Ventriculitis: Infection or Inflammation

Ventriculitis, or infection of the cerebrospinal fluid, in the presence of external ventricular drains (EVD), is an important complication and associated with substantial mortality, morbidity, and healthcare costs. Further, the conditions that require the insertion of an EVD, such as neurotrauma and subarachnoid hemorrhage, are themselves associated with inflammation of the cerebrospinal fluid. Phenotypically, patients with inflammation of the cerebrospinal fluid can present with very similar symptoms, signs, and laboratory findings to those with infection. This review examines various controversies relating to the definitions, diagnosis, challenges of differentiating infection from inflammation, prevention, and treatment of ventriculitis in patients with EVDs.

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Accelerated Non-Muscle Contraction after Subarachnoid Hemorrhage: Cerebrospinal Fluid Testing in a Culture Model

Neurosurgery ◽

10.1227/00006123-199012000-00010 ◽

1990 ◽

Vol 27 (6) ◽

pp. 921-928 ◽

Cited By ~ 26

Author(s):

Yoshihiro Yamamoto ◽

David H. Bernanke ◽

Robert R. Smith

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Collagen Matrix ◽

Aneurysm Rupture ◽

Lattice Contraction ◽

Symptomatic Vasospasm ◽

Luminal Narrowing ◽

Chronic Vasospasm ◽

Vitro Model

Abstract The cause of chronic cerebral vasospasm after subarachnoid hemorrhage has been studied intensively, but it is still controversial whether the observable luminal narrowing should be attributed to the contraction of vascular smooth muscle cells or whether it results from some organic change in the wall. A proliferation of myointimal cells, accompanied by increased deposition of collagen, as well as myonecrosis, have been frequently observed several days after aneurysm rupture. Studies from our laboratory showed that these myointimal cells had characteristics identical to myofibroblasts. In this study, we quantitatively and morphologically examined the effect of cerebrospinal fluid on the ability of myofibroblasts to alter collagen matrices using an in vitro model. Myofibroblasts contract the collagen matrix by rearranging or compacting the framework of collagen fibers. Cerebrospinal fluid obtained from patients with recently ruptured aneurysms significantly accelerated lattice contraction, especially when the patient developed symptomatic vasospasm. This study suggests that myofibroblasts in the spastic artery can produce a contractile force that contributes to chronic vasospasm, tightening the proliferated collagen. Some unknown agent present in bloody cerebrospinal fluid accelerates the rearrangement of the collagen lattice by myofibroblasts, both of which have, until now, been considered non-contractile components.

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Increased concentration of atrial natriuretic factor in the cerebrospinal fluid of patients with aneurysmal subarachnoid hemorrhage and raised intracranial pressure

Neurosurgery ◽

10.1097/00006123-198807000-00003 ◽

1988 ◽

Vol 23 (1) ◽

pp. 16???9

Author(s):

T D??czi ◽

F Jo?? ◽

M Vecserny??s ◽

M Bodosi

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Intracranial Pressure ◽

Atrial Natriuretic Factor ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Raised Intracranial Pressure ◽

Natriuretic Factor ◽

Atrial Natriuretic

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Abstract TMP23: Inflammasome-derived Caspase-1 is Elevated in the Cerebrospinal Fluid of Subarachnoid Hemorrhage Patients and Correlated to Outcome

Stroke ◽

10.1161/str.51.suppl_1.tmp23 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Yonatan Hirsch ◽

Joseph R Geraghty ◽

Eitan A Katz ◽

Jeffrey A Loeb ◽

Fernando Testai

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

External Ventricular Drain ◽

Analysis Of Covariance ◽

Control Group ◽

Normal Brain ◽

Poor Outcome ◽

Caspase 1 ◽

Initial Severity ◽

Poor Outcomes

Introduction: The role of neuroinflammation following aneurysmal subarachnoid hemorrhage (SAH) and its relationship to outcome is the subject of many ongoing studies. The proteolytic enzyme, caspase-1, activated by the inflammasome complex, is known to contribute to numerous downstream pro-inflammatory effects. In this study, we investigated caspase-1 activity in the cerebrospinal fluid (CSF) of SAH patients and its association to outcome. Methods: SAH patients were recruited from a regional stroke referral center. CSF samples from 18 SAH subjects were collected via an external ventricular drain and obtained within 72 hours of the onset of symptoms. For control subjects, we collected the CSF from 9 patients undergoing lumbar puncture with normal CSF and normal brain MRI. Caspase-1 activity was measured using commercially available luminescence assays. SAH subjects were categorized at hospital discharge into those with good outcomes (Glasgow Outcome Scale, GOS, of 4-5) and poor outcomes (GOS of 1-3). The levels of caspase-1 activity in various groups were analyzed using Mann-Whitney and Pearson correlation tests. Caspase-1 activity was also adjusted by initial severity of bleed using analysis of covariance (ANCOVA). Results: Caspase-1 levels from SAH patients were significantly higher than that measured from the control group (mean 1.06x10-2 vs 1.90x10-3 counts per second (CPS)/μl*min), p = 0.0002). Within the SAH group, 10 patients (55.6%) had good outcomes and 8 patients (44.4%) had poor outcomes. Caspase-1 activity was significantly higher in the poor outcome group (mean 1.54x10-2 vs 1.60x10-3 CPS/μl*min), p = 0.0012). Additionally, caspase-1 activity had a statistically significant correlation with GOS score (r = -0.60; p = 0.0100). When adjusted for initial severity of bleed, the difference in caspase-1 activity in good vs. poor outcome remained significant (adjusted mean 7.10x10-3 vs. 2.54x10-2 CPS/μl*min, p=0.004). Conclusions: The inflammasome-dependent protein caspase-1 is elevated in CSF early after SAH and higher in those with poor functional outcome. Inflammasome activity therefore may serve as a novel biomarker to predict outcome shortly after aneurysm rupture.

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Abstract T P351: Unbound Iron and Ceruloplasmin Levels in Cerebrospinal Fluid Are Associated with Development of Deep Cerebral Infarcts Following Subarachnoid Hemorrhage

Stroke ◽

10.1161/str.45.suppl_1.tp351 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Lauren Koffman ◽

Gabor Toth ◽

M. Shazam Hussain ◽

Magdy Selim ◽

Peter Rasmussen ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Subarachnoid Hemorrhage ◽

Cerebral Infarcts ◽

Active Iron ◽

Redox Active ◽

Wilcoxon Rank Sum Test ◽

Radiological Data ◽

Experimental Subarachnoid Hemorrhage ◽

Preliminary Study ◽

Iron Redox

Introduction: Iron-dependent formation of reactive oxygen species has been implicated in the development of vasospasm (VSP) and neuronal injury following experimental subarachnoid hemorrhage (SAH). We report the association between unbound (“free”) iron in CSF of SAH patients and the risk of angiographic vasospasm and cerebral infarcts (CI) on neuroimaging from a recently completed pilot study. Methods: Samples of cerebrospinal fluid (CSF) were obtained on days 1, 3, and 5. A fluorometric assay that relies on an oxidation sensitive probe was used to measure redox active iron (REDOX-Fe). Ceruloplasmin (Cp) concentration and levels of malondialdehyde (MDA), a marker of lipid peroxidation were also measured. We prospectively collected and recorded demographic, clinical, and radiological data. Logistic regression and Wilcoxon Rank Sum test were used. Results: Five of 12 patients developed angiographic VSP (41.6%) and eight developed CI (66.6%). Mean REDOX-Fe was higher in patients with CI (3.96 ± 0.97 Vs. 2.77 ± 0.87 mcg/dl, p 0.07), particularly in patients with deep-seated strokes (4.56 ± 0.67 Vs. 3.35 ± 0.89, p 0.03). Levels of Cp at day 3 were lower in patients with deep strokes (34,092 ± 23,780 Vs. 86,045 ± 34,752 ng/ml, p 0.03). A trend towards higher REDOX-Fe on day 3 in patients who developed VSP (4.52 ± 1.16 Vs. 2.96 ± 0.71, p 0.07), and lower Cp levels on day 5 (45,033 ± 29,079 Vs. 63,044 ± 24,821, p 0.1) was found. Levels of MDA were higher in patients who developed CI (10.36 ± 4.36 Vs. 5.9 ± 4.2 nmol, p 0.08). Conclusions: In this preliminary study we found higher concentrations of redox active iron in CSF of SAH patients who develop deep-seated CI on neuroimaging. Evidence of increased oxidative damage correlated with development of CI. A possible association between non-protein bound iron and angiographic VSP is suggested as well. Ceruloplasmin may exert a protective effect in this setting. Further studies are needed to validate these findings.

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AUREOMYCIN IN STAPHYLOCOCCIC MENINGITIS COMPLICATING SUBARACHNOID HEMORRHAGE IN SICKLE CELL ANEMIA

PEDIATRICS ◽

10.1542/peds.3.6.764 ◽

1949 ◽

Vol 3 (6) ◽

pp. 764-768

Author(s):

JOHN R. ALMKLOV ◽

ARILD E. HANSEN

Keyword(s):

Subarachnoid Hemorrhage ◽

Sickle Cell ◽

Sickle Cell Anemia ◽

Therapeutic Agent ◽

In Vitro Studies ◽

Neurologic Complications ◽

Rare Occurrence ◽

Laboratory Findings ◽

Spontaneous Subarachnoid Hemorrhage

The rare occurrence of a spontaneous subarachnoid hemorrhage in an 11 year old Negro boy with sickle cell anemia is recorded. Of the eight reported cases five have occurred in children. In the study of sickle cell anemia it is evident there is an increasing awareness of this as well as other neurologic complications. This patient developed staphylococcus albus meningitis which for 12 days resisted combined penicillin, streptomycin and sulfadiazine therapy. The response to aureomycin as a sole therapeutic agent was dramatic, and this represents the first reported case of meningitis treated with this drug. The use of aureomycin as the only antibiotic in this staphylococcic infection seems to have been fortunate in view of the laboratory findings. In vitro studies disclosed that when penicillin and aureomycin or streptomycin and aureomycin were combined, the result was a decrease in the effectiveness of either drug on staphylococci.

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