Hydrocephalus Cerebrospinal Fluid Research Articles

The Neuroepithelium Disruption Could Generate Autoantibodies against AQP4 and Cause Neuromyelitis Optica and Hydrocephalus.

Neuromyelitis optica is an inflammatory disease characterized by neuritis and myelitis of the optic nerve. Its physiopathology is connected with the aquaporin-4 water channel, since antibodies against aquaporin-4 have been found in the cerebrospinal fluid and blood of neuromyelitis optica patients. The seropositivity for aquaporin-4 antibodies is used for the diagnosis of neuromyelitis optica or neuromyelitis optica spectrum disease. On the other hand, aquaporin-4 is expressed in astrocyte feet in the brain-blood barrier and subventricular zones of the brain ventricles. Aquaporin-4 expression is high in cerebrospinal fluid in hydrocephalus. Furthermore, neuroepithelial denudation precedes noncommunicating hydrocephalus and this neuroepithelial disruption could allow aquaporin-4 to reach anomalous brain areas where it is unrecognized and induce the generation of aquaporin-4 antibodies which could cause the neuromyelitis optica and certain types of hydrocephalus.

Expression of Insulin Like Growth Factor in the Cerebrospinal Fluid of Children with Hydrocephalus

Insulin like growth factor-1 (IGF-1) is ubiquitously expressed growth factor that has profound effects on the survival, growth and differentiation of many cell types and tissues, including cells of the central nervous system (CNS). IGF-1 is found in many biological fluids including cerebrospinal fluid (CSF). IGF-1 has broad range neuroprotective effects and is a therapeutic candidate for neurodegenerative diseases. Hydrocephalus is a condition in which there is an abnormal build-up of CSF within the ventricles and/or subarachnoid spaces. Since CSF is in contact with the extracellular space of the brain, biochemical brain modifications could be reflected in the CSF. The aim of this study was to determine the level of CSF IGF-1 level in the children with non-communicating hydrocephalus. A total of 46 samples of CSF from normal and children with hydrocephalic were collected by lumbar puncture performed routinely on the basis of the clinical suspicion of neurological disease. Samples were aged matched between the two groups analyzed. A western blot analysis using anti-IGF-1 antibody as a probe confirmed the presence of IGF-1 in the samples. Quantification of Western blot gels showed that the amount of IGF-1 was increased in the hydrocephalus CSF when compared with normal controls. Using ELISA, it was shown that the concentration of CSF IGF-1 in the hydrocephalus was significantly higher than in controls. The data from this study indicate that IGF-1 is a constant component of human CSF. It is also concluded that high levels of CSF IGF-1 may be partly related to hydrocephalus pathophysiology.

Nerve growth factor level in the cerebrospinal fluid in hydrocephalus

Nerve growth factor level in the cerebrospinal fluid in hydrocephalus

The Pathogenesis of Normal Pressure Hydrocephalus: A Theoretical Analysis

Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in the cerebral ventricles, usually caused by impaired absorption of the fluid into the bloodstream. Despite obstructed absorption and continued secretion of CSF into the ventricles at a near normal rate, the ventricular CSF pressure (VCSFP) is often normal. We attempt to understand how hydrocephalus can exist with normal VCSFP by exploring the role of the brain parenchyma in absorbing CSF in hydrocephalus. We test three theories: (1) the ventricular wall is impermeable to CSF; (2) ventricular CSF seeps into the parenchyma, from which it is efficiently absorbed; and (3) ventricular CSF seeps into the parenchyma but is absorbed inefficiently. We model the brain as a thick spherical shell consisting of a porous, elastic, solid matrix, containing interstitial fluid and blood. We modify the equations of poroelasticity, which describe flow of fluid through porous solids, to allow for parenchymal absorption. For each of the three theories we calculate the steady state changes in VCSFP and in parenchymal fluid pressure caused by an incremental defect in CSF absorption. We also calculate the steady state changes in fluid content, tissue volume, tissue displacement, and stresses caused by a small increment of VCSFP. We conclude that only the second theory—seepage of CSF with efficient parenchymal absorption—accounts for the clinical features of normal pressure hydrocephalus. These features include sustained ventricular dilatation despite normal VCSFP, increased periventricular fluid content, and localized periventricular white matter damage.

Influence of the rate of ventricular enlargement on the white matter water content in progressive feline hydrocephalus.

The effectiveness of transependymal absorption of cerebrospinal fluid in hydrocephalus was studied by correlating the measured water content of feline hydrocephalic white matter with the rate of enlargement of the ventricles. Two groups of cats were subjected to opening of either the calvaria or the calvaria and dura before the intracisternal injection of kaolin to obtain two profiles of ventricular enlargement. The water content 1, 2, and 3 mm from the lateral ventricles was measured in each group using the dry/wet weight and microgravimetric techniques after sacrificing the animals in each group at 2, 3, or 6 weeks after inducing hydrocephalus. In the animals with both calvarial and dural opening, the ventricles enlarged rapidly in the first 2 to 3 weeks and then continued to increase but at a slower rate. Concomitant with this early increase of ventricular size was a progressive increase in white matter water content both adjacent to and remote from the ventricles, which continued through 6 weeks. When only the calvaria was opened, ventricular size increased gradually, but continued to increase at a constant rate throughout the 6 weeks. Water content adjacent to the ventricle did not increase until the 3rd week, with little spread to adjacent areas by the 6th week. The central canals of the spinal cord were enlarged in both groups at all sampling levels. Neither increased periventricular water nor dilatation of the central canal was associated with stabilization of ventricular size in these studies. The authors conclude that these pathways are not sufficient to arrest the hydrocephalic process in these models.

Electrophoretic pattern of cerebrospinal fluid proteins in non-neoplastic infantile hydrocephalus.

Lumbar cerebrospinal fluid (CSF) from 28 non-neoplastic hydrocephalic children was studied for total protein and electrophoretic protein patterns. These were classified as normal, degenerative, transudative and gamma-globulinic according to Laterre. We found higher total CSF protein mean values than in normal cases with the same age and abnormal electrophoretic patterns in 72% of the cases, of which degenerative was the most common (54%). Gamma-globulinic and transudative patterns were found in 11% and 7% of the cases, respectively. Several factors which may explain the increase in the total CSF protein in infantile hydrocephalus are described: low age, ventricular block in the noncommunicating hydrocephalus, and probable passage of tissue proteins to the CSF from the damaged brain. The predominance of degenerative patterns may be explained by the enrichment of the CSF in tissue proteins resulting from the white matter damage provoked by the abnormal conditions of production, flow and absorption of the CSF in hydrocephalus. Ventricular CSF was studied in four cases, and the results obtained are in agreement with the above-mentioned findings.

Epidural and subdural haematomas as a complication of internal drainage of cerebrospinal fluid in hydrocephalus.

After mentioning the most important indications for the implantation of atrio-ventricular systems in increased intracranial pressure, the importance of epidural and/or subdural bleeding as one of the main postoperative complications is pointed out. In the literature, known to us, there are reports of 9 epidural and 25 subdural haematomas. Four more personal cases are reported. The cause of the bleeding is collapse of the cortex which leads to rupture of cortical veins or epidural vessels. Especially at risk are adult patients with high intracranial pressure or atrophy of the cortex in long standing hydrocephalus. Epidural haematoma always develops in the first few hours after the operation, whereas subdural haematomas may develop either in the first days or even after weeks and months. The incidence of this complication in our adult patients is 5.6%. Some possibilities for the prophylaxis of intracranial bleeding are mentioned.

Transventricular absorption and isotope ventriculography.

A simulation of isotope ventriculography with the use of iodinated I 131 serum albumin in a glass ventricular model is used for comparison with conventional air ventriculography. The poor resolution of the rectilinear scanning method does not allow good definition of the true ventricular outline. The geometry of a rectilinear scanning system precludes direct comparisons between scans and air ventriculography. The interpretation of isotope ventriculograms as providing evidence for the transventricular absorption of protein and of cerebrospinal fluid in hydrocephalus is invalid.

Passage of cerebrospinal fluid into cranial venous sinuses in normal and experimental hydrocephalic cats

The passage of cerebrospinal fluid (CSF) into both the sagittal and straight sinuses was studied in normal cats and cats with experimental chronic obstructive hydrocephalus. This was performed by perfusing the CSF system with mock CSF containing labeled albumin with simultaneous measurements of radioactivity in the blood from the two sources. In the normal cats the tracer was found almost exclusively to pass into the sagittal sinus. In the hydrocephalic animals. however, blood from the straight sinus alone or from both sinuses contained the tracer. The calculated amounts of tracer transferred by both routes could be correlated with the total amount recovered from the blood. The results are regarded as further evidence of transventricular absorption and the presence of alternate pathways for absorption of CSF in hydrocephalus.

Peritoneal atrial shunt for intractable ascites.

MECHANICAL means have in the past been tested to drain peritoneal fluid into the venous system^1,2but none has been successful due mainly to a propensity for clotting. The analogous problem of draining cerebrospinal fluid in hydrocephalus has been assisted by insertion of a manually compressable subcutaneous pump in the line which helps to keep the system patent.^3,4Smith reported using such a device for drainage of ascitic fluid in one patient.⁵This is a report of the development of a peritoneal-right atrial shunt fitted with a plastic clearing pump that has been used in eight patients. <h3>Description of Device</h3> The shunt has three elements: the intraperitoneal collecting sump, the connecting tubes containing the one-way valves, and the flushing pump. Each has undergone progressive modification during this clinical experience.^6,7The shunt now used is illustrated (Fig 1). <h3>Sump.</h3> —The intraperitoneal collecting device consists of a double

AMOUNT OF CEREBROSPINAL FLUID IN HYDROCEPHALUS

It is difficult to measure the progress of hydrocephalus. The method of estimating changes in the amount of cerebrospinal fluid by the effect produced on the size of the head is unsatisfactory, the variations in circumference showing only relatively gross changes and not giving any definite idea of the actual amount of fluid present in the cranium. The thickness of the brain tissue in the region of the parietal lobes can be gaged roughly by noting the distance it is necessary to insert a needle before the ventricles are entered, but this procedure again furnishes no information on which to base an estimate of the actual amount of fluid in the ventricles and subarachnoid space. A knowledge of the quantity of cerebrospinal fluid in hydrocephalus would certainly be advantageous. It could be used as an index of the progress of the disease, and a variation in the amount would probably