Liqüido cefalorraqueano em acidentes vasculares cerebrais: estudo de 1500 casos

Spina-França, A.; Livramento, J. A.; Machado, L. R.; Nóbrega, J. P. S.; Bacheschi, L. A.

doi:10.1590/S0004-282X1987000200010

Resumos

Para avaliar a informação que pode ser obtida mediante o estudo do líquido cefalorraqueano (LCR) em acidentes vasculares cerebrais (AVC) foram analisados os dados de 1500 casos. Três tipos fundamentais de AVC podem ser considerados do ponto de vista do LCR: AVC LCR tipo 1, sem hemácias e sem xantocromia (incolor); AVC LCR tipo 2, sem hemácias e com xantocromia; AVC LCR tipo 3, com hemácias e com xantocromia. Os dados quanto a cada grupo são discutidos bem como suas correlações. O papel de alterações metabólicas sistêmicas, da barreira hêmato-encefálica e do comprometimento do parênquima do sistema nervoso central são discutidos na interpretação dos achados. Considerações finais são feitas quanto à utilidade do estudo do LCR em AVC frente a avanços em outras técnicas de investigação, como as de neuroimagem.

In order to evaluate information on acute stroke through the study of cerebrospinal fluid (CSF) data em 1500 patients were analysed in the first 48 hours following stroke. Cases were distributed in three groups according to CSF basic findings: type 1, CSF without erythrocytes and without xanthochromy; type 2, CSF without erythrocytes and with xanthochromy; tipe 3, CSF with erythrocytes and with xanthocromy. Data on each type are discussed as well as correlation findings. Systemic metabolic disturbances, blood-brain barrier impairment and central nervous system lesions are discussed as to the role they have in CSF changes observed in stroke. Indication of CSF exam in stroke is reviewed taking into account progress in neuroimaging techniques.

Liqüido cefalorraqueano em acidentes vasculares cerebrais: estudo de 1500 casos

Cerebrospinal fluid in acute stroke: a study based upon 1500 cases

A. Spina-França^I; J. A. Livramento^II; L. R. Machado^III; J. P. S. Nóbrega^III; L. A. Bacheschi^II

^IProfessor Titular - Centro de Investigações em Neurologia (CIN), Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIDocente Livre - Centro de Investigações em Neurologia (CIN), Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP)

^IIIAssistente Doutor - Centro de Investigações em Neurologia (CIN), Departamento de Neurologia, Faculdade de Medicina da Universidade de São Paulo (FMUSP)

RESUMO

Para avaliar a informação que pode ser obtida mediante o estudo do líquido cefalorraqueano (LCR) em acidentes vasculares cerebrais (AVC) foram analisados os dados de 1500 casos. Três tipos fundamentais de AVC podem ser considerados do ponto de vista do LCR: AVC LCR tipo 1, sem hemácias e sem xantocromia (incolor); AVC LCR tipo 2, sem hemácias e com xantocromia; AVC LCR tipo 3, com hemácias e com xantocromia. Os dados quanto a cada grupo são discutidos bem como suas correlações. O papel de alterações metabólicas sistêmicas, da barreira hêmato-encefálica e do comprometimento do parênquima do sistema nervoso central são discutidos na interpretação dos achados. Considerações finais são feitas quanto à utilidade do estudo do LCR em AVC frente a avanços em outras técnicas de investigação, como as de neuroimagem.

SUMMARY

In order to evaluate information on acute stroke through the study of cerebrospinal fluid (CSF) data em 1500 patients were analysed in the first 48 hours following stroke. Cases were distributed in three groups according to CSF basic findings: type 1, CSF without erythrocytes and without xanthochromy; type 2, CSF without erythrocytes and with xanthochromy; tipe 3, CSF with erythrocytes and with xanthocromy. Data on each type are discussed as well as correlation findings. Systemic metabolic disturbances, blood-brain barrier impairment and central nervous system lesions are discussed as to the role they have in CSF changes observed in stroke. Indication of CSF exam in stroke is reviewed taking into account progress in neuroimaging techniques.

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Centro de Investigações em Neurologia, FMUSP - Caixa Postal 5199 - 01000 - São Paulo, SP . Brasil.

1. BANIK, N.L. & HOGAN, E.L. - Cerebrospinal fluid enzymes in neurological disease. In H. Wood (ed.): Neurobiology of Cerebrospinal Fluid 2. Plenum Press, New York, 1983, pg. 205.
2. BARROWS, L.J.: HUNTER, F.T. & BANKER, B.Q. - The nature and clinical significance of pigments in the cerebrospinal fluid. Brain 78:59, 1955.
3. BRADBURY, M. - The Concept of a Blood-Brain Barrier. John Wiley and Sons, Chichester, 1979.
4. BRITTON, M.; HULTMAN, E.; MURRAY, V. & SJOHOLM, H. - The diagnostic accuracy of CSF analyses in stroke. Acta med. scand. 214:3, 1983.
5. BUSSE, O. & HOFFMAN, O. - CSF lactate and CT findings in middle cerebral artery infarction: a comparative study. Stroke 14:960, 1983.
6. CHANDLER, W.L.; CLAYSON, K.J.; LONGSTRETH Jr., W.T. & FINE, J.S. - Creatine kinase isoenzymes in human cerebrospinal fluid and brain. Clin. Chem. 30:1804, 1984.
7. DOCZI, T.; NEMESSANYI, Z.; SZVEGARY, Z. & HUSZKA, E. - Disturbance of cerebrospinal fluid circulation during the acute stage of subarachnoid hemorrhage. Neurosurgery 12:435, 1983.
8. DONNAN, G.A.; ZAPF, P.; DOYLE, A.E. & BLADIN, P.F. - CSF enzymes in lacunar and cortical stroke. Stroke 14:266, 1983.
9. DUFFY, G.P. - Lumbar puncture in spontaneous subarachnoid haemorrhage. Brit, med. J. 285:1163, 1982.
10. FISHMAN, R.A. - Cerebrospinal Fluid in Diseases of the Nervous System. W.B. Saunders, Philadelphia, 1980.
11. FURUI, T.; SATOH, K.; ASANO, Y.; SHIMOSAWA, S.; HASUO, M. & YAKSH, T.D. - Increase of beta-endorphin levels in cerebrospinal fluid but not in plasma in patients with cerebral infarction. J. Neurosurg. 61:748, 1984.
12. GAETANI, R.; BAENA, R.R.; SILVANI, V.; RAINOLDI, F. & PAOLETTI, P. - Prostacyclin and vasospasm in subarachnoid hemorrhage from ruptured intracranial aneurysm. Acta neurol. scand. 73:33, 1986.
13. HACHINSKI, V. & NORRIS, J.W. - The Acute Stroke. F.A. Davis, Philadelphia. 1985.
14. HALLGREN, R.; NIKLASSON, F.; TERENT, A.; AKERBLOM, A. & WIDERLOV, E. - Oxypurines in cerebrospinal fluid as indices of disturbed brain metabolism: a clinical study of ischemic brain diseases. Stroke 14:382, 1983.
15. HORNIG, C.R.; BUSSE, O.; DORNDORF, W. & KAPS, M. - Changes in CSF blood-brain barrier parameters in ischaemic cerebral infarction. J. Neurol. 11:229, 1983.
16. ITOH, Y.; ENEMOTO, H.; TAKAGI, K.; OBAYASHI, T. & KAWAI, T. - Human alpha-1 microglobulin levels in neurological disorders. Eur. Neurol. 22:1, 1983.
17. KJELLIN, K.G. - Xanthochromic compounds in cerebrospinal fluid: quantitative spectrophotometry and electromigration. In J.H. Wood (ed.): Neurobiology of Cerebrospinal Fluid 2. Plenum Press, New York, 1983, pg. 559.
IS. KOSTELJANETZ, M. - CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage. J. Neurosurg. 60:940, 1984.
19. KRONHOLM, V. & LINTRUP, J. - Spectrophotometric investigation of the cerebrospinal fluid in the near ultraviolet region: a possible diagnostic aid in diseases of the central nervous system. Acta psychiat. neurol. scand. 35:314, 1960.
20. LANGE, O. - O Liqüido Cefalo-Raquidiano em Clínica. Melhoramentos (Weizflog Irmãos Inc.), São Paulo, 1938.
21. MACHADO, L.R.; LIVRAMENTO, J.A.; TABARES-OLIVES, A.; CLEMENTE, H.A.M. & SPINA-FRANÇA, A. - Dinâmica de sinalização citomorfológica do liqüido cefa-lorraqueano. Arq. Neuro-Psiquiat. (São Paulo) 37:1, 1979.
22. MARLET, J.M. - índices para estimar o tempo transcorrido entre o surto hemorrágico subaracnóideo e a colheita de liqüido cefalorraqueano. Arq. Neuro-Psiquiat. (São Paulo) 31:290, 1973.
23. MERRITT, H.H. & FREMONT-SMITH, F. - The Cerebrospinal Fluid. Saunders, Philadelphia, 1937.
24. SAGE, J.I.: van UITERT, R.L. & DUFFY, T.E. - Early changes in blood brain barrier permeability to small molecules after transient cerebral ischemia. Stroke 15:46, 1984.
25. SHENKIN, H.A. & FINNESON, B.E. - Clinical significance of low cerebral spinal fluid pressure. Neurology 8:157, 1958.
26. SHIGENO, T. - Norepinephrine in cerebrospinal fluid of patients with cerebral vasospasm. J. Neurosurg. 56:344, 1982.
27. SMITH, B.F. & MATZ, R. - Cerebrospinal fluid pleocytosis following hemorrhagic cerebral infarction. Amer. J. Med. 286:37, 1983.
28. SPINA-FRANÇA, A. - Liqüido cefalorraqueano. In A. Tolosa & H.M. Canelas (eds.): Propedêutica Neurológica. Ed. 2. Procienx, São Paulo, 1971, pg. 443.
29. SPINA-FRANÇA, A. - Peculiaridades imunológicas do sistema nervoso central. In R. Melaragno Filho & C.K. Naspitz (eds.): Neuroimunologia. Sarvier, São Paulo, 1982, pg. 67.
30. STRAND, T.; ALLING, C.; KARLSSON, I. & WINBLAD, B. - Brain and plasma proteins in spinal fluid as markers for brain damage and severity of stroke. Stroke 15:138, 1984.
31. TOOLE, J.F. - Cerebrovascular Disorders. Ed. 3. Raven Press, New York, 1984.
32. TOURTELLOTTE, W.W.; METZ, L.N.; BRYAN, E.R. & DeJONG, R.N. - Spontaneous subarachnoid hemorrhage: factors affecting the rate or clearing of the cerebrospinal fluid. Neurology 14:301, 1964.
33. TOURTELLOTTE, W.W.; SOMERS, J.P.; PARKER, J.A.; ITABASHI, H.H. & DeJONG, R.N. - A study on traumatic lumbar punctures. Neurology 8:129, 1958.
34. VIALLARD, J.L.; GAULME, J.; DALENS, B. & DASTUGUE, B. - Cerebrospinal fluid enzymology: creatine kinase, lactate dehydrogenase activity and isozyme pattern as a brain damage index. Clin. chim. Acta 89:405, 1978.
35. WIKKELSO, C.; FAHRENKRUG, J.; BLOOMSTRAND, C. & JOHANSSON, B.B. - Dementia of different etiologies: vasoactive intestinal polypeptide in CSF. Neurology 35:592, 1985.
36. WOLINTZ, A.H.; JACOBS, L.D.; CHRISTOFF, N.; SOLOMON, M. & SHERNIK, N. - Serum and cerebrospinal fluid enzyme in cerebrovascular disease: creatine phosphokinase, aldolase, and lactic dehydrogenase. Arch. Neurol. 20:54, 1969.

Datas de Publicação

Publicação nesta coleção
22 Jun 2011
Data do Fascículo
Jun 1987

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. BANIK, N.L. & HOGAN, E.L. - Cerebrospinal fluid enzymes in neurological disease. In H. Wood (ed.): Neurobiology of Cerebrospinal Fluid 2. Plenum Press, New York, 1983, pg. 205.

[2] 2. BARROWS, L.J.: HUNTER, F.T. & BANKER, B.Q. - The nature and clinical significance of pigments in the cerebrospinal fluid. Brain 78:59, 1955.

[3] 3. BRADBURY, M. - The Concept of a Blood-Brain Barrier. John Wiley and Sons, Chichester, 1979.

[4] 4. BRITTON, M.; HULTMAN, E.; MURRAY, V. & SJOHOLM, H. - The diagnostic accuracy of CSF analyses in stroke. Acta med. scand. 214:3, 1983.

[5] 5. BUSSE, O. & HOFFMAN, O. - CSF lactate and CT findings in middle cerebral artery infarction: a comparative study. Stroke 14:960, 1983.

[6] 6. CHANDLER, W.L.; CLAYSON, K.J.; LONGSTRETH Jr., W.T. & FINE, J.S. - Creatine kinase isoenzymes in human cerebrospinal fluid and brain. Clin. Chem. 30:1804, 1984.

[7] 7. DOCZI, T.; NEMESSANYI, Z.; SZVEGARY, Z. & HUSZKA, E. - Disturbance of cerebrospinal fluid circulation during the acute stage of subarachnoid hemorrhage. Neurosurgery 12:435, 1983.

[8] 8. DONNAN, G.A.; ZAPF, P.; DOYLE, A.E. & BLADIN, P.F. - CSF enzymes in lacunar and cortical stroke. Stroke 14:266, 1983.

[9] 9. DUFFY, G.P. - Lumbar puncture in spontaneous subarachnoid haemorrhage. Brit, med. J. 285:1163, 1982.

[10] 10. FISHMAN, R.A. - Cerebrospinal Fluid in Diseases of the Nervous System. W.B. Saunders, Philadelphia, 1980.

[11] 11. FURUI, T.; SATOH, K.; ASANO, Y.; SHIMOSAWA, S.; HASUO, M. & YAKSH, T.D. - Increase of beta-endorphin levels in cerebrospinal fluid but not in plasma in patients with cerebral infarction. J. Neurosurg. 61:748, 1984.

[12] 12. GAETANI, R.; BAENA, R.R.; SILVANI, V.; RAINOLDI, F. & PAOLETTI, P. - Prostacyclin and vasospasm in subarachnoid hemorrhage from ruptured intracranial aneurysm. Acta neurol. scand. 73:33, 1986.

[13] 13. HACHINSKI, V. & NORRIS, J.W. - The Acute Stroke. F.A. Davis, Philadelphia. 1985.

[14] 14. HALLGREN, R.; NIKLASSON, F.; TERENT, A.; AKERBLOM, A. & WIDERLOV, E. - Oxypurines in cerebrospinal fluid as indices of disturbed brain metabolism: a clinical study of ischemic brain diseases. Stroke 14:382, 1983.

[15] 15. HORNIG, C.R.; BUSSE, O.; DORNDORF, W. & KAPS, M. - Changes in CSF blood-brain barrier parameters in ischaemic cerebral infarction. J. Neurol. 11:229, 1983.

[16] 16. ITOH, Y.; ENEMOTO, H.; TAKAGI, K.; OBAYASHI, T. & KAWAI, T. - Human alpha-1 microglobulin levels in neurological disorders. Eur. Neurol. 22:1, 1983.

[17] 17. KJELLIN, K.G. - Xanthochromic compounds in cerebrospinal fluid: quantitative spectrophotometry and electromigration. In J.H. Wood (ed.): Neurobiology of Cerebrospinal Fluid 2. Plenum Press, New York, 1983, pg. 559.

[18] IS. KOSTELJANETZ, M. - CSF dynamics in patients with subarachnoid and/or intraventricular hemorrhage. J. Neurosurg. 60:940, 1984.

[19] 19. KRONHOLM, V. & LINTRUP, J. - Spectrophotometric investigation of the cerebrospinal fluid in the near ultraviolet region: a possible diagnostic aid in diseases of the central nervous system. Acta psychiat. neurol. scand. 35:314, 1960.

[20] 20. LANGE, O. - O Liqüido Cefalo-Raquidiano em Clínica. Melhoramentos (Weizflog Irmãos Inc.), São Paulo, 1938.

[21] 21. MACHADO, L.R.; LIVRAMENTO, J.A.; TABARES-OLIVES, A.; CLEMENTE, H.A.M. & SPINA-FRANÇA, A. - Dinâmica de sinalização citomorfológica do liqüido cefa-lorraqueano. Arq. Neuro-Psiquiat. (São Paulo) 37:1, 1979.

[22] 22. MARLET, J.M. - índices para estimar o tempo transcorrido entre o surto hemorrágico subaracnóideo e a colheita de liqüido cefalorraqueano. Arq. Neuro-Psiquiat. (São Paulo) 31:290, 1973.

[23] 23. MERRITT, H.H. & FREMONT-SMITH, F. - The Cerebrospinal Fluid. Saunders, Philadelphia, 1937.

[24] 24. SAGE, J.I.: van UITERT, R.L. & DUFFY, T.E. - Early changes in blood brain barrier permeability to small molecules after transient cerebral ischemia. Stroke 15:46, 1984.

[25] 25. SHENKIN, H.A. & FINNESON, B.E. - Clinical significance of low cerebral spinal fluid pressure. Neurology 8:157, 1958.

[26] 26. SHIGENO, T. - Norepinephrine in cerebrospinal fluid of patients with cerebral vasospasm. J. Neurosurg. 56:344, 1982.

[27] 27. SMITH, B.F. & MATZ, R. - Cerebrospinal fluid pleocytosis following hemorrhagic cerebral infarction. Amer. J. Med. 286:37, 1983.

[28] 28. SPINA-FRANÇA, A. - Liqüido cefalorraqueano. In A. Tolosa & H.M. Canelas (eds.): Propedêutica Neurológica. Ed. 2. Procienx, São Paulo, 1971, pg. 443.

[29] 29. SPINA-FRANÇA, A. - Peculiaridades imunológicas do sistema nervoso central. In R. Melaragno Filho & C.K. Naspitz (eds.): Neuroimunologia. Sarvier, São Paulo, 1982, pg. 67.

[30] 30. STRAND, T.; ALLING, C.; KARLSSON, I. & WINBLAD, B. - Brain and plasma proteins in spinal fluid as markers for brain damage and severity of stroke. Stroke 15:138, 1984.

[31] 31. TOOLE, J.F. - Cerebrovascular Disorders. Ed. 3. Raven Press, New York, 1984.

[32] 32. TOURTELLOTTE, W.W.; METZ, L.N.; BRYAN, E.R. & DeJONG, R.N. - Spontaneous subarachnoid hemorrhage: factors affecting the rate or clearing of the cerebrospinal fluid. Neurology 14:301, 1964.

[33] 33. TOURTELLOTTE, W.W.; SOMERS, J.P.; PARKER, J.A.; ITABASHI, H.H. & DeJONG, R.N. - A study on traumatic lumbar punctures. Neurology 8:129, 1958.

[34] 34. VIALLARD, J.L.; GAULME, J.; DALENS, B. & DASTUGUE, B. - Cerebrospinal fluid enzymology: creatine kinase, lactate dehydrogenase activity and isozyme pattern as a brain damage index. Clin. chim. Acta 89:405, 1978.

[35] 35. WIKKELSO, C.; FAHRENKRUG, J.; BLOOMSTRAND, C. & JOHANSSON, B.B. - Dementia of different etiologies: vasoactive intestinal polypeptide in CSF. Neurology 35:592, 1985.

[36] 36. WOLINTZ, A.H.; JACOBS, L.D.; CHRISTOFF, N.; SOLOMON, M. & SHERNIK, N. - Serum and cerebrospinal fluid enzyme in cerebrovascular disease: creatine phosphokinase, aldolase, and lactic dehydrogenase. Arch. Neurol. 20:54, 1969.