Bacterial meningitis caused by the use of ventricular or lumbar cerebrospinal fluid catheters

2005 ◽  
Vol 102 (2) ◽  
pp. 229-234 ◽  
Author(s):  
Rogier P. Schade ◽  
Janke Schinkel ◽  
Leo G. Visser ◽  
J. Marc C. van Dijk ◽  
Joan H. C. Voormolen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Clinical Symptoms ◽  
External Drainage ◽  
Content Type ◽  
Ventricular Catheters ◽  
Independent Risk Factors ◽  
Lumbar Cerebrospinal Fluid ◽  
Fine Print

Object. In the present study the authors compared the incidence and risk factors for external drainage—related bacterial meningitis (ED-BM) by using ventricular and lumbar catheters. Methods. A cohort of 230 consecutive patients with ED was evaluated. Cerebrospinal fluid samples were obtained daily for microbiological culture, and ED-BM was defined based on culture results in combination with clinical symptoms. The incidence of ED-BM was 7% in lumbar and 15% in ventricular drains. Independent risk factors included site leakage, drain blockage, and most importantly duration of ED. Despite a higher infection rate, ventricular catheters did not have a significant higher risk of infection after correcting for duration of drainage. Conclusions. Analysis of data in the present study showed that the incidence of ED-associated death is low (0.45%) in patients who do not receive continuous antibiotic prophylaxis during ED.

Tunneled lumbar drain

2002 ◽  
Vol 96 (6) ◽  
pp. 1130-1131 ◽  
Author(s):  
Michael Hahn ◽  
Raj Murali ◽  
William T. Couldwell
Keyword(s):  
Cerebrospinal Fluid ◽  
Lateral Position ◽  
Tuohy Needle ◽  
External Drainage ◽  
Content Type ◽  
Rapid Procedure ◽  
Lumbar Drain ◽  
Csf Drainage ◽  
Usual Manner ◽  
Fine Print

✓ The authors report a simple and rapid procedure for tunneling a lumbar drain subcutaneously to facilitate chronic cerebrospinal fluid (CSF) drainage. A standard lumbar puncture (LP) is performed with a large-bore Tuohy needle (14- to 16-gauge), the drainage catheter is advanced into the subarachnoid space, and the needle is removed. The free Tuohy needle is then passed from a lateral position and brought out through the initial LP site. The free catheter is fed through the needle, and the needle is removed. The drain is attached to an external drainage bag in the usual manner. The authors have found this method particularly useful in some skull base and spinal surgical applications in which longer term continuous CSF drainage is desired.

Independent predictors of morbidity after image-guided stereotactic brain biopsy: a risk assessment of 270 cases

2005 ◽  
Vol 102 (5) ◽  
pp. 897-901 ◽  
Author(s):  
Matthew J. McGirt ◽  
Graeme F. Woodworth ◽  
Alex L. Coon ◽  
James M. Frazier ◽  
Eric Amundson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Basal Ganglia ◽  
Predictive Value ◽  
Brain Biopsy ◽  
Stereotactic Brain Biopsy ◽  
Content Type ◽  
Image Guided ◽  
Independent Risk Factors ◽  
Thalamic Lesions ◽  
Fine Print

Object. Image-guided stereotactic brain biopsy is associated with transient and permanent incidences of morbidity in 9 and 4.5% of patients, respectively. The goal of this study was to perform a critical analysis of risk factors predictive of an enhanced operative risk in frame-based and frameless stereotactic brain biopsy. Methods. The authors reviewed the clinical and neuroimaging records of 270 patients who underwent consecutive frame-based and frameless image-guided stereotactic brain biopsies. The association between preoperative variables and biopsy-related morbidity was assessed by performing a multivariate logistic regression analysis. Transient and permanent stereotactic biopsy-related morbidity was observed in 23 (9%) and 13 (5%) patients, respectively. A hematoma occurred at the biopsy site in 25 patients (9%); 10 patients (4%) were symptomatic. Diabetes mellitus (odds ratio [OR] 3.73, 95% confidence interval [CI] 1.37–10.17, p = 0.01), thalamic lesions (OR 4.06, 95% CI 1.63–10.11, p = 0.002), and basal ganglia lesions (OR 3.29, 95% CI 1.05–10.25, p = 0.04) were independent risk factors for morbidity. In diabetic patients, a serum level of glucose that was greater than 200 mg/dl on the day of biopsy had a 100% positive predictive value and a glucose level lower than 200 mg/dl on the same day had a 95% negative predictive value for biopsy-related morbidity. Pontine biopsy was not a risk factor for morbidity. Only two (4%) of 45 patients who had epilepsy before the biopsy experienced seizures postoperatively. The creation of more than one needle trajectory increased the incidence of neurological deficits from 17 to 44% when associated with the treatment of deep lesions (those in the basal ganglia or thalamus; p = 0.05), but was not associated with morbidity when associated with the treatment of cortex lesions. Conclusions. Basal ganglia lesions, thalamic lesions, and patients with diabetes were independent risk factors for biopsy-associated morbidity. Hyperglycemia on the day of biopsy predicted morbidity in the diabetic population. Epilepsy did not predispose to biopsy-associated seizure. For deep-seated lesions, increasing the number of biopsy samples along an established track rather than performing a second trajectory may minimize the incidence of morbidity. Close perioperative observation of glucose levels may be warranted.

Risk factors for surgical site infection in spinal surgery

2003 ◽  
Vol 98 (2) ◽  
pp. 149-155 ◽  
Author(s):  
Margaret A. Olsen ◽  
Jennie Mayfield ◽  
Carl Lauryssen ◽  
Louis B. Polish ◽  
Marilyn Jones ◽  
...  
Keyword(s):  
Risk Factors ◽  
Morbid Obesity ◽  
Spinal Fusion ◽  
Spinal Surgery ◽  
Posterior Approach ◽  
Tumor Resection ◽  
Content Type ◽  
Independent Risk Factors ◽  
Postoperative Incontinence ◽  
Fine Print

Object. The objective of this study was to identify specific independent risk factors for surgical site infections (SSIs) occurring after laminectomy or spinal fusion. Methods. The authors performed a retrospective case-control study of data obtained in patients between 1996 and 1999 who had undergone laminectomy and/or spinal fusion. Forty-one patients with SSI or meningitis were identified, and data were compared with those acquired in 178 uninfected control patients. Risk factors for SSI were determined using univariate analyses and multivariate logistic regression. The spinal surgery—related SSI rate (incisional and organ space) during the 4-year study period was 2.8%. Independent risk factors for SSI identified by multivariate analysis were postoperative incontinence (odds ratio [OR] 8.2, 95% confidence interval [CI] 2.9–22.8), posterior approach (OR 8.2, 95% CI 2–33.5), procedure for tumor resection (OR 6.2, 95% CI 1.7–22.3), and morbid obesity (OR 5.2, 95% CI 1.9–14.2). In patients with SSI the postoperative hospital length of stay was significantly longer than that in uninfected patients (median 6 and 3 days, respectively; p < 0.001) and were readmitted to the hospital for a median additional 6 days for treatment of their infection. Repeated surgery due to the infection was required in the majority (73%) of infected patients. Conclusions. Postoperative incontinence, posterior approach, surgery for tumor resection, and morbid obesity were independent risk factors predictive of SSI following spinal surgery. Interventions to reduce the risk for these potentially devastating infections need to be developed.

Cerebrospinal fluid GABA reductions in seizure patients evoked by cerebellar surface stimulation

1977 ◽  
Vol 47 (4) ◽  
pp. 582-589 ◽  
Author(s):  
James H. Wood ◽  
Bruce S. Glaeser ◽  
Theodore A. Hare ◽  
Jonas Sode ◽  
Benjamin R. Brooks ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cyclic Guanosine Monophosphate ◽  
Guanosine Monophosphate ◽  
Gamma Aminobutyric Acid ◽  
Content Type ◽  
Percentage Decrease ◽  
Radio Immunoassay ◽  
Lumbar Cerebrospinal Fluid ◽  
Fine Print ◽  
Cerebellar Stimulation

✓ Lumbar cerebrospinal fluid (CSF) gamma-aminobutyric acid (GABA) levels determined by fluorometric assay in four seizure patients were found to be significantly lower during bilateral, continuous cerebellar stimulation than those determined after a 7-day period without stimulation. The CSF GABA concentrations during chronic unilateral, alternating cerebellar stimulation were reduced in three seizure patients but unchanged in a fourth patient. The percentage decrease in CSF GABA appeared to be independent of cerebellar stimulation frequency. These findings suggest that GABA-mediated neuronal transmission is depressed during cerebellar surface stimulation and this evoked reduction in GABA activity may compromise the efficacy of cerebellar stimulation in the treatment of epilepsy. Lumbar CSF cyclic guanosine monophosphate levels determined by radio-immunoassay were not significantly altered by either mode or frequency of cerebellar stimulation.

Norepinephrine in cerebrospinal fluid of patients with cerebral vasospasm

1982 ◽  
Vol 56 (3) ◽  
pp. 344-349 ◽  
Author(s):  
Taku Shigeno
Keyword(s):  
Cerebrospinal Fluid ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Fluorometric Method ◽  
Content Type ◽  
Highly Sensitive ◽  
Secondary Phenomenon ◽  
Lumbar Cerebrospinal Fluid ◽  
The Brain ◽  
Fine Print

✓ The content of norepinephrine (NE) in the ventricular, basal cisternal, and lumbar cerebrospinal fluid (CSF) was determined in 19 patients with ruptured cerebral aneurysms at different intervals according to the presence or absence of vasospasm. Twelve were operated on within 3 days after subarachnoid hemorrhage (SAH), prior to the occurrence of vasospasm. Postoperatively, CSF was continuously drained from a basal cistern or lateral ventricle. Norepinephrine was assayed by the highly sensitive automated fluorometric method. The concentration of NE increased in all sites of CSF sampling along with the appearance of vasospasm. Above all, the cisternal CSF of patients with vasospasm contained significantly higher NE (0.246 ± 0.049 ng/ml, mean ± SEM) compared to those without vasospasm (0.075 ± 0.001 ng/ml) (p < 0.001). However, since this increase cannot be considered to be high enough locally to constrict cerebral arteries, this might be only a secondary phenomenon due to release of NE into CSF from various sources in the brain.

Prophylactic administration of ceftriaxone for the prevention of meningitis after traumatic pneumocephalus: results of a clinical trial

2004 ◽  
Vol 101 (5) ◽  
pp. 757-761 ◽  
Author(s):  
Behzad Eftekhar ◽  
Mohammad Ghodsi ◽  
Farideh Nejat ◽  
Ebrahim Ketabchi ◽  
Babak Esmaeeli
Keyword(s):  
Risk Factors ◽  
Clinical Trial ◽  
Cerebrospinal Fluid ◽  
Head Injury ◽  
Intracranial Hemorrhage ◽  
Mild Head Injury ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Air Volume ◽  
Fine Print

Object. The purpose of this study was to compare the efficacy of the prophylactic use of ceftriaxone for the prevention of meningitis in patients with acute traumatic pneumocephalus. Methods. In this prospective, single-institution, randomized clinical trial, 109 patients with mild head injury and traumatic pneumocephalus were randomly assigned to receive or not receive an antibiotic medication (ceftriaxone, 1 g given twice a day) until occurrence of meningitis or at least 5 days after trauma. The patients were followed up for 1 month posttrauma. The 109 patients were divided into two groups: 53 were assigned to the prophylactic antibiotics therapy group and 56 to the control group. The overall rate of meningitis was 20.1% and the rates of meningitis in the two groups were not significantly different. The results were the same when adjusted for the patient's Glasgow Coma Scale score, sex, and age, as well as for an intradural location of air, air volume, presence of cerebrospinal fluid (CSF) rhinorrhea or CSF otorrhea, radiological sign of a skull base fracture, or intracranial hemorrhage. Conclusions. The results of this study do not substantiate the efficacy of ceftriaxone used in the prevention of meningitis in patients with traumatic pneumocephalus after mild head injury or in any specific subgroup of these patients. Cerebrospinal fluid rhinorrhea and intracranial hemorrhage may be considered primary risk factors for the development of meningitis in patients with posttraumatic pneumocephalus and, in the absence of these symptoms, intradural location of air and air volume greater than 10 ml may be considered secondary risk factors. Further studies in this area are warranted.

Mixed bacterial meningitis: A complication of ventriculo- and lumboperitoneal shunts

1977 ◽  
Vol 47 (6) ◽  
pp. 961-964 ◽  
Author(s):  
Itzhak Brook ◽  
Neil Johnson ◽  
Gary D. Overturf ◽  
Jeanette Wilkins
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Infectious Complications ◽  
Colonic Perforation ◽  
Shunt Surgery ◽  
Peritoneal Catheter ◽  
Distal Limb ◽  
Content Type ◽  
Aerobic And Anaerobic ◽  
Fine Print

✓ Infectious complications of ventriculo- and lumboperitoneal shunts in two patients are presented. Cerebrospinal fluid infection due to aerobic and anaerobic enteric flora was characteristic of each case. Both infections occurred several months after shunt surgery and were associated with colonic perforation by the distal limb of the peritoneal catheter. These cases emphasize this unusual hazard of peritoneal shunts and demonstrate methods for diagnosis and effective therapy.

Intracranial lipoma

1980 ◽  
Vol 52 (2) ◽  
pp. 234-245 ◽  
Author(s):  
Ekkehard Kazner ◽  
Otto Stochdorph ◽  
Sigurd Wende ◽  
Thomas Grumme
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Approach ◽  
Clinical Symptoms ◽  
Ct Scanning ◽  
Shunt Operation ◽  
Content Type ◽  
X Ray ◽  
Intracranial Lipoma ◽  
X Ray Absorption ◽  
Fine Print

✓ Eleven cases of intracranial lipoma, diagnosed during life by computerized tomography (CT) scanning, are presented. Clinical symptoms related to the lesions were present in eight. The CT scan establishes the diagnosis of intracranial lipoma on the basis of typical x-ray absorption and location. Only dermoid cysts and teratomas may produce a similar CT appearance. In cases of intracranial lipoma, a direct surgical approach is seldom necessary, although in certain locations, lipomas may cause blockage of cerebrospinal fluid pathways and require a shunt operation.

Cerebrospinal fluid shunt infection: a prospective study of risk factors

2001 ◽  
Vol 94 (2) ◽  
pp. 195-201 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
James M. Drake ◽  
Maria Lamberti-Pasculli
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Shunt Infection ◽  
Csf Leak ◽  
Csf Shunt ◽  
Shunt System ◽  
Content Type ◽  
Increased Risk ◽  
Csf Shunt Infection ◽  
Fine Print

Object. Hydrocephalus is a common condition of childhood that usually requires insertion of a cerebrospinal fluid (CSF) shunt. Infection is one of the most devastating complications that may arise from the presence of CSF shunts. In this study, the authors prospectively analyzed perioperative risk factors for CSF shunt infection in a cohort of children. Methods. Between 1996 and 1999, 299 eligible patients underwent CSF shunt operations (insertions and revisions) that were observed by a research nurse at a tertiary care pediatric hospital. Several perioperative variables were recorded. All cases were followed postoperatively for 6 months to note any development of CSF shunt infection. A Cox proportional hazards model was used to analyze the relationship between the variables and the development of shunt infection. Thirty-one patients (10.4%) experienced shunt infection. Three perioperative variables were significantly associated with an increased risk of shunt infection: 1) the presence of a postoperative CSF leak (hazard ratio [HR] 19.16, 95% confidence interval [CI] 6.96–52.91); 2) patient prematurity (< 40 weeks' gestation at the time of shunt surgery: HR 4.72, 95% CI 1.71–13.06); and 3) the number of times the shunt system was inadvertently exposed to breached surgical gloves (HR 1.07, 95% CI 1.02–1.12). Conclusions. Three variables associated with an increased incidence of shunt infection have been identified. Changes in clinical practice should address these variables, as follows. 1) Great care should be taken intraoperatively to avoid a postoperative CSF leak. 2) Alternatives to placement of a CSF shunt in premature infants should be studied. 3) Surgeons should minimize manual contact with the shunt system and consider the use of double gloves.

Primary intranasal encephalocele

1982 ◽  
Vol 57 (4) ◽  
pp. 552-555 ◽  
Author(s):  
A. Rashid Choudhury ◽  
Julien C. Taylor
Keyword(s):  
Cerebrospinal Fluid ◽  
Bacterial Meningitis ◽  
Nasal Polyp ◽  
Nasal Polyps ◽  
Csf Rhinorrhea ◽  
Content Type ◽  
Cranial Trauma ◽  
The Third ◽  
Fine Print ◽  
Anatomical Defects

✓ Four cases of primary intranasal encephalocele are presented. Three of the patients had been treated for nasal polyps. One of these three patients presented with persistent cerebrospinal fluid (CSF) rhinorrhea after a fourth polypectomy, another with recurrent CSF rhinorrhea and bacterial meningitis following a second polypectomy, and the third case with recurrence of meningitis, also following polypectomy. Recurrent bacterial meningitis was the mode of presentation in the fourth case. Encephalocele was the isolated abnormality in three, but the fourth had a degree of associated hypertelorism. The diagnosis of encephalocele should be considered in any patient with a nasal polyp, especially in children and in patients with recurrent bacterial meningitis, with or without rhinorrhea, in the absence of cranial trauma or surgery, or in the absence of external craniospinal anatomical defects.

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