Increased cerebral pressure | Spinal fluid

Increased cerebral pressure

An increase in intracranial pressure may be congenital or acquired. The causes can also be different, either the drainage of the nerve water is disturbed or increased production occurs. Due to the excess of nerve water, there is not enough space in the so-called ventricles of the brain and the brain mass is pushed to the edge.

This can be so severe that it can lead to circulatory disorders of the brain. When the cerebrospinal fluid is removed, this manifests itself in a strong effervescence of the cerebrospinal fluid. However, this sudden release of pressure can also lead to problems, as the brain can now slip into the spinal cord space, which is a life-threatening situation.In children born with an outflow disorder, for example, CT shows that the brain is not pressed to the side, but that these children have greatly enlarged nereval water spaces in the gehrin (ventricle).

This can be treated with a so-called shunt, a kind of overflow valve. In some cases, children with such a water head (hydrocephalus) show mental retardation. These mental retardations can range from mild to severe.

In order to be able to examine the cerebrospinal fluid/spinal fluid in the laboratory, it must be obtained from the spinal canal. To do this, a long needle is inserted into the spinal canal and the fluid can escape (lumbar puncture). The lumbar puncture can be performed on a sitting or lying patient.

The only important thing is that the curvature of the lower back be as efficient as possible, since this causes the spinal column’s extensions to diverge further, thus facilitating puncture through the ligamentous structures of the spinal column. The puncture is performed at the level of the space between the third and fourth or fourth and fifth lumbar vertebrae to avoid injuries to the spinal cord. Since the spinal cord already ends at about the level of the first lumbar vertebra, there is hardly any risk of a lesion.

If it is not possible to withdraw cerebrospinal fluid in the lumbar spine, as is rarely the case with tumor infestation of the spinal column, it is in principle also possible to withdraw it from the so-called cisterna cerebello-medullaris, a space between the occiput and the first cervical vertebra. In the usual lumbar puncture, the needle is advanced into the spinal canal until cerebrospinal fluid emerges. This fluid is collected in test tubes and examined.

In order to avoid complications such as infections, strictly sterile conditions should be created and patients should subsequently remain on bed rest. Sufficient fluid intake must be ensured to avoid headaches after the procedure. Bleeding from the puncture is rare.

Many diseases of the central nervous system cannot be diagnosed by blood tests alone; in such cases, lumbar puncture is often the method of choice. This allows viral or bacterial infections that cause inflammatory reactions to be detected. Bleeding in the subarachnoid space, i.e. bleeding from vessels at the base of the skull that supply the brain/brain with blood, as well as tumorous changes in the central nervous system can also be assessed.

Infections caused by fungi and parasites are less common. After the liquor/spinal fluid has been removed, it is examined in the laboratory for the following criteria: macroscopically for color changes and cloudiness, which often allow an initial suspicious diagnosis, microscopically for cell type and number, protein, sugar and mineral content, antibodies as well as bacteria and fungi. Since diseases of the central nervous system (CNS) are associated with changes in the cerebrospinal fluid or its composition, CSF diagnostics can often confirm suspected diagnoses.

Inflammatory diseases of the central nervous system (CNS) such as encephalitis, meningitis, myelitis or inflammatory autoimmune diseases such as multiple sclerosis can be assessed. In the case of bacterial infections, neutrophil granulocytes, a subtype of the white blood cells, can be detected. In viral infections, however, lymphocytes are found in greater numbers.

Tumor cells in the cerebrospinal fluid lead to the suspicion of a tumor attack of the meninges (meningeosis neoplastica), which can occur in lymphomas, leukemias or carcinoma. Bleeding in the subarachnoid space, which originates from arteries supplying the brain, is confirmed by the presence of erythrocytes (red blood cells) in the cerebrospinal fluid. However, artifacts must be taken into account here, as small amounts of blood can also be caused by the puncture during the puncture.

The CSF examination can also be used to diagnose Lyme disease and neurolues (last stage of syphilis). Increased intracranial pressure is an absolute contraindication for a lumbar puncture, as the removal of cerebrospinal fluid can cause the brain to subside and become trapped. The respiratory center is compressed and there is a risk of respiratory arrest with immediate life-threatening consequences. For this reason, a cerebral pressure measurement is essential before cerebrospinal fluid is taken.