Experimental effects of steroids and steroid withdrawal on cerebrospinal fluid absorption

1975 ◽  
Vol 42 (6) ◽  
pp. 690-695 ◽  
Author(s):  
Ian Johnston ◽  
David L. Gilday ◽  
E. Bruce Hendrick
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Chronic Administration ◽  
Benign Intracranial Hypertension ◽  
Steroid Withdrawal ◽  
Content Type ◽  
Cisterna Magna ◽  
Sagittal Sinus ◽  
Ringer’S Lactate ◽  
Csf Absorption

✓ The authors studied the effects on cerebrospinal fluid (CSF) absorption of chronic administration and acute withdrawal of steroids in dogs. CSF absorption was measured by determining the amount of isotope (indium 111DTPA) recovered over a 4-hour period after injection into the cisterna magna. Resistance to CSF absorption was estimated by determining rates of flow of Ringer's lactate infusion into the cisterna magna over a range of pressure gradients between CSF and sagittal sinus. Steroid withdrawal was associated with a marked reduction in CSF absorption and an increase in resistance to CSF flow. Dogs on steroids also showed reduced CSF absorption although the reduction was not statistically significant when compared with controls. The results are discussed in terms of possible mechanisms of action of steroids on CSF absorption, the etiology of the benign intracranial hypertension syndrome and the use of steroids in the control of intracranial hypertension.

Benign intracranial hypertension with spinal and radicular pain

1982 ◽  
Vol 57 (6) ◽  
pp. 833-836 ◽  
Author(s):  
Marco Bortoluzzi ◽  
Leonardo Di Lauro ◽  
Giovanni Marini
Keyword(s):  
Cerebrospinal Fluid ◽  
Serum Albumin ◽  
Intracranial Hypertension ◽  
Spinal Pain ◽  
Radicular Pain ◽  
Benign Intracranial Hypertension ◽  
Csf Flow ◽  
Content Type ◽  
Csf Absorption ◽  
Fine Print

✓ A case of benign intracranial hypertension with polyradiculopathy and spinal pain is reported. Radioactive iodinated serum albumin (RISA) cisternography demonstrated the absence of cerebrospinal fluid (CSF) flow into the intracranial cisterns, and gave evidence of CSF absorption through the spinal arachnoid villi.

Cerebrospinal fluid drainage as influenced by ventricular pressure in the rabbit

1982 ◽  
Vol 56 (6) ◽  
pp. 790-797 ◽  
Author(s):  
J. Gordon McComb ◽  
Hugh Davson ◽  
Shigeyo Hyman ◽  
Martin H. Weiss
Keyword(s):  
Cerebrospinal Fluid ◽  
Indigo Carmine ◽  
Normal Pressure ◽  
Cervical Lymph Nodes ◽  
Content Type ◽  
Cisterna Magna ◽  
Arterial Circulation ◽  
Sagittal Sinus ◽  
Arterial Blood ◽  
Ventriculocisternal Perfusion

✓ Artificial cerebrospinal fluid (CSF) containing radioisotope iodinated (125I) serum albumin (RISA) and either blue dextran or indigo carmine was given to white New Zealand rabbits over 4 hours. In one group it was given by ventriculocisternal perfusion, in one by ventricular infusion, and in one by cisterna magna infusion. Blood was sampled continuously from the superior sagittal sinus (SSS) or intermittently from the systemic arterial circulation. Removal of CSF from the cisterna magna during the ventriculocisternal perfusion kept the intracranial pressure (ICP) at 0 to 5 torr, whereas ventricular or cisterna magna infusion raised the ICP to 20 to 30 torr and 15 to 20 torr, respectively. In the two groups with raised ICP, an increased concentration of RISA was present in the optic nerves, olfactory bulbs, episcleral tissue, and deep cervical lymph nodes; but this was not found in the group with normal ICP. In all three groups, the concentration of RISA in the SSS blood was the same as in the systemic arterial blood. The concentration gradient of RISA across the cerebral cortex was similar in both the ventriculocisternal perfusion and the ventricular infusion groups. With cisterna magna infusion, the concentration of RISA was the same on the cortical surface and less in the ventricles compared with the ventricular infusion. It is concluded that, with elevated ICP, CSF drained via pathways that are less evident under normal pressure. Drainage of CSF was similar irrespective of whether the infusion site was the ventricles or cisterna magna. It did not appear that acute dilatation of the ventricles during ventricular infusion compromised the subarachnoid space over the surface of the hemisphere, as the concentration of RISA on the convexities and in the SSS blood did not significantly differ between the groups. Transcortical bulk transfer of CSF was not evident with raised ICP.

Cerebrospinal fluid diversion in the treatment of benign intracranial hypertension

1988 ◽  
Vol 69 (2) ◽  
pp. 195-202 ◽  
Author(s):  
Ian Johnston ◽  
Michael Besser ◽  
Michael K. Morgan
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Primary Treatment ◽  
Consecutive Series ◽  
Complication Rates ◽  
Benign Intracranial Hypertension ◽  
Content Type ◽  
Cerebrospinal Fluid Diversion ◽  
Cerebrospinal Fluid Shunting ◽  
Shunt Dependence

✓ Thirty-six patients from a consecutive series of 41 patients with benign intracranial hypertension (BIH) were treated by cerebrospinal fluid shunting. In 12 patients this was selected as the primary treatment due to the severe deterioration of vision or concern regarding the possible adverse effects of steroids; all 12 patients showed rapid and complete resolution of the disease, although eight patients still have a shunt in place. In 24 patients a shunt was inserted when other forms of treatment failed; all of these patients showed rapid resolution of the condition, although 20 patients still have a shunt in place. Three patients had the shunt removed without sequelae, and one patient in whom the shunt was removed because of low-pressure symptoms remains symptomatic with persistent papilledema (over 6 years). The percutaneous lumboperitoneal (LP) shunt was associated with the lowest revision and complication rates. Cisternal shunting to either the atrium or pleural cavity was next most effective, whereas valved LP shunts inserted via a laminectomy were least effective; ventricular shunts were used in only two cases. Shunting is therefore very effective in the treatment of BIH, but the significant complication rate and the possibility of inducing shunt dependence must be recognized.

Benign intracranial hypertension associated with inhaled corticosteroids in a child with asthma

2021 ◽  
Vol 14 (5) ◽  
pp. e242455
Author(s):  
James Trayer ◽  
Declan O'Rourke ◽  
Lorraine Cassidy ◽  
Basil Elnazir
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Inhaled Corticosteroids ◽  
Benign Intracranial Hypertension ◽  
Inhaled Corticosteroid ◽  
Moderate Dose ◽  
Opening Pressure ◽  
Blurred Vision ◽  
Corticosteroid Dose ◽  
Steroid Side Effects

A 13-year-old male asthmatic presented to the general paediatric clinic with papilloedema identified following a check-up with his optician due to blurred vision. His asthma was well controlled on a moderate dose of inhaled corticosteroid and there had been no recent increase or decrease in the dose. A diagnosis of benign intracranial hypertension (BIH) was made based on a raised cerebrospinal fluid opening pressure, papilloedema, a normal neurological examination and normal neuroimaging. The only associated risk factor was his inhaled corticosteroids. He was commenced on acetazolamide and the inhaled corticosteroid dose was reduced, resulting in resolution of his papilloedema. This case serves to highlight that steroid side effects including BIH may occur at moderate doses of inhaled corticosteroids and that inhaled corticosteroid dose should be regularly reviewed and decreased to the lowest dose that maintains asthma control.

Pressure in the sagittal sinus during intracranial hypertension in man

1974 ◽  
Vol 40 (5) ◽  
pp. 603-608 ◽  
Author(s):  
Albert N. Martins ◽  
Arthur I. Kobrine ◽  
Douglas F. Larsen
Keyword(s):  
Brain Tumors ◽  
Intracranial Hypertension ◽  
Cerebral Blood Volume ◽  
Content Type ◽  
Sagittal Sinus ◽  
Sagittal Sinus Pressure ◽  
The Mean ◽  
The Difference ◽  
Spatial Compensation ◽  
Sinus Pressure

✓ Intracranial pressure (ICP) and sagittal sinus pressure (SSP) were measured simultaneously in 12 patients with brain tumors and secondary intracranial hypertension (ICH). In nine, the mean SSP was largely unaffected by changes in ICP. In three, SSP changed with the ICP. In all but one patient, the ICP remained higher than SSP and, as the ICP increased, the difference between the two also increased. Sinograms performed during ICH demonstrated partial collapse of the sinuses in some patients and not in others. The mean SSP in adults with brain tumors appears to respond unpredictably to changes in ICP. Since the rate of cerebrospinal fluid drainage depends upon the gradient between ICP and SSP, intracranial spatial compensation is probably influenced by the response of SSP to ICP. Individuals with gradients that rapidly increase because their sinuses do not collapse probably compensate more rapidly than those whose sinuses do collapse. This assumed difference in the rate of spatial compensation may account for some of the variability of the ICP response to an enlarging intracranial mass or a change in cerebral blood volume.

Significance of Empty Sella in Cerebrospinal Fluid Leaks

2003 ◽  
Vol 128 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Rodney J. Schlosser ◽  
William E. Bolger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Sella Turcica ◽  
Radiographic Finding ◽  
Empty Sella ◽  
Senior Author ◽  
Csf Leak ◽  
Benign Intracranial Hypertension ◽  
Cerebrospinal Fluid Leaks ◽  
Csf Leaks

OBJECTIVE: The role of elevated cerebrospinal fluid (CSF) pressures in the pathophysiology of various CSF leaks is not clear. Empty sella syndrome (ESS) is a radiographic finding that can be associated with elevated CSF pressures and may represent a radiographic indicator of intracranial hypertension. We present our experience with CSF leaks of various causes, the prevalence of ESS in the spontaneous and nonspontaneous categories, and the potential pathophysiology and unique management issues of the spontaneous CSF leak group. METHODS: We conducted a retrospective review of medical records, imaging studies, and surgical treatment of CSF leaks in patients treated by the senior author. RESULTS: Sixteen patients with spontaneous CSF leaks and 12 patients with nonspontaneous CSF leaks were surgically treated from 1996 through 2002. In the spontaneous group, 15 patients had complete imaging of the sella turcica. Ten had completely empty sellae and 5 had partially empty sellae, for a total of 100% (15 of 15). In the nonspontaneous group, 9 patients had complete imaging of the sella. Only 11% (1 of 9) had a partially empty sella and that was a congenital leak. Comparison of proportions between these 2 groups was significant ( P = 0.01). The spontaneous group consisted primarily of obese, middle-aged females (13 of 16 patients). CONCLUSION: Empty sella probably represents a sign of elevated intracranial pressure that leads to idiopathic, spontaneous CSF leaks. Spontaneous CSF leaks are strongly associated with the radiographic finding of an empty sella and are more common in obese females, similar to benign intracranial hypertension. This unique population may require more aggressive surgical and medical treatment to prevent recurrent or multiple leaks.

Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system

1975 ◽  
Vol 43 (5) ◽  
pp. 523-534 ◽  
Author(s):  
Anthony Marmarou ◽  
Kenneth Shulman ◽  
James LaMorgese
Keyword(s):  
Cerebrospinal Fluid ◽  
Compartmental Analysis ◽  
Pressure Data ◽  
Outflow Resistance ◽  
Fluid System ◽  
Content Type ◽  
Spinal Axis ◽  
Pressure Dynamics ◽  
Total Compliance ◽  
Csf Absorption

✓ The distribution of compliance and outflow resistance between cerebral and spinal compartments was measured in anesthetized, ventilated cats by analysis of the cerebrospinal fluid (CSF) pressure response to changes in CSF volume. Cerebral and spinal compartments were isolated by inflating a balloon positioned epidurally at the level of C-6. The change of CSF volume per unit change in pressure (compliance) and change of CSF volume per unit of time (absorption) were evaluated by inserting pressure data from the experimental responses into a series of equations developed from a mathematical model. It was found that 68% of total compliance is contributed by the cerebral compartment while the remaining 32% is contained within the spinal axis. The cerebral compartment accounted for 84% of total CSF absorption. The mechanism for spinal absorption appears to be similar in that no differences were obvious on the basis of pressure dynamics.

BENIGN INTRACRANIAL HYPERTENSION IN CHILDREN

PEDIATRICS ◽  
1967 ◽  
Vol 39 (2) ◽  
pp. 227-237
Author(s):  
Arthur Rose ◽  
Donald D. Matson
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Otitis Media ◽  
Viral Infections ◽  
Corticosteroid Treatment ◽  
Clinical Syndrome ◽  
Benign Intracranial Hypertension ◽  
Upper Respiratory Tract ◽  
Initial Manifestation ◽  
Tract Infections

The clinical features of 23 cases of benign intracranial hypertension occurring in childhood have been reviewed. Eight cases followed minor bacterial or viral infections, four cases occurred in association with head or neck injury, four cases occurred with otitis media, and one case followed sudden cessation of corticosteroid treatment. There were no apparent associated clinical factors in the remaining six cases. Benign intracranial hypertension thus emerges as a clinical syndrome of varied etiology, generally with a short course, good prognosis, little tendency to recurrence, and only rarely requiring surgical intervention. Clinical evidence suggests that, in addition to otitis media, cerebral venous thrombosis may, in certain circumstances, follow head injury, trauma to the jugular vein, and thrombosis in the pterygoid venous plexus. Therefore, it is suggested that complete visualization of the venous cerebral circulation should be attempted in the investigation of patients with benign intracranial hypertension. In view of the occurrence of the syndrome following gastroenteritis, upper respiratory tract infections, and chickenpox, diagnostic virological studies, including culture of cerebrospinal fluid, are of special interest. Other precipitating causes of this clinical syndrome are discussed. The occurrence of benign intracranial hypertension as an initial manifestation of two well defined endocrine abnormalities is described. It is possible in the future that systematic endocrine study of patients, particularly pre-pubertal females, will reveal other hormonal defects. It appears probable that transient generalized cerebral edema of any type may be responsible for the occurrence of this syndrome. The elucidation of its pathophysiology will probably have to wait more accurate and safe methods of clinical measurement of intra- and extra-cellular fluid shifts within the brain, as well as more reliable understanding of cerebrospinal fluid and cerebral blood flow alterations.

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