Cerebrospinal Fluid (Csf) Scanning: Cisternography

James, A. Everette; DeLand, Frank H.; Hodges, Fred J.; Wagner, Henry N.; North, Wendy A.

doi:10.2214/ajr.110.1.74

Cited by 21 publications

(2 citation statements)

References 8 publications

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“…It has been shown that radionuclide injection into the lumbar subarachnoid space appears in the basal cisterns within 1 hour and before appearing in other areas of the brain. 31 Furthermore, a similar predilection for the base of the brain has been seen in cases of Aspergillus meningitis associated …”

Section: Discussionmentioning

confidence: 65%

Exserohilum Infections Associated with Contaminated Steroid Injections

Ritter

Muehlenbachs

Blau

et al. 2013

The American Journal of Pathology

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The ASCP designates this journal-based CME activity ("ASIP 2013 AJP CME Program in Pathogenesis") for a maximum of 48 AMA PRA Category 1 Credit(s)ä. Physicians should only claim credit commensurate with the extent of their participation in the activity. CME Disclosures: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose. September 2012 marked the beginning of the largest reported outbreak of infections associated with epidural and intra-articular injections. Contamination of methylprednisolone acetate with the black mold, Exserohilum rostratum, was the primary cause of the outbreak, with >13,000 persons exposed to the potentially contaminated drug, 741 confirmed drug-related infections, and 55 deaths. Fatal meningitis and localized epidural, paraspinal, and peripheral joint infections occurred. Tissues from 40 laboratoryconfirmed cases representing these various clinical entities were evaluated by histopathological analysis, special stains, and IHC to characterize the pathological features and investigate the pathogenesis of infection, and to evaluate methods for detection of Exserohilum in formalin-fixed, paraffin-embedded (FFPE) tissues. Fatal cases had necrosuppurative to granulomatous meningitis and vasculitis, with thrombi and abundant angioinvasive fungi, with extensive involvement of the basilar arterial circulation of the brain. IHC was a highly sensitive method for detection of fungus in FFPE tissues, demonstrating both hyphal forms and granular fungal antigens, and PCR identified Exserohilum in FFPE and fresh tissues. Our findings suggest a pathogenesis for meningitis involving fungal penetration into the cerebrospinal fluid at the injection site, with transport through cerebrospinal fluid to the basal cisterns and subsequent invasion of the basilar arteries. Further studies are needed to characterize Exserohilum and investigate the potential effects of underlying host factors and steroid administration on the pathogenesis of infection. Accepted for publication

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Section: Discussionmentioning

confidence: 65%

Exserohilum Infections Associated with Contaminated Steroid Injections

Ritter

Muehlenbachs

Blau

et al. 2013

The American Journal of Pathology

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“…Anterior, lateral and occasionally posterior and vertex views were obtained at 1, 3, 6, 24, 48 and occasionally 72 h with the Anger camera [19,25]. The following four main classical patterns [20,22,26,29] could be detected: (1) normal; (2) occult hydrocephalus, the radionuclide not ascending the normal pathways to the cerebral convexities as ex pected within 24 h and persistent ventricular reflux being observed; (3) mixed forms, i.e. occult hydrocephalus and focal cortical atrophy (stagnation and positive images); (4) cerebral atrophy (CA), i.e.…”

Section: Methodsmentioning

confidence: 99%

Occult Disorders of the Cerebrospinal Fluid Dynamics

Botez¹,

Léveillé²,

Bérubé³

et al. 1975

Eur Neurol

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Workable criteria are proposed that allow early recognition of mild forms of occult hydrocephalus and correlated disorders. Two groups of patients are analyzed, i.e. a group of twelve mild but classical forms of low-pressure hydrocephalus and another group of 20 patients with atypical clinical forms of disorders of the CSF dynamics. Two control groups are presented for neuropsychological comparison purposes: a normal control group of 50 subjects and a small group of three commissurotomized subjects. Patients with an overt demential syndrome due to a normotensive hydrocephalus syndrome were excluded from the study. The authors found the grasp reflex of the foot and the tonic foot response to be present in all cases with the Hakim and Adams triad. In such cases the grasp reflex is usually accompanied by the forward groping of the foot and the grasp reflex of the hand. The most helpful and useful clinical findings for an early diagnosis are the presence of the grasp reflex of the foot and of the tonic foot response of the sole in such organic brain-damaged patients with (1) a normal routine neurological examination and (2) an apparently normal mental status and even with a rather normal IQ. These reflexes are usually the single objective clinical findings in all forms of mild and occult disorders of the CSF dynamics, i.e., low-pressure hydrocephalus syndromes, cerebral atrophies and mixed forms cases. The next step for the diagnosis consists in a conventional IQ evaluation and a battery of tests exploring more specifically the sensorimotor integration, i.e. bimanual vs. unimanual activity, the Kohs block design test and part of the Halstead-Reitan neuropsychological test battery. In such patients there is a striking dissociation between a normal or rather normal IQ on the one hand and the results of the neuropsychological evaluation with the Kohs and Reitan tests on the other. The clinical and neuropsychological testings are then followed by isotope cisternography, PEG and EMI-Scan which confirm the presence of the organic brain damage. The recognition of such conditions is of great practical importance because it allows an early diagnosis of the brain damages. Some preliminary data regarding the medical treatment - acetazolamide - are shortly reviewed.

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Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status

Glantz

Hall

Cole

et al. 1995

Cancer

187

140

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Background. The authors assessed cerebrospinal fluid (CSF) flow in patients with carcinomatous meningitis using technetium‐99m‐DTPA (Tc‐99) ventriculography to determine the frequency of flow abnormalities, their reversibility with treatment, and the implications for successful therapy and survival. Methods. Technetium‐99m‐DTPA flow studies were performed in 31 patients after placement of Ommaya reservoirs (Baxter, McGaw Park, IL). Two millicuries of Tc‐99 were injected into the reservoir. Planar images of the head and entire spine were obtained after 10 and 30 minutes and after 1, 4, 6, and 24 hours. Follow‐up studies were performed for 12 patients whose initial studies were abnormal or who developed complications of therapy. Results. In 19 of the 31 patients (61%), ventricularoutlet, spinal, or convexity blocks were identified. In 11 of these 19 patients, focal radiotherapy to the site of the block restored normal flow. Survival among patients with initially normal, abnormal but correctable, and abnormal but uncorrectable CSF flow differed significantly (6.9, 13.0, and 0.7 months respectively; P < 0.001). Some patients who were treated intrathecally despite abnormal CSF flow experienced drug‐related toxicity. Conclusions. Cerebrospinal fluid‐flow blocks are common in patients with carcinomatous meningitis and may occur at the skull base, in the spinal canal, and over the convexities. These flow abnormalities often can be corrected with appropriately directed radiotherapy. If untreated, CSF tumor progression (protected site effect), neurotoxicity (high concentration effect), and systemic toxicity (reservoir effect) can occur, resulting in shortened survival and treatment‐related morbidity. Therefore, intrathecal chemotherapy should be preceded by a radionuclide flow study and should be delayed if abnormal flow is documented until appropriate radiotherapy reestablishes normal flow. Cancer 1995;75:2919–31.

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Cerebrospinal Fluid (Csf) Scanning: Cisternography

Cited by 21 publications

References 8 publications

Exserohilum Infections Associated with Contaminated Steroid Injections

Exserohilum Infections Associated with Contaminated Steroid Injections

Occult Disorders of the Cerebrospinal Fluid Dynamics

Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status

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