Cerebrospinal Fluid (CSF) Leak: Causes, Symptoms, & Treatments

Overview

Cerebrospinal fluid (CSF) leak occurs when CSF escapes through a small tear or hole in the tissue that surrounds the brain and spinal cord called the dura mater.

What is cerebrospinal fluid (CSF)?

Cerebrospinal fluid (CSF) is a clear fluid that surrounds the brain and spinal cord. It cushions the brain and spinal cord from injury and also serves as a nutrient delivery and waste removal system for the brain. CSF is manufactured continuously in areas of the brain called ventricles and is absorbed by the bloodstream.

What is a cerebrospinal fluid (CSF) leak?

Cerebrospinal fluid (CSF) leak occurs when CSF escapes through a small tear or hole in the outermost layer of connective tissue (called the dura mater) that surrounds the brain and spinal cord and holds in the CSF. The tear or hole allows the CSF to leak out.

The loss of CSF causes the previously cushioned brain to sag inside the skull, which results in a headache. Loss of fluid also causes a lowering of pressure within the skull, a condition called intracranial hypotension.

CSF leaks can occur in the brain (cranial CSF leak) or at any point along the spinal column (spinal CSF leak).

How common is a cerebrospinal fluid (CSF) leak?

Cerebrospinal fluid (CSF) leaks are a rare event. Researchers estimate that they occur in about 5 in every 100,000 people. However, they also believe that this is an underestimate and that the true number of people affected remains unknown. They are mostly found in people in their 30s and 40s. CSF leaks are commonly misdiagnosed as migraines, other headache disorders or sinusitis.

Are certain people more prone to a cerebrospinal fluid (CSF) leak?

Anyone can get a cerebrospinal fluid (CSF) leak. However, they tend to occur more often in:

• Women
• People with certain connective tissue disorders such as Ehlers-Danlos and Marfan syndromes
• People who are obese or have high blood pressure

What are the complications from having a cerebrospinal fluid (CSF) leak?

Meningitis is the most significant risk associated with cranial CSF leaks. There is no increased risk of meningitis with a spinal CSF leak.

Symptoms and Causes

What causes a cerebrospinal fluid (CSF) leak?

Many cases of cerebrospinal fluid (CSF) leak have no known causes. This is called a spontaneous CSF leak. The following are other possible common causes:

• Head trauma or spine injury
• Lumbar puncture (spinal tap)
• History of epidurals or spinal catheters
• Certain head and spine surgeries
• Epidural injection (for pain relief)
• Skull base defects (such as meningoencephaloceles)
• High pressure intracranial hydrocephalus (an abnormal buildup of CSF in the brain)
• Underlying and untreated intracranial hypertension (elevated pressure in the brain fluid)
• Underlying and untreated connective tissue diseases, such as Ehlers-Danlos and Marfan syndromes
• Bone spurs along the spine

What are the symptoms of a cerebrospinal fluid (CSF) leak?

Symptoms of a cerebrospinal fluid (CSF) leak can include:

• Headache, which feels worse when sitting up or standing and better when laying down; may come on gradually or suddenly
• Vision changes (blurred vision, double vision, visual field changes)
• Hearing changes/ringing in ears
• Sensitivity to light
• Sensitivity to sound
• Balance problems
• Neck stiffness and pain
• Nausea and vomiting
• Pain between the shoulder blades
• Arm pain

In addition to these symptoms, other symptoms unique to cranial CSF leaks include:

• Clear, watery drainage usually from only one side of the nose or one ear when tilting the head forward
• Salty or metallic taste in mouth
• Drainage down back of throat
• Loss of smell

Diagnosis and Tests

How are cranial cerebrospinal fluid (CSF) leaks diagnosed?

Your doctor will perform a history and physical exam. Often, the doctor will examine your nose with an endoscope. Your doctor may also ask you to lean forward for several minutes to see if drainage comes out your nose. If the drainage can be collected, it is often sent for laboratory testing to confirm that it is cerebrospinal fluid. Your ears will also be examined. One or more of the following other tests may be ordered to determine the location of the leak as well as changes in structures and features in the brain or spinal cord area:

Management and Treatment

What is the treatment for a cerebrospinal fluid (CSF) leak?

Treatment options for a CSF leak depend on its cause and the location of the leak (cranial vs spine). In general, conservative treatments are usually tried first for leaks at either location.

Conservative treatments

• Bed rest (days to up to 2 weeks)
• Hydration (2 to 3 quarts)
• IV caffeine infusions
• Saline infusions

Additional instructions for patients with cranial CSF leaks are to avoid coughing, sneezing, nose blowing, heavy lifting and to take stool softeners to avoid straining during bowel movements.

Surgical treatments

If conservative treatments are not successful in stopping the leak, more invasive procedures are tried.

Cranial CSF leaks. Repair of cranial CSF leaks depend on the size and the location of the leak. CSF leaks from your nose can usually be repaired using nasal endoscopy (using a camera and a thin long lens through your nostril). CSF leaks into your ear will usually need the use of a microscope. Options including using a synthetic graft; using a piece of your own tissue including fat, muscle, and mucosal lining; or using a flap of tissue. In addition, various surgical adhesives (glues) and bony cement could also be used. If hydrocephalus is suspected to be the cause of the CSF leak, a lumbar drain may also be placed in the lower back to decrease intracranial pressure.

Spinal CSF leaks. After conservative treatments have been tried, an epidural blood patch is the most common treatment for spinal CSF leaks. In this procedure, your own blood is injected into the spinal canal. The blood clot that forms creates a seal to stop the leak. If several attempts of epidural blood patches do not work, other grafting materials, such as epidural fibrin glue, or fat or muscle patches, may be tried. If these methods are not successful, other surgical approaches to repair the leak include using stitches (sutures) or aneurysm clips.

What precautions should I take following a CSF leak repaired?

Your doctor will give you additional instructions, but these are also some reasonable precautions to follow for 4 to 6 weeks after your CSF leak repair:

• Avoid lifting anything over 10 pounds
• Avoid bending, lifting, stretching and twisting
• Avoid straining to have bowel movements; a stool softener is often prescribed
• Avoid coughing and sneezing, but if you must, do so with your mouth open
• Do not blow your nose
• Avoid use of straws
• Keep your back straight during all movements (bend at knees and hips)

Cerebrospinal Fluid Leak | Cedars-Sinai

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What is a cerebrospinal fluid leak?

Cerebrospinal fluid (CSF) leak occurs when there is a tear or hole in the membranes surrounding the brain or spinal cord, allowing the clear fluid that surrounds and cushions those organs to escape.

Cranial CSF leaks occur in the head and are associated with CSF rhinorrhea, in which the cerebrospinal fluid escapes through the nasal passages (runny nose).

Spinal CSF leaks develop due to tears in the soft tissues surrounding the spinal cord.

What causes a cerebrospinal fluid leak?

Some CSF leaks occur spontaneously and the cause is unknown, while others are a result of trauma such as a head injury, brain or spinal surgery, an epidural, a lumbar puncture (spinal tap) or a skull base tumor.

Patients with high-pressure hydrocephalus, an abnormal accumulation of cerebrospinal fluid, also may be at an increased risk of developing leaks.

What are the symptoms of a cerebrospinal fluid leak?

The most common symptoms of a spinal CSF leak are:

• Positional headaches, which feel worse when sitting upright and better when lying down; caused by intracranial hypotension
• Nausea and vomiting
• Neck pain or stiffness
• Change in hearing (muffled, ringing in the ears)
• Sense of imbalance
• Photophobia (sensitivity to light)
• Phonophobia (sensitivity to sound)
• Pain between the shoulder blades

For patients with cranial CSF leaks, the most common indicators are:

• Drainage from the nose (rhinorrhea)
• Salty or metallic taste in the mouth
• Sense of drainage down back of throat
• Drainage from the ear (otorrhea)
• Cutaneous sinus tract drainage (CSF leaks into the sinus tract, which then creates a pathway to drain through the skin)
• Loss of sense of smell (anosmia)
• Change in hearing or ringing in the ears

Less frequently, patients with cranial CSF leaks experience cognitive changes.

How is a cerebrospinal fluid leak diagnosed?

Diagnosis of a CSF leak generally begins with a physical exam and history. A CSF leak can be difficult to detect, causing misdiagnosis or delayed diagnosis. Experts such as those in the Cedars-Sinai CSF Leak Program can be pivotal in providing relief.

If a cranial CSF leak is suspected, the patient’s physician may ask them to lean forward so they can observe if this increases the flow of nasal discharge. If the discharge can be collected, it is sent for laboratory tests to determine if it is cerebrospinal fluid.

The patient’s physician also may order tests to examine the condition of the brain and spinal cord. Whether the hole or tear is in the cranial area or the spine, the physician can order imaging tests to determine the exact location of the leak.

These tests may include:

A pledget test may be used to determine if a cranial CSF leak is occurring by placing small cotton pads (pledgets) in the nose.

The pledget test, however, cannot be used to determine the location of the leak. A CT scan, MRI, myelogram or a cisternogram can assist the physician in determining the location of the leak in either the cranial or spinal area.

How is a cerebrospinal fluid leak treated?

While many CSF leaks heal on their own and require only a period of bed rest, patients with symptoms of the condition should still visit their physician due to the increased risk of meningitis that is associated with cranial CSF leaks.

For cranial cerebrospinal fluid leaks that do not respond to conservative treatments, surgery may be necessary to repair the leak. The Cedars-Sinai Sinus Center has extensive experience in the use of nasal endoscopy, which is much less invasive than traditional surgical methods.

For spinal CSF leaks that do not respond to bed rest and other conservative treatments, an epidural blood patch or epidural patching with fibrin glue are treatment options. An epidural blood patch involves injecting the patient’s own blood into the spinal canal. The resulting blood clot then “patches” the hole where the leak is occurring.

If an epidural blood patch does not work, other surgical repairs may be necessary.

If high-pressure hydrocephalus is causing the CSF leak, the condition may reoccur until shunts are used to help drain the excess fluid.

Key points

• Cerebrospinal fluid (CSF) leak occurs when there is a tear or hole in the membranes surrounding the brain or spinal cord, allowing the clear fluid that surrounds and cushions those organs to escape.
• An increased risk of meningitis is associated with cranial CSF leaks.
• CSF leaks can be cause by an injury, surgery, an epidural, a spinal tap or a tumor.
• Many CSF leaks heal on their own, but others require surgical repair.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your provider if you have questions.

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Brain abscess – NHS

A brain abscess is a pus-filled swelling in the brain. It usually occurs when bacteria or fungi enter the brain tissue after an infection or severe head injury.

Although the risk of developing a brain abscess is extremely low in England, it is a life-threatening condition and should be diagnosed and treated as soon as possible.

Symptoms of a brain abscess

The symptoms of a brain abscess may develop quickly or slowly but can include:

• headache – which is often severe, located in a single section of the head and cannot be relieved with painkillers
• changes in mental state – such as confusion or irritability
• problems with nerve function – such as muscle weakness, slurred speech or paralysis on one side of the body
• a high temperature
• seizures (fits)
• feeling sick
• being sick
• stiff neck
• changes in vision – such as blurring, greying of vision or double vision (due to the abscess putting pressure on the optic nerve)

When to get medical advice

Any symptoms that suggest a problem with the brain and nervous system should be treated as a medical emergency. These include:

• slurred speech
• muscle weakness or paralysis
• seizures occurring in a person with no previous history of seizures

If you or someone you know experiences any of these symptoms, phone 999 immediately and ask for an ambulance.

Any symptoms that suggest a worsening infection, such as a high temperature or being sick, should be reported to your GP immediately.

If your GP is not available, contact your local out-of-hours service or call NHS 111.

Causes of a brain abscess

There are 3 main ways a brain abscess can develop. These are:

• an infection in another part of the skull – such as an ear infection, sinusitis or dental abscess, which can spread directly into the brain
• an infection in another part of the body – for example, the infection that causes pneumonia spreading into the brain via the blood
• trauma, such as a severe head injury – that cracks open the skull, allowing bacteria or fungi to enter the brain

However, in some cases, the source of the infection remains unknown.

Read more about the causes of a brain abscess.

Diagnosing a brain abscess

If a brain abscess is suspected, an initial assessment will be made based on your symptoms, medical history and whether you’ve had a recent infection or a weakened immune system.

Blood tests can also be carried out to check for an infection.

If you’re referred to hospital for further tests, you may have either:

• a CT scan – a series of X-rays are used to produce a detailed image of the inside of your body
• an MRI scan – which uses strong magnetic fields and radio waves to produce a detailed image of the inside of your body.

If an abscess is found, a procedure known as CT-guided aspiration may be used to remove a sample of pus for testing. This involves using a CT scan to guide a needle to the site of the abscess.

Treating a brain abscess

A brain abscess is regarded as a medical emergency. Swelling caused by the abscess can disrupt the blood and oxygen supply to the brain. There’s also a risk of the abscess bursting (rupturing).

If left untreated, a brain abscess can cause permanent brain damage and could be fatal.

A brain abscess is usually treated using a combination of:

• medicines – either antibiotics or antifungals
• surgery – either draining the pus through a hole in the skull (simple aspiration) or opening the skull and removing the abscess entirely (craniotomy)

Treatment with antibiotics often begins before a diagnosis is confirmed, to reduce the risk of complications.

Read more about treating a brain abscess.

Complications of a brain abscess

Complications of a brain abscess can include:

• a reoccurring abscess – seek immediate medical advice if you think there’s even a small chance your abscess has reoccurred; this is more common in people with a weakened immune system or cyanotic heart disease
• brain damage – mild to moderate brain damage often improves with time but severe brain damage is likely to be permanent; brain damage is more of a risk if diagnosis and treatment are delayed
• epilepsy – where a person has repeated seizures (fits)
• meningitis – a life-threatening infection of the protective membranes around the brain, which requires urgent treatment; this is more common in children

Page last reviewed: 20 May 2019
Next review due: 20 May 2022

Encephalitis – NHS

Encephalitis is an uncommon but serious condition in which the brain becomes inflamed (swollen).

It can be life threatening and requires urgent treatment in hospital.

Anyone can be affected, but the very young and very old are most at risk.

Symptoms of encephalitis

Encephalitis sometimes starts off with flu-like symptoms, such as a high temperature and headache.

More serious symptoms come on over hours, days or weeks, including:

• confusion or disorientation
• seizures or fits
• changes in personality and behaviour
• difficulty speaking
• weakness or loss of movement in some parts of the body
• loss of consciousness

Dial 999 for an ambulance immediately if you or someone else has these more serious symptoms.

Causes of encephalitis

It’s not always clear what causes encephalitis, but it can be caused by:

• viral infections – very rarely, encephalitis may be caused by the common viruses that causes cold sores (herpes simplex) or chickenpox (herpes varicella) spreading to the brain
• a problem with the immune system, the body’s defence against infection – sometimes something goes wrong with the immune system and it mistakenly attacks the brain, causing it to become inflamed
• bacterial or fungal infections – these are much rarer causes of encephalitis than viral infections

Some types of encephalitis are spread by mosquitoes (such as Japanese encephalitis), ticks (such as tick-borne encephalitis) and mammals (such as rabies).

You cannot catch encephalitis from someone else.

Treatments for encephalitis

Encephalitis needs to be treated in a hospital. The earlier treatment is started, the more successful it’s likely to be.

Treatment depends on the underlying cause, but may include:

• antiviral medicines
• steroid injections
• treatments to help control the immune system
• antibiotics or antifungal medicines
• painkillers to reduce discomfort or a high temperature
• medicine to control seizures or fits
• support with breathing, such as oxygen through a face mask or a breathing machine (ventilator)

How long someone with encephalitis needs to stay in hospital can range from a few days to several weeks or even months.

Recovering from encephalitis

Some people eventually make a full recovery from encephalitis, although this can be a long and frustrating process.

Many people never make a full recovery and are left with long-term problems caused by damage to their brain.

Common complications include:

• memory loss
• frequent seizures or fits
• personality and behavioural changes
• problems with attention, concentration, planning and problem solving
• persistent tiredness

These problems can have a significant impact on the life of the affected person, as well as their family and friends.

But help and support is available.

Preventing encephalitis

It’s not always possible to prevent encephalitis, but some of the infections that cause it can be prevented with vaccinations.

These include the:

Speak to a GP surgery if you’re not sure whether your vaccinations are up to date, or you’re planning to travel abroad and do not know if you need any vaccinations.

Page last reviewed: 03 December 2019
Next review due: 03 December 2022

What Is Cerebrospinal Fluid?

Cerebrospinal fluid is the liquid around your brain and spinal cord. If a doctor thinks you have an illness that affects your nervous system, they might take a sample for testing.

The fluid is made by a group of cells, called the choroid plexus, that are deep inside your brain. Your body has about 150 milliliters of fluid — roughly two-thirds of a cup.

As the colorless fluid goes around your brain and spinal cord, it cushions those organs, picks up needed supplies from your blood, and gets rid of waste products from brain cells.

Sometimes cerebrospinal fluid can have things in it that shouldn’t be there, like bacteria or viruses that can attack your brain. With some illnesses, what’s in that fluid can help your doctor figure out what’s going on.

What Can It Tell Your Doctor?

A sample of cerebrospinal fluid can be an important clue. It can tell your doctor if you have one of a number of conditions, such as:

• Multiple sclerosis (when your body’s immune system attacks your nerves) or other similar conditions known as autoimmune diseases
• Myelitis: inflammation of your spinal cord
• Encephalitis: inflammation of your brain cells
• Meningitis: inflammation of the thin tissues that cover and protect your brain and spinal cord. This usually is caused by an infection in the cerebrospinal fluid.
• A stroke or similar condition that causes bleeding around your brain
• Leukemia: a kind of blood cancer
• Dementia

How Is the Sample Taken?

Your doctor will use a procedure called a spinal tap or lumbar puncture. They’ll take a sample of cerebrospinal fluid with a long, thin needle. You’ll get a local anesthetic to numb the skin in the area, and the needle will go in between two of your vertebrae, the bones that surround your spinal cord and make up your spine. They’ll take a tablespoon or two of the fluid for testing.

It usually takes about 45 minutes. You’ll rest for a while afterward and may be told not to do anything strenuous for about a day. You may have a headache afterward, but tell your doctor if it lasts more than a few hours.

How Is the Sample Used?

What’s in your cerebrospinal fluid can help your doctor identify or rule out various diseases.

• If you have high levels of a substance called immunoglobulin, which your body uses to fight disease, or other things related to your nerve cells, that could point to multiple sclerosis.
• If your doctor thinks you have Alzheimer’s disease or another kind of dementia, certain types of proteins linked to the disease may be in the fluid.
• Discolored fluid might be a sign of a cerebral hemorrhage (bleeding in your brain) or stroke.
• Signs of bacterial or viral infection could tell your doctor you have an illness like meningitis or encephalitis.

Cerebrospinal Fluid (CSF) Leak | Johns Hopkins Medicine

What is cerebrospinal fluid?

Cerebrospinal fluid (CSF) is a clear liquid that surrounds the brain and spinal cord. It provides a cushion for delicate brain and spinal tissue. Reduced cerebrospinal fluid, as in the case of a leak, requires immediate care by a trained expert.

What is a CSF leak?

A CSF leak is when the CSF escapes through a tear or hole in the dura, the outermost layer of the meninges, which surround the brain. The dura can be injured or punctured during a head injury or a surgical procedure involving the sinuses, brain or spine. It may also be damaged by a lumbar puncture, including a spinal tap, spinal anesthesia or myelogram. Spontaneous CSF leaks can occur due to increased intracranial pressure (pressure in the head). This can happen to patients with hydrocephalus, a buildup of CSF in the skull.  Spontaneous leaks may also occur without an identifiable cause.

CSF Leak Symptoms

Symptoms of a CSF leak include:

• Headache
• Meningitis (bacterial or viral)
• Nasal drainage of CSF (this may be difficult to distinguish from normal nasal discharge without testing)
• Tinnitus (ringing in the ears)
• Visual disturbances

Diagnosis of a CSF Leak

If your doctor suspects a CSF leak, he or she may recommend the following tests.

• Analysis of the nasal fluid: This test is used to detect beta-2 transferrin, a protein found almost exclusively in CSF.
• CT scan: This noninvasive diagnostic imaging procedure uses X-rays and computer technology to produce detailed imaging of bones and planes of the brain.

• MRI scan: This uses a large magnet, radiofrequencies and a computer to produce detailed images of organs and structures in the body. MRI scans can help determine the location and severity of a CSF leak. scan: This uses a large magnet, radiofrequencies and a computer to produce detailed images of organs and structures in the body. MRI scans can help determine the location and severity of a CSF leak.

• Cisternogram — CT or nuclear medicine: These two tests, each performed in a similar way, require a spinal tap (also known as a lumbar puncture) to administer a fluid to the CSF that allows your doctor to identify if a CSF leak is present and the source of the leak.
• A CT cisternogram may help identify the site of a CSF leak into the nasal cavities or mastoid bone. During this test, a contrast medium is injected into the spinal fluid through a spinal tap, and then a CT scan is performed.
• A pledget study can confirm whether CSF is leaking into the nose or mastoid from a break in the bone at the base of the skull. During this test, a radioactive tracer is injected into the spinal fluid through a spinal tap. Pledgets (small cotton pads) are inserted into the nose for several hours to collect fluid and are later checked for the presence of the radionuclide.
• During a myelogram scan, a contrasting substance is injected into the spinal cord, and MRI or CT scans are used to look for tears or ruptures in the dura.

CSF Leak Treatment

A CSF leak is a very serious condition, and patients who have tears in their dura with persistent CSF leaks need repair as soon as possible to reduce headache pain and the chance of meningitis.

Nasal CSF Leak

Surgery for endoscopic nasal CSF leak closure, which is performed entirely through the nostrils, does not require cutting through the skin. The CSF leak is repaired using your own tissue from the nose or with a biomaterial graft. Length of stay in the hospital depends on the size of the leak — most patients are in the hospital for a few days after surgery. Some patients may require a lumbar drain that is removed before going home.

Ear CSF Leak

Ear CSF leak closure requires cutting the skin behind the ear and removing portions of mastoid (honeycomb-like, bony tissue) to access the source of the CSF leak around the ear. Using your own tissue or a biomaterial graft, the surgeon repairs the leak and seals the surgical opening.  

Spinal CSF Leak

For CSF leaks that drain into the spinal canal, there are other treatments, such as use of blood or fibrin patches. For these procedures, the physician uses CT guidance to inject a small amount of the patient’s own blood or a plug of fibrin (the fibrous protein in blood that helps it clot) into the spinal canal. This can often repair the leak. If these methods fail, duraplasty — surgical repair of the dura — may be necessary.

Application of combined cerebrospinal fluid physicochemical parameters to detect intracranial infection in neurosurgery patients | BMC Neurology

Information of experimental patients and confirmed patients

A total of 221 adults with positive culture were retrospectively collected between January 1, 2016 and December 31, 2018 in the First Affiliated Hospital of Nanchang University, China. The age was ranged from 19 to 71 years old, with a mean age and standard deviation (SD) of 50.61 ± 12.76 years old. Fifty adults with negative culture were also collected during the same period, and the age was ranged from 19 to 69 years, with a mean age and SD of 49.64 ± 11.64 years old. Furthermore, the age of confirmed adults was from 20 to 65 years, with a mean age and SD of 49.34 ± 13.51 years old. The statistical analysis showed that there was no significant difference in age and sex (P > 0.05) among the three groups.

Distribution of pathogens for intracranial infection

A total of 221 pathogens were isolated from postoperative intracranial specimen, including 121 (121/221, 54.8%) gram-positive bacteria, 98 (98/221, 44.3%) gram-negative bacteria and 2 Cryptococcus neoformans. Among them, coagulase-negative staphylococci, Acinetobacter baumannii, Klebsiella pneumonia and Escherichia coli accounted for 41.6% (92/221), 12.7% (28/221), 10. 0% (22/221) and 4.1% (9/221), respectively. The detailed results were shown in Table 1.

Table 1 Distribution and composition of pathogen isolated from postoperative intracranial specimen

Comparisons between infection group and non-infection group

For the 221 cases with CSF infection, the mean glucose concentration was 2.20 mmol/L, the highest value was 8.36 mmol / L, and the lowest value was 0.01 mmol/L. There were 59 cases with a glucose level below 1.0 mmol / L, 48 cases were showed 1.0 to 2.25 mmol / L, and glucose concentration in patients with fungal infection was between 2.5–3.5 mmol/L. The average CSF glucose concentration in the 50 cases with non-infection was 3.72 mmol/L, the highest value was 8.12 mmol / L, and the lowest value was 2.11 mmol/L. Statistics showed that glucose concentration in non-infection group was significantly higher than that in infection group (P < 0.001). It was estimated to be related to the energy consumption in the period of pathogenic growth. The average chloride ion concentration of CSF in the infection group was 118.3 mg / L, the highest value was 167.7 mg/L, and the lowest value was 89.5 mg / L; the average chlorine ion concentration of the non-infection group was 123.2 mg / L, the highest value was 149.2 mg / L, and the lowest value was 104.3 mg / L. Statistics showed that the chloride ion concentration in the non-infection group was significantly higher than that in the infection group (P < 0.05), which indicated that the blood-CSF barrier function was reduced after intracranial infection, thereby leading to the loss of CSF chloride ions. The average value of total CSF protein concentration in the infection group was 2587.6 mg / L, the highest value was 10,590 mg / L, and the lowest value was 281 mg / L; while the average value of total protein concentration in the non-infection group was 691.7 mg / L, the highest value was 4118 mg /L, and the lowest value was 72 mg /L. Statistics showed that protein concentration of the infection group was significantly higher than that of non-infection group (P < 0. 001), indicating that blood-CSF barrier function was decreased and protein inflow was increased after intracranial infection. The average CSF leukocyte concentration in the infection group was 1628.3 × 10⁶/L, the highest value was 42,000 × 10⁶ / L, and the lowest value was 1 × 10⁶ / L. The average leukocyte concentration in the non-infection group was 22.1 × 10⁶ / L, the highest value was 182 × 10⁶ / L, and the lowest value was 1 × 10⁶ / L. Statistics showed that the leukocyte concentration in the non-infection group was significantly higher than that in the infection group (P < 0.001). The specimen color of the infection group was mainly yellow or light yellow, while that of the specimen from patient without infection was almost colorless (48/50). The color variance of the two groups were significantly different (P < 0.001). Turbidity often appeared in infectious specimen, this study showed that specimens were mainly slightly turbid and turbid in the infection group, while the specimens from patients without infection were mainly clear and transparent (49/50). The appearance of specimens between the two groups was significantly different (P < 0.001). In addition, the presence of clots was also related to infection. We found that the specimens of infection patients showed more clots than that of specimens of the non-infection patients. Sixty-three cases were showed clots in the infection group, while only one case was showed clots in the non-infection group. Statistics showed that there was a significant difference between the two groups (P < 0.001).

Establishment of discriminant model and verification of results

In order to screen the parameters, we separately analyzed seven variables by importing these data into SPSS software 17.0. The results showed that all these parameters were of great value (P < 0.05), as shown in Table 2. Fisher discriminant analysis was performed with inclusion of the 7 parameters, and a discriminant model “C” was obtained, C = 0.952–0.183 × glucose value (mmol/L) – 0.024 × chloride ion value (mmol/L) – 0. 000122 × protein value (mg/L) – 0.0000859 × number of leukocytes per microliter (× 10⁶/L) + 1.354 × color number code + 0.236 × turbidity number code + 0.691 × clot number code.

Table 2 Sensitivity and specificity of Fisher interpretation function

In order to verify the validity of the above model, 40 cases with positive culture and 10 cases with negative culture were included in the interpretation model, and the obtained values were compared with the centroid results to determine patients involving in infection group or non-infection group. The result showed that the diagnostic sensitivity and specificity of this model was 85.0 and 100%, respectively.

Meningitis | Clinic of new technologies

Meningitis – inflammation of the membranes of the spinal cord and brain, can be found in the practice of a doctor of any specialty, and a timely adequate start of treatment determines the outcome of the disease. The causative agents of meningitis can be bacteria, viruses, chlamydia, mycoplasma, protozoa and fungi.

Meningitis may be primary, i.e. develop without previous signs of a pathological process, or secondary, when the damage to the meninges is preceded by other manifestations of the infection.Meningitis caused by the same pathogen proceed as primary and secondary, so the latter is more correct to consider as a manifestation of the corresponding infection. Primary meningitis is an airborne infection, while enteroviral meningitis has a fecal-oral transmission mechanism. It is important for the doctor that meningitis is one of the clinical forms of infection caused by the corresponding microorganism; secondary meningitis can be caused by conditionally pathogenic flora, therefore, cases of meningitis in family foci are isolated, and group diseases occur only in collectives.

Susceptibility to meningitis depends on:

• specific antecedent immunity,
• genetic factors,
• premorbid background,
• duration of contact with the source of infection.

Those who have had many forms of meningitis develop strong immunity. Meningitis is more common in children and young people. Persons with a congenital sacrum defect – spina bifida can suffer from repeated meningitis.Ways of penetration of the pathogen: hematogenous, lymphogenous and by contact in the presence of purulent-inflammatory foci on the head (otitis media) and in the spine (osteomyelitis, epidural abscess).

Meningitis is accompanied by increased production of cerebrospinal fluid and increased intracranial pressure, increased permeability of the blood-brain barrier, toxic damage to the brain substance, impaired cerebral circulation, impaired cerebrospinal fluid dynamics, cerebral hypoxia and, as a consequence, cerebral edema.

In viral meningitis, the phenomena of cerebral edema are less pronounced, but the brain substance is also involved in the pathological process. Meningitis begins acutely (unlike tuberculous and fungal), is preceded by general infectious symptoms – fever, weakness, muscle pain, etc. , with meningococcal infection – a rash, with pneumococcal – rhinitis, pneumonia, otitis media; with paratitic infection – damage to the salivary glands, with enterovirus infection – dyspeptic disorders and catarrhal phenomena.

A bright early symptom of meningitis is a diffuse headache, rapidly growing, bursting. Soon, nausea and repeated vomiting begins. The headache is aggravated by a change in body position, from sound and visual stimuli. General hyperesthesia of the skin, patients lie on their side, bending their heads, sometimes tucking their legs to the stomach. Examination reveals muscle tension in the occiput, anisoreflexia, pyramidal signs; in later periods, paresis of the cranial nerves, paresis of the extremities, cerebellar disorders, and disturbances of consciousness are possible.Cerebrospinal fluid is examined to confirm the diagnosis of meningitis; determine the pressure of the cerebrospinal fluid during puncture; transparency, color, in the sediment determine the number and composition of cells, the presence of microflora. Biochemical and microbiological studies are carried out.

Meningococcal meningitis begins acutely with high fever, chills. In the first days, most patients develop a hemorrhagic rash, meningeal symptoms. Cerebrospinal fluid is cloudy, milky white or yellowish.Contains several thousand neutrophils in 1 ml, in the cytoplasm of which bean-shaped diplococci are visible. The amount of protein is significantly increased, glucose is reduced. With the help of immunological methods, the antigen of the pathogen can be detected in the cerebrospinal fluid. In the blood, inflammatory changes are pronounced. If the appropriate treatment is not carried out, the mortality rate for meningitis is 50%, with timely therapy – 5%, due to severe forms of meningococcemia, complicated by infectious-toxic shock.

Pneumococcal meningitis is preceded by otitis media, pneumonia, sinusitis. For the majority, it proceeds as primary. The onset is acute, the meningeal syndrome is detected later. Even with early hospitalization, the disease progresses rapidly; there is a disorder of consciousness, convulsions, paresis of the cranial nerves, hemiparesis. In the cerebrospinal fluid – pus, xanthochromia, extracellularly located lanceolate diplococci. Due to the rapid involvement of the brain substance in the process, the rapid consolidation of purulent exudate, the lethality reaches 15-25%.

Meningitis caused by Haemophilus influenzae occurs in children under 1 year of age, can begin acutely or gradually with fever and catarrhal phenomena. Meningeal symptoms appear on days 2-5 of illness. Difficulties are presented by patients who have received antibiotic treatment in insufficient doses for recovery. The temperature drops to 37, 5-38.5 * C, meningeal symptoms regress, the headache is less intense, but persistent, more often nausea, less often vomiting. After a few days, a sharp deterioration occurs.General cerebral and focal neurological symptoms appear. Mortality and the frequency of residual events increase sharply.

Viral meningitis begins with the corresponding infectious symptoms, and the clinic of meningitis develops later. There is a two-wave course of the disease. In contrast to purulent bacterial meningitis, in this case the fever is moderate, meningeal symptoms appear 2-3 or 5-7 days after the onset of the disease, patients feel poor, meningeal symptoms are moderately expressed, disturbance of consciousness is not typical.Lumbar puncture with evacuation of 4-8 ml of cerebrospinal fluid brings relief to the patient. Cerebrospinal fluid is transparent, more than 90% of leukocytes are lymphocytes. In 1-2 days, the puncture should be repeated to avoid a diagnostic error. The glucose content is increased or normal, the amount of protein can be used. lowered and raised, with a tank. sowing – the liquid is sterile (aseptic meningitis), during immunological examination, virus antigens can be detected in the cerebrospinal fluid.

Tuberculous meningitis in most patients is the first clinical manifestation of tuberculosis infection. Often it is atypical, therefore, in the presence of a large number of effective anti-tuberculosis drugs, the mortality rate is 15-25%. The disease begins with a fever, after a few days there is a headache and vomiting. Meningeal symptoms appear on days 3-10 of the disease, paresis of the cranial nerves is often found, by the end of 2 weeks, sometimes later, cerebral symptoms appear.In the absence of specific therapy, patients die by the end of the month. Cerebrospinal fluid with tubmeningitis is opalescent, flows out under high pressure, the number of leukocytes ranges from several tens to 3-4 hundreds in 1 μl. The protein content is increased, the amount of glucose is reduced from 2-3 weeks of illness. Mycobacterium tuberculosis in the cerebrospinal fluid is very rare. For diagnostics, it is necessary to detect the antigens of the pathogens of ELISA, to identify the pulmonary process (miliary tuberculosis).

Meningitis has to be differentiated with a variety of diseases occurring with meningism syndrome, which is not associated with the inflammatory process in the meninges. These are primarily infectious diseases that occur with neurotoxicosis. The severity of the condition is an indication for emergency hospitalization in an infectious diseases hospital, meningeal syndrome is an indication for a spinal tap. Patients with any form of meningitis should be treated prehospital. Before transportation, enter sedatives and analgesics, if there are no signs of dehydration, Lasix; if bacterial meningitis is suspected – penicillin 3-4 mln.units i / m, in the presence of seizures – anticonvulsants. Patients should be hospitalized by the intensive care service.

In the hospital, therapy is carried out in the following areas:

• etiotropic,
• treatment and prevention of the development of cerebral edema,
• detoxification,
• individual therapy.

After discharge from the hospital, the patient is under the supervision of a neurologist. Issues of restoration of the ability to work visiting children.collectives are decided individually. Outpatient treatment for about 1 month, convalescents need to avoid excessive physical and psycho-emotional stress, sun exposure, excess fluid intake, limit the amount of salt, exclude alcohol consumption.

90,000 Hydrocephalus – Red Flag for Parents – Into-Sana

Hydrocephalus (also called dropsy of the brain) is an increase in the amount of cerebrospinal fluid in the subarachnoid space of the spinal cord and brain and / or ventricles of the brain, leading to an increase in intracranial pressure.

If untreated, this problem can lead to a lag in the neuropsychic development of the child, which will further affect the deterioration of social and labor adaptation to adulthood. Therefore, every parent should be aware of the signs of hydrocephalus.

Causes of hydrocephalus

The brain and spinal cord are surrounded by cerebrospinal fluid, which supplies these parts of the nervous system with nutrients, protects against the effects of infection, prevents mechanical damage by shock absorption, and also removes metabolic products.

CSF circulates in the subarachnoid space (between the soft and arachnoid membranes of the brain) and in the ventricular system of the brain. The ventricular system consists of two paired lateral ventricles and two unpaired – Ⅲ and Ⅳ ventricles, in which there are vascular plexuses that directly produce cerebrospinal fluid. All ventricles are interconnected by holes for even distribution of cerebrospinal fluid and maintaining stable intracranial pressure. The outflow of cerebrospinal fluid from the lateral ventricles to the Ⅲ ventricle occurs through the Monroe interventricular foramen, from there the cerebrospinal fluid enters the Ⅳ ventricular cavity through the cerebral aqueduct, from which, in turn, the fluid moves into the subarachnoid space of the brain and spinal cord through Lyushka’s lateral foramen and the median foramen Magendie.During the day, there is a constant circulation of cerebrospinal fluid, it is absorbed by the membranes of the brain and is produced again by the vascular plexuses, ensuring the regular vital activity of nerve cells.

When the circulation of cerebrospinal fluid is disturbed, intracranial pressure increases, compression of the brain tissue increases, which leads to its gradual atrophy and the emergence of focal neurological symptoms.

In pediatric practice, hydrocephalus most often occurs due to:

• Intrauterine exposure to pathogenic microflora.

Microorganisms, tropic to the nervous tissue, can damage it at the earliest stages of the formation of the central nervous system of the embryo. Toxoplasmosis, herpes virus, rubella, cytomegalovirus infection, syphilis or mumps often lead to congenital anomalies of the brain and spinal cord in the fetus. One of the complications of intrauterine infection is hydrocephalus.

• Malformations.

Organic abnormalities in the structure of the brain, leading to increased secretion of cerebrospinal fluid, poor outflow or the impossibility of reabsorption, can also occur as a result of teratogenic effects of chemical (toxic substances, drugs) or physical (radiation therapy, ionizing radiation) factors on the body of a pregnant woman, when hereditary predisposition, folic acid deficiency in the first trimester of gestation. The fetus is most susceptible to pathological influences in the first three months of life, when the neural tube and other organs and systems are laid.

• Birth trauma.

Epidural, subdural, subarachnoid, intraventricular hemorrhages, traumatic lesions of brain tissue can lead to impaired outflow of cerebrospinal fluid. The risk group includes premature and large babies born against the background of rapid or protracted labor, complicated pregnancy (infection, hypoxia, preeclampsia)

• Inflammatory diseases of the brain and its membranes.

Encephalitis and meningitis lead to impaired absorption of cerebrospinal fluid. At the same time, its production continues, which aggravates the process.

• Other factors.

These include intracranial tumors and ruptures of abnormal cerebral vessels (aneurysms, arteriovenous connections, malformations). These reasons are more typical for adolescents and children of the older age group.

The main defects of the central nervous system, leading to hydrocephalus, include:

1. Hereditary narrowing of the Sylvian aqueduct (recessive transmission of a defective gene associated with the X chromosome).This is an important structure of the brain that communicates between the third and fourth ventricles of the cerebrospinal fluid system. With a narrowing of the water supply system, the child’s symptoms of hydrocephalus rapidly increase.
2. Chiari Syndrome. It occurs when the size of the brain and skull does not match. In this case, the cerebellum and the trunk squeeze the water supply, impairing the circulation of the cerebrospinal fluid.
3. Underdevelopment of the openings connecting the ventricles and subarachnoid space

Types of hydrocephalus

According to the mechanism of occurrence of hydrocephalus, there are two types:

• Open. Production of cerebrospinal fluid is normal, but its absorption is impaired. In such children, there is a gradual increase in signs of the disease.
• Closed (or occlusal). The outflow of cerebrospinal fluid is severely impaired, and fluid rapidly accumulates in the ventricular system or subarachnoid space.

According to the level of lesion, dropsy of the brain is of three types:

1. Internal. CSF accumulates inside the ventricles and expands them.
2. Outside. Fluid compresses the nerve tissue around the brain, collecting underneath the membranes.
3. Mixed. Has signs of both types.

There is also hydrocephalus replacement. This type of disease occurs as a result of compensation, when the volume of brain tissue decreases, and CSF takes its place. The destruction of nerve cells is possible due to various reasons (infection, rupture of blood vessels, cysts, etc.). The compensatory form is very dangerous, as it may not manifest itself for a long time.

Symptoms of hydrocephalus

The main sign of hydrocephalus is an enlargement of the skull. It manifests itself in children under two years of age, since their bones have not yet completely grown together, deforming under the influence of high intracranial pressure.

Many symptoms are visible to the naked eye. A sharp discrepancy between the facial and cerebral skull, bulging eyes, bulging fontanelles, divergence of cranial sutures, protruding and pulsating veins on the head should alert parents.

The children’s mood deteriorates, they become whiny, eat poorly, often spit up, and cannot sleep at night.

A child with hydrocephalus has impaired normal development. He does not show curiosity, reacts poorly to toys, begins to walk late and pronounce sounds, over time, vision deteriorates, up to blindness.

At an older age, when the bones of the skull grow together, symptoms of increased intracranial pressure appear, since cerebrospinal fluid, due to blockage of the cerebrospinal fluid, accumulates in large quantities inside and does not find a way out. Therefore, headache, seizures and vomiting come to the fore. These symptoms result from compression of the brain structures.

Diagnostics of hydrocephalus

For a full diagnosis, it is necessary to carefully study all the complaints of the child, and also to find out if the mother had any complications during pregnancy. Already at the first examination of the newborn, signs of hydrocephalus are revealed. To clarify the diagnosis, laboratory and instrumental research methods are used.

Measuring head circumference. An easy and quick way to diagnose hydrocephalus by comparing the result with the normal size.

Ultrasound. Ultrasound diagnostic technique was initially used as a routine screening study to identify anomalies in the development of an unborn child during pregnancy. With the help of ultrasound in the fetus, it is possible to determine the size of the head, see the areas of ischemia, malformations of the central nervous system, and confirm the presence of dropsy of the brain.

Neurosonography. This is an ultrasound scan of the internal structures of the skull in children of the first year of life, which is possible due to the presence of non-ossified areas of connective tissue – fontanelles – in small patients on the cranial vault. Since the bones do not transmit high-frequency waves well, the examination takes place through the anterior fontanelle. The method reliably determines the excessive enlargement of the ventricles and the accumulation of cerebrospinal fluid in the subarachnoid space, gross congenital malformations, inflammatory processes, oncological and vascular diseases.The information content of neurosonography is generally inferior to CT or MRI, but the study is much simpler, absolutely safe, and in fact has no contraindications.

With the help of radiography, the bones of the skull are visualized, their thickness and the presence of changes in the inner surface of the type of “digital impressions” are determined. These signs, combined with thinning of the bones and the divergence of the sutures between them, speak in favor of hydrocephalus.

Radiation diagnostic methods – CT and MRI – allow the doctor to obtain the greatest amount of information not only about the presence of dropsy of the brain, but also about its cause.Vascular malformations, congenital anomalies, tumors or hematomas are easily visualized, so that the tactics of treatment can be quickly determined.

Treatment of hydrocephalus

In most cases, hydrocephalus requires surgical treatment. Conservative therapy is used to reduce the symptoms of compensated dropsy of the brain only with a minimal increase in the amount of cerebrospinal fluid and a moderate course of the disease. For this purpose, diuretics or glucocorticosteroids are prescribed.

Closed hydrocephalus requires urgent surgical intervention, since the cerebrospinal fluid rapidly accumulates and there is a risk of displacement of the brain stem and its pressing into the foramen magnum. At the same time, vital departments responsible for breathing and blood circulation are damaged. There comes a cessation of respiratory and cardiac activity.

An emergency operation is performed to decompress the cranial cavity. The simplest method is resection trepanation.A child of the first year of life can undergo puncture of the lateral ventricles of the brain through the fontanelles, which contributes to a rapid decrease in intracranial hypertension. With closed hydrocephalus, drainage is used, which is much more effective than ventriculopuncture, especially in children with developmental abnormalities. A silicone catheter is inserted into the ventricle of the brain, which communicates with the other end with a sterile container. In some cases, it is necessary to carry out bilateral drainage. In neurosurgical practice, unloading lumbar punctures are also used.The above methods have a temporary effect and are preparatory steps for a more complex operation.

Surgery for occlusive hydrocephalus is aimed at removing the obstruction to the outflow of cerebral fluid. After the barrier is removed, circulation resumes and the child is recovering. But sometimes this procedure cannot be done fully, so the surgeon is looking for workarounds to dump excess cerebrospinal fluid by shunting.

Open brain dropsy was incurable for a long time.With the introduction of new materials, neurosurgery has successfully solved this problem. The cavity of the cerebral ventricles is connected with other organs through drainage valve systems, where the cerebrospinal fluid is absorbed and does not accumulate. Basically, two types of shunting are used – ventriculoperitoneostomy and ventriculoatriostomy. In the first case, the catheter is inserted into the abdominal cavity. This is the most effective and common way. But if there are obstacles to its implementation, then the second is used, during which the shunt is connected to the atrium.

Consequences of hydrocephalus

Complications of hydrocephalus are very serious, so it is not worth delaying treatment. The neuropsychic development of a child, his intellect, motor skills, vision and even life depend on a correct diagnosis. In many cases, hydrocephalus is the result of a more serious problem, such as a brain tumor.

To prevent the negative consequences of the disease, parents are advised to regularly examine their child by a pediatrician and neurologist.Routine examinations will help identify pathology at an early stage. The Into-Sana clinic employs the best specialists who take care of the health of each patient. Here you will be provided with qualified assistance of the European level.

Prof. Dr. Erkan Kaptanoğlu

Hydrocephalus in adults

Hisdocephalus is an enlargement and expansion of chambers or ventricles in brain tissue as a result of an increase in this fluid. In normal healthy people, cerebrospinal fluid is produced by specialized cells in these chambers and is reabsorbed as it travels through the chambers of the brain, the lining of the brain, and the spinal cord. The accumulation of fluid in the ventricles of the brain may increase and hydrocephalus may develop as a result of increased production of this fluid, decreased absorption, or blockage of the pathways from which it is produced to the area where it is absorbed.

Hydrocephalus can be seen at any age. Hydrocephalus in adults has slightly different characteristics than in children. Hydrocephalus that occurs in adulthood can usually develop after a tumor or cerebral hemorrhage and injury.Another special type of hydrocephalus is normal pressure hydrocephalus, also seen in adults (also known as Hakeem-Adams syndrome).

After Tumor Hydrocephalus

This is especially noticeable in tumors that shrink or settle in the spaces of the cerebrospinal fluid and block the path of fluid flow. In these cases, removal of the tumor is an effective treatment for hydrocephalus because it opens up fluid flow pathways. However, the contents of some specific tumors, such as vestibular schwannomas and epidermoid tumors, can cause hydrocephalus. In these cases, even if the tumor is surgically removed, the hydrocephalus may not heal. In this case, separate treatment for hydrocephalus may be required.

Post-Bloody Hydrocephalus

After cerebrospinal fluid is released from the ventricles of the brain, it travels through the brain and spinal cord and is absorbed from small channels. Cerebrospinal fluid is located between the brain and the arachnoid membrane, one of the membranes covering the brain.Regardless of where the cerebrospinal fluid is bleeding from in the brain, it almost always mixes with the chambers in which this fluid is located and with all the fluid in the channels through which this fluid circulates. After these haemorrhages, called subaraknoid haemorrhages (SAH), hydrocephalus develops due to blockage of the flow of blood fluid and blood products, or blockage of fluid absorption by blocking small ducts that allow fluid absorption.If this bleeding is caused by a vascular bladder (aneurysm) (anevrizma), the rate of development of hydrocephalus is higher. Rarely, in middle-aged and elderly patients, hemorrhage into the brain tissue (parenchyma) (parenkimal) due to tension can also cause hydrocephalus, opening into the subarachnoid space or ventricles.

Symptoms of hydrocephalus in adult patients

Although this type of hydrocephalus usually occurs in older patients, it can sometimes occur in middle-aged and young patients.The characteristic symptoms of this disease are gait disturbance (walking in short steps, imbalance), forgetfulness (especially recent) and urinary incontinence. The symptoms of this condition can often be confused with dementia. It is recommended to perform lumbar puncture (removal of fluid from the waist) to clarify the diagnosis in patients with hydrocephalus at normal pressure on MRI images of the brain of patients presenting with such complaints. In patients whose complaints regress after a lumbar puncture, the diagnosis becomes clear and bypass surgery may be recommended.

Erişkin hastallarda hidrosefali belirtileri

Middle-aged adults may have imbalances, urinary incontinence, symptoms of dementia, as well as headache, difficulty waking or staying awake, personality disorder, and visual impairment. Elderly patients may experience instability when walking, difficulty remembering, urinary incontinence, and in addition, impaired contact formation and headache.

Diagnostics

1. Magnetic resonance imaging (MRI) is the gold standard.With the help of these studies, you can study the brain tissue in detail. In addition, it is possible to assess the movement of cerebrospinal fluid in the brain tissue between cells, as well as the flow and movement of this fluid in and around the brain in the ventricles and canals. In addition, pathologies such as a tumor causing hydrocephalus can be detected.
2. Magnetic resonance imaging (MRI) techniques showing cerebrospinal fluid flow: These tests are especially used in situations where the flow of cerebrospinal fluid is blocked.Although large tumors and other large abnormalities that obstruct fluid flow can be diagnosed with normal MRI, small tumors and sometimes congenital and acquired structures and obstructions in the drainage pathways cannot be seen on normal MRI. In these cases, you can also use MRI showing the outflow of cerebrospinal fluid.
3. Computed tomography (CT) is also often used for hydrocephalus, although it is an examination that better reveals bone tissue.It also indicates bleeding, especially in patients with new bleeding.

Treatment

1. Shunt placement: The purpose of shunt placement is to move excess fluid accumulated in the brain cavities to different parts of the body. In this procedure, a catheter is placed in the ventricles of the head, this catheter is connected to the pump, a second, longer catheter is attached to the other end of the pump, this catheter is transferred under the skin into the abdominal cavity and its tip is placed into the abdominal cavity.Thus, excess cerebral fluid is transferred to the abdominal cavity. The excess fluid is directed to the abdominal cavity and absorbed from the abdominal cavity. A pump that connects catheters leading to the brain and abdomen just above the skull allows cerebrospinal fluid to flow in a controlled manner above a certain pressure. Thus, the fluid accumulated in the brain is transferred to another part of the body. Typically, the abdominal cavity is used to drain this fluid. The other end of the catheter leading to the abdominal side can also be attached to different parts of the body.In some cases, this fluid can also be drained into the heart through a vein in the chest cavity or neck to the heart. The used mixing pumps can have a fixed pressure setting and can be changed externally after setting the regulation. The selection is made depending on the clinical condition of the patients. Patients with shunts are closely monitored. The shunt may be defective or infected. Although infection usually develops in the first 6 weeks after surgery, it can be seen later.Antibiotic shunts can be used for patients with recurrent shunt infections.
2. Endoscopic third ventriculostomy (vertikulostomy): This treatment option can be used when the fluid pathways are blocked for mechanical reasons. This treatment is not suitable for all patients with hydrocephalus. In this treatment, to allow fluid to flow in the ventricles (fluid-filled brain cavities), an endoscope is inserted into these spaces, a new opening is opened, and the accumulated fluid is allowed to flow.

The neurologist spoke about the little-studied complications after coronavirus

With coronavirus infection, people with neurological and vascular diseases are at risk. Neonila Fomina-Chertousova, a neurologist of the highest category, candidate of medical sciences, told Rossiyskaya Gazeta why this is happening, how to protect oneself from complications.

Delayed exacerbation

Neonila Anatolyevna, how quickly do complications begin after coronavirus infection in those who have problems with nerves and blood vessels?

Neonila Fomina-Chertousova : Neurological complications in coronavirus are still poorly understood.They can appear during the acute period of infection. And there may be delayed, that is, do not occur immediately, but some time after healing from the infection.

So, for example, it was during the First World War. Then humanity was faced with a new disease, which proceeded like a severe flu, but at the same time people fell into hibernation. She was called lethargic encephalitis. And then, after a few years, those who had such flu developed Parkinson’s syndrome, that is, degenerative changes in the brain occurred.Today, no one knows whether the transferred coronavirus will also become an impetus for the development of serious brain diseases in the future. Let’s hope for the best.

I want to sleep all the time

It is already known that with a coronavirus infection, problems with the central nervous system can arise .

Neonila Fomina-Chertousova : Yes, this is a deterioration in sleep, muscle damage. Even such a concept has appeared: covid-associated strokes. Since when infected with coronavirus, the chance of getting a stroke is greater – by about six percent.Moreover, it can happen either one to three weeks after infection with covid, or become the first symptom of an infectious disease. Therefore, patients with acute stroke must undergo spiral computed tomography.

Is it true that coronavirus accelerates dementia?

Neonila Fomina-Chertousova : With encelopapathy (chronic cerebral vascular insufficiency) and coronavirus infection, a person can indeed develop rapidly dementia.And without the presence of a virus in the body, it generally develops slowly. Postcoid chronic vascular disorders can also be accompanied by agitation, convulsions with loss of consciousness, or, conversely, drowsiness and apathy. The reason is that the brain in this case does not receive the required amount of oxygen due to pulmonary insufficiency. Inflammatory diseases of the spinal cord due to COVID-19 have also been described.

Not only 60+ at risk

Probably all these problems concern older people more?

Neonila Fomina-Chertousova : This is not so.With covid and Alzheimer’s or Parkinson’s, which, as a rule, affect the elderly, the underlying ailment is, indeed, exacerbated. But since the peripheral nervous system often suffers with the virus, young patients are also at risk. After all, the infection can proceed without pneumonia, and the young man does not understand that he is sick. And then his hands and feet may become numb. Such cases are known. It happens that non-aged patients come to the clinic with complaints of burning pain in the distal extremities due to covid.

Who else is at risk, with what diseases?

Neonila Fomina-Chertousova : There are many chronic neurological patients who receive therapy that suppresses the immune system – for cancer, rheumatological diagnoses, or, for example, patients with multiple sclerosis. It is believed that they are at risk during a pandemic. Because when treating the underlying disease, their immunity is artificially suppressed. Although the cases are different.

Yes, COVID-19 conceals many mysteries …

Neonila Fomina-Chertousova : By the way, about the riddles. There is a version that the coronavirus enters the cranial cavity through the sinuses. But at the same time, no one was able to determine it in the cerebrospinal fluid. This is a mystery to scientists. After all, it is able to affect brain cells, probably due to general systemic inflammation.

Discipline first of all

Neonila Anatolyevna, what would you advise people with neurological and vascular diseases? How to behave if the coronavirus does overtake them?

Neonila Fomina-Chertousova : First of all, I want to address people with neurological diseases.In a pandemic, they must disciplinedly follow, even if they get sick with coronavirus, all the recommendations for the underlying disease.

In general, with any chronic ailment, it is now especially important to monitor your condition and follow previously prescribed medical recommendations. For example, a person with diabetes should be doubly careful about their diet and taking medications on time.

If a healthy person needs to perform all anti-epidemiological measures, then a chronic patient should do this with even greater care.

All materials of the story “COVID-19. We can handle it!” read here .

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An American had cerebrospinal fluid flowing from his nose for five years

The American allegedly suffered from a runny nose for five years, but in reality the fluid surrounding the brain was flowing from his nose. Gazeta.Ru tells how to distinguish a “leak” from a cold and recover from this condition.

An American thought for five years that he was suffering from an allergic rhinitis, but in fact, the fluid surrounding the brain was leaking from his nose. His story, which could have ended in disability or death, is told on channel ABC11 .

When Greg Philpotts from North Carolina was faced with the fact that his nose was flowing almost all the time, he bypassed many doctors. The man received several different diagnoses, including pneumonia and chronic bronchitis, but more often the doctors tended towards allergic rhinitis.

A persistently “leaking” nose brought a lot of complications to Philpotts’ life.

He was finally finished off by the last Thanksgiving Day – when the man was preparing a festive dinner, liquid again flowed from his nose, filling the dish.

“I was preparing food, standing in the kitchen, and it was just added to the ingredients. It ruined the whole lunch, he says. – You can be anywhere. You can be on the plane, you can talk to someone – and it just flows down your face. ”

Nothing helped from a strange rhinitis. Philpotts had to stuff his nostrils with napkins in order not to flood everything around with the liquid flowing from the nose.

It is not known how long the man would have fought with what he considered a runny nose, and how much his health would have suffered, but he got an appointment with Dr. Alfred Iloret.

He, having examined the man, found the cause of his suffering – the rupture of the meninges. The fluid in which the brain is located flowed through the opening and flowed out of the nose.

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Philpotts was lucky – during the time that he lived with erroneous diagnoses, his brain was not damaged.

“This fluid protects the brain from shock, injury and so on,” Iloretta explains. – Sometimes, when there is such damage, an ascending infection can develop. Bacteria can travel from the nose to the brain, leading to meningitis. ”

These “leaks” usually occur when cracks in the bones or ruptured membranes. Fluid flows out through the nose or ear. This can cause headaches, vision changes, and hearing loss.

According to doctors, from rupture of membranes, excluding those caused by trauma, five people suffer for every 100 thousand.

In most cases, the tears heal on their own – the patient is only required to stay in bed. But in Philpotts’ case, surgery was needed.

Using an endoscope, the surgeons reached the rupture and closed it with the patient’s own tissues.

Dr. Iloreta notes that if only one nostril flows with a runny nose, and there is a headache or a salty taste in the mouth, it is worth paying attention to these symptoms – perhaps they are not indicative of a runny nose.

There are other ways to tell the difference between damage to the meninges and the common cold.

So, if the flow of fluid has arisen after an injury, continues for a long time, intensifies when the head is tilted, does not depend on the time of year and the environment, and the volume of fluid is noticeably greater than with a common cold or allergy – this is a cause for concern and a thorough examination.

For an accurate diagnosis, most likely, you will have to do CT and MRI, as well as pass for analysis the very fluid flowing from the nose. With conservative treatment, it is necessary to take measures to reduce intracranial pressure – bed rest, taking diuretics, in some cases – installing drainage. During surgery, surgeons close the hole in the lining of the brain. Most often, doctors recommend first letting the body cope with the “leak” on its own, it takes one to two weeks. If this does not help, then an operation is prescribed.

In May 2018, doctors treated women with a similar problem. In 2013, Kendra Jackson was involved in a car accident in which she hit her face on the dashboard.Subsequently, she developed a chronic runny nose, severe headaches and sleep problems.

For a long time, doctors attributed a runny nose to an allergy, and only one of the otolaryngologists found out that it was not mucus that was flowing from Kendra’s nose, but cerebrospinal fluid.

A woman lost up to 240 ml of cerebrospinal fluid per day – almost half of the volume produced by the spinal cord. Neurosurgeons have found the source of the “leak” – a tiny hole between the patient’s skull and nostrils. They got rid of it with the help of Jackson’s own adipose tissue.Doctors expect the woman to recover completely.

90,000 Intracranial hypertension (pressure) in children.

Intracranial hypertension ( ICH ) in children is a common condition. The increase in the incidence of one of the forms of intracranial hypertension – inflammatory, is due to the fact that the modern population, including childbearing age, has a reduced immune status, which leads to an active course of chronic infections, including those that can cause inflammation of the vascular plexus, increased permeability vascular walls and an increase in the formation of cerebrospinal fluid.

There are 4 variants of intracranial hypertension:

• 1. Posttraumatic – a consequence of birth and other craniocerebral injuries, the pressure in the ventricles of the brain rises due to a violation of the outflow through the holes in the region of the 4th ventricle of the brain;
• 2. Congenital – a consequence of the narrowing of the outflow tract of cerebrospinal fluid in the region of the 4th ventricle of the brain, caused by a developmental abnormality;
• 3. Tumor – compression by the tumor of the outflow tract in the region of the 4th ventricle or at the level of the Sylvian aqueduct connecting the 3rd and 4th ventricles;
• 4. Inflammatory – can be caused both by excessive formation of fluid in the choroid plexuses in the lateral ventricles of the brain, and by impaired outflow at one level or another due to the adhesion process.

Diagnostics.

The proposed diagnostic and treatment program is aimed at the inflammatory form of ICH.
1. The most ICG – clinical
– neurosonography;
– computed tomography.

2. Causes ICH – persistence of herpes viruses (PCR, ELISA)
– study of the immune status (immunogram)

Infection of a child can occur:
1 Intrauterine
2 Airborne droplets (if one or both parent are active emitters of viruses).

With intrauterine infection, the signs of ICG appear from the first months of life.
The cause of the inflammatory HCG is a vasotropic virus from the herpes family (herpes simplex virus type II).The background for the active course of infection is created by viruses that cause or enhance immunodeficiency (human immunodeficiency virus – HIV, cytomegalovirus – CMV, Epstein – Barr virus – EBV).

Treatment

The currently accepted treatment program does not provide success, since it does not include medications that can significantly affect inflammation of the vascular plexus.

1. 1 Diacarb is a weak diuretic.
2. 2 Ascorutin is a drug that reduces the permeability of small vessels.
3. 3 Vitamins of group B.
4. 4 Drugs affecting metabolism in the nervous tissue – cortexin, actovegin, riboxin, etc.

None of these areas has significant antiviral activity.
Over the past 10 years, we have repeatedly observed children who received this treatment program for a long time without effect.
An alternative treatment option is primarily aimed at suppressing the activity of HSV-II or a packet of viral infections leading to an inflammatory process in the vascular plexuses.

• 1. Antiviral agents

  – acyclovir at an age dose
  – short – 10 days.
  – average – 20 days (100% dose – 10 days, 66% dose – 10 days).
  – long – 30 days (100% dose – 10 days, 66% dose – 10 days, 33% dose – 10 days).
  The daily dose is divided into 3 – 5 doses.

• 2. Immunostimulants
  – polyoxidonium in an age dose, by mouth or intramuscularly – 10 days, in some cases it is possible without examining the immune status
  – stimulants of the T – cell link (thymalin, T – activin, thymogen, immunofan, 10 – 14 days.Before their appointment, it is imperative to conduct an immunogram.
• 3 Interferon inducers
  – dibazol, 1%, in drops, in an age dose,
  3 r / d – 10 days,
  2 r / d – 10 days,
  1 r / d – long-term (to maintain the effect ).