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Rich J, Hubler S, Vidondo B, Raillard M, Schweizer D. Influence of body weight, age, and sex on cerebrospinal fluid peak flow velocity in dogs without neurological disorders. J Vet Intern Med 2024; 38:1608-1617. [PMID: 38664973 PMCID: PMC11099718 DOI: 10.1111/jvim.17073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Changes in the brain can affect the flow velocity of cerebrospinal fluid (CSF). In humans, the flow velocity of CSF is not only altered by disease but also by age and sex. Such influences are not known in dogs. HYPOTHESIS Peak flow velocity of CSF in dogs is associated with body weight, age, and sex. ANIMALS Peak flow velocity of CSF was measured in 32 client-owned dogs of different breeds, age, and sex. METHODS Peak flow velocity of CSF was determined by phase-contrast magnetic resonance imaging (PC-MRI) at the mesencephalic aqueduct, foramen magnum (FM), and second cervical vertebral body (C2). Dogs were grouped according to body weight, age, and sex. Flow velocity of CSF was compared between groups using linear regression models. RESULTS Dogs with body weight >20 kg had higher CSF peak velocity compared with dogs <10 kg within the ventral and dorsal subarachnoid space (SAS) at the FM (P = .02 and P = .01, respectively), as well as in the ventral and dorsal SAS at C2 (P = .005 and P = .005, respectively). Dogs ≤2 years of age had significantly higher CSF peak flow velocity at the ventral SAS of the FM (P = .05). Females had significantly lower CSF peak flow velocity within the ventral SAS of FM (P = .04). CONCLUSION Body weight, age, and sex influence CSF peak flow velocity in dogs. These factors need to be considered in dogs when CSF flow is quantitatively assessed.
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Affiliation(s)
- Johannes Rich
- Division of Clinical Radiology, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Sarah Hubler
- Division of Clinical Radiology, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Beatriz Vidondo
- Veterinary Public Health InstituteUniversity of BernLiebefeldSwitzerland
| | - Mathieu Raillard
- Division of Anesthesiology and Pain Management, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
| | - Daniela Schweizer
- Division of Clinical Radiology, Departement of Clinical Veterinary Medicine, Vetsuisse FacultyUniversity of BernBernSwitzerland
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Wolf K, Luetzen N, Mast H, Kremers N, Reisert M, Beltrán S, Fung C, Beck J, Urbach H. CSF Flow and Spinal Cord Motion in Patients With Spontaneous Intracranial Hypotension: A Phase Contrast MRI Study. Neurology 2023; 100:e651-e660. [PMID: 36357188 PMCID: PMC9969913 DOI: 10.1212/wnl.0000000000201527] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Spontaneous intracranial hypotension (SIH) is characterized by loss of CSF volume. We hypothesize that in this situation of low volume, a larger CSF flow and spinal cord motion at the upper spine can be measured by noninvasive phase contrast MRI. METHODS A prospective, age-, sex-, and body mass index (BMI)-matched controlled cohort study on patients with SIH presenting with spinal longitudinal extradural fluid collection (SLEC) was conducted from October 2021 to February 2022. Cardiac-gated 2D phase contrast MRI sequences were acquired at segment C2/C3, and C5/C6 for CSF flow, and spinal cord motion analysis. Data processing was fully automated. CSF flow and spinal cord motion were analyzed by peak-to-peak amplitude and total displacement per segment and heartbeat, respectively. Clinical data included age, height, BMI, duration of symptoms, Bern score according to Dobrocky et al., and type of the spinal CSF leak according to Schievink et al. Groups were compared via the Mann-Whitney U test; multiple linear regression analysis was performed to address possible relations. RESULTS Twenty patients with SIH and 40 healthy controls were analyzed; each group consisted of 70% women. Eleven patients with SIH presented with type 1 leak, 8 with type 2, and 1 was indeterminate. CSF flow per heartbeat was increased at C2/C3 (peak-to-peak amplitude 65.68 ± 18.3 vs 42.50 ± 9.8 mm/s, total displacement 14.32 ± 3.5 vs 9.75 ± 2.7 mm, p < 0.001, respectively). Craniocaudal spinal cord motion per heartbeat was larger at segment C2/C3 (peak-to-peak amplitude 7.30 ± 2.4 vs 5.82 ± 2.0 mm/s, total displacement 1.01 ± 0.4 vs 0.74 ± 0.4 mm, p = 0.006, respectively) and at segment C5/C6 (total displacement 1.41 ± 0.7 vs 0.97 ± 0.4 mm, p = 0.021). DISCUSSION SLEC-positive patients with SIH show higher CSF flow and higher spinal cord motion at the upper cervical spine. This increased craniocaudal motion of the spinal cord per heartbeat might produce increased mechanical strain on neural tissue and adherent structures, which may be a mechanism leading to cranial nerve dysfunction, neck pain, and stiffness in SIH. Noninvasive phase contrast MRI of CSF flow and spinal cord motion is a promising diagnostic tool in SIH. TRIAL REGISTRATION INFORMATION German Clinical Trials Register, identification number: DRKS00017351. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that noninvasive phase contrast MRI of the upper spine identifies differences in CSF flow and spinal cord motion in patients with SIH compared with healthy controls.
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Affiliation(s)
- Katharina Wolf
- From the Departments of Neurology and Neurophysiology (K.W., S.B.), Neuroradiology (N.L., H.M., N.K., H.U.), Radiology, Medical Physics (M.R.), and Neurosurgery (C.F., J.B.), Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
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Yıldırım F, Turan A, Güven S, Akdağ T. Absence of CSF flow within the cerebral aqueduct in spontaneous intracranial hypotension: a report of two cases. Br J Neurosurg 2021:1-4. [PMID: 34796783 DOI: 10.1080/02688697.2021.2006141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/10/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
Spontaneous intracranial hypotension (SIH) is a potentially debilitating condition resulting from a low cerebrospinal fluid (CSF) volume secondary to spinal CSF leakage. Characteristic clinical and radiological imaging findings are helpful in diagnosis. Herein, we present and discuss the magnetic resonance imaging (MRI) and CSF flow study of two patients with SIH and no CSF flow within the cerebral aqueduct, which is extremely rare in the literature.
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Affiliation(s)
- Ferhat Yıldırım
- Radiology Department, Diskapi Yildirim Beyazit Health Application and Research Center, University of Health Sciences, Ankara, Turkey
| | - Aynur Turan
- Radiology Department, Diskapi Yildirim Beyazit Health Application and Research Center, University of Health Sciences, Ankara, Turkey
| | - Selda Güven
- Radiology Department, Diskapi Yildirim Beyazit Health Application and Research Center, University of Health Sciences, Ankara, Turkey
| | - Tuba Akdağ
- Radiology Department, Diskapi Yildirim Beyazit Health Application and Research Center, University of Health Sciences, Ankara, Turkey
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Risk factors for nonresponsive hydration in patients with spinal cerebrospinal fluid leakage. BMC Neurol 2021; 21:427. [PMID: 34732159 PMCID: PMC8564966 DOI: 10.1186/s12883-021-02464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spinal cerebrospinal fluid (CSF) leakage is frequently encountered clinically after lumbar puncture or spontaneous events. Although some patients recover without treatment or after intensive hydration, some require an epidural blood patch (EBP). The risks of nonresponsive hydration remain unknown. Therefore, we identified the risk factors for patients with spinal CSF leakage nonresponsive to hydration. METHODS We retrospectively reviewed patients diagnosed with spinal CSF leakage between January 2010 and March 2021. Clinical data, including patient age, sex, etiology, and radiological indications in magnetic resonance imaging, were compared between patients who were responsive and non-responsive to hydration. RESULTS Of the 74 patients with spinal CSF leakage, 25 were responsive to hydration and 49 required EBP. Patients who were nonresponsive to hydration were older (39.27 vs. 34.32 years, P = 0.01), had a higher percentage of spontaneous intracranial hypotension (93.88% vs. 68.00%, P = 0.005), had more spinal CSF leakage (12.04 vs. 8.04, P = 0.01), and had a higher percentage of dural sinus engorgement (81.63% vs. 60.00%, P = 0.044). Spontaneous intracranial hypotension (odds ratio [OR]: 4.63; 95% confidence interval [CI]: 1.00-21.38) and having ≥9 spinal CSF leakages (OR: 3.29; 95% CI: 1.08-10.01), as indicated by magnetic resonance myelography, are considered risk factors for noneffective hydration. CONCLUSIONS Patients with spinal CSF leakage who have spontaneous intracranial hypotension and those with ≥9 spinal CSF leakages are considered at risk for noneffective hydration. EBP should be considered early in these patients.
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Christen MA, Schweizer-Gorgas D, Richter H, Joerger FB, Dennler M. Quantification of cerebrospinal fluid flow in dogs by cardiac-gated phase-contrast magnetic resonance imaging. J Vet Intern Med 2020; 35:333-340. [PMID: 33274812 PMCID: PMC7848380 DOI: 10.1111/jvim.15932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/20/2020] [Accepted: 09/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background Cerebrospinal fluid (CSF) flow in disease has been investigated with two‐dimensional (2D) phase‐contrast magnetic resonance imaging (PC‐MRI) in humans. Despite similar diseases occurring in dogs, PC‐MRI is not routinely performed and CSF flow and its association with diseases is poorly understood. Objectives To adapt 2D and four‐dimensional (4D) PC‐MRI to dogs and to apply them in a group of neurologically healthy dogs. Animals Six adult Beagle dogs of a research colony. Methods Prospective, experimental study. Sequences were first optimized on a phantom mimicking small CSF spaces and low velocity flow. Then, 4D PC‐MRI and 2D PC‐MRI at the level of the mesencephalic aqueduct, foramen magnum (FM), and cervical spine were performed. Results CSF displayed a bidirectional flow pattern on 2D PC‐MRI at each location. Mean peak velocity (and range) in cm/s was 0.92 (0.51‐2.08) within the mesencephalic aqueduct, 1.84 (0.89‐2.73) and 1.17 (0.75‐1.8) in the ventral and dorsal subarachnoid space (SAS) at the FM, and 2.03 (range 1.1‐3.0) and 1.27 (range 0.96‐1.82) within the ventral and dorsal SAS of the cervical spine. With 4D PC‐MRI, flow velocities of >3 cm/s were visualized in the phantom, but no flow data were obtained in dogs. Conclusion Peak flow velocities were measured with 2D PC‐MRI at all 3 locations and slower velocities were recorded in healthy Beagle dogs compared to humans. These values serve as baseline for future applications. The current technical settings did not allow measurement of CSF flow in Beagle dogs by 4D PC‐MRI.
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Affiliation(s)
- Muriel A Christen
- Division of Clinical Radiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Henning Richter
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Fabiola B Joerger
- Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Matthias Dennler
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Fukumoto G, Kanagaki M, Ishimoto T, Kitazumi K, Hara A, Kimura H. Identification of a Dural Defect with Cine Phase Contrast MR Imaging. Magn Reson Med Sci 2020; 19:89-91. [PMID: 31217398 PMCID: PMC7232035 DOI: 10.2463/mrms.ci.2019-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Genki Fukumoto
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Mitsunori Kanagaki
- Department of Diagnostic Radiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takeshi Ishimoto
- Division of Clinical Radiology Service, Hyogo Prefectural Amagasaki General Medical Center
| | - Kazuya Kitazumi
- Division of Clinical Radiology Service, Hyogo Prefectural Amagasaki General Medical Center
| | - Atsushi Hara
- Department of Neurology, Hyogo Prefectural Amagasaki General Medical Center
| | - Hiroaki Kimura
- Department of Orthopedic Surgery, Hyogo Prefectural Amagasaki General Medical Center
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Redon S, Elzière M, Kaphan E, Donnet A. Contribution of Otoacoustic Emissions for Diagnosis of Atypical or Recurrent Intracranial Hypotension. A Cases Series. Headache 2019; 59:1374-1378. [DOI: 10.1111/head.13621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Sylvain Redon
- Department of Evaluation and Treatment of Pain FHU INOVPAIN, CHU Timone, AP‐HM Marseille France
| | - Maya Elzière
- Centre des vertiges Hôpital Européen Marseille France
| | - Elsa Kaphan
- Pôle de Neurosciences Cliniques CHU Timone, AP‐HM Marseille France
| | - Anne Donnet
- Department of Evaluation and Treatment of Pain FHU INOVPAIN, CHU Timone, AP‐HM Marseille France
- INSERM U‐1107 CHU de Clermont‐Ferrand Clermont‐Ferrand France
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Tsai YH, Chen HC, Tung H, Wu YY, Chen HM, Pan KJ, Cheng DC, Chen JH, Chen CCC, Chai JW, Shen WC. Noninvasive assessment of intracranial elastance and pressure in spontaneous intracranial hypotension by MRI. J Magn Reson Imaging 2018; 48:1255-1263. [PMID: 29437266 DOI: 10.1002/jmri.25976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 01/24/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Spontaneous intracranial hypotension (SIH) is often misdiagnosed, and can lead to severe complications. Conventional MR sequences show a limited ability to aid in this diagnosis. MR-based intracranial pressure (MR-ICP) may be able to detect changes of intracranial elastance and pressure. PURPOSE To determine whether MR-ICP is able to differentiate SIH patients from normal subjects, improve diagnostic sensitivity, and provide an insight into the pathophysiology. STUDY TYPE Prospective. SUBJECTS Twenty-eight SIH cases with orthostatic headache and 20 healthy volunteers. FIELD STRENGTH/SEQUENCE Cine phase-contrast MRI on a 1.5T scanner. ASSESSMENT Intracranial elastance (IE) was derived from the ratio of the peak-to-peak cerebrospinal fluid (CSF) pressure gradient (PGcsf-pp ) and intracranial volume change, obtained by summing all flows before each sequential cardiac frame. STATISTICAL TESTS Student's t-test was used to compare the MR-ICP indexes and flow parameters between SIH patients and healthy volunteers (P < 0.01). RESULTS The SIH patients with cervical epidural venous dilatation (EVD) had an IE of 0.121 ± 0.027 mmHg/cm/ml, significantly higher than that of the normal volunteers (0.085 ± 0.027 mmHg/cm/ml; P = 0.002). In contradistinction, the EVD-negative SIH patients, including four with no sign of CSF leaks, had significantly lower IE (0.055 ± 0.012 mmHg/cm/ml) compared with the normal volunteers and the EVD-positive group (P = 0.001, P < 0.001). The EVD-negative patients had significantly lower PGcsf-pp (0.024 ± 0.007 mmHg/cm) compared with the normal volunteers and the EVD-positive group (0.035 ± 0.011 mmHg/cm, 0.040 ± 0.010 mmHg/cm; P = 0.003, P < 0.001). Additionally, the MRI flow study showed a significant decrease in transcranial inflow and outflow of SIH patients (P < 0.01). DATA CONCLUSION We found that the MR-ICP method is potentially more sensitive than morphological MRI in the early diagnosis of SIH. Also, contrary to common belief, our results suggest that an abnormal craniospinal elastance might be the cause of SIH, instead of CSF leak. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1255-1263.
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Affiliation(s)
- Yi-Hsin Tsai
- Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Chieh Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hsin Tung
- Neurological Institute, Taichung Veterans General Hospital, Taiwan
| | - Yi-Ying Wu
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hsian-Min Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Biomedical Engineering, Hung Kuang University, Taichung, Taiwan
| | - Kuan-Jung Pan
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Da-Chuan Cheng
- Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan
| | - Jeon-Hor Chen
- Center for Functional Onco-Imaging, Department of Radiological Sciences, University of California, Irvine, California, USA.,Department of Radiological Technology, Central Taiwan University of Science and Technology, Taichung, Taiwan
| | - Clayton Chi-Chang Chen
- Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan.,Department of Radiology, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Jyh-Wen Chai
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wu-Chung Shen
- College of Medicine, China Medical University, Taichung, Taiwan.,Department of Radiology, China Medical University Hospital, Taichung, Taiwan
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Chen HC, Chen PL, Tsai YH, Chen CH, Chen CCC, Chai JW. Quantitative Measurement of CSF in Patients with Spontaneous Intracranial Hypotension. AJNR Am J Neuroradiol 2017; 38:1061-1067. [PMID: 28385881 DOI: 10.3174/ajnr.a5134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE CSF hypovolemia is a core feature of spontaneous intracranial hypotension. Spontaneous intracranial hypotension is characterized by orthostatic headache and radiologic manifestations, including CSF along the neural sleeves, diffuse pachymeningeal enhancement, and/or venous engorgement. However, these characteristics are only qualitative. Quantifying intraspinal CSF volumes could improve spontaneous intracranial hypotension diagnosis and evaluation of hypovolemic statuses in patients with spontaneous intracranial hypotension. The purpose of this study was to compare intraspinal CSF volumes across spontaneous intracranial hypotension stages and to test the clinical applicability of these measures. MATERIALS AND METHODS A cohort of 23 patients with spontaneous intracranial hypotension and 32 healthy controls was subjected to brain MR imaging and MR myelography with 1.5T imaging. An automatic threshold-based segmentation method was used to calculate intraspinal CSF volumes at initial hospitalization (spontaneous intracranial hypotension-initial), partial improvement (spontaneous intracranial hypotension-intermediate), and complete recovery (spontaneous intracranial hypotension-recovery) stages. RESULTS The mean intraspinal CSF volumes observed were the following: 95.31 mL for healthy controls, 72.31 mL for spontaneous intracranial hypotension-initial, 81.15 mL for spontaneous intracranial hypotension-intermediate, and 93.74 mL for spontaneous intracranial hypotension-recovery. Increased intraspinal CSF volumes were related to disease recovery (P < .001). The intraspinal CSF volumes of patients before complete recovery were significantly lower than those of healthy controls. With the estimated intradural CSF volumes as a reference, the intraspinal CSF volume percentage was lower in patients with spontaneous intracranial hypotension with venous engorgement than in those without it (P = .058). CONCLUSIONS With a threshold-based segmentation method, we found that spinal CSF hypovolemia is fundamentally related to spontaneous intracranial hypotension. Intraspinal CSF volumes could be a sensitive parameter for the evaluation of treatment response and follow-up monitoring in patients with spontaneous intracranial hypotension.
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Affiliation(s)
- H-C Chen
- From the Departments of Radiology (H.-C.C., C.-H.C., C.C.-C.C., J.-W.C.).,Department of Medicine (H.-C.C.), National Yang-Ming University, Taipei, Taiwan
| | - P-L Chen
- Neurology (P.-L.C.), Taichung Veterans General Hospital, Taichung, Taiwan
| | - Y-H Tsai
- College of Medicine (Y.-H.T., J.-W.C.), China Medical University, Taichung, Taiwan
| | - C-H Chen
- From the Departments of Radiology (H.-C.C., C.-H.C., C.C.-C.C., J.-W.C.)
| | - C C-C Chen
- From the Departments of Radiology (H.-C.C., C.-H.C., C.C.-C.C., J.-W.C.)
| | - J-W Chai
- From the Departments of Radiology (H.-C.C., C.-H.C., C.C.-C.C., J.-W.C.) .,College of Medicine (Y.-H.T., J.-W.C.), China Medical University, Taichung, Taiwan
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CSF Levels of Angiopoietin-2 Do Not Differ between Patients with CSF Fluid Leakage Syndrome and Controls. DISEASE MARKERS 2015; 2015:343818. [PMID: 26448679 PMCID: PMC4581498 DOI: 10.1155/2015/343818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 12/21/2022]
Abstract
CSF abnormalities have been reported in CSF leakage syndrome. However, the mechanism for these CSF changes is actually unknown and they may indicate impaired CSF flow or blood-CSF barrier. Angiopoietin-2 (Ang-2), a protein which is expressed and released by endothelial cells, has been associated with increased vascular permeability. In the assumption that CSF changes are due to an impaired blood-CSF barrier, we hypothesized that subjects with persistent CSF leakage may have increased CSF Ang-2 levels. We enrolled 10 subjects with a clinically definite diagnosis of persisting CSF leakage syndrome and 10 control subjects. In CSF analyses, CSF to serum albumin ratio (Qalb) was the most frequently increased parameter indicating a disturbed blood-CSF barrier function. Comparison of the mean CSF Ang-2 levels, CSF to serum Ang-2 ratio (QAng-2), and QAng-2/Qalb between the control and CSF leakage patients did not show any significant difference. We suggest that the increase of Qalb results from a low CSF flow. Future studies with phase contrast-MRI in conjunction with CSF analyses before and after epidural blood patch treatment are required to address this question. It would be of particular interest whether Qalb can be used as a marker for successful nontargeted epidural blood patch treatment.
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