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Neurology and neurosurgery
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
The history and physical examination suggest a diagnosis of a space-occupying lesion with raised intracranial pressure in the left hemisphere, possibly associated with infection. Lumbar puncture is dangerous as it may cause herniation of the medulla. The EEG would be abnormal and a CAT scan would accurately demonstrate the position and the nature of the lesion. Head ultrasound, though helpful, is not possible (fonantelle being closed) and therefore will not establish the diagnosis.
Encephalitis
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Perform lumbar puncture and assess (see Chapter 2.8 for interpretation of CSF) Opening pressureWhite cell count and differentiationRed blood cell countProteinGlucose CSF:blood ratioLactate
Clinical Assessment of Patients with Dementia
Published in Zaven S. Khachaturian, Teresa S. Radebaugh, Alzheimer’s Disease, 2019
Several other investigations are indicated in the evaluation of selected patients with cognitive disorders, depending upon the results of the history and examination. Lumbar puncture is an important test when the history and examination suggest an infectious process such as bacterial, fungal, or viral meningitis or a neoplastic process such as carcinomatous meningitis. Studies are currently in process to determine whether cerebrospinal fluid immunoreactivity with a monoclonal antibody, Alz-50, might be helpful in the diagnosis of Alzheimer’s disease.54 Electroencephalography can be diagnostic in patients suspected of having Creutzfeldt-Jakob disease and seizure disorders. The finding that abnormalities in the EEG correlate with the severity of the dementia in Alzheimer’s disease55 is interesting but does not justify the use of EEG in the regular evaluation of persons with cognitive disorder. Evoked potential studies have some promise of assisting in the diagnosis of early Alzheimer’s disease, since changes in the P300 wave are associated with dementia.56 The specificity and sensitivity of these changes, however, are inadequate to allow this test to be regarded as a definitive diagnostic tool. Roentgenograms of the skull are not helpful in the evaluation of cognitive disorders except after recent craniocerebral trauma, and cerebral arteriography is indicated only in patients with cognitive changes under evaluation for vasculitis or arteriosclerotic cerebrovascular disease.
SCN1A as a therapeutic target for Dravet syndrome
Published in Expert Opinion on Therapeutic Targets, 2023
Another potential barrier to human trials is administration, given that in animal testing, these agents have been given via a single injection into the cerebral ventricles. Intrathecal injection is reasonably straightforward to arrange in humans but can become problematic if injections must be repeated frequently. Each lumbar puncture carries with it risks for headache, infection, bleeding, and persistent cerebrospinal fluid leak which could require treatment with blood patch, an invasive, painful procedure. Additionally, when comparing to spinal muscular atrophy, the prototypic neurological disease treated with ASOs, Dravet syndrome has some unique challenges. Spinal muscular atrophy patients typically have normal intelligence so older individuals can undergo intrathecal injection with only local anesthetic; however, because of the significant cognitive impairment, even adult Dravet patients would require sedation, which has associated risks.
Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications
Published in Expert Review of Medical Devices, 2023
The CSF is a highly informative source to inquire about CNS. Under normal conditions, the composition of CSF remains roughly constant within certain ranges of normality. However, various neurological diseases can alter the composition, quantity, and pressure. Lumbar puncture for CSF analysis is a routine test in clinical neurology diagnostic workouts. Also, CSF is an extremely useful matrix for biomarker research for several purposes, such as diagnosis, prognosis, monitoring, and identification of prominent leads in pathways of neurologic diseases [2]. In contrast, CSF has not been extensively regarded as a target biological fluid for therapies for CNS conditions. Today, few drugs are delivered in the CSF, mainly because it is an invasive procedure not without risks. However, in the last decades, therapies addressed at the CSF have gained some momentum as a result of advanced treatments such as gene therapies and replacement enzymatic therapies which need intrathecal (IT) or intraventricular (IVT) delivery. In addition, methods aimed at filtration CSF are a group of therapeutic procedures that have been proposed to treat neurological conditions where pathogens are present in the CSF. This includes microorganisms, antibodies, inflammatory mediators, or abnormal peptides that are the cause or play an important role in the pathogenesis of the disease [3,4].
Purkinje cell (PC) antibody positivity in a patient with autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy
Published in International Journal of Neuroscience, 2022
Li Xu, Wenbiao Xian, Jin Li, Xiaoli Yao, Youming Long
The study was approved by the Ethics Committee of the First Affiliated Hospital of Sun Yat-Sen University, China. The patient provided informed consent for this study. Demographic features, clinical characteristics, CSF parameters, and neuroimaging findings were collected from this patient between September 2018 and October 2019 (Table 1). We used both the Expanded Disability Status Scale (EDSS) score and the Modified Rankin Scale (MRS) score to assess the treatment outcome [5,12]. Cognitive function was measured with the Mini Mental State Examination (MMSE). The patient underwent lumbar puncture before the treatment during hospitalization. CSF specimens were assayed for leucocytes, glucose, protein, India ink staining, cultures, and various autoimmune antibody profiles. Clinical information was recorded at discharge and at 1, 2, 5, and 8 months of follow-up.