CSF Protein Concentration Research Articles

Prognostic Analysis of Primary Central Nervous System Lymphoma Patients with Diffuse Large B-Cell Immunophenotype

To investigate the prognostic influencing factors of primary central nervous system lymphoma (PCNSL) patients with diffuse large B-cell immunophenotype. 42 PCNSL patients with diffuse large B-cell lymphoma treated in our hospital from March 2011 to October 2017 were enrolled. The effects of different treatments on overall survival of patients were analyzied. The analysis for 42 PCNSL patients with diffuse large B-cell immunophenotype showed that there was no affect of their clinical characteristics,such as sex, age, CSF protein content, treatment with and without temozolomide and rituximab on overall survival of the patients(P>0.05). And it was found that active treatment and the application of conventional intrathecal injection and methotrexate in the treatment could effectively prolong the overall survival time of patients. Early diagnosis of PCNSL and active standardized treatment can significantly prolong the survival time of patients, and it is further emphasized that the necessity of conventional intrathecal injection to prolong the survival of patients.

Mesenchymal Stem Cell Derived Extracellular Vesicles Enhance Myelin Plasticity in Rhesus Monkeys

Cortical injury, such as injury from stroke, results in a cascade of events that includes cell death, inflammation and disruption of myelin. To date, there are no highly effective treatments for reducing the deficits that occur after injury. Recently, we have demonstrated that extracellular vesicles (EVs) harvested from rhesus monkey bone marrow derived cells when given 1 day and 14 days following injury facilitate recovery of function in aged rhesus monkeys within the first 3–5 weeks after cortical injury. Based on these findings and current proteomic literature of MSC‐EVs, we hypothesized that MSC‐EVs enhance myelin plasticity by limiting damage to oligodendrocytes and stimulating remyelination.To assess general myelin integrity after injury, we used Spectral Confocal Reflectance Microscopy (SCoRe) to image myelinated axons and found an increase in the density of myelinated axons in the EV group (p < 0.05). To assess whether the difference was due to reduced damage or remyelination, in sublesional white matter we assessed immunohistochemical labeling of Olig2, a general oligodendrocyte marker, and 8OHdG, a marker for DNA damage. We found reduced densities of Olig2 colocalized with 8OHdG in the EV group (p<0.05). As a marker of active demyelination and myelin debris clearance, we measured Myelin Basic Protein (MBP) concentrations in CSF and found a longitudinal reduction in the EV animals. To assess remyelination, we measured expression of MBP, a gene for myelination in mature oligodendrocytes, Myelin Regulatory Factor (MyRF), a gene for oligodendrocyte differentiation and maintenance, and Breast Carcinoma Amplified Sequence 1 (BCAS1), a gene for newly myelinating oligodendrocytes. Interestingly, we found a 4 fold increase in MyRF expression, and a 1.5 fold increase in MBP and BCAS1 in the EV animals relative to the vehicle control animals in perilesional brain tissue. Consistent with these gene expression differences associated with re‐myelination, we found that the densities of newly‐myelinating oligodendrocytes immune‐labeled with BCAS1, as well as mature oligodendrocytes expressing CC1, exhibited a trend towards an increase in the EV group (p = 0.09). These results suggest that EV treatment reduces myelin damage, while also stimulating myelin repair. Finally, these results correlated with enhanced motor recovery, suggesting that EV‐mediated white matter plasticity is a critical component for recovery after cortical injury.Support or Funding InformationSupported by NIH grant R21NS102991‐02.

Enteroviral meningitis reduces CSF concentration of A\u03b242, but does not affect markers of parenchymal damage

Biomarkers classically studied in Alzheimer’s disease have been analyzed in numerous central nervous system infections in adults, but there are scarce data on these biomarkers in children. Enteroviruses appear to be the most common cause of aseptic meningitis throughout the world. The aim of the study was to investigate neuroinflammatory properties of non-polio enteroviruses by measuring CSF concentrations of biomarkers that are involved in neuropathological pathways of neurodegenerative disorders. We measured Aβ42, t-tau, and S100B concentrations in 42 children with enteroviral meningitis (EM) compared to control group without central nervous system infection. We found enteroviral meningitis (EM) to reduce CSF concentration of Aβ42 (median, 1051.1 pg/mL; interquartile range (IQR), 737.6–1559.5 vs. median, 459.4 pg/mL; IQR, 312.0–662.0, p < 0.001). In contrast, CSF concentrations of t-tau and S100B were not affected by EM. There was a correlation between total neutrophil count in CSF and Aβ42 (R = − 0.59, p < 0.001). Absolute number of mononuclear cells in the CSF correlated with CSF t-tau (R = 0.41, p < 0.05). Both correlations remained significant after adjustment for age, blood leukocytes, serum CRP, CSF leukocytes, and CSF protein concentration.

CSF Protein Concentration Shows No Correlation With Brain Volume Measures.

Background: CSF protein concentrations vary greatly among individuals. Accounting for brain volume may lower the variance and increase the diagnostic value of CSF protein concentrations.Objective: To determine the relation between CSF protein concentrations and brain volume.Methods: Brain volumes (total intracranial, gray matter, white matter volumes) derived from brain MRI and CSF protein concentrations (total protein, albumin, albumin CSF/serum ratio) of 29 control patients and 497 patients with clinically isolated syndrome or multiple sclerosis were studied.Finding: We found significant positive correlations of CSF protein concentrations with intracranial, gray matter, and white matter volumes. None of the correlations remained significant after correction for age and sex.Conclusion: Accounting for brain volume derived from brain MRI is unlikely to improve the diagnostic value of protein concentrations in CSF.

Study of ophthalmic manifestations in tubercular meningitis patients

Abstract Introduction: Ophthalmic complications are very common in tuberculous meningitis (TBM) patients, understanding the ocular problems in tubercular meningitis patients is very important for ophthalmologists to intervene on time to prevent irreversible damage to eye. Hence this investigation has been undertaken to study ophthalmic manifestations in suspected tubercular meningitis patients in both Pediatric and adult population in Basaveshwara teaching and general hospital, Kalaburagi attached to Mahadevappa Rampure Medical College (MRMC). Materials and Mathods: The study was conducted at Basaveshwara Teaching and General Hospital, Kalaburagi attached to M.R. Medical College, from Dec 2011 to May 2013. 100 admitted patients diagnosed with TB meningitis, were selected for the study. The patients were divided into 2 groups. Group A consisted of TBM patients who were conscious and cooperative for ophthalmic examination. Group B consisted of TBM patients who were in a state of coma, uncooperative for ophthalmic evaluation. Results: Out of the 100 patients, 64% had ocular findings. In our study 22% had cranial nerve palsy. Fundus changes were seen in 50% of the patients. Around 22% patients had visual acuity, CSF protein content was considerably high in all patients. Hydrocephalous was seen in 31% (20) patients. Conclusion: In our study it was observed that most of TBM patients had ocular findings, CSF protein was found in many patients and after treatment there was improvement in ocular problems. We suggest further research with larger sample size to support our findings. Keywords: Meningitis, Tuberculosis, Ophthalmic manifestations. Introduction Tuberculosis (TB) is still increasing in India at an alarming rate. The most serious form of tuberculosis is tubercular meningitis (TBM). [1] TBM causes many complications in both children and adult patients. The close association between optic nerve and meninges produces many ocular

Antibody negative autoimmune encephalitis- Does it differ from definite one?

Context:Autoimmune encephalitis (AE) is an emerging cause of non-infective encephalitis, presentations of which vary widely. Traditionally the diagnosis of AE is based on detection of antibodies in a patient with clinical picture suggestive of AE.Aim:To evaluate the clinical characteristics and response to immunotherapy in patients with antibody negative autoimmune encephalitis and to compare them with definite cases.Settings and Design:A prospective follow-up study was done in patients presenting with presumptive symptoms of AE from January 2017 to January 2019. The study was done in a tertiary care institute of Northern India.Patients and Methods:Demographic and clinical parameters were noted and relevant investigations for management were done according to well-defined protocol. The patients were treated with immunomodulatory therapy in the form of steroids and/or intravenous immunoglobulins (IVIg). They were followed up for treatment response and relapse at 2 monthly intervals.Statistical Analysis Used:The data was expressed as either proportions or mean/median. Chi-square test/Independent T test was used to compare antibody positive and antibody negative group.Results:Out of 31 patients with presumptive AE, 16 patients tested positive for autoimmune antibodies (definite AE). Incidences of seizure, behavioral abnormalities, dementia and altered sensorium were similar between the 2 groups (p > 0.05). Complete or partial response was seen in all treated patients in both groups with no significant difference (p 0.716). CSF protein concentration and cellularity were higher in the definite group although only high protein concentration could reach statistical significance (p 0.002). Malignancy could be confirmed after extensive search in 2 out of 16 patients with definite AE and in 1 out of 15 antibody negative AE patients.Conclusions:Clinical presentation of antibody negative cases does not differ significantly from definite ones. Since treatment response is also similar in both the groups, starting immunotherapy in a patient presenting with presumptive symptoms of AE, while ruling out other common mimickers, seems to be the need of the hour in the management of this evolving entity.

Study of Etiological Pattern of Acute Meningo-Encephalitis Syndrome

Background: Acute meningo-encephalitis syndrome is a medical emergency which claim urgent management. So the objectives of the present study was to find out aetiological factors and differentiating parameter between different types acute meningoencephalitis syndrome with minimum investigation. Methods: This hospital based observational study was carried out in medicine units of Chittagong Medical College. Fifty cases were studied who present with acute onset fever with central nervous system dysfunction. Results: In this study it reveals that hospital rate of bacterial meningitis was 26%, viral encephalitis was 34% and severe malaria was 26% among the patient with acute meningo-encephalitis syndrome. It shows that mean age (years) in viral encephalitis was 33.71, bacterial meningitis was 34.15 &amp; in severe malaria was 27.92. It reveals that all patients of this series presented with acute onset fever (n=50,100%), maximum patients present with sign of meningeal irritation (n=44, 88%) &amp; altered mental state (n=41,82%). Few patients was present with new onset seizure (n=11,22%) &amp; neurologic deficit (n=1,2%). In Bacterial meningitis most patient was with low CSF glucose (n=10, 76.9%). In viral meningitis there were normal CSF glucose level (n=17,100%). High protein content in bacterial (n=13,100%) &amp; Viral (n=15,88.2%) was found. It shows differential count of CSF WBC in different type of meningitis where in Bacterial meningitis it is neutrophils &amp; in other type of meningitis it is the lymphocyte. Conclusion: CSF findings are hallmark of diagnosing various type of meningitis. CSF glucose and protein content found in this study significantly correlate with different etiology (p value = 0.000). Bangladesh Journal of Neuroscience 2018; Vol. 34 (1): 45-51

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

Objective: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.Methods: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.Results: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 (R2 = 36%, p < 0.001) and repeated CSF sampling (R2 = 46%, p < 0.001). Hypoglycorrhachia (<40 mg/dL) was observed in 50.1% of microbial cases, but only 9.6% of aseptic cases, most of which were neurosarcoidosis. Absolute 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.Conclusions: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.

Parathyroid hormone related protein concentration in human serum and CSF correlates with age

BackgroundParathyroid Hormone-Related Protein (PTHrP) is involved in intracellular calcium (Ca) regulation, and has been demonstrated to participate in regulation of Ca in brain cells, activation of neurons, and modulation of pain. However, there are conflicting reports regarding the presence of PTHrP in CSF. Design and methodsPTHrP and Ca were quantified in paired CSF and serum samples using mass spectrometry-based methods. Associations between PTHrP and Ca concentrations with age, sex and concentrations of nine CSF diagnostic markers in a set of 140 paired serum and CSF patient samples were evaluated. ResultsThe observed median PTHrP concentration in CSF was 51 times higher than in serum; the median concentration of Ca in CSF was 1.8 times lower than in serum. We observed positive correlation between concentrations of PTHrP in CSF and serum (p=0.013). Distribution of PTHrP concentrations in serum was associated with age (p=0.0068) and the concentrations were higher in women. In samples with serum calcium concentrations within the reference intervals (n=118), central 95% distribution of concentrations for Ca-CSF, PTHrP-serum and PTHrP-CSF were 5.4 (4.5–6.1) mg/dL, 1.2 (0.5–2.5) pmol/L, 62 (22–125) pmol/L, respectively. ConclusionsOur data demonstrate that PTHrP is a normal constituent of human CSF with median concentrations 51 fold higher than in serum. Elevated serum PTHrP concentrations were positively correlated with age and significantly higher in women. Our data suggest that CSF could be a significant source of circulating PTHrP.

Cerebrospinal fluid β-glucocerebrosidase activity is reduced in parkinson's disease patients.

Reduced β-glucocerebrosidase activity was observed in postmortem brains of both GBA1 mutation carrier and noncarrier Parkinson's disease patients, suggesting that lower β-glucocerebrosidase activity is a key feature in the pathogenesis of PD. The objectives of this study were to confirm whether there is reduced β-glucocerebrosidase activity in the CSF of GBA1 mutation carrier and noncarrier PD patients and verify if other lysosomal enzymes show altered activity in the CSF. CSF β-glucocerebrosidase, cathepsin D, and β-hexosaminidase activities were measured in 79 PD and 61 healthy controls from the BioFIND cohort. The whole GBA1 gene was sequenced. Enzyme activities were normalized according to CSF protein content (specific activity). β-glucocerebrosidase specific activity was significantly decreased in PD versus controls (-28%, P < 0.001). GBA1 mutations were found in 10 of 79 PD patients (12.7%) and 3 of 61 controls (4.9%). GBA1 mutation carrier PD patients showed significantly lower β-glucocerebrosidase specific activity versus noncarriers. β-glucocerebrosidase specific activity was also decreased in noncarrier PD patients versus controls (-25%, P < 0.001). Cathepsin D specific activity was lower in PD versus controls (-21%, P < 0.001). β-Hexosaminidase showed a similar trend. β-Glucocerebrosidase specific activity fairly discriminated PD from controls (area under the curve, 0.72; sensitivity, 0.67; specificity, 0.77). A combination of β-glucocerebrosidase, cathepsin D, and β-hexosaminidase improved diagnostic accuracy (area under the curve, 0.77; sensitivity, 0.71; specificity, 0.85). Lower β-glucocerebrosidase and β-hexosaminidase specific activities were associated with worse cognitive performance. CSF β-glucocerebrosidase activity is reduced in PD patients independent of their GBA1 mutation carrier status. Cathepsin D and β-hexosaminidase were also decreased. The possible link between altered CSF lysosomal enzyme activities and cognitive decline deserves further investigation. © 2017 International Parkinson and Movement Disorder Society.

Risk factors for poor prognosis in children with refractory purulent meningitis and the discharge criteria.

This study was undertaken to investigate the relationship between cerebrospinal fluid abnormalities and prognosis in pediatric refractory purulent meningitis. Ninety cases of pediatric refractory purulent meningitis were stratified into "good" (n=33) or "poor" (n=57) prognosis groups according to the Glasgow clinical outcome scores. The symptoms, laboratory results, and prognosis were compared by using univariate and multivariate logistic regression analyses. Univariate analysis showed that poor prognosis was associated with: unequal pupil size in both eyes; positive Babinski sign; CSF-WBC >500×106/L, CSF protein concentration >1.0g/L, CSF glucose content <1.5mmol/L; initial procalcitonin result >0.1ng/dL on admission; hemoglobin <90g/L during hospitalization; abnormal head imaging, and abnormal electroencephalogram. On multivariate analysis only unequal pupil size in both eyes and CSF glucose content <1.5mmol/L remained significant. The CSF protein concentration was significantly different between groups at discharge. The cutoff value was 0.68g/L. We recommend that discharged patients meet the following criteria: full antibiotic course and over 1 week of defervesce, disappearance of acute phase symptoms, CSF-WBC ≤28×106/L, CSF glucose >1.75mmol/L, and protein <0.68g/L. The patient may be discharged for follow-up if no relapse occurs during 3-5 days of observation after drug withdrawal.

The microbiology and clinical characteristics of bacterial and fungal meningitis in a Chinese hospital

&lt;br&gt;&lt;b&gt;Introduction:&lt;/b&gt; The aim was to investigate the distribution, antibiotic resistance, initial clinical and laboratory characteristics of pathogens isolated from the cerebrospinal fluid samples (CSF).&lt;br /&gt; &lt;br&gt;&lt;b&gt;Material and methods: &lt;/b&gt; The CSF were subjected for identification. The minimum inhibitory concentrations (MICs) of antimicrobial agents were tested. The initial clinical and laboratory characteristics were collected.&lt;br /&gt; &lt;br&gt;&lt;b&gt;Results: &lt;/b&gt; The rate of positive yield of pathogen meningitis in our study was 8.16% . Among the 1994 non-repetitive pathogens, Gram-positive pathogen was the most common (71.71%), followed by Gram-negative pathogen (20.36%), fungal (6.62%) and Mycobacterium tuberculosis (1.30%). Coagulase-negative staphylococci (CNS) was the most common Gram-positive pathogen and Acinetobacter baumannii (Ab) was the most common Gram-negative pathogen. As to fungal pathogen, Cryptococcus neoformans (CN) was the most common. The main CNS showed higher antimicrobial resistant rate for Penicillin G, oxacillin, clindamycin and erythromycin. Acinetobacter baumannii resistant to the most tested antibiotics and only showed considerable rate of resistance to cefoperazone/sulbactam, tigecycline and amikacin. All CN were susceptible to 5-fluorocytosine and only 3.6% CN were resistance to fluconazole. Long days of hospital stay, fever and meningeal irritation signs were common symptoms in the bacterial and fungal meningitis. Head injury, disturbance of consciousness, the pupil size of both eyes was not equal, pupillary reaction to light was slow or absent were more common in the Ab meningitis. The CSF protein concentration and white blood cells count as well as glucose concentration can be used in guiding initial treatment and further microbiological investigation.&lt;br /&gt; &lt;br&gt;&lt;b&gt;Conclusions: &lt;/b&gt; The main pathogens showed higher antimicrobial resistant rate and the selection of empiric antibiotics should take into consideration local epidemiology, antibiotic resistance patterns and the suspected causative microorganism.

The clinical characteristics of AQP4 antibody positive NMO/SD in a large cohort of Chinese Han patients

We aim to summarize the clinical features of AQP4-ab-positive NMO/SD in a large Chinese Han cohort. The clinical data of 145 AQP4-ab-seropositive patients was retrospectively reviewed. 55.9% (81/145) of the patients were defined as NMO while 39.3% (57/145) were defined as NMOSD according to the criteria established in 2006 and 2007. The mean onset age was 34.4years and the female to male ratio was 8.7:1. The median disease duration was 57months. The median of “time to second attack” and “time to develop NMO” was 7 and 13months respectively. Ratio of monophasic to relapsing was 1:7.1. Myelitis and optic neuritis (ON) were the most common manifestations at onset, followed by postrema syndrome. The median age of patients presenting with ON at disease onset was significantly younger than patients presenting with myelitis. Only 17.2% of the patients younger than 30years presented with longitudinally extensive transverse myelitis (LETM) at onset, while 55.6% of the patients over 30years presented with LETM at onset. The patients presenting with ON at disease onset all exhibited a relapsing course, had a higher probability of subsequent involvement of other CNS regions and developing into definite NMO over time compared with those with LETM as the first attack. AQP4-ab levels were higher in patients with circulating auto-antibodies such as ANA, SSA, anti-Ro-52, anti-dsDNA, anti-histone antibody, pANCA and SSB, and positively correlated with CSF protein concentrations.

Flubendiamide and Lead Exposure Alters Glial Fibrillary Acidic Protein and Aspartic Acid Concentrations in Cerebrospinal Fluid in Buffalo Calves

Changes in glial fibrillary acidic protein (GFAP) and aspartic acid (AA) concentrations in CSF following flubendiamide and lead exposure was studied. Male buffalo calves received daily oral dose of flubendiamide alone (n=4) @ 0.024mg/ kg/ day or lead acetate alone (n=4) @ 9.2 mg/ kg/ day or a combination of these two (n=4) for 90 days. Blood and CSF samples were collected and analyzed. GFAP in CSF did not alter in animals receiving flubendiamide alone. However, a significant increase in GFAP concentration in CSF was observed in animals receiving lead acetate. GFAP concentration showed a positive correlation (r = +0.545) with blood lead concentration in lead exposed animals, but no significant correlation was evident in animals exposed to both lead and flubendiamide. On the basis of results, it can be concluded that Aspartic acid concentration in CSF did not change significantly in lead treated animals, but increased significantly in flubendiamide treated animals. No significant alteration in AA level in CSF was observed in combined flubendiamide and lead treated animals. Flubendiamide exposure is associated with increase in AA level in CSF. Flubendiamide may have interactive effects with lead as evident from increase in GFAP and AA level in CSF after their combined exposure. This is the first report documenting alterations in GFAP and AA concentrations in CSF after flubendiamide exposure in mammals.

Clinical, biological, and microbiological pattern associated with ventriculostomy-related infection: a retrospective longitudinal study.

Our aim was to describe the pattern of ventriculostomy-related infection (VRI) development using a dynamic approach. Retrospective longitudinal study. We analyzed the files of 449 neurosurgical patients who underwent placement of external ventricular drain (EVD). During the study period, CSF sampling was performed on a daily base setting. VRI was defined as a positive CSF culture resulting in antibiotic treatment. For VRI patients, we arbitrary defined day 0 (D0) as the day antibiotic treatment was started. In these patients, we compared dynamic changes in clinical and biological parameters at four pre-determined time points: (D-4, D-3, D-2, D-1) with those of D0. For all CSF-positive cultures, we compared CSF biochemical markers' evolution pattern between VRI patients and the others, considered as a control cohort. Thirty-two suffered from VRI. Peripheral white blood cell count did not differ between D-4-D0. Median body temperature, CSF cell count, median Glasgow Coma Scale, CSF protein, and glucose concentrations were significantly different between D-4, D-3, D-2, and D0. At D0, 100 % of CSF samples yielded organisms in culture. The physician caring for the patient decided to treat VRI based upon positive CSF culture in only 28 % (9/32) of cases. In the control cohort, CSF markers' profile trends to normalize, while it worsens in the VRI patients. We showed that clinical symptoms and biological abnormalities of VRI evolved over time. Our data suggest that VRI decision to treat relies upon a bundle of evidence, including dynamic changes in CSF laboratory exams combined with microbiological analysis.

III. Current concepts in primary central nervous lymphoma.

III. Current concepts in primary central nervous lymphoma.

Revisiting the dilution factor as vital parameter for sensitivity of ELISA assay in CSF and Plasma.

Enzyme Linked Immunosorbent Assay (ELISA) is very sensitive assay which provides quantitative data about expression of antigens. However, its utility is based on certain parameters which vary in the experimental situations. We aimed to analyse the dilution factor as an important parameter for determining the sensitivity of ELISA in human samples. Total of n = 57 ALS patients and n = 48 normal controls were selected for the study. All the patients were recruited from, Department for Neurology and Anaesthesia, PGIMER. Blood and CSF sample was collected and ELISA run was performed in both plasma and blood sample. ELISA of OPTN and TDP-43 was employed to check the respective protein concentration in CSF and Plasma. There was no significant difference which was reported for Plasma as well as CSF values of TDP-43 and OPTN. Dilution test prior to actual experiment made a significant impact in deciding the actual concentration of sample and led to overshootingbeyond range of reference protein. Negative results from our study highlights the significance of determining the dilution factor as an important parameter for conduct of ELISA.

Analysis of Prognostic Factors of Children with Intracranial Infection Coma

Objective: To investigate the prognostic factors of coma due to intracranial infection in children, in order to judge the prognosis of coma earlier and guide appropriate treatment. Methods: 1) Collecting the clinical data of 39 comatose children due to intracranial infection admitted into Department of Neurology in Children’s Hospital of Chongqing Medical University from July to September 2007 and 2009, and analyzing their age and sex distribution, causes of coma, and laboratory examinations retrospectively. 2) Implementing the Glasgow coma score among these children immediately after admission, and collecting the serum and cerebrospinal fluid within 24 - 48 hours, and then measuring the NSE levels. 3) Following up these children 3 months after discharge, and analyzing the relationships among prognosis and age, sex, etiology, protein content in CSF, and NSE levels in Serum and CSF. Results: 1) In the cases studied, the age range was from 9 months to 14 years, the average age was (4.25 ± 2.82) years, and 9 months - 3 years, 3 - 5 years, 5 - 11 years, and ≥11 years were accounted for 33.3%, 30.8%, 30.8%, 5.1% respectively. There were 24 males and 15 females, and the gender ratio (male-to-female) was 1.6:1. 2) The group of 39 patients consists of Japanese encephalitis (23 cases, 59%), Viral encephalitis (5 cases, 12.8%), Tuberculous meningitis (5 cases, 12.8%), Acute disseminated encephalomyelitis (5 cases, 12.8%) and Purulent meningitis (1 cases, 2.6%). 3) CSF examination in 33 cases, protein elevated in 18 cases (54.5%), content between 0.47 and 4.33 g/L. 4) The statistical analysis showed that the causes, CSF protein content, serum and cerebrospinal fluid NSE levels were correlated with the prognosis, and that the age and sex had no correlation with the prognosis. Conclusions: 1) In this group of 39 patients, the incidence of children under 5 years old was the highest, and the incidence of boys was higher than girls. 2) Infectious diseases were the most common cause of coma in children. 3) Cerebrospinal fluid protein content was correlated with the prognosis, and the prognosis was worse as the protein content was higher. 4) NSE was a specific biochemical parameter of pathological damage nerve tissue; serum NSE levels could indirectly reflect the changes in CSF.

Assessment of ventriculo-peritoneal (VP) shunt malfunction in an in vitro model of artificial CSF flow: influence of CSF protein concentration, CSF contamination and time of shunt incubation

Experiments were carried out in an In Vitro model of CSF flow through VP shunts (Medtronic Inc) to investigate the influence of three factors on shunt function: 1) CSF protein concentration; 2) CSF contamination and; 3) Time of shunt incubation in the artificial CSF.

O-072 Increased Intracranial Pressure In Children With Acute Disseminated Encephalomyelitis

Introduction Lumbar puncture (LP) is routinely performed as part of the workup evaluation of suspected acute disseminated encephalomyelitis (ADEM). Mild pleocytosis and/or increased CSF protein concentration are common findings in ADEM. However, the CSF opening pressure, reflecting the intracranial pressure (ICP), has not been acknowledged to date in the literature. Methods Chart reviews of paediatric patients hospitalised in the Tel-Aviv Sourasky medical centre, between 2005–2013, that were diagnosed with ADEM, were identified retrospectively. Results Among 35 children diagnosed with ADEM, 20 who had documented CSF opening pressure comprised the study group. The mean age was 5.3 ± 4.1 years, ten males (50%); Mean CSF opening pressure was 27.8 ± 12.4 cmH 2 O, range 10–55 cmH 2 O. Considering the upper normal limit of CSF opening pressure in this age group (18 cmH 2 O), 15/20 (75%) patients had elevated pressure and one sample t-test comparison showed significant elevated CSF opening pressure among patients with ADEM (p v = 0.0023, 95% CI 3.9–15.6). Minimal pleocytosis was present in seven samples (median=2 cells/mm 2 ). Eighteen out of twenty (90%) patients had clinical complaints/signs that can be explained by increased ICP (drowsiness/encephalopathy n = 18, vomiting n = 8, headache n = 8). Discussion This study highlights that increased ICP is a prominent patho-physiologic change occurring in the CNS of ADEM patients. In our cohort, this was the most common CSF abnormal finding, independent of pleocytosis level. This observation is in line with the common non-focal neurological symptoms and signs and the beneficial effect of steroid treatment in ADEM. Furthermore, it suggests a potential efficacy of other reducing ICP treatments in ADEM.