According to previous studies on hydrocephalus, VPS placement has a high complication rate 18, 19, 20, 21, 22, 23. A VPS placement is effective in treating persistent increased CSF pressure and hydrocephalus. Non-HIV infected patients with CM are more likely to have intractable, high intracranial pressure, which is the leading cause of death and poor outcomes 17. To date, there have been rare reports of ventricular CSF and CSF gradients in the study of human disease 6, 7, 8, 9, 10, 11, 12, 16.Ĭryptococcal meningitis (CM) is a subacute, but a life-threatening fungal infection of the CNS. Although there are no normal reference ranges for various parameters of ventricular CSF, analysis of ventricular CSF may be used for evaluating certain diseases, such as meningeal carcinomatosis by detecting malignant cells and subarachnoid hemorrhage by detecting red blood cells. reported no difference of total protein level between ventricular and lumbar CSF in patients with tuberculous meningitis 8. Most protein fractions have a higher concentration in lumbar CSF than in ventricular CSF 9, 11, while some protein fractions have the opposite concentration gradients 9, 11. Some studies have indicated that the total protein concentration is higher in lumbar CSF than in ventricular CSF 10, 11. Of CSF components, the protein concentration gradient of ventricular to lumbar CSF is the most studied 8, 9, 10, 11, 12, 13. Whether there is a difference between the composition of ventricular and lumbar CSF is unclear 6, 8, 9, 10, 11. In some cases, however, CSF is obtained during more invasive procedures such as external ventricular drainage (EVD) and ventriculoperitoneal shunt (VPS) placement 5, 6, 7. CSF samples are usually acquired by lumbar puncture 2, 4. Transient deterioration of lumbar CSF parameters after ventriculoperitoneal shunt placement may not be due to disease progression, but to change in CSF flow rate by CSF shunts.Ĭerebrospinal fluid (CSF) analysis is commonly used to identify and follow-up disease of the central nervous system (CNS) 1, 2, 3. Furthermore, ventricular and lumbar CSF parameters may have different clinical implications. These findings suggest that the composition of ventricular CSF differs from that of lumbar CSF, and different CSF parameters have disparate rostro-caudal gradients in patients with Cryptococcal meningitis. After shunt placement, total protein concentration was transiently increased, white blood cell count, CSF/blood glucose ratio and chloride ion concentration were continued at the preoperative level until two months after shunting surgery. The changes in lumbar CSF indices over time after shunt placement were also analyzed. The lumbar CSF parameters had no significant differences between these groups.

Compared to patients without surgical complications, patients with complications had a significantly lower CSF/blood glucose ratio in ventricular CSF ( p = 0.032). Compared to patients without ventriculomegaly, patients with ventriculomegaly had a significantly higher total protein concentration in ventricular CSF ( p = 0.047). White blood cell count, total protein level and Cryptococcal count were lower in ventricular CSF than in lumbar CSF, while CSF/blood glucose ratio and chloride ion concentration were higher. All parameters between lumbar and ventricular CSF were remarkably different (all p < 0.001). We analyzed the following parameters: white blood cell count, total protein concentration, CSF/blood glucose ratio, chloride ion concentration, and Cryptococcal count. To determine whether there are differences between ventricular and lumbar CSF parameters and whether the differences have clinical significance, we retrospectively reviewed 77 patients with Cryptococcal meningitis who received a ventriculoperitoneal shunt. Lumbar cerebrospinal fluid (CSF) parameters are widely studied and have wide clinical applications, but ventricular CSF has rarely been studied since it is relatively difficult to obtain.

Cryptococcal meningitis csf findings