• Clinical and Experimental Pediatrics
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• v.53 no.4
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• pp.607-611
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• 2010

Bickerstaff's brainstem encephalitis (BBE) is a rare disease diagnosed by specific clinical features such as 'progressive, relatively symmetric external ophthalmoplegia and ataxia by 4 weeks' and 'disturbance of consciousness or hyperreflexia' after the exclusion of other diseases involving the brain stem. Anti-ganglioside antibodies (GM, GD and GQ) in the serum or cerebrospinal fluid (CSF) are sometimes informative for the diagnosis of BBE because of the rarity of positive findings in other diagnositic methods: brain magnetic resonance imaging (MRI), routine CSF examination, motor nerve conduction study, and needle electromyography. We report a rare case of childhood BBE with elevated anti-GM1 antibodies in the serum, who had specific clinical symptoms such as a cranial polyneuropathy presenting as ophthalmoplegia, dysarthria, dysphagia, and facial weakness; progressive motor weakness; altered mental status; and ataxia. However, the brain MRI, routine CSF examination, nerve conduction studies, electromyography, somatosensory evoked potentials, and brainstem auditory evoked potentials were normal. BBE was suspected and the patient was successfully treated with intravenous immunoglobulins.

• Journal of Veterinary Clinics
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• v.37 no.5
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• pp.255-260
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• 2020

The purpose of this retrospective study was to describe the characteristics of magnetic resonance imaging (MRI) findings in dogs with meningoencephalitis of unknown etiology (MUE), and to evaluate the usefulness of meningeal enhancement. Thirty-two dogs were included in MUE group on the basis of clinical signs, MRI findings and cerebrospinal fluid (CSF) results, and for comparison of the meningeal enhancement, twenty-three dogs with normal MRI, normal CSF and no clinical sign were included in the control group. The evaluated MRI findings included lesion site, lesion number, signal intensity of each MRI sequence, mass effect, perilesional edema, contrast enhancement, and meningeal enhancement. The MUE was most frequently associated with multiple lesions (50%) with perilesional edema (72%) in forebrain (66%) that were hyperintense (92%) in T2W and FLAIR images. Of the meningeal enhancement, there was no significant difference between the control group and the MUE groups in the pachymeningeal enhancement. However, leptomeningeal (or both) enhancement was found relatively high proportion in the MUE group than in the control group (P < 0.001, Odd ratio = 10.26), and based on this result, leptomeningeal (or both) enhancement is considered to be significant finding for indicating MUE.

• The Journal of Churna Manual Medicine for Spine and Nerves
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• v.1 no.1
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• pp.45-50
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• 2006

Objectives : A rare case of dural tear ensuing after a cervical Chuna Manipulation Treatment leading to cerebrospinal fluid (CSF) leakage in the lower cervical and upper thoracic spine was found, so we report it. Methods : A 32-year-old woman presented with back and neck pain in 1 days earlier. The patient undertook a cervical Chuna Manipulation Treatment. After this maneuver, the patient complained of an orthostatic headache with nausea. The patient's headache worsened, and lying down gave the only measure of limited relief. In Brain CT and MRI study, nonspecific finding was detected. In Cistemography study, CSF leakage at lower cervical or upper thoracic area was detected. Results and Conclusions : It is supposed that this patient suffered a dural tear and CSF leakage secondarily due to a cervical Chuna Manipulation Treatment. From this case, we can understand the etiology of dural tear to some extent and consider the complication of Chuna Manipulation Treatment. In the future, more study, research and prospective trial for complications of a cervical Chuna Manipulation Treatment is needed.

• The Journal of Korean Institute of Communications and Information Sciences
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• v.25 no.7A
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• pp.1006-1016
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• 2000

This study is to segment white matter, gray matter, and cerebrospinal fluid(CSF) on a brain MR image and to calculate the volume of each. First, after removing the background on a brain MR image, we segmented the whole region of a brain from a skull and a fat layer. Then, we calculated the partial volume of each component, which was present in scanning finite thickness, with the arithmetical analysis of gray value from the internal region of a brain showing the blurring effects on the basis of the MR image forming principle. Calculated partial volumes of white matter, gray matter and CSF were used to determine the threshold for the segmentation of each component on a brain MR image showing the blurring effects. Finally, the volumes of segmented white matter, gray matter, and CSF were calculated. The result of this study can be used as the objective diagnostic method to determine the degree of brain atrophy of patients who have neurodegenerative diseases such as Alzheimer's disease and cerebral palsy.

• Pediatric Infection and Vaccine
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• v.29 no.1
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• pp.46-53
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• 2022

It is challenging to treat ventriculitis with parenteral treatment alone in some cases because of the difficulty involved in maintaining an appropriate level of antibiotics in cerebrospinal fluid (CSF). We report two cases of ventriculitis who did not respond to intravenous (IV) antibiotics but were successfully treated with intraventricular antibiotics using IV agents. The first case was a four-month-old male patient with X-linked hydrocephalus. He showed ventriculitis due to Klebsiella pneumoniae not producing extended-spectrum β-lactamase and susceptible to third-generation cephalosporins and gentamicin, following ventriculoperitoneal (VP) shunt. His condition did not improve during the 47 days of treatment with IV cefotaxime and meropenem. We achieved improvement in clinical presentation and CSF profile after three times of intraventricular gentamicin injection. The patient was discharged from the hospital with antiepileptic drugs. The second case was a six-month-old female patient with a history of neonatal meningitis complicated with hydrocephalus at one month of age, VP shunt at two months of age, followed by a methicillin-resistant coagulase-negative staphylococci (CoNS) shunt infection with ventriculitis after the shunt operation. CoNS ventriculitis recurred four weeks later. We failed to treat intractable methicillin-resistant CoNS ventriculitis with IV vancomycin for ten days, and thus intraventricular antimicrobial treatment was considered. Five times of intraventricular vancomycin administration led to improvement in clinical parameters. There were only neurological sequelae of delayed language development but no other major complications. Patients in these two cases responded well to intraventricular antibiotics, with negative CSF culture results, and were successfully treated for ventriculitis without serious complications.

• The Korean Journal of Pharmacology
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• v.30 no.3
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• pp.313-319
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• 1994

This study was undertaken to investigate the relationship between the $Na^+$ channels of the cardiovascular regulation center and the responses to increased $Na^+$ concentration in the cerebrospinal fluid (CSF), by observing the effects of icv administration of the agents affecting $Na^+$ transport. Icv infusion of $200\;{\mu}l$ of 1 M NaCl produced hypertension and bradycardia in the urethane-anesthetized rabbit, and the bradycardia was inhibited and reversed to tachycardia by vagotomy. Amiloride, a $Na^+$ transport inhibitor, produced hypertension and bradycardia, which were not altered by vagotomy, and it did not affect the NaCl-induced responses. Benzamil, a derivative of amiloride with higher specificity, neither produced any cardiovascular effects by itself, nor affected the NaCl-induced responses. In vagotomized rabbits, icv amiloride reversed the NaCl-induced tachycardia to a bradycardia, but the bradycardiac effect was not altered by pretreating with NaCl. This study showed that although amiloride and benzamil slightly differ in their cardiovascular action, neither of them did affect the NaCl-induced responses. We suggest that the $Na^+$ channels which are sensitive to amiloride or benzamil in the cardiovascular regulation center are not involved in the NaCl-induced response.

• Parasites, Hosts and Diseases
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• v.28 no.1
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• pp.1-10
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• 1990

To establish an animal model of intracranial sparganosis, the fate and behavior of the experimentally inoculated spargana were observed. A total of 102 scolices of spargana were injected into 22 cat brains, and the cats were sacrificed at 2 weeks, 1 month, 3 months and 6 months after the inoculation. Neurosparganosis was established in 77% of the cats. Of 43 recovered worms,19 (44%) were located in the subdural or subarachnoid space,16 (37%) in the brain Parenchyme, and 2 (5%) in the lateral ventricle. One was detected at the diploic space of the skull and 5 were outside the cranial cavity. All but one were alive, and had grown tails. They were distributed in the brain parenchyme randomly. There was no place which they could not invade. No adult was found in the intestine. Cerebrospinal fluid (CSF) was collected before inoculation, 1 week, 2 weeks, 1 month, 3 months and 6 months after inoculation. The level of anti-sparganum IgG antibody in CSF measured by ELISA began to increase above the criteria of positivity 1 month after inoculation. Three months after inocula- tion, the values markedly increased. The present findings reveal that intracranial inoculation of spargana into the brains of cats would be a good animal model of experimental neurosparganosis.

• Pediatric Infection and Vaccine
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• v.24 no.1
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• pp.54-59
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• 2017

Purpose: Urinary tract infection (UTI) is the most common serious bacterial infection in infants younger than 3 months of age. Lumbar puncture is routinely performed to evaluate febrile young infants for sepsis. However, there is no clear consensus on the use of routine lumbar puncture to diagnose concomitant meningitis in infants with UTI. We evaluated the prevalence of coexisting bacterial meningitis and sterile cerebrospinal fluid (CSF) pleocytosis in young infants with UTI. Methods: We retrospectively reviewed the medical records of 85 infants with UTI, aged from 29 to 99 days, who were admitted to Daegu Catholic University Medical Center from January 2013 to May 2016. We included 80 patients who had undergone lumbar puncture. Demographic features, clinical features, and laboratory findings were analyzed. Patients were divided into two groups based on the presence of sterile CSF pleocytosis and we compared these groups and assessed the differences between them. Results: Of the 80 UTI patients enrolled, 34 (43%) had sterile CSF pleocytosis. None had bacterial meningitis, and CSF polymerase chain reaction for enterovirus was positive in two patients without CSF pleocytosis. There were no significant differences between the two groups with regards to age, body temperature, peripheral white blood cell count, urinalysis, and duration of hospital stay. Conclusions: Though sterile CSF pleocytosis is common in young UTI patients, coexisting bacterial or viral meningitis is very rare. Indications for lumbar puncture in these patients depend on clinical condition.

• Parasites, Hosts and Diseases
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• v.24 no.1
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• pp.25-41
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• 1986

The applicability of micro-ELISA was evaluated in human neuro-cysticercosis using paired samples of serum and CSF. A total of 355 cases who were mostly neurologic patients was subjected. Cystic fluid of C. cellulosae was used as antigen in protein concentration of $2.5{\;}{\mu}g/ml$. Serum was diluted to 1 : 100 and CSF was undiluted in the assay for the specific IgG antibody level. The differential criterion of the positive reaction was the abs. of o. 18 in both samples. The results were summarized as follows: 1. The overall sensitivity of the micro-ELISA in 71 confirmed neurocysticercosis was 90.1% ; the sensitivity by serum was 77.5% and that by CSF was 83.1%. CSF was a more sensitive and valuable material. Most of the false negative cases of neuro-cysticercosis showed far lower level of abs. rather than marginal. 2. The overall specificity of the micro-ELISA in 52 confirmed other neurologic diseases was 88.5%; the specificities by serum and by CSF were 94.2% respectively. Cases of other neurologic diseases did not show false positive reactions in both samples. 3. When serum was assayed, taeniasis(2/18), sparganosis(2/20), paragonimiasis(1/56), clonorchiasis(1/15) and fascioliasis(1/1) cases showed cross reactions. When CSF was assayed, 2 ot 10 neuro-sparganosis showed cross reactions while none of 9 neuro-paragonimiasis showed it. Out of 71 confirmed neuro-cysticercosis cases, 6 and 11 showed cross reactions by serum and CSF to crude extract antigen of sparganum; but no case did show it to crude extract antigen of Paragonimus westermani. 4. Ventricular CSF showed low or negative levels of IgG antibody than lumbar CSF unless the lesion was at the lateral ventricle itself. 5. Out of 4 racemose cysticercosis cases, 3 showed positive reaction in serum while all of 3 examined CSF were positive. The above results indicated that the serological test for detecting the specific IgG antibody by micro-ELISA using paired samples of serum and CSF was very helpful for clinical differentiation of neuro-cysticercosis from neurologic diseases of other causes.

• Journal of Korean Neurosurgical Society
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• v.43 no.6
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• pp.281-287
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• 2008

Objective : Cerebral vasospasm still remains a major cause of the morbidity and mortality, despite the developments in treatment of aneurysmal subarachnoid hemorrhage. The authors measured the utility and benefits of external lumbar cerebrospinal fluid (CSF) drainage to prevent the clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage in this randomized study. Methods : Between January 2004 and March 2006, 280 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Among them, 107 patients met our study criteria. The treatment group consisted of 47 patients who underwent lumbar CSF drainage during vasospasm risk period (about for 14 days after SAH), whereas the control group consisted of 60 patients who received the management according to conventional protocol without lumbar CSF drainage. We created our new modified Fisher grade on the basis of initial brain computed tomography (CT) scan at admission. The authors established five outcome criteria as follows : 1) clinical vasospasm; 2) GOS score at 1-month to 6-month follow-up; 3) shunt procedures for hydrocephalus; 4) the duration of stay in the ICU and total hospital stay; 5) mortality rate. Results : The incidence of clinical vasospasm in the lumbar drain group showed 23.4% compared with 63.3% of individuals in the control group. Moreover, the risk of death in the lumbar drain group showed 2.1 % compared with 15% of individuals in the control group. Within individual modified Fisher grade, there were similar favorable results. Also, lumbar drain group had twice more patients than the control group in good GOS score of 5. However, there were no statistical significances in mean hospital stay and shunt procedures between the two groups. IVH was an important factor for delayed hydrocephalus regardless of lumbar drain. Conclusion : Lumbar CSF drainage remains to playa prominent role to prevent clinical vasospasm and its sequelae after endovascular coiling on aneurysmal subarachnoid hemorrhage. Also, this technique shows favorable effects on numerous neurological outcomes and prognosis. The results of this study warrant clinical trials after endovascular treatment in patients with aneurysmal SAH.