ABSTRACT
ABSTRACT INTRODUCTION: Intrathecal fluorescein has been effective for topographic diagnosis of rhinoliquorrhea. Nonetheless, there are no reports on the study of cerebral spinal fluid (CSF) after use of intrathecal fluorescein. OBJECTIVE: A prospective study attempting to evaluate CSF through chemical and cytological analysis, after injection of fluorescein. METHODS: Prospective analysis of 24 samples of CSF after intrathecal injection of fluorescein for topographic diagnosis of CSF fistulae, collected at the time of puncture and after 24 and 48 h, divided by cellularity: Group 1, up to five cells, and Group 2, with more than five cells. RESULTS: The yellow-greenish color of CSF remained after 48 h in 36%, evidencing permanence of fluorescein. No changes in protein and glucose levels were observed between 0-24 h and 0-48 h. In group 2, an increase in cell count was observed between 24 h and 48 h (p = 0.019). In both groups, there was an increase of neutrophils between 0 and 48 h (p = 0.048) and a decrease between 24 and 48 h (p = 0.05). CONCLUSION: Intrathecal fluorescein provoked discreet meningeal reactions, such as an increase of cells between 24 and 48 h and an increase of neutrophils at 24 h, with a subsequent decrease at 48 h with no correlation with symptomatology.
RESUMO Introdução: A fluoresceína intratecal tem sido efetiva no diagnóstico topográfico da rinoliquorréia. Entretanto, não há estudos no líquor após o uso de fluoresceína intratecal. Objetivo: Estudo prospectivo visando avaliar o líquor, através de análise química e citológica, após injeção de fluoresceína. Método: Análise prospectiva de 24 punções após injeção intratecal de fluoresceína para diagnóstico topográfico de fístula liquórica, coletado no momento da punção, 24 e 48 horas, divididos pela celularidade: grupo 1, com até 5 células e grupo 2 com mais de 5 células. Resultado: A coloração amarelo-esverdeada do líquor permaneceu após 48 horas em 36%, evidenciando permanência de fluoresceína. Observou-se ausência de mudanças no nível de proteína e glicose entre 0-24 horas e 0-48 horas. No grupo 2, um aumento na contagem celular foi observado entre 24 e 48 horas (p = 0,019). No dois grupos juntos, observou-se um aumento de neutrófilos entre 0 e 48 horas (p = 0,048) e uma diminuição entre 24 e 28 horas (p = 0,05). Conclusão: Fluoresceína intratecal provocou discretas reações meníngeas, como o aumento de células entre 24 e 48 horas e aumento dos dos neutrófilos em 24 horas com uma subsequente dimi nuição em 48 horas sem correlação com sintomas.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Humans , Middle Aged , Young Adult , Cerebrospinal Fluid/drug effects , Fluoresceins/administration & dosage , Fluorescent Dyes/administration & dosage , Cerebrospinal Fluid Proteins/analysis , Cerebrospinal Fluid Proteins/drug effects , Cerebrospinal Fluid Rhinorrhea/diagnosis , Cerebrospinal Fluid/chemistry , Cerebrospinal Fluid/cytology , Glucose/analysis , Immunohistochemistry , Injections, Spinal , Neutrophils/drug effects , Prospective Studies , Time FactorsABSTRACT
We assessed the benefit of prednisolone regimen in adult-patients with tuberculous meningitis by a randomised, double-blind trial. 59 patients were treated with combined antituberculous drugs and randomised to receive oral prednisolone regimen or a placebo. There were 29 and 30 patients in the treatment and placebo groups respectively. The results revealed that prednisolone was not beneficial in patients with severe brain lesions, increased intracranial pressure and cranial nerve palsies. The role of prednisolone in patients with paraparesis, visual impairment and newly developed neurological complications during treatment needs further study.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents/administration & dosage , Antitubercular Agents/therapeutic use , Cerebrospinal Fluid/drug effects , Chi-Square Distribution , Double-Blind Method , Female , Humans , Male , Middle Aged , Prednisolone/administration & dosage , Prospective Studies , Treatment Outcome , Tuberculosis, Meningeal/diagnosisABSTRACT
Clinical features and serial cerebrospinal fluid (CSF) samples of 50 patients who underwent myelography with iophendylate were studied. Forty two patients (84%) developed one or more features suggestive of meningism lasting for 2-4 days. There was significant rise in the average (mean) CSF counts from 9.81 in the premyelogram sample to 532.6 at the end of 24 hours (p less than 0.001). Both neutrophil and lymphocyte (p less than 000) count increased. At the end of one week, there was significant decrease of total cells in the CSF to 204 (p less than 0.001). Both, neutrophils and lymphocytes decreased. There was significant rise in total proteins in the 24 hours sample, but the fall at one week was not significant statistically. The sugar and chloride values did not change significantly. All CSF samples were negative for bacterial cultures. In conclusion, a significant proportion of the patients undergoing iophendylate myelography develop clinical features suggestive of meningeal irritation and change in the CSF fractions suggestive of meningitis: however these changes are transient and do not warrant institution of chemotherapy or steroids.
Subject(s)
Cerebrospinal Fluid/drug effects , Diagnosis, Differential , Female , Humans , Iophendylate/adverse effects , Male , MyelographyABSTRACT
Cuando se infunde bicarbonato de sodio intravenoso el propósito de corregir la acidosis metabólica se obtienen resultados opuestos en el líquido cefalorraquídeo. La caída del pH en el líquido y, por lo tanto, en el sistema nervioso central, puede ocasionar empeoramiento en el estado de conciencia, modificación de la ventilación y modificación de la perfusión cerebral. Por el contrario, la infusión de THAM - Tris(hidroximetil)aminometano-, modifica en el mismo sentido el estado ácido-base en sangre, líquido cefalorraquídeo y, por lo tanto, en sistema nervioso central, logrando el objetivo de corregir la acidosis, sin introducir secuelas neurológicas. Para demostrar lo expuesto anteriormente, se trabajó con dos grupos de perros que fueron anestesiados y ventilados mecánicamente. A un grupo se le infundió bicarbonato de sodio intravenoso y al otro THAM por la misma vía. Se midieron los siguientes parámetros ácido-base en sangre arterial, venosa y líquido cefalorraquídeo; pH, presión parcial de dióxido de carbono, bicarbonato real, exceso de bases y THAM en el líquido, con un método que desarrollamos para tal fin
Subject(s)
Dogs , Animals , Bicarbonates/pharmacology , Cerebrospinal Fluid/drug effects , Acid-Base Equilibrium/drug effects , Methane/analogs & derivatives , Sodium/pharmacologyABSTRACT
Cerebral oedema often occurs following trauma to the brain. Recently several biogenic amines have been suggested for their possible mediation in the pathophysiology of traumatic brain oedema. The present investigation indirectly indicates that prostaglandins of E series are also involved in the etiology of cerebral oedema, since administration of a potent PG synthetase inhibitor, indomethacin significantly diminished oedematous swelling of traumatised rat brain.