China
Africa
Explore chapters and articles related to this topic
Basics of CSF production
Published in Jyotirmay S. Hegde, Hemanth Vamanshankar, CSF Rhinorrhea, 2020
Hemanth Vamanshankar, Jyotirmay S Hegde
CSF has a mean production of 0.36 ml/min and a density of 1.003–1.008 g/cm.9 Beta-2-transferrin, being specific to CSF (found otherwise only in perilymph and ocular fluids) is a desialated isoform of the iron-binding glycoprotein transferrin.10 β-trace protein (βTP), the second most abundant protein in human CSF after albumin and produced in epithelial cells of the choroid plexus, is another potential marker of CSF diagnosis. It is thought to be important in the maturation and maintenance of CSF as it is identical to prostaglandin D synthase. It also has a higher sensitivity and specificity as a CSF marker than β2 transferrin. Chemically, CSF has a higher concentration of chloride and lower concentrations of potassium, protein and glucose, as compared to plasma.11
Management of acute nasal trauma
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
A CSF leak may occur after nasal or facial trauma when the fracture involves the cribriform plate or the lateral lamella of the cribriform plate. These are the thinnest areas of the skull base, where the dura is very adherent to the bone and tears when the bone fractures. The most common presentation is unilateral watery rhinorrhea, which registers positive to Beta 2-transferrin (asialotransferrin) on testing. Beta 2-transferrin is a product of neuraminidase activity within the central nervous system, and is therefore only found within the CSF, perilymph and aqueous humor; it is therefore a highly sensitive test for the presence of CSF. The majority of traumatic CSF leaks resolve within 7–14 days with conservative management. This includes strict bed rest and elevation of the head, with avoidance of straining, retching or nose blowing. Antibiotics may mask meningitis, and discussion with the neurosurgeons is advised to check local policy. If the CSF leak does not settle, the location should be identified using high resolution CT scanning of the skull base, along with MRI if required. Endoscopic repair of the leak should be undertaken as soon as possible, as there is a significantly increased risk of meningitis (0.3–10% per year).
CSF Leaks
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The next goal is to obtain fluid for testing. Ideally this can be obtained at the office visit, sometimes with postural provocation (Figure 108.4). When this is unsuccessful we will sometimes have patients run up stairs in an effort to increase intra-cranial pressure and produce drainage or strain on a closed glottis. If this fails, patients are given vials to take home to catch fluid for testing. In the United States the beta-2-transferrin test is widely available and the most commonly used. A downside of the test is that it may only be performed in certain major centres and thus it may take a few days to get a result. The beta-2-transferrin test provides excellent sensitivity, specificity and positive and negative predictability in the diagnosis of CSF leaks.19 A concomitant serum value enhances its utility. Occasional false positives have been reported in certain liver diseases or hereditary disorders of protein metabolism. It has been suggested in some European studies that beta-trace protein is an even better test than beta-2-transferin in detecting CSF leaks.19
Advances in CSF shunt devices and their assessment for the treatment of hydrocephalus
Published in Expert Review of Medical Devices, 2021
Kamran Aghayev, Sheikh MA Iqbal, Waseem Asghar, Bunyad Shahmurzada, Frank D. Vrionis
Shunt malfunctioning may occur due to various reasons including obstruction, disconnection, and migration of the catheters to undesired locations [82]. Traditionally, the performance of the CSF shunt device has been assessed using clinical evaluation combined with imaging such CT, MRI, or X-ray. Shunt reservoir pressing with refill is also of commonly used. However, all above mentioned methods are not sufficient to properly evaluate the shunt’s performance. Therefore, additional noninvasive methods are being developed. One innovative solution is M.scio (Aesculap Miethke). This is an electronic pressure sensor-transmitter incorporated into a reservoir. It can be used to measure the pressure in a noninvasive, telemetric way via reader kit. Therefore, it can be used to diagnose shunt obstruction as well as provide feed-back information for pressure adjustments. Another recent innovative product is ShuntCheck III, which uses thermal flow evaluation. The device detects drop in temperature on the skin over skin shunt’s distal catheter while ice pack is applied immediately proximal to thermal sensors. The absence of temperature dip is an indicator of obstruction [83–85]. Also, laboratory beta 2 transferrin detection in plasma as diagnostic tool has been reported by our group [86]. However, this method should be verified in a large number of studies for full clinical implementation.
Recurrent symptomatic pleural effusion from a syringopleural shunt
Published in Baylor University Medical Center Proceedings, 2021
Crystal T. Ajja, Tiffany F. Chang, Eric Ayers
Upon further chart review, the patient was found to have had a right-sided pleural effusion for multiple years with previous thoracenteses resulting in negative infectious workups. Upon suspicion that the pleural effusion was secondary to the syringopleural shunt, the pleural fluid was tested for beta-2 transferrin, which was detected, indicating the presence of cerebrospinal fluid (CSF). The patient reported five revisions prior to the last shunt revision 5 years prior. CT of the thorax with contrast showed appropriate placement of the syringopleural shunt, and magnetic resonance imaging (MRI) of the thoracic spine without contrast showed no recurrence of syringomyelia (Figure 1b). Since the fluid was transudative and cultures were negative, this pleural effusion was likely secondary to his syringopleural shunt draining into the pleural space without resorption of fluid. Nine days following thoracentesis, the patient began experiencing increasing dyspnea again, and repeat chest x-ray demonstrated a reaccumulation of pleural fluid. He was to follow-up with neurosurgery to discuss shunt revision options with a programmable valve.
Paediatric orbital conjunctival epithelial cyst with positive asialotransferrin
Published in Orbit, 2020
Rukaiya Malik, James English, Thomas G. Hardy
Conjunctival orbital cysts are rare; they are typically either dermoid or epithelial cysts – congenital or acquired (inclusion). The case of a pediatric orbital conjunctival cyst from which an aspirate tested positive for asialotransferrin, with an adjacent middle cranial fossa anomaly, is explored including discussing the possible explanations for the unusual finding of asialotransferrin, typically found in cerebrospinal fluid. The gold standard biochemical marker for cerebrospinal fluid leakage is asialotransferrin, also known as Beta-2 transferrin.1 This marker is a desialated isoform of transferrin that does not contain neuraminic acid. This transferrin is most commonly present in cerebrospinal fluid but notably is also present in aqueous humor and inner ear perilymph.2,3 It is not detected in serum, nasal secretion, tears, saliva or any other body fluid.4,5 A literature review of asialotransferrin testing, developmental anomalies, and pediatric conjunctival orbital cyst classification are presented.