieve, Dennis C.; Silver, Barbara; Loeffler, Jay S.; Tarbell, Nancy J.

    1997-01-01

    Purpose: To determine the optimal dose and treatment outcome of patients treated with radiation for intracranial germinoma. Methods and Materials: Between 1975 and 1995, 40 patients with the diagnosis of intracranial germinoma were treated with radiation (RT) to the central nervous system. All patients received whole-brain (WB) RT (median dose: 32.4 Gy, range: 15-44.37 Gy) and a boost to the tumor volume (median total tumor volume dose: 52 Gy, range: 45-59.5 Gy). Thirty patients received RT to the spine (median dose: 26 Gy, range: 18.75-37.5 Gy). Four patients were treated with cisplatin-based chemotherapy and WB RT with a boost to the tumor volume (dose range: 51-54 Gy). A low-dose RT only group was defined as ≤25.5 Gy to the WB (9 patients); <50 Gy to the primary site (14 patients); and <22 Gy to the spine (9 patients) Seventeen tumors were biopsy-proven germinoma, and 17 patients presented with multiple midline germinomas (MMG). Among 26 patients who had tumor markers measured, 27% had elevation of β-human chorionic gonadotropin and by definition, no patient had an elevation of AFP. Twenty-four percent of 26 patients who had spine imaging or cerebral spinal fluid cytology had evidence of tumor seeding at diagnosis. The male to female ratio was 1.9:1. Median age at diagnosis was 14 years for male patients and 9.5 years for female patients (p = 0.02), (overall age ranges: 0.5-31 years). Median follow-up was 62 months (range: 3-226 months). Late effects of 29 patients with follow-up of ≥20 months and adequate documentation in their medical records were analyzed. Results: The 5-year actuarial rate of disease-free survival (DFS) and overall survival (OS) for biopsy-proven germinomas and presumed germinomas was 97%. No patient died of germinoma. There were no local failures regardless of the dose of RT, elevation of HCG tumor marker, or CSF dissemination at presentation. At presentation 22 patients had evidence of at least one endocrine abnormality. At follow

  16. PET measurements of cerebral metabolism corrected for CSF contributions

    International Nuclear Information System (INIS)

    Chawluk, J.; Alavi, A.; Dann, R.; Kushner, M.J.; Hurtig, H.; Zimmerman, R.A.; Reivich, M.

    1984-01-01

    Thirty-three subjects have been studied with PET and anatomic imaging (proton-NMR and/or CT) in order to determine the effect of cerebral atrophy on calculations of metabolic rates. Subgroups of neurologic disease investigated include stroke, brain tumor, epilepsy, psychosis, and dementia. Anatomic images were digitized through a Vidicon camera and analyzed volumetrically. Relative areas for ventricles, sulci, and brain tissue were calculated. Preliminary analysis suggests that ventricular volumes as determined by NMR and CT are similar, while sulcal volumes are larger on NMR scans. Metabolic rates (18F-FDG) were calculated before and after correction for CSF spaces, with initial focus upon dementia and normal aging. Correction for atrophy led to a greater increase (%) in global metabolic rates in demented individuals (18.2 +- 5.3) compared to elderly controls (8.3 +- 3.0,p < .05). A trend towards significantly lower glucose metabolism in demented subjects before CSF correction was not seen following correction for atrophy. These data suggest that volumetric analysis of NMR images may more accurately reflect the degree of cerebral atrophy, since NMR does not suffer from beam hardening artifact due to bone-parenchyma juxtapositions. Furthermore, appropriate correction for CSF spaces should be employed if current resolution PET scanners are to accurately measure residual brain tissue metabolism in various pathological states

  17. Neurocysticercosis: relationship between Taenia antigen levels in CSF and MRI

    International Nuclear Information System (INIS)

    Abraham, Ronaldo; Livramento, Jose Antonio; Machado, Luis dos Ramos; Leite, Claudia da Costa; Pardini, Alessandra Xavier; Vaz, Adelaide Jose

    2010-01-01

    Objective: to determine the relationship between Taenia antigen (TA) detection in cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) findings in patients with definite diagnosis of neurocysticercosis (NC). Method: sixty-three patients with definite diagnosis of NC were submitted to a MRI of the brain, and to a CSF examination, with a meticulous search for TA by ELISA. Results: TA detection was positive in 36 patients (57.1%). A total of 836 lesions were analyzed, greatly within the cerebral parenchyma (98.7 of the lesions). Intact or non-degenerating cysts were the most common evolutive phase observed (50.4% of all lesions), 22.1% were degenerating cysts and 19.5% calcified cysts. We observed a significant relationship between TA levels detected and the total number of lesions and the number of non-degenerating cysts, but not with calcified lesions. Conclusion: according to our results, we propose at least four important types of contribution: TA detection may allow etiologic diagnosis in transitional phases of NC, with non-characteristic images; in final stages of evolution of cysticercoids in the CNS, lesions may not appear on CT or MRI, and TA detection may contribute to a definite etiologic diagnosis; TA detection may permit diagnosis of NC in some patients with previous negative tests for antibody detection in CSF; TA detection may represent an accurate marker of disease activity in the epileptic form of NC. (author)

  18. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI

    International Nuclear Information System (INIS)

    Isoda, Haruo; Takeda, Hiroyasu; Yamashita, Shuhei; Takehara, Yasuo; Sakahara, Harumi; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Hiramatsu, Hisaya; Namba, Hiroki; Alley, Marcus T.; Bammer, Roland; Pelc, Norbert J.

    2010-01-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall. (orig.)

  19. In vivo hemodynamic analysis of intracranial aneurysms obtained by magnetic resonance fluid dynamics (MRFD) based on time-resolved three-dimensional phase-contrast MRI.

    Science.gov (United States)

    Isoda, Haruo; Ohkura, Yasuhide; Kosugi, Takashi; Hirano, Masaya; Takeda, Hiroyasu; Hiramatsu, Hisaya; Yamashita, Shuhei; Takehara, Yasuo; Alley, Marcus T; Bammer, Roland; Pelc, Norbert J; Namba, Hiroki; Sakahara, Harumi

    2010-10-01

    Hemodynamics is thought to play a very important role in the initiation, growth, and rupture of intracranial aneurysms. The purpose of our study was to perform in vivo hemodynamic analysis of unruptured intracranial aneurysms of magnetic resonance fluid dynamics using time-resolved three-dimensional phase-contrast MRI (4D-Flow) at 1.5 T and to analyze relationships between hemodynamics and wall shear stress (WSS) and oscillatory shear index (OSI). This study included nine subjects with 14 unruptured aneurysms. 4D-Flow was performed by a 1.5-T magnetic resonance scanner with a head coil. We calculated in vivo streamlines, WSS, and OSI of intracranial aneurysms based on 4D-Flow with our software. We evaluated the number of spiral flows in the aneurysms and compared the differences in WSS or OSI between the vessel and aneurysm and between whole aneurysm and the apex of the spiral flow. 3D streamlines, WSS, and OSI distribution maps in arbitrary direction during the cardiac phase were obtained for all intracranial aneurysms. Twelve aneurysms had one spiral flow each, and two aneurysms had two spiral flows each. The WSS was lower and the OSI was higher in the aneurysm compared to the vessel. The apex of the spiral flow had a lower WSS and higher OSI relative to the whole aneurysm. Each intracranial aneurysm in this study had at least one spiral flow. The WSS was lower and OSI was higher at the apex of the spiral flow than the whole aneurysmal wall.

  20. Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations

    International Nuclear Information System (INIS)

    Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.

    1989-12-01

    Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig

  1. Clinical results of stereotactic heavy-charged-particle radiosurgery for intracranial angiographically occult vascular malformations

    Energy Technology Data Exchange (ETDEWEB)

    Levy, R.P.; Fabrikant, J.I.; Phillips, M.H.; Frankel, K.A.; Steinberg, G.K.; Marks, M.P.; DeLaPaz, R.L.; Chuang, F.Y.S.; Lyman, J.T.

    1989-12-01

    Angiographically occult vascular malformations (AOVMs) of the brain have been recognized for many years to cause neurologic morbidity and mortality. They generally become symptomatic due to intracranial hemorrhage, focal mass effect, seizures or headaches. The true incidence of AOVMs is unknown, but autopsy studies suggest that they are more common than high-flow angiographically demonstrable arteriovenous malformations (AVMs). We have developed stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of inoperable intracranial vascular malformations, using the helium ion beams at the Lawrence Berkeley Laboratory 184-inch Synchrocyclotron and Bevatron. This report describes the protocol for patient selection, radiosurgical treatment planning method, clinical and neuroradiologic results and complications encountered, and discusses the strengths and limitations of the method. 10 refs., 1 fig.

  2. G-CSF-primed autologous and allogeneic bone marrow for transplantation in clinical oncology. Cell content and immunological characteristics

    Science.gov (United States)

    Grivtsova, L. Yu; Melkova, K. N.; Kupryshkina, N. A.; Vorotnikov, I. K.; Grigoryeva, T. A.; Selchuk, V. Yu; Grebennikova, O. P.; Titova, G. V.; Tupitsyn, N. N.

    2018-01-01

    60 samples of G-CSF-primed bone marrow (39 cancer patients and 21 healthy donors) to be used for transplantation to cancer patients were analyzed and compared by main characteristics with historical control and 13 bone marrow samples from control patient with mastopathy. Basing on morphological and multicolor flow cytometry findings certain characteristics of G-CSF-primed bone marrow were discovered, such as a significant increase in blast count in cancer patients as compared to donors and control patients (p<0.037), a higher neutrophil maturation index (p<0.001) and a lower percentage of mature lymphocytes (p<0.008) as compared to the control group. Among lymphocyte populations G-CSF-priming was associated with a significant increase in the total of mature CD3+ T-cells and CD8+ T-killers (p<0.0001) and a decrease in CD56+CD3- and/or CD16+CD3- NK-cells (p<0.006) both in cancer patients and healthy donors in comparison with the controls.

  3. Chimeric classical swine fever (CSF)-Japanese encephalitis (JE) viral particles as a non-transmissible bivalent marker vaccine candidate against CSF and JE infections

    Science.gov (United States)

    A trans-complemented CSF- JE chimeric viral replicon was constructed using an infectious cDNA clone of the CSF virus (CSFV) Alfort/187 strain. The E2 gene of CSFV Alfort/187 strain was deleted and the resultant plasmid pA187delE2 was inserted by a fragment containing the region coding for a truncate...

  4. Outcomes of a questionnaire survey on intracranial hypotension following minor head injury

    International Nuclear Information System (INIS)

    Dohi, Kenji; Aruga, Tohru; Abe, Toshiaki; Ogawa, Takeki; Onuma, Takehide; Katayama, Yoichi; Sakaki, Toshisuke; Shima, Katsuji; Hirakawa, Kimiyoshi

    2007-01-01

    Intracranial hypotension (IH) is a rare condition caused by leakage of cerebrospinal fluid (CSF). Recently, a small number of clinicians have proposed a new concept about IH following minor head injury. They suggest that many of their patients with IH can be successfully treated with epidural blood patch therapy. They also argue that some patients with post-traumatic cervical syndrome and general fatigue syndrome suffer from IH following minor head injury. Consequently, IH following minor head injury was widely recognized and dealt with as a social problem in Japan. On the other hand, pathophysiological aspects of the condition as well as the provisional criteria to describe this clinical entity remain to be elucidated. In 2006, the Japan Society of Neurotraumatology performed a questionnaire survey asking 44 hospitals belonging to trustees of this society about IH following minor head injury. This paper provides a report of the outcomes of this survey. The response rate to this questionnaire was 57% (25/44). Fifty-six percent of respondents did not have experience of IH following minor head injury. Moreover, respondents' criteria for describing this disease differed greatly, especially in the radiological examinations and symptoms for the diagnosis of this entity which showed significant variation. These problems might originate from the general features of this disease. With the exception of postural headache, the symptoms of this disease varied enormously. This wide range of symptoms confused with the pathophysiolosies of a great many similar conditions. As such, clarifications of the pathophysiological characteristics of IH following minor head injury, together with consensus on specific criteria to describe the condition, are required. In conclusion, the results of this survey revealed many serious scientific and social problems associated with the diagnosis and treatment of intracranial hypotension following minor head injury. Scientific study including the

  5. The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm.

    Directory of Open Access Journals (Sweden)

    Wei Ting Chiu

    Full Text Available The presence of an intracranial aneurysm is contraindicated to recombinant tissue plasminogen activator (r-tPA treatment for acute ischemic stroke. However, it is difficult to exclude asymptomatic intracranial aneurysms by using conventional, noncontrast head computed tomography (CT, which is the only neuroimaging suggested before r-tPA. Recent case reports and series have shown that administering r-tPA to patients with a pre-existing aneurysm does not increase the bleeding risk. However, Asians are known to have a relatively higher bleeding risk, and little evidence is available regarding the risk of using r-tPA on Asian patients with intracranial aneurysms.Medical records from the Shuang Ho hospital stroke registration between July 2010 and December 2014 were retrospectively reviewed, and 144 patients received r-tPA. Unruptured intracranial aneurysms were detected using CT, or magnetic resonance or conventional angiography after r-tPA. The primary and secondary outcomes were the difference in overall intracranial hemorrhage (ICH and symptomatic ICH after r-tPA. The differences were analyzed using Fisher's exact or Mann-Whitney U tests, and p < 0.05 was defined as the statistical significance.A total of 144 patients were reviewed, and incidental unruptured intracranial aneurysms were found in 11 of them (7.6%. No significant difference was observed in baseline demographic data between the aneurysm and nonaneurysm groups. Among patients with an unruptured aneurysm, two had giant aneurysms (7.7 and 7.4 mm, respectively. The bleeding risk was not significant different between aneurysm group (2 out of 11, 18% with nonaneurysm group (7 out of 133, 5.3% (p = 0.14. None of the patients with an unruptured aneurysm had symptomatic ICH, whereas one patient without an aneurysm exhibited symptomatic ICH.The presence of an unruptured intracranial aneurysm did not significantly increase the risk of overall and symptomatic ICH in Taiwanese patients after they

  6. Magnetic resonance imaging (MRI) of intracranial chordomas

    Energy Technology Data Exchange (ETDEWEB)

    Fukuda, Teruo; Inoue, Yuichi; Shakudo, Miyuki and others

    1988-03-01

    MR images of 5 patients with intracranial chordoma were evaluated and compared with those of other clival lesions (1 clival osteomyelitis, 1 metastatic clival tumor, 3 clival meningiomas). The MR examination was performed using a 0.5 T superconductive magnet, with approximately 10 mm section thickness, one average and a 256 x 256 matrix. T1 weighted images were obtainned by inversion recovery (IR) with TR 2100 - 2500 msec, TI 600 msec and TE 40 msec. T2 weighted images were obtained by spin echo pulse sequence with TR 1800 - 2500 msec and TE 120 msec (long SE). In several cases, the spin echo pulse sequences with TR 1000 msec and TE 40 msec (short SE) were also done. Multiplaned images were obtained. Four of 5 intracranial chordomas were low in intensity compared to cerebral gray matter on T1 weighted images, and all of 5 chordomas were as high in intensity as cerebrospinal fluid or higher than that of cerebrospinal fluid on T2 weighted images. Clival fatty marrow is high intensity on T1 weighted images. Clival involvement by a tumor was a clearly demonstrated as disappearance of this high intensity in all cases. In two cases, the tumor extended to the retropharyngeal space and this was detected clearly on short SE image. Although clival fatty marrow was disappeared, osteomyelitis and metastatic tumor in clivus were iso-intense to cerebral gray matter on both T1 and T2 weighted images. All of 3 clival meningiomas showed iso-intensity to cerebral gray matter on T1 weighted images and slightly