Elevation of cerebrospinal fluid levels of basic fibroblast growth factor in moyamoya and central nervous system disorders.

Moyamoya syndrome is a vaso-occlusive disease involving the intracranial vessels of the circle of Willis which is accompanied by an intense compensatory recruitment of new vessels. Angiogenic substances such as basic fibroblast growth factor (bFGF) present in the cerebrospinal fluid (CSF) have been proposed as possible mediators of the neovascular response. We analyzed CSF samples collected intraoperatively from predominantly pediatric patients with moyamoya and other conditions such as Chiari malformation (Ch), tethered cord (TC), arteriovenous malformation (AVM), brain tumor (BT) and hydrocephalus (HCP). We found that CSF bFGF was significantly elevated in patients with moyamoya (141 pg/ml, n = 37), Ch (56.7 pg/ml, n = 22), TC (55.1 pg/ml, n = 23), AVM (354 pg/ml, n = 5), and BT (208 pg/ml, n = 5) compared to patients with HCP (5.5 pg/ml, n = 7) and controls (1.6 pg/ml, n = 25; p < 0.05). There was no dependence of CSF bFGF on patient age or gender. Although CSF bFGF in the moyamoya group showed no correlation with the Suzuki radiographic stage at either pre- or post-operative (1-year follow-up) angiography, it showed a trend with the Matsushima angiographic score with increasing collateral vascularization from the synangiosis developing at higher levels of CSF bFGF. Our findings suggest that CSF bFGF may be playing a wide-ranging role in a number of central nervous system conditions associated with ischemia and hypervascularity. Although not a specific marker for moyamoya, elevated CSF bFGF may serve as a weak predictor of the extent of angiogenesis to be expected in indirect revascularization procedures.

Elevation of cerebrospinal fluid substance P concentrations in spina bifida.

Concentrations of substance P, a peptide believed to have neurotransmitter and possible trophic functions, were determined by radioimmune assay in the cerebrospinal fluids of ten babies and one foetus with spina bifida, and compared to those of five normal babies and ten normal foetuses. The results (mean +/- S.E.M.) were: spina bifida babies (864 +/- 357.6 fmol ml-1), normal babies (141 +/- 14.2 fmol ml-1), spina bifida foetuses (150,000 fmol ml-1), normal foetuses (22,673 +/- 8,340 fmol ml-1). Hence, in spina bifida cerebrospinal fluid substance P concentrations were grossly elevated both pre- and post-natally. The significance of these results can be considered from two aspects: there is the possibility that substance P plays a role in the development of the spinal cord which is disturbed in spina bifida; as substance P has been shown to be involved with sensory perception and autonomic reflexes, abnormal concentration of substance P in cerebrospinal fluid may aggravate the neurological deficit in spina bifida. Possibly, therapeutic manipulation of substance P, when available in the future, may be considered in these patients.

Isoelectric focusing of cerebrospinal fluid proteins in children with nontumoral hydrocephalus. A preliminary report.

The cerebrospinal fluid (CSF) protein patterns of 42 children with nontumoral hydrocephalus, 33% with associated congenital malformations (meningocele, myelomeningocele, spina bifida, monoventricular prosencephalon) were determined by isoelectric focusing and polyacrylamide gel electrophoresis. 50% of the patients showed a barrier damage pattern, 19% showed a degenerative pattern, a block pattern or a normal pattern were less frequently found. 14 children presented hydrocephalus associated with other malformations, 44% of these cases showed a degenerative pattern. Combining results from quantitative polyacrylamide gel electrophoresis and qualitative isoelectric focusing, resulted in better characterization of CSF protein abnormalities, the high resolution capacity of these techniques may give a new approach to the evaluation of the blood CSF barrier in the management of hydrocephalus.

Cerebrospinal fluid protein findings in various lower back pain syndromes.

Cerebrospinal fluid (CSF) total protein, albumin and IgG concentrations were measured in 53 patients with lower back pain syndromes. In the majority of the patients (81 %) the protein values were within normal ranges, a finding contrary to previous studies. In six of 28 patients with acute lumbar disc prolapse and in two of four cases with spinal stenosis, a clearly abnormal protein pattern was observed, while patients who had been earlier operated on for disc prolapse showed normal values. The calculated permeability indexes suggest that the elevation of various proteins is linked with increased permeability across the blood-brain barrier and that the local immunoglobulin synthesis in CNS is lacking. In only one of the cases with an abnormal CSF protein pattern could no evidence of the cause of the pathological finding be observed in subsequent examinations.