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Journal of Nuclear Medicine : Official... Jan 1976A source of error in cerebrospinal fluid (CSF) infusion tests is leakage at the dural puncture site. The addition of a bolus of radionuclide to the infusion fluid was...
A source of error in cerebrospinal fluid (CSF) infusion tests is leakage at the dural puncture site. The addition of a bolus of radionuclide to the infusion fluid was helpful in detecting the existence of leakage as shown by increased infusion pressure in six of eight patients studied with and without scintigraphic evidence of leakage. Comparison of CSF dynamics in 26 patients studied by infusion cisternography and conventional cisternography showed similar patterns, suggesting no alteration of CSF dynamics by the artificial CSF infusion. Combining the two tests, therefore, resulted in simple identification of the leakage and saved the patient time and discomfort.
Topics: Cisterna Magna; Humans; Hydrocephalus; Pentetic Acid; Radionuclide Imaging; Ytterbium
PubMed: 1244453
DOI: No ID Found -
The Indian Journal of Medical Research Nov 2020
Topics: Arachnoiditis; Humans; Tuberculosis, Meningeal
PubMed: 35345103
DOI: 10.4103/ijmr.IJMR_1497_19 -
Journal of Infection in Developing... Dec 2023Corticosteroids are used as adjunctive treatment in tuberculous meningitis (TBM). However, there is no universally accepted regimen, type, duration, or route of steroid... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Corticosteroids are used as adjunctive treatment in tuberculous meningitis (TBM). However, there is no universally accepted regimen, type, duration, or route of steroid administration.
METHODOLOGY
In a randomized open labelled pilot study, TBM patients were divided into overlap oral dexamethasone (OOD) and direct oral dexamethasone (DOD) arms. The total duration of steroid administration was 8 weeks. The primary outcome was symptomatic resolution at 1 month post randomization. The secondary outcomes were mortality and modified Rankin scale (mRS) at 3 and 6 months after initiation of steroids.
RESULTS
Symptomatic resolution after one month of randomization in 53 randomized patients was similar in OOD (71.4% (15/21)) versus DOD ((85.0% (17/20)) arm (p value:0.45). Median mRS was also similar in OOD versus DOD (OOD: 2.5 (IQR: 1.0; 6.0) versus DOD: 1.0 (IQR: (0.0; 4.0); p value: 0.31)) arm at 6 months. The mortality at 6 months was 31.8% (7/22) in the OOD versus 20.0% (4/20) in the DOD arm (p value: 0.49).
CONCLUSIONS
In this open label pilot study, the outcomes were similar in OOD versus DOD arms in terms of symptomatic resolution at 1 month, and morbidity, and mortality at 3 and 6 months. Patients with stage I to III TBM may be given injectable steroids for 1 week after which they may be switched to oral steroid. This regime cannot be applied to stage IV TBM and patients with complications like optico-chiasmatic or spinal arachnoiditis or vasculitic infarcts.
Topics: Humans; Pilot Projects; Tuberculosis, Meningeal; Arachnoiditis; Steroids
PubMed: 38252729
DOI: 10.3855/jidc.17563 -
Acta Neurochirurgica Sep 2020The membrane of Liliequist is one of the best-known inner arachnoid membranes and an essential intraoperative landmark when approaching the interpeduncular cistern but... (Review)
Review
BACKGROUND
The membrane of Liliequist is one of the best-known inner arachnoid membranes and an essential intraoperative landmark when approaching the interpeduncular cistern but also an obstacle in the growth of lesions in the sellar and parasellar regions. The limits and exact anatomical description of this membrane are still unclear, as it blends into surrounding structures and joins other arachnoid membranes.
METHODS
We performed a systematic narrative review by searching for articles describing the anatomy and the relationship of the membrane of Liliequist with surrounding structures in MEDLINE, Embase and Google Scholar. Included articles were cross-checked for missing references. Both preclinical and clinical studies were included, if they detailed the clinical relevance of the membrane of Liliequist.
RESULTS
Despite a common definition of the localisation of the membrane of Liliequist, important differences exist with respect to its anatomical borders. The membrane appears to be continuous with the pontomesencephalic and pontomedullary membranes, leading to an arachnoid membrane complex around the brainstem. Furthermore, Liliequist's membrane most likely continues along the oculomotor nerve sheath in the cavernous sinus, blending into and giving rise to the carotid-oculomotor membrane.
CONCLUSION
Further standardized anatomical studies are needed to clarify the relation of the membrane of Liliequist with surrounding structures but also the anatomy of the arachnoid membranes in general. Our study supports this endeavour by identifying the knowledge hiatuses and reviewing the current knowledge base.
Topics: Arachnoid; Brain; Humans; Neurosurgical Procedures
PubMed: 32193727
DOI: 10.1007/s00701-020-04290-0 -
British Journal of Anaesthesia Aug 2004
Topics: Anesthesia, Epidural; Anesthesia, Obstetrical; Arachnoiditis; Chronic Disease; Female; Humans; Pregnancy; Tissue Adhesions
PubMed: 15251994
DOI: 10.1093/bja/aeh591 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2013Thecaloscopy is less invasive exploration of spinal subarachnoid space with ultra-thin flexible endoscope and endoscopic fenestration of scars and adhesions.... (Review)
Review
Thecaloscopy is less invasive exploration of spinal subarachnoid space with ultra-thin flexible endoscope and endoscopic fenestration of scars and adhesions. Thecalopscopy was used in Russian neurosurgery at the first time. Since 2009 we operated 32 patients with following diagnosis: 17--spinal adhesive arachnoiditis (8--local forms, 9--diffuse forms), 12--spinal arachnoid cysts (7--posstraumatic cysts, 5--idiopathic cysts), 3--extramedullary tumors (thecaloscopic videoassistance and biopsy). In all cases we realized exploration of subarachnoid space and pathologic lesion with endoscopic perforation of cyst or dissection of adhesions using special instrumentation. Mean follow-up in our group was 11.4 months. Neurological improvement (mean 1.4 by modified Frankel scale, 1.8 by Ashworth spasticity scale) was seen in 87% of patients operated for spinal arachnopathies. Temporary neurological deterioration (mild disturbances of deep sensitivity) was seen in 9% of patients and managed successfully with conservative treatment. 1 (3.1%) patient was operated 3 times because of relapse of adhesions. There were no serious intraoperative complications (e.g., serious bleeding, dura perforation etc). Postoperative complications included 1 CSF leakage and 1 postoperative neuralgic pain. Mean term of hospitalization was 7.6 days. According to our data, we suppose that thecaloscopy is efficient and safe method, and should be widely used for spinal arachnopaties, adhesive arachnoiditis and arachnoid cysts. Taking into account that adhesive spinal arachnoiditis is systemic process and spinal arachnoid cysts can be extended as well, thecaloscopy may be regarded as the most radical and less-invasive way of surgical treatment existing currently in neurosurgery.
Topics: Adult; Arachnoid Cysts; Arachnoiditis; Brain Neoplasms; Female; Humans; Male; Neuroendoscopy
PubMed: 24564085
DOI: No ID Found -
Neurologia Medico-chirurgica 2012A 66-year-old woman with primary Sjogren syndrome developed syringomyelia following two episodes of subarachnoid hemorrhage (SAH) due to the rupture of basilar artery... (Review)
Review
A 66-year-old woman with primary Sjogren syndrome developed syringomyelia following two episodes of subarachnoid hemorrhage (SAH) due to the rupture of basilar artery aneurysms. Gait disturbance and abnormal sensation with pain over the foot and abdomen appeared 3 years after the last SAH. Magnetic resonance (MR) imaging revealed a syringomyelia throughout the thoracic cord, from the T2 to T11 levels. In addition, the thoracic cord was compressed by multiple arachnoid cysts in the ventral side of spinal cord. Computed tomography myelography revealed complete block of cerebrospinal fluid (CSF) flow at the T7 level. Surgery for microlysis of the adhesions and restoration of the CSF flow pathway was performed. Postoperatively, leg motor function slowly improved and she could walk unaided. However, abdominal paresthesia was persisted. Postoperative MR imaging revealed diminished size of the syrinxes. We should recognize syringomyelia and arachnoid cysts due to adhesive arachnoiditis as a late complication of SAH. Microlysis of the adhesions focusing on the lesion thought to be the cause of the symptoms is one of the choices to treat massive syringomyelia and arachnoid cysts associated with arachnoiditis following SAH.
Topics: Aged; Aneurysm, Ruptured; Arachnoid Cysts; Arachnoiditis; Craniotomy; Decompression, Surgical; Embolization, Therapeutic; Female; Gait Disorders, Neurologic; Humans; Intracranial Aneurysm; Laminectomy; Ligation; Paresthesia; Recurrence; Rupture, Spontaneous; Sjogren's Syndrome; Spinal Cord Compression; Subarachnoid Hemorrhage; Syringomyelia; Thoracic Vertebrae; Urinary Incontinence
PubMed: 23006888
DOI: 10.2176/nmc.52.686 -
Fluids and Barriers of the CNS Apr 2020Infusion testing is a common procedure to determine whether shunting will be beneficial in patients with normal pressure hydrocephalus. The method has a well-developed...
BACKGROUND
Infusion testing is a common procedure to determine whether shunting will be beneficial in patients with normal pressure hydrocephalus. The method has a well-developed theoretical foundation and corresponding mathematical models that describe the CSF circulation from the choroid plexus to the arachnoid granulations. Here, we investigate to what extent the proposed glymphatic or paravascular pathway (or similar pathways) modifies the results of the traditional mathematical models.
METHODS
We used a compartment model to estimate pressure in the subarachnoid space and the paravascular spaces. For the arachnoid granulations, the cribriform plate and the glymphatic circulation, resistances were calculated and used to estimate pressure and flow before and during an infusion test. Finally, different variations to the model were tested to evaluate the sensitivity of selected parameters.
RESULTS
At baseline intracranial pressure (ICP), we found a very small paravascular flow directed into the subarachnoid space, while 60% of the fluid left through the arachnoid granulations and 40% left through the cribriform plate. However, during the infusion, 80% of the fluid left through the arachnoid granulations, 20% through the cribriform plate and flow in the PVS was stagnant. Resistance through the glymphatic system was computed to be 2.73 mmHg/(mL/min), considerably lower than other fluid pathways, giving non-realistic ICP during infusion if combined with a lymphatic drainage route.
CONCLUSIONS
The relative distribution of CSF flow to different clearance pathways depends on ICP, with the arachnoid granulations as the main contributor to outflow. As such, ICP increase is an important factor that should be addressed when determining the pathways of injected substances in the subarachnoid space. Our results suggest that the glymphatic resistance is too high to allow for pressure driven flow by arterial pulsations and at the same time too small to allow for a direct drainage route from PVS to cervical lymphatics.
Topics: Cerebrospinal Fluid; Glymphatic System; Humans; Hydrodynamics; Intracranial Hypertension; Intracranial Pressure; Models, Biological; Subarachnoid Space
PubMed: 32299464
DOI: 10.1186/s12987-020-00189-1 -
The Neuroradiology Journal Apr 2014External hydrocephalus (EH) is a benign clinical entity in which macrocephaly is associated with an increase in volume of the subarachnoid space, especially overlying... (Review)
Review
External hydrocephalus (EH) is a benign clinical entity in which macrocephaly is associated with an increase in volume of the subarachnoid space, especially overlying both frontal lobes, and a normal or only slight increase in volume of the lateral ventricles. Several pathogenic hypotheses have been proposed but the most accredited theory seems to be delayed maturation of the arachnoid villi. There is a consensus that this is a benign entity, correlated to a familial predisposition and, in some cases, inheritance. CT and MRI are very important to make a diagnosis but also to establish the prognosis in patients who encounter the rare complications such as subdural haematomas. In conclusion, CT and MRI can provide a highly accurate diagnosis in these patients, allowing a preliminary assessment of the prognosis, particularly regarding the enlarged subarachnoid space limits and the "cortical vein" sign which can predict a further complication. These results are obtained with the same examination performed in a standard CT or MRI study of the brain and no injection of contrast medium is needed.
Topics: Brain; Female; Humans; Hydrocephalus; Infant; Magnetic Resonance Imaging; Male; Megalencephaly; Retrospective Studies; Subarachnoid Space; Tomography, X-Ray Computed
PubMed: 24750715
DOI: 10.15274/NRJ-2014-10020 -
Acta Medica Portuguesa 2003Arachnoiditis ossificans is a uncommon disorder, is generally associated with neurologic deficits, but patients could be only mild sintomatic, regardless of the degree...
Arachnoiditis ossificans is a uncommon disorder, is generally associated with neurologic deficits, but patients could be only mild sintomatic, regardless of the degree of ossification. Unenhanced CT has been well show to be sensitive for the disorder, useful to evaluate the full extenstion of the ossified mass and their remotion if surgical intervention is needed. On MRI imaging the manifestations could be minimal and variable, being important to access another pathologic conditions (arachnoid cysts, intramedullary cysts and syringomyelia).
Topics: Aged; Arachnoiditis; Humans; Male
PubMed: 12868398
DOI: No ID Found