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Arquivos de Neuro-Psiquiatria

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BRAGA, Fernando Menezes; REIS-FILHO, João Baptista dos  and  CAMARGO-LIMA, José Geraldo de. Cerebrospinal fluid protein concentration gradient: 2 - Effect of the ventriculoatrial shunt. Arq. Neuro-Psiquiatr. [online]. 1983, vol.41, n.3, pp.266-273. ISSN 0004-282X.

On a previous paper, based upon the data obtained from comparative studies of cerebrospinal fluid samples of two groups of patients with neuro-cysticercosis in activity, one with patency, the other one with blockage of the spinal subarachnoid space, evidence was presented that the concentration gradient of proteins along the neuraxis was the consequence of the escape of water from cerebrospinal fluid. The second paper is a continuance of that one. The material for this survey consisted of the clinical records of 11 patients with neurocysticercosis who during the course of the disease presented severe intracranial hypertension which required ventriculoatrial shunt as an emergency operation in order to allow survival. After surgery, it was observed a marked improvement in the clinical picture. Later, it was noticed a large increase in the protein content of the spinal fluid of the majority of the patients, as compared with the results verified prior to surgery. However, in these spinal fluid samples the increase in protein content was observed without a simultaneous rise in cell count, suggesting an improvement in the inflammatory condition. It seems very likely that this large elevation of the protein content in the subarachnoid fluid is the consequence of a reduction in the spinal fluid flow rate due to the ventricle-venous shunt. The decrease in the intensity of the central nervous system immune response and inflammatory reaction, estimated on the basis of the spinal fluid changes after surgery, indicates a restored normal state of cerebrospinal fluid pressure due to the beneficial effect of the ventriculoatrial shunt. In search of the world literature we have been unable to find previous description of this marked increase in the protein content of the spinal fluid after ventriculoatrial or peritoneal shunts, either in patients with neurocysticercosis or in patients with other disease processes of no tumoral origin that later develloped blockage of the fourth ventricle and basal cisterns.

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