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CSF Levels of Angiopoietin-2 Do Not Differ between Patients with CSF Fluid Leakage Syndrome and Controls.

Pul R, Yildiz Ö, Morbiducci F, Skripuletz T, Schwenkenbecher P, Stangel M, Götz F, Berding G, Trebst C, Donnerstag F - Dis. Markers (2015)

Bottom Line: Angiopoietin-2 (Ang-2), a protein which is expressed and released by endothelial cells, has been associated with increased vascular permeability.We suggest that the increase of Qalb results from a low CSF flow.It would be of particular interest whether Qalb can be used as a marker for successful nontargeted epidural blood patch treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

ABSTRACT
CSF abnormalities have been reported in CSF leakage syndrome. However, the mechanism for these CSF changes is actually unknown and they may indicate impaired CSF flow or blood-CSF barrier. Angiopoietin-2 (Ang-2), a protein which is expressed and released by endothelial cells, has been associated with increased vascular permeability. In the assumption that CSF changes are due to an impaired blood-CSF barrier, we hypothesized that subjects with persistent CSF leakage may have increased CSF Ang-2 levels. We enrolled 10 subjects with a clinically definite diagnosis of persisting CSF leakage syndrome and 10 control subjects. In CSF analyses, CSF to serum albumin ratio (Qalb) was the most frequently increased parameter indicating a disturbed blood-CSF barrier function. Comparison of the mean CSF Ang-2 levels, CSF to serum Ang-2 ratio (QAng-2), and QAng-2/Qalb between the control and CSF leakage patients did not show any significant difference. We suggest that the increase of Qalb results from a low CSF flow. Future studies with phase contrast-MRI in conjunction with CSF analyses before and after epidural blood patch treatment are required to address this question. It would be of particular interest whether Qalb can be used as a marker for successful nontargeted epidural blood patch treatment.

No MeSH data available.


Related in: MedlinePlus

Imaging in a patient with symptomatic CSF leakage. (a + b) MRI with intravenous contrast media displays enhancement of the meninges over the convexity and tentorium (arrow heads). A fluid collection separates the periosteal and the inner layer of the enhancing dura mater (arrows). (c + d) MRI with intrathecally applied gadolinium contrast agent. (c) Distribution of contrast agent in the subarachnoid space (solid arrow). (d) MRI depicts transforaminal contrast leakage as the diagnosis of meningeal tears in the left T2 nerve root (double arrow) with epidural distribution of contrast agent in the epidural space (triangle). (e + f) CT-guided blood patch. (e) Tuohy needle in the epidural space of T1/2 (curved arrows) used to inject a mixture of blood and iodine contrast agent into the epidural space (black triangles). (f) Epidural blood patch by means of a Tuohy needle (curved arrow) with epidural (triangle) and transforaminal (double arrow) distribution of the blood at the level of the T2 nerve root.
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fig1: Imaging in a patient with symptomatic CSF leakage. (a + b) MRI with intravenous contrast media displays enhancement of the meninges over the convexity and tentorium (arrow heads). A fluid collection separates the periosteal and the inner layer of the enhancing dura mater (arrows). (c + d) MRI with intrathecally applied gadolinium contrast agent. (c) Distribution of contrast agent in the subarachnoid space (solid arrow). (d) MRI depicts transforaminal contrast leakage as the diagnosis of meningeal tears in the left T2 nerve root (double arrow) with epidural distribution of contrast agent in the epidural space (triangle). (e + f) CT-guided blood patch. (e) Tuohy needle in the epidural space of T1/2 (curved arrows) used to inject a mixture of blood and iodine contrast agent into the epidural space (black triangles). (f) Epidural blood patch by means of a Tuohy needle (curved arrow) with epidural (triangle) and transforaminal (double arrow) distribution of the blood at the level of the T2 nerve root.

Mentions: Figure 1 shows characteristic findings in cranial MRI as well as the diagnostic procedure with intrathecal gd MR myelography (Figure 1). CSF scintigraphy resulted in the localization of the level of CSF leakages in 3 of 6 subjects, while MR myelography with intrathecal gd was more efficient with 9 of 9 subjects (Table 1). The early appearance of the radioisotope in the bladder enabled the diagnosis of CSF leakage in 5 of 6 subjects. Moreover, intrathecal gd MR myelography revealed additional CSF leakages in 3 subjects who had CSF leakages already detected by scintigraphy. Cranial MRI demonstrated subdural effusions in 9 of 10 subjects, while after the application of gd contrast agent meningeal enhancement was found in 7 of 9 subjects suggesting that subdural effusions are at least as reliable sign as meningeal contrast enhancement (Table 1).


CSF Levels of Angiopoietin-2 Do Not Differ between Patients with CSF Fluid Leakage Syndrome and Controls.

Pul R, Yildiz Ö, Morbiducci F, Skripuletz T, Schwenkenbecher P, Stangel M, Götz F, Berding G, Trebst C, Donnerstag F - Dis. Markers (2015)

Imaging in a patient with symptomatic CSF leakage. (a + b) MRI with intravenous contrast media displays enhancement of the meninges over the convexity and tentorium (arrow heads). A fluid collection separates the periosteal and the inner layer of the enhancing dura mater (arrows). (c + d) MRI with intrathecally applied gadolinium contrast agent. (c) Distribution of contrast agent in the subarachnoid space (solid arrow). (d) MRI depicts transforaminal contrast leakage as the diagnosis of meningeal tears in the left T2 nerve root (double arrow) with epidural distribution of contrast agent in the epidural space (triangle). (e + f) CT-guided blood patch. (e) Tuohy needle in the epidural space of T1/2 (curved arrows) used to inject a mixture of blood and iodine contrast agent into the epidural space (black triangles). (f) Epidural blood patch by means of a Tuohy needle (curved arrow) with epidural (triangle) and transforaminal (double arrow) distribution of the blood at the level of the T2 nerve root.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4581498&req=5

fig1: Imaging in a patient with symptomatic CSF leakage. (a + b) MRI with intravenous contrast media displays enhancement of the meninges over the convexity and tentorium (arrow heads). A fluid collection separates the periosteal and the inner layer of the enhancing dura mater (arrows). (c + d) MRI with intrathecally applied gadolinium contrast agent. (c) Distribution of contrast agent in the subarachnoid space (solid arrow). (d) MRI depicts transforaminal contrast leakage as the diagnosis of meningeal tears in the left T2 nerve root (double arrow) with epidural distribution of contrast agent in the epidural space (triangle). (e + f) CT-guided blood patch. (e) Tuohy needle in the epidural space of T1/2 (curved arrows) used to inject a mixture of blood and iodine contrast agent into the epidural space (black triangles). (f) Epidural blood patch by means of a Tuohy needle (curved arrow) with epidural (triangle) and transforaminal (double arrow) distribution of the blood at the level of the T2 nerve root.
Mentions: Figure 1 shows characteristic findings in cranial MRI as well as the diagnostic procedure with intrathecal gd MR myelography (Figure 1). CSF scintigraphy resulted in the localization of the level of CSF leakages in 3 of 6 subjects, while MR myelography with intrathecal gd was more efficient with 9 of 9 subjects (Table 1). The early appearance of the radioisotope in the bladder enabled the diagnosis of CSF leakage in 5 of 6 subjects. Moreover, intrathecal gd MR myelography revealed additional CSF leakages in 3 subjects who had CSF leakages already detected by scintigraphy. Cranial MRI demonstrated subdural effusions in 9 of 10 subjects, while after the application of gd contrast agent meningeal enhancement was found in 7 of 9 subjects suggesting that subdural effusions are at least as reliable sign as meningeal contrast enhancement (Table 1).

Bottom Line: Angiopoietin-2 (Ang-2), a protein which is expressed and released by endothelial cells, has been associated with increased vascular permeability.We suggest that the increase of Qalb results from a low CSF flow.It would be of particular interest whether Qalb can be used as a marker for successful nontargeted epidural blood patch treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

ABSTRACT
CSF abnormalities have been reported in CSF leakage syndrome. However, the mechanism for these CSF changes is actually unknown and they may indicate impaired CSF flow or blood-CSF barrier. Angiopoietin-2 (Ang-2), a protein which is expressed and released by endothelial cells, has been associated with increased vascular permeability. In the assumption that CSF changes are due to an impaired blood-CSF barrier, we hypothesized that subjects with persistent CSF leakage may have increased CSF Ang-2 levels. We enrolled 10 subjects with a clinically definite diagnosis of persisting CSF leakage syndrome and 10 control subjects. In CSF analyses, CSF to serum albumin ratio (Qalb) was the most frequently increased parameter indicating a disturbed blood-CSF barrier function. Comparison of the mean CSF Ang-2 levels, CSF to serum Ang-2 ratio (QAng-2), and QAng-2/Qalb between the control and CSF leakage patients did not show any significant difference. We suggest that the increase of Qalb results from a low CSF flow. Future studies with phase contrast-MRI in conjunction with CSF analyses before and after epidural blood patch treatment are required to address this question. It would be of particular interest whether Qalb can be used as a marker for successful nontargeted epidural blood patch treatment.

No MeSH data available.


Related in: MedlinePlus