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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.41 no.3 São Paulo Sept. 1983

http://dx.doi.org/10.1590/S0004-282X1983000300006 

Gradiente ventrículo-lombar de concentração das proteínas totais do líquido cefalorraquiano: 1 - Mecanismo de origem

 

Cerebrospinal fluid protein concentration gradient: 1. Mechanism of origin

 

 

Fernando Menezes BragaI; João Baptista dos Reis-FilhoI; José Geraldo de Camargo-LimaII

IProfessor Adjunto. Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Disciplina de Neurologia
IIProfessor Titular. Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, Disciplina de Neurologia

 

 


RESUMO

Foi feito estudo do mecanismo de origem do gradiente ventriculo-lombar de concentração das proteínas totais do LCR baseado no comportamento da taxa das proteínas totais e do título da reação de fixação de complemento para cisticerco em pacientes com neurocisticercose em atividade. O aumento concomitante da taxa das proteínas totais e da intensidade da reação imunitária, em amostras simultâneas cisternal e lombar do LCR de pacientes com comunicação livre no espaço subaracnóideo espinhal, e as grandes elevações simultâneas destes dados da semiologia no LCR lombar de pacientes que apresentaram bloqueio do espaço subaracnóideo espinhal, indicam que o gradiente de concentração das proteínas ao longo do neuro-eixo resulta da saída seletiva de água.


SUMMARY

In normal conditions there is a concentration gradient of proteins along the neuraxis. From a low level in the ventricles, ranging from 5 to 15 mg/100 ml, to an intermediate level in the cisterna magna, the protein content reaches its highest level in the lumbar sac, 12 to 44 mg/100 ml. Several mechanisms were considered to elucidate the origin of this gradient but many investigators think that the progressive increase of the protein concentration is best explained by the transfer of proteins from serum to the cerebrospinal fluid due to the relatively raised permeability of blood-cerebrospinal fluid barrier in the spinal subarachnoid space. This paper presents a study of the protein concentrations in cisternal and lumbar cerebrospinal fluid samples of patients with neurocysticercosis in activity. The 11 patients of the first group had free subarachnoid space communication between the cisterna magna and the lumbar sac; the 6 patients of the second group had a complete block of the subarachnoid space between these two levels. In every cerebrospinal fluid specimen the quantitative complement fixation test for cysticercus was performed and the titer determined in order to make an assessment of the central nervous system humoral immune response. The analysis of the data of this investigation shows that the concentration gradient of proteins is evident in the cerebrospinal fluid of patients with patency of the spinal subarachnoid space, and the ratio of concentrations of protein contents in simultaneous cisternal and lumbar samples was similar to that one observed in normal individuals. This gradient is also detected when the intensity of the humoral immune response is determined by quantitative complement fixation test for cysticercus in simultaneous cisternal and lumbar specimens. After the onset of spinal subarachnoid block, the confront of the results of the tests in cerebrospinal fluid samples, obtained before and after the blockage, shows a large increase both in the total protein content as well as the intensity of the humoral immune response, in the lumbar level. The similar increases both in protein concentration and titer of cysticercus complement fixation test in the lumbar fluid, in comparison with the cisternal fluid, in patients with patent spinal subarachnoid space, and the large simultaneous and similar increases in both protein content and titer of the cysticercus complement fixation test in the lumbar fluid of patients with spinal subarachnoid block are in disagreement with the usual explanation of the origin mechanims of the gradient. If the large increase in the protein content were the consequence of its transfer from serum to cerebrospinal fluid, it would have determined a decrease in the intensity of the immune response because of the negative or low complement fixation test titer usually verified in blood serum. Due to the poor systemic repercussion of the humoral immune response, the blood serum has a low reagin concentration or no reagin at all. Thus, it would have resulted in a decrease of the reagin concentration, instead of the constant increase observed in the spinal fluid of the great majority of the patients of the two groups.
The comparative study of the protein contents and of the degrees of the intensity of the immune response in the cerebrospinal fluid of patients with neurocysticercosis, with patency of the cistern-lumbar subarachnoid space, and with spinal subarachnoid space block, suggests that the cerebrospinal fluid protein concentration gradient is the consequence of the scape of water from the fluid.


 

 

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