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PubMed2003

MR demonstration of brain abscess rupture into the subarachnoid space and its possible implication in management.

BACKGROUND: Rupture of brain abscess into the subarachnoid space as a cause of meningitis is rare. Early diagnosis improves the outcome. There is no previous report of MR demonstration of rupture of brain abscess into the subarachnoid space. CASE DESCRIPTION: Two young adults with chronic suppurative otitis media presenting with signs of increased intracranial pressure and meningeal irritation underwent magnetic resonance imaging, which showed brain abscess with evidence of rupture into the subarachnoid space and meningitis. This helped in early diagnosis and aggressive management. CONCLUSION: In cases of brain abscess where meningitis is suspected clinically, documentation of rupture of the abscess into the subarachnoid space will help in avoiding cerebrospinal fluid (CSF) examination that may be disastrous in these patients who already have increased intracranial pressure.

Adolescent↗
PubMed1986

The prophylactic use of phenytoin during iopamidol contrast studies of the subarachnoid space.

Contrast examinations of the subarachnoid space are associated with side effects including convulsions. Attention has been given to the prophylactic use of anticonvulsants. We describe a simple oral regimen using the established anticonvulsant phenytoin that can be administered to short-stay patients and that achieves effective serum and CSF concentrations. A preliminary account of this work was presented to the British Pharmacological Society in January 1984 in London.

Contrast Media↗
PubMed2001

Ultrasonographic measurement of subarachnoid space in normal infants and children.

This study was undertaken to evaluate the sonographic measurement of subarachnoid spaces in normal children and its relationship with age and to define a normal range in a Chinese population and to differentiate normal variant findings from pathologic dilatation. The subarachnoid spaces in 278 normal term neonates, infants, and children were studied with real-time ultrasound using a 7.5-MHz vector transducer. The craniocortical width, sinocortical width, and interhemispheric width were measured in the coronal plane at the level of the foramen of Monro, on either side of the hemispheres. Correlation of sonographic measurements with age was made. The mean widths were plotted against age. A correlation with age was found in all three spaces, with an increasing trend with age until 28 weeks of gestation. Thereafter, a decreasing trend was noted. The normal upper limit of subarachnoid spaces for children is proposed to be the values on the ninety-fifth percentile of the regression curve. Correlation of measurement with age must be considered to decide whether an increase in subarachnoid space is pathologic or not.

Cephalometry↗
PubMed1998

Echodense spinal subarachnoid space in neonates with progressive ventricular dilatation: a marker of noncommunicating hydrocephalus.

OBJECTIVE: Our purpose was to evaluate the frequency and clinical significance of echogenic debris in the spinal subarachnoid space of neonates at risk for progressive ventricular dilatation. SUBJECTS AND METHODS: Spinal sonography was performed on 15 neonates with severe intracranial hemorrhage (n = 10) or bacterial meningitis (n = 5). Spinal sonography also was performed on 16 control neonates. Images were analyzed for the presence and location of echogeric debris within the thoracolumbar subarachnoid space. Lumbar punctures were performed on all 31 neonates, and CSF was analyzed for cell count and protein content. Ten of 15 neonates required ventricular drainage procedures. RESULTS: Progressive ventricular dilatation occurred in 11 of 15 neonates with intracranial hemorrhage or meningitis. Echogenic debris was present in the thoracolumbar subarachnoid space on spinal sonography in every neonate with progressive ventricular dilatation compared with none of the 16 control neonates (p < .0001 by chi-square analysis). In addition, the 11 neonates with echogenic subarachnoid space had significantly higher protein and RBC contents in the lumbar CSF (p < .04). CONCLUSION: Echogenic subarachnoid space revealed by sonography is associated with progressive ventricular dilatation after severe intracranial hemorrhage or bacterial meningitis and is caused by high protein and RBC contents in the subarachnoid space. This finding may be helpful in identifying neonates who will not benefit from serial lumbar punctures for treatment of hydrocephalus.

Case-Control Studies↗
PubMed1998

[A new way for neural transplantation: the grafted central neurons migration from the subarachnoid space into the spinal cord and cerebral cortex].

In the studies of neural transplantation, Chen and his colleagues observed that the grafted central neurons could migrate from the subarachnoid space into the spinal cord and cerebral cortex. This finding promises an attractive possibility that a lot of neurons might be introduced into a long distance of the spinal cord and the extensive superficial layer of the brain which has suffered neuronal loss and thus might reinnervate a wide range of denervated area. Female rats were used in the study. Neural tissues or cell suspension containing fetal monoaminergic or arginine vasopressin (AVP) neurons were implanted into the subarachnoid space of the transected spinal cord or the normal brain and spinal cord. The rats were treated in different ways: some were grafted and the spinal cord was cut at the same time; grafted one month later or before the spinal cord was cut; grafted but the brain and spinal cord remained intact. Immunohistochemical method was used to monitor the grafted neurons after these rats survived for one or nine months. The results showed that there were a few to hundreds of 5-HT, TH or AVP-immunoreactive neurons and fibers found in the spinal cord or cerebral cortex near the grafted region. These neurons grew well and displayed their capacity of adaptability and long-time survival in the host CNS. No neurons, however, were found in the subarachnoid space of the grafted rats which had survived for another month or longer. On the other side, grafted with tissue block, it was found that transplants left in the grafted region grew as a "nodule" attaching to the surface of the spinal cord. The "nodule" was also found occasionally when the cell suspension was centered heavily at one region of the subarachnoid space. In both cases, the pia mater between them disappeared. Immunoreactive neurons were found in the "nodule" and neighboring spinal cord, some fibers from the neurons in the "nodule" extended into the spinal cord. It is supposed that a part of cells in the suspension died after grafted in the subarachnoid space and released hydrolases which injured the near pia mater by hydrolysis. As a result, some neurons in the suspension had a chance to migrate into the spinal cord and cerebral cortex. After the transplant in the subarachnoid space was gradually cleaned out, the enzymatic hydrolysis to the pia mater became weaker and finally stopped, the lesioned pia mater was gradually repaired. If the transplant was not cleared timely, the pia mater could not withstand the persistent hydrolysis and collapsed finally, leading the transplant to be fused with the host CNS.

Animals↗
PubMed1976

[Dimer-X in the intracranial subarachnoid space--its toxicity (author's transl)].

The reaction of the rats to injection of Dimer-X into the intracranial subarachnoid space or the cerebrum was examined. When 28% iodine Dimer-X was injected into the subarachnoid space, 7 of 10 rats showed agitation, which is the most severe complication, and all died within one hour. All of the reactions were reduced with the lower concentrations of Dimer-X. The rats which were premedicated with Valium and/or Decadron revealed fewer and less severe complications. It is believed that the intracerebral injection method has many disadvantages, the results of its experiment are therefore reported without further elaboration. From the results of the experiment it is concluded as follows: 1) Dimer-X should not be injected into the intracranial subarachnoid space. 2) Dimer-X of low concentration in the subarachnoid space reduces the complications. 3) Complications from the subarachnoid application of Dimer-X can be reduced by premedication with Valium and Decadron.

Animals↗
PubMed1981

Intercellular channels in the pars tuberalis of the rat hypophysis and their relationship to the subarachnoid space.

A system of intercellular channels is described in the pars tuberalis (PT) of the female rat. These spaces are lined by all types of cells found in the PT and are not sealed off by tight junctions. Ventrally and dorsally, the intercellular spaces open toward the basement membranes separating the PT from (i) the subarachnoid space, and (ii) the perivascular space of the portal capillaries, respectively. These intercellular channels differ from the follicles, which are also found in the PT, being lined by a particular type of cell. In a second group of female rats an epoxy mixture was injected into the third ventricle; 10 min thereafter horseradish peroxidase was infused into the cisterna magna. After processing the brain for the demonstration of exogenous peroxidase, it was found that the tracer had reached the subarachnoid space adjacent to the hypothalamus and entered into all ventricular cavities with the exception of the infundibular recess. Under these experimental conditions it was found that the tracer fills all intercullular channels of the PT, thus indicating that there is no barrier between the subarachnoid space and the PT. It is suggested that the subarachnoid space should be regarded as a probable route for the transport of trophic factor(s) and/or secretory product(s) of the PT.

Animals↗
PubMed1987

Developmental prognosis for infants with benign enlargement of the subarachnoid spaces.

The development of nine infants with enlarged subarachnoid spaces identified by specific CT-scan criteria was prospectively followed to two to three years of age. Infants with intracranial hemorrhage, CNS anomaly, microcephaly or other factors of potentially major negative impact on their development were excluded. All study infants had normal or only minimally increased ventricular size and none developed hydrocephalus. Head circumference was greater than or equal to 90th percentile in all cases, and six fathers also had a head circumference greater than or equal to 90th percentile. Six infants had gross motor delay and mild hypotonia in the first year. One, born at 30 weeks gestational age, had transient dystonia. At follow-up all the infants were developing normally, apart from four with minor concerns. Infants with macrocephaly or rapid head-growth, CT-scan findings of enlarged subarachnoid spaces and normal to minimally increased ventricular size, and who have a parent with macrocephaly, have a good developmental prognosis and a characteristic pattern of neuromotor development in the first year.

Cephalometry↗
PubMed2004

The distance from the skin to the subarachnoid space can be predicted in premature and former-premature infants.

PURPOSE: Spinal anesthesia can be technically challenging in young infants. We studied whether the distance between the skin and the lumbar subarachnoid space in premature and former-premature young infants could be predicted prior to lumbar puncture. METHODS: The distance from skin entry point to tip of the spinal needle was measured using a caliper after lumbar spinal anesthesia at the L4-5 interspace. This distance was correlated to the patient's weight, postconceptual age and lumbar ultrasonographic measurement of the skin-to-subarachnoid space and predictive statistical models were sought. RESULTS: Thirty-five premature or former-premature infants were studied. Three models were examined: all three independent variables, weight and postconceptual age only, and weight only. The model selected contained the weight and postconceptual age, because it had the highest value for adjusted R squared, as well as the lowest value for the mean squared error. Adding the ultrasonic measurement to the model worsened the results. The statistical model that described the depth of the subarachnoid space at the L4-5 level was Y = 13.19 + 0.0026 x W - 0.12 x PCA, where Y is the distance (mm) from the skin to the subarachnoid space, W is the patient's weight (g) and PCA is the postconceptual age (weeks). Adjusted R squared was 0.72, mean square error was 2.63 and P < 10(-9). CONCLUSION: The distance between the skin and the subarachnoid space at the level of L4-5 interspace can be predicted using a statistical model based on the infant's weight and postconceptual age. Spinal ultrasound has no value in L4-5 subarachnoid space depth prediction.

Anesthesia, Spinal↗
PubMed1999

Technical note: a new model for quantitative analysis of brain oedema resolution into the ventricles and the subarachnoid space.

OBJECTIVE: The aim of the current study was to develop an experimental animal model for quantitative analysis of oedema resolution via the subarachnoid space and the ventricular system using fluorescent oedema markers. METHODS: Artificial cerebrospinal fluid (CSF) containing TRITC-albumin (MW 67.000D) and Na(+)-fluorescein (MW 376D) was continuously infused into the white matter of the left frontal lobe of New Zealand white rabbits (n = 6) at a rate of 100 microliters/h for 3 hrs. A closed cranial window for superfusion of the brain surface with artificial CSF fluid (3 ml/h) was implanted above the left parietal cortex for measurement of the fluorescence markers in the subarachnoid space. Uptake of the fluorescence indicators into the ventricles was quantified by ventriculo-cisternal perfusion (3 ml/h). The effluates were collected at 30 min intervals for 3 hrs after the start of infusion. Clearance of the oedema fluid into the perfusates was measured by fluorescence spectrophotometry. RESULTS: At an intracranial pressure of 15.0 +/- 1.7 mm Hg (mean +/- SEM) both indicators started to accumulate in the subarachnoid and ventricular perfusates at 90 min following onset of oedema fluid infusion. The concentrations of the indicators in the ventricular system increased to 7.7 +/- 5.1% of Na(+)-fluorescein and 16.1 +/- 13.0% of TRITC-albumin of the total amount infused were recovered in the ventricular system at 3 hours after start of the oedema infusion, while 3.4 +/- 3.2% of Na(+)-fluorescein and 3.7% +/- 3.2 of TRITC-albumin, respectively, were found in the effluates of the subarachnoid space. CONCLUSION: The present study demonstrates that resolution of vasogenic brain oedema into the cerebral ventricular system and the subarachnoid space following its entry into cerebral white matter can be quantitatively analysed using fluorescence markers, which serve as oedema fluid indicators. The results indicate that the oedema fluid is cleared not only into the ventricular system but also via the subarachnoid space.

Animals↗
PubMedDate not supplied

CT and MR in infants with pericerebral collections and macrocephaly: benign enlargement of the subarachnoid spaces versus subdural collections.

PURPOSE: To compare CT and MR in the differentiation of benign enlargement of the subarachnoid spaces and subdural collections in infants with macrocephaly. METHODS: MR was performed in 19 infants with macrocephaly, showing bifrontal enlargement of the subarachnoid spaces on CT. RESULTS: In 11 patients, a single fluid layer could be distinguished on MR of the pericerebral collections, suggesting benign enlargement of the subarachnoid spaces. In eight patients, two separate layers were clearly differentiated, an outer layer that was hyperintense on all sequences and an inner layer with the same intensity as the cerebrospinal fluid. This indicated the presence of subdural collections. These collections were mainly frontal in six and extended over the entire hemisphere in two patients. On CT, these separate lesions were seen only in three patients and missed in three others. In two final patients, CT findings were equivocal with evidence of membrane formation within the hypodense collections. In seven patients with a subdural collection, subdural-external drainage was performed. In three patients, the collection was hemorrhagic. The protein content of the fluid showed a mean of 1381.7 +/- 785.6 mg/dL. The MR and surgical findings of a subdural collection correlated with the absence of a family history of macrocrania, an age under 5 months, and acute clinical signs of vomiting, somnolence, and hypotonia. CONCLUSION: MR appears essential in the differential diagnosis between benign enlargement of the subarachnoid spaces and subdural collections in infants.

Brain Diseases↗
PubMed2003

Intraspinal synovial cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability.

STUDY DESIGN: The first case of intraspinal synovial cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability is presented. OBJECTIVES: To describe the diagnosis and successful treatment of a synovial cyst of the C1-C2 junction in a patient with rheumatoid arthritis and atlantoaxial instability. SUMMARY OF BACKGROUND DATA: Intraspinal synovial cysts of the C1-C2 junction are extremely rare. Neither association with rheumatoid atlantoaxial instability nor communication with the C1-C2 facet joints and the subarachnoid space has been previously reported in a synovial cyst of the C1-C2 junction. MATERIALS AND METHODS: The clinical and radiologic features of a 71-year-old woman with a symptomatic synovial cyst of the C1-C2 junction with rheumatoid atlantoaxial instability are detailed. Posterior atlantoaxial fusion alone was performed. RESULTS: Preoperative magnetic resonance images demonstrated a large cystic mass around the dens, compressing the spinal cord. The mass was of low signal intensity on T1-weighted images, was of high signal intensity on T2-weighted images, and was enhanced marginally with gadolinium-DTPA on T1-weighted images. Computed tomograms performed after myelography disclosed the cyst around the dens communicating with the subarachnoid space and the C1-C2 facet joints. Spontaneous regression of the cyst was identified on the magnetic resonance images 3 months after surgery. One year after surgery, myelopathic symptoms were improved. CONCLUSION: An intraspinal cyst communicating with the C1-C2 facet joints and subarachnoid space associated with rheumatoid atlantoaxial instability was reported. Computed tomograms after myelography were useful in delineating the relationships among the synovial cyst, facet joints, and the subarachnoid space. Spontaneous regression of the cyst and clinical improvement were achieved by C1-C2 posterior fusion alone.

Aged↗
PubMed1995

Fibrous structures in the subarachnoid space: a study with spinaloscopy in autopsy subjects.

The lumbar and lower thoracic subarachnoid space of 26 human autopsy subjects was studied using rigid endoscopy, spinaloscopy. Fibrous attachments were found between nerve roots and/or nerve roots and the arachnoid membrane at least at one spinal level in 16 subjects. The appearance and density of the structures varied, and caused restriction of nerve root mobility in nine subjects. In three of them, the impeded mobility prevented the nerve root from yielding to the contact and pressure exerted either by the tip of the endoscope or by a spinal needle introduced into the subarachnoid space. In another three subjects, a distinct membranous structure was identified in the posterior midline of the subarachnoid space in the lower thoracic and upper lumbar regions. These findings may possibly be associated with the variation in the extent of subarachnoid block and to the development of isolated nerve root trauma in connection with this procedure.

Aged↗
PubMed2005

Evolution of subarachnoid space in normal fetuses using magnetic resonance imaging.

OBJECTIVE: The purpose of this study was to measure the fetal subarachnoid spaces at different sites of the brain using magnetic resonance (MR) images and analyze them in relation to gestational age. METHODS: Fetal MR images were obtained from 158 fetuses between 18 and 39 weeks of gestation who later showed no neurological problems. We bilaterally measured the distance between the superoanterior gyrus and the cranium as the frontal subarachnoid space (FSS) and the distance between the cortex in the parieto-occipital sulcus and the cranium as the parietal subarachnoid space (PSS). We also measured the cisterna magna between the cerebellar vermis and the cranium. Each of these was analyzed in relation to gestational age. RESULTS: The width of the FSS began to decrease significantly at 32 weeks of gestation (P < 0.05). The width of the PSS started to decrease significantly at 34 weeks of gestation (P < 0.05). There was no difference between the right and left sides (P < 0.05). The size of the cisterna magna showed a positive correlation with gestational age (P < 0.05). CONCLUSION: Measurement of the subarachnoid space is potentially useful for evaluating fetal development.

Cisterna Magna↗
PubMed1995

The size of the intra- and extraventricular cerebrospinal fluid compartments in children with idiopathic benign widening of the frontal subarachnoid space.

The aim of this study was to quantify the intra- and extraventricular cerebrospinal fluid (CSF) spaces in children with benign enlargement of the frontal subarachnoid space (BE). The infra- and supratentorial CSF compartments were measured in 61 CT examinations of children with BE, 3-27 months old, and compared with those of 96 CT examinations considered normal. Measurements of the ventricular system, and the pontine and chiasmatic cisterns were related to cranial size. In all children with BE the lateral and third ventricles were dilated and the chiasmatic cistern was widened. The subarachnoid space was wider than the upper limits in the control group, in the frontal region (4 mm), and the anterior interhemispheric (4 mm) and Sylvian (3 mm) fissures. The infratentorial CSF compartments, the occipital subarachnoid space, the posterior part of the interhemispheric fissure and, in most cases, the cortical sulci were normal in size in children with BE. The majority were macrocephalic or had rapid head growth but there were also normocephalic children with normal head growth. The size of the posterior fossa was within the normal range in all children with BE. Idiopathic BE is not uncommon in children up to about 3 years old who are healthy or have minimal neurological disturbance and is characterised by a specific pattern of widening of the supratentorial CSF compartments.

Cephalometry↗
PubMed1981

Benign enlargement of the subarachnoid spaces in the infant.

The authors report 18 infants with benign enlargement of the subarachnoid spaces seen at their institution during a 1-year time interval. This condition is characterized by the computerized tomography findings of dilatation of the subarachnoid spaces, normal or slightly enlarged ventricular size, and prominence of the basilar cisterns. Most cases were found in children referred for the evaluation of abnormally increasing head circumference measurements. Although it was not possible to document the development, and, in several cases, improvement of this process, in these patients enlargement of the subarachnoid spaces was a benign diagnosis, not associated with serious neurological dysfunction.

Head↗
PubMed2004

Silicone oil in the subarachnoidal space--a possible route to the brain?

Using this case report, we sought evidence that silicone oil may infiltrate the subarachnoidal space. Vitrectomy combined with silicone oil implantation was performed on the right eye of a 72-year-old woman. The silicone oil was removed 2 months later, because the patient had developed elevated intraocular pressure. The blind and painful eye was subsequently enucleated. By light microscopy, presumed silicone oil bubbles were identified in the optic nerve and the subarachnoidal space of the enucleated eye. These vacuoles were examined by energy-dispersive X-ray analysis (EDAX). In addition, in the vacuoles, immunohistochemistry was used to test for the presence of CD 68-positive macrophages. Silicone oil infiltration sites in the optic nerve, in the central retinal artery, and in the subarachnoidal space were located by light microscopy and confirmed by EDAX. CD 68-positive macrophages were found in the silicone-filled vacuoles. Silicone oil used for endotamponade may infiltrate the optic nerve and even the subarachnoidal space. This supports the assumption that silicone oil, under special circumstances, may even migrate into the brain.

Aged↗