Clinical Assessment of Patients with Dementia
Zaven S. Khachaturian, Teresa S. Radebaugh in 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.
Questions for part B
Henry J. Woodford in Essential Geriatrics, 2022
A 65-year-old woman presents with a five-month history of progressive confusion. She is no longer able to feed herself, struggles to verbally express her needs and spends most of the day sitting in a chair. Occasional twitching of her arms has been noticed. An MRI scan of the brain did not detect a focal abnormality. A lumbar puncture is performed. Which test should be performed on the fluid obtained?14-3-3 proteinElectrophoresisPrion-related proteinSyphilis serologyViral serology
ENTRIES A–Z
Philip Winn in Dictionary of Biological Psychology, 2003
The CSF protects the brain from mechanical shocks, and provides an optimal chemical environment for neuronal signalling. It also has a role in circulating HORMONES and NEUROTRANSMITTERS (see VOLUME TRANSMISSION) and removing waste products and drugs. CSF is formed in the CHOROID PLEXUS on ventricular walls via chemical filtering of the blood across the blood-cerebrospinal fluid barrier. The CSF passes through the ventricles, central canal of the spinal cord, and the surface of the brain and spinal cord and is then absorbed back into the blood through the arachnoid villi located in the superior sagittal sinus, a large superficial vein. Normally, the rate of formation matches the rate of reabsorption of CSR However, an obstruction of the normal drainage, excess formation of CSF, or any space-occupying conditions such as a TUMOUR or haematoma could result in an abnormal increase in the CSF pressure, causing damage to brain tissues and nerves. This condition is called HYDROCEPHALUS. CSF can be sampled in patients by LUMBAR PUNCTURE— insertion of a needle into the central canal of the spinal cord and drawing off of fluid. Chemical analysis of CSF can provide important clues to dysfunction in the state of the brain.
Cerebrospinal fluid leaks secondary to dural tears: a review of etiology, clinical evaluation, and management
Published in International Journal of Neuroscience, 2021
Jason Gandhi, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
There are several options when using neuroimaging to assist in clinically diagnosing a dural tear and an associated CSF leak. Table 4 validates the functionality of each option currently available. These diagnostic tools aid clinicians in correctly diagnosing a dural tear and SIH. Although these neuroimaging studies can identify the leak, they cannot approximate the intracranial pressure present. Lumbar puncture is used to document the CSF pressure present in the patient. This is not necessary for cases where MRI or neuroimaging have already confirmed the suspected diagnosis, as the lumbar puncture can exacerbate the symptoms with inducing another tear. Patients with SIH will obtain lumbar puncture opening pressures of 0–70 mmH2O, compared to a normal range of 60 to 200 mmH2O [57].
Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications
Published in Expert Review of Medical Devices, 2023
Manuel Menéndez González
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].
Excluding subarachnoid haemorrhage within 24 hours: to LP or not to LP?
Published in British Journal of Neurosurgery, 2021
Carolyn Chee, Akmal Mohamad Roji, Nathan Lorde, Hrushikesh Divyateja, Graham Dow, Jagrit Shah, K. Chokkalingam
CSF analysis for xanthochromia is the second line investigation in patients presenting with suspicion of non-traumatic SAH. This involves obtaining CSF via lumbar puncture, a relatively non-invasive bedside procedure with minor but recognised complications. In the UK, xanthochromia is most commonly analysed via spectrophotometry, with established national guidelines for analysis.17 CSF analysis is performed after a normal head CT, where the combined sensitivities are deemed highly sufficient18–21 to exclude a SAH and warrant no further investigations. The 2013 National Confidential Enquiry into Patient Outcome and Deaths (NCEPOD) ‘Managing the Flow?’ report on SAH highlighted several inadequacies within the UK. One of which have shown that only 75% of hospitals could provide a 24 hour LP service, with a small minority (5.4%) unable to do so at all.22 Taking this into consideration, could clinicians safely exclude SAH from relying on normal head CT scans without CSF analysis, provided these are performed within 24 hours from ictus? Could this be regarded as a safe and justifiable approach in the management of suspected SAH? The primary aim of this study was to determine whether CSF analysis for xanthochromia is necessary to exclude a diagnosis of SAH after a normal and timely head CT scan.
Related Knowledge Centers
- Bleeding Diathesis
- Central Nervous System
- Cerebrospinal Fluid
- Intracranial Pressure
- Local Anesthesia
- Meningitis
- Subarachnoid Hemorrhage
- Spinal Canal
- Lumbar
- Post-Dural-Puncture Headache