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Häni L, Fung C, Jesse CM, Schild C, Piechowiak EI, Dobrocky T, Raabe A, Beck J. Cerebrospinal fluid biomarkers of superficial siderosis in patients with spontaneous intracranial hypotension. Eur J Neurol 2023; 30:235-240. [PMID: 36209476 DOI: 10.1111/ene.15591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Spontaneous intracranial hypotension (SIH) is an important etiology of infratentorial superficial siderosis (iSS) of the central nervous system. However, the prevalence of iSS amongst patients with SIH is unknown and the imaging findings of iSS might represent a late stage of disease. The aim was to identify cerebrospinal fluid (CSF) biomarkers of iSS in patients with SIH. METHODS Consecutive patients evaluated for SIH at our institution between May 2017 and January 2019 were included. Lumbar CSF samples were analyzed for the presence of ferritin and bilirubin. Magnetic resonance imaging was assessed for the presence of iSS. RESULTS Twenty-four patients with SIH were included. CSF samples were positive for bilirubin in 2/19 (10.5%). CSF ferritin was elevated in 7/23 (30.4%). Signs of iSS on imaging were present in four patients (16.7%). All patients with imaging signs of iSS demonstrated elevated CSF ferritin. Ferritin level was significantly higher amongst patients demonstrating iSS compared to those without (median 45.0 vs. 11.0 μg/l; p = 0.003). Symptom duration was longer in patients with iSS than in patients without iSS (median 40 months vs. 9 months, p = 0.018). CONCLUSION Cerebrospinal fluid alterations indicative of iSS are prevalent amongst patients with SIH. It is speculated that a preclinical phase without symptoms or imaging signs but during which elevated biomarkers of the disease are apparent from CSF analysis might exist. It is suggested that measurement of CSF ferritin is incorporated in the work-up of patients with SIH to identify those at risk of developing iSS.
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Affiliation(s)
- Levin Häni
- Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland.,Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christian Fung
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christopher Marvin Jesse
- Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Christof Schild
- University Institute of Clinical Chemistry, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Eike Immo Piechowiak
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Tomas Dobrocky
- Institute of Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Jürgen Beck
- Department of Neurosurgery, Medical Center - University of Freiburg, Freiburg, Germany
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Luh HT, Chung YW, Cho PY, Hsiao YC. Label-Free Cholesteric Liquid Crystal Biosensing Chips for Heme Oxygenase-1 Detection within Cerebrospinal Fluid as an Effective Outcome Indicator for Spontaneous Subarachnoid Hemorrhage. BIOSENSORS 2022; 12:204. [PMID: 35448264 PMCID: PMC9025456 DOI: 10.3390/bios12040204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/24/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
A novel device for cholesteric liquid crystal (LC; CLC)-based biosensing chips for detecting heme oxygenase (HO)-1 within the cerebrospinal fluid (CSF) was invented. In the CLC device, the reorientation of the LCs was strongly influenced by the alignment layer surface and adjacent LCs. When the substrate was coated with the alignment layer, the CLCs oriented homeotropically in a focal conic state. Once HO-1 was immobilized onto the orientation sheet-coated substrate, the CLC changed from a focal conic state to a bright planar state by disrupting the CLCs. The concentration of HO-1 within CSF was shown to be an effective outcome indicator for patients with a spontaneous subarachnoid hemorrhage. We showed that the CLC immunoassaying can be used to measure HO-1 with a lower detection limit of about 10 ng/mL. The linear range was 10 ng/mL to 1 mg/mL. An easy-to-use, rapid-detection, and label-free CLC immunoassay device is proposed.
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Affiliation(s)
- Hui-Tzung Luh
- Department of Neurosurgery, Taipei Medical University-Shuang Ho Hospital, New Taipei 23561, Taiwan;
- Taipei Neuroscience Institute, Taipei Medical University, New Taipei 23561, Taiwan
- Department of Neurosurgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei 10617, Taiwan;
- Stanford Byers Center for Biodesign, Stanford, CA 94305, USA
| | - Yi-Wei Chung
- Graduate Institute of Clinical Medicine, National Taiwan University, Taipei 10617, Taiwan;
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, New Taipei 23561, Taiwan
- Taipei Heart Institute, Taipei Medical University, Taipei 11031, Taiwan
- Cardiovascular Research Center, Taipei Medical University Hospital, Taipei 11031, Taiwan
- Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
| | - Po-Yi Cho
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan;
| | - Yu-Cheng Hsiao
- Graduate Institute of Biomedical Optomechatronics, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan;
- Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
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Kumar N. Superficial Siderosis: A Clinical Review. Ann Neurol 2021; 89:1068-1079. [PMID: 33860558 DOI: 10.1002/ana.26083] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/29/2021] [Accepted: 04/11/2021] [Indexed: 12/15/2022]
Abstract
Superficial siderosis of the central nervous system results from subpial hemosiderin deposition due to chronic low-grade bleeding into the subarachnoid space. The confluent and marginal subpial hemosiderin is best appreciated on iron-sensitive magnetic resonance imaging sequences. With widespread use of magnetic resonance imaging, the disorder is increasingly being recognized, including in asymptomatic individuals. Gait ataxia, often with hearing impairment is a common clinical presentation. A clinical history of subarachnoid hemorrhage is generally not present. A macrovascular pathology is generally not causative. The most common etiology is dural disease, often dural tears. Prior or less commonly ongoing symptoms of craniospinal hypovolemia may be present. Common etiologies for dural tears include disc disease and trauma, including surgical trauma. Patients with dural tears due to herniated and calcified discs often have a ventral intraspinal fluid collection due to cerebrospinal fluid leak. A precise identification of the dural tear relies on multimodality imaging. It has been speculated that chronic bleeding from fragile blood vessels around the dural tear may be the likely underlying mechanism. Surgical correction of the bleeding source is a logical therapeutic strategy. Clinical outcomes are variable, although neuroimaging evidence of successful dural tear repair is noted. The currently available data regarding use of deferiprone in patients with superficial siderosis is insufficient to recommend its routine use in patients. ANN NEUROL 2021;89:1068-1079.
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Affiliation(s)
- Neeraj Kumar
- Department of Neurology, Mayo Clinic, Rochester, MN
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Kappa Free Light Chains in the Context of Blood Contamination, and Other IgA- and IgM-Related Cerebrospinal Fluid Disease Pattern. Cells 2021; 10:cells10030616. [PMID: 33799494 PMCID: PMC7998777 DOI: 10.3390/cells10030616] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/05/2021] [Accepted: 03/05/2021] [Indexed: 11/16/2022] Open
Abstract
In this retrospective, monocentric cohort study, we tested if an intrathecal free light chain kappa (FLC-k) synthesis reflects not only an IgG but also IgA and IgM synthesis. We also analysed if FLC-k can help to distinguish between an inflammatory process and a blood contamination of cerebrospinal fluid (CSF). A total of 296 patient samples were identified and acquired from patients of the department of Neurology, University Medicine Greifswald (Germany). FLC-k were analysed in paired CSF and serum samples using the Siemens FLC-k kit. To determine an intrathecal FLC-k and immunoglobulin (Ig) A/-M-synthesis we analysed CSF/serum quotients in quotient diagrams, according to Reiber et al. Patient samples were grouped into three cohorts: cohort I (n = 41), intrathecal IgA and/or IgM synthesis; cohort II (n = 16), artificial blood contamination; and the control group (n = 239), no intrathecal immunoglobulin synthesis. None of the samples had intrathecal IgG synthesis, as evaluated with quotient diagrams or oligoclonal band analysis. In cohort I, 98% of patient samples presented an intrathecal synthesis of FLC-k. In cohort II, all patients lacked intrathecal FLC-k synthesis. In the control group, 6.5% presented an intrathecal synthesis of FLC-k. The data support the concept that an intrathecal FLC-k synthesis is independent of the antibody class produced. In patients with an artificial intrathecal Ig synthesis due to blood contamination, FLC-k synthesis is lacking. Thus, additional determination of FLC-k in quotient diagrams helps to discriminate an inflammatory process from a blood contamination of CSF.
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Abstract
Diseases of the central nervous system that are caused by an underlying vascular pathology typically result in either hemorrhage or ischemia. Most prominent entities include spontaneous subarachnoid hemorrhage, spontaneous intracerebral hemorrhage, and ischemic stroke. For anatomic reasons, cerebrospinal fluid (CSF) qualifies as body fluid for the exploration of biomarkers in these disorders. Even though in subarachnoid hemorrhage a few CSF parameters have been established for routine diagnostic purposes, there is still an unmet need and broad interest in the identification of molecules that would allow further insight into disease mechanisms and supplement patients' medical care. This chapter provides an overview on what is presently known about CSF biomarkers in spontaneous subarachnoid hemorrhage, spontaneous intracerebral hemorrhage, and ischemic stroke. We recapitulate current evidence on established diagnostic tests, discuss the role of various CSF molecules in the pathophysiology of these diseases, and illuminate their potential use in future clinical practice. Furthermore, we address methodologic aspects as well as shortcomings of research in this field.
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Affiliation(s)
- Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michael Auer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Wang KC, Tang SC, Lee JE, Lai DM, Huang SJ, Hsieh ST, Jeng JS, Tu YK. Prognostic value of intrathecal heme oxygenase–1 concentration in patients with Fisher Grade III aneurysmal subarachnoid hemorrhage. J Neurosurg 2014; 121:1388-93. [DOI: 10.3171/2014.7.jns131704] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Experimental studies have demonstrated the crucial role of posthemorrhagic erythrocyte catabolism in the pathogenesis of subarachnoid hemorrhage (SAH). The authors of this study aimed to investigate the prognostic value of a series of CSF biomarkers linked to heme metabolism in SAH patients.
Methods
Patients with Fisher Grade III aneurysmal SAH undergoing early aneurysm obliteration were enrolled. The levels of heme oxygenase–1 (HO-1), oxyhemoglobin, ferritin, and bilirubin in intrathecal CSF were measured on the 7th day posthemorrhage. The associations of functional outcome with clinical and CSF parameters were analyzed.
Results
The study included 41 patients (mean age 59 ± 14 years; 16 male, 25 female), 17 (41.5%) of whom had an unfavorable outcome (Glasgow Outcome Scale score ≤ 3) 3 months after SAH. In terms of the clinical data, age > 60 years, admission World Federation of Neurosurgical Societies Grade ≥ III, and the presence of acute hydrocephalus were independent factors associated with an unfavorable outcome. After adjusting for clinical parameters, a higher level of HO-1 appeared to be the most significant CSF parameter related to an unfavorable outcome among all tested CSF molecules (OR 0.934, 95% CI 0.883–0.989, p = 0.018). Further analysis using a generalized additive model identified a cutoff HO-1 value of 81.2 μM, with higher values predicting unfavorable outcome (82.4% accuracy).
Conclusions
The authors propose that the level of intrathecal CSF HO-1 at Day 7 post-SAH can be an effective outcome indicator in patients with Fisher Grade III aneurysmal SAH.
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Affiliation(s)
| | - Sung-Chun Tang
- 2Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Jing-Er Lee
- 3Department of Neurology, Taipei Medical University–Wan Fang Hospital; and
| | - Dar-Ming Lai
- 1Division of Neurosurgery, Department of Surgery, and
| | | | - Sung-Tsang Hsieh
- 2Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine
- 4Department of Anatomy and Cell Biology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jiann-Shing Jeng
- 2Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine
| | - Yong-Kwang Tu
- 1Division of Neurosurgery, Department of Surgery, and
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Petersmann A, Kallner A, Preez H, Thein E, Dressel A. Diagnosis of late presenting subarachnoid hemorrhage: comparison of methods for cerebrospinal fluid ferritin. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:524-6. [PMID: 24874083 DOI: 10.3109/00365513.2014.913187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The majority of subarachnoid hemorrhage (SAH) is diagnosed using imaging techniques. The sensitivity of computed tomography scans decreases with increasing time after the bleeding event which can lead to false negative CT scans. Spectrophotometry and microscopic investigations of the cerebrospinal fluid (Csf) can provide additional diagnostic support, but may not be available for emergency diagnoses. Csf-Ferritin has been suggested as an alternative additional marker for SAH that present late and has a potency to be measured in a routine laboratory. METHODS A routine Ferritin chemiluminescent assay (Dimension Vista) was compared with a branded and CE-marked Csf-Ferritin nephelometric assay (BN ProSpec) using surplus routine patient samples. We calculated imprecision at pertinent concentrations, compared patient samples, and established reference intervals. RESULTS The standard deviation was about a third for the Dimension Vista assay compared to that of the BN ProSpec assay at the three tested concentrations. The correlation showed a systematic difference between the methods but the correlation was high (r = 0.955). Accordingly, the reference intervals were higher for the BN ProSPec (2.7-16.8 μg/L) than for the Dimension Vista (2.0-12.6 μg/L). CONCLUSION The precision of the Dimension Vista measurements was considerably better than that of the BN ProSpec. The Dimension Vista results correlated well with those of the comparative method, yielding slightly lower values. This is reflected in the reference intervals. These findings permit the use of the routinely available Ferritin assay of the Dimension Vista for measuring Csf-Ferritin and complementing the late diagnosis of SAH outside office hours of specialized Csf laboratories.
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Affiliation(s)
- Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald , Greifswald , Germany
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Nagy K, Skagervik I, Tumani H, Petzold A, Wick M, Kühn HJ, Uhr M, Regeniter A, Brettschneider J, Otto M, Kraus J, Deisenhammer F, Lautner R, Blennow K, Shaw L, Zetterberg H, Mattsson N. Cerebrospinal fluid analyses for the diagnosis of subarachnoid haemorrhage and experience from a Swedish study. What method is preferable when diagnosing a subarachnoid haemorrhage? Clin Chem Lab Med 2013; 51:2073-86. [DOI: 10.1515/cclm-2012-0783] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Accepted: 03/12/2013] [Indexed: 11/15/2022]
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Crossley RA, Raza A, Adams WM. The lumbar sedimentation sign: spinal MRI findings in patients with subarachnoid haemorrhage with no demonstrable intracranial aneurysm. Br J Radiol 2011; 84:279-81. [PMID: 21325365 DOI: 10.1259/bjr/68122723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We present a new MRI finding within the lumbar spine in a series of six patients admitted with CT proven subarachnoid haemorrhage (SAH) where cerebral angiography demonstrated no aneurysm and who had not had a lumbar puncture. A retrospective audit of 130 patients presenting to a regional neurosciences centre over a 13 month period with a suspected diagnosis of SAH was performed. Seven patients with proven SAH underwent MRI of the lumbar spine during the same admission. In six of these patients layering of haemorrhagic blood products was demonstrated within the lumbosacral spine. The process is analogous to the previously ubiquitous bedside erythrocyte sedimentation rate assay and has has been termed the "lumbar sedimentation" sign. This finding has not previously been reported in the literature in relation to SAH. While this is a small unselected group it may provide a useful adjunct in the diagnosis of SAH.
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Affiliation(s)
- R A Crossley
- Department of Neuroradiology, Derriford Hospital, Plymouth Hospitals NHS trust, Plymouth, Devon.
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[Cerebrospinal fluid-based diagnostics of CT-negative subarachnoid haemorrhage]. DER NERVENARZT 2010; 81:973-9. [PMID: 20700683 DOI: 10.1007/s00115-010-2997-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The diagnostic investigation of CT-negative subarachnoid haemorrhage (SAH) is a particular challenge in clinical neurology. Cerebrospinal fluid (CSF) analysis via lumbar puncture is the method of choice. The diagnosis of SAH in CSF is based on a bloody or xanthochromic discoloration of the CSF as well as on findings in non-automated CSF cytology including the detection of erythrophages and siderophages. The automated determination of CSF ferritin concentrations or spectrophotometric detection of xanthochromia may contribute to the diagnosis but are only useful with regard to the overall clinical picture. Generally, the knowledge of the time flow of CSF changes associated with SAH is essential for a correct interpretation of CSF findings.
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Petzold A, Worthington V, Appleby I, Kerr ME, Kitchen N, Smith M. Cerebrospinal fluid ferritin level, a sensitive diagnostic test in late-presenting subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2010; 20:489-93. [PMID: 20719531 DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 01/15/2010] [Accepted: 02/05/2010] [Indexed: 10/19/2022] Open
Abstract
The workup of patients with suspected subarachnoid hemorrhage (SAH) presenting late is complicated by a loss of diagnostic sensitivity of computed tomography (CT) brain imaging and cerebrospinal fluid (CSF) bilirubin levels. In this prospective longitudinal study of CSF ferritin levels in SAH, serial CSF samples from 14 patients with aneurysmal SAH requiring extraventricular drainage (EVD) were collected. The control group comprised 44 patients presenting with headache suspicious of SAH. Nine patients underwent a traumatic spinal tap. CSF ferritin levels were significantly higher in the patients with SAH compared with controls (P < .0001). The upper reference range of CSF ferritin is 12 ng/mL, and there was no significant difference between the traumatic and normal spinal taps (mean, 9.0 ng/mL vs 3.9 ng/mL; P = .59). CSF ferritin levels increased after SAH, from an average of 65 ng/mL on day 1 to 1750 ng/mL on day 11 (P < .01). Both the Fisher and Columbia CT scores were significantly correlated with CSF ferritin level. The increase in CSF ferritin level after SAH and possibly may provide additional diagnostic information in patients with suspected SAH who present late to the clinic.
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Affiliation(s)
- Axel Petzold
- Department of Neuroimmunology, University College London Institute of Neurology, London, UK. .
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