BACKGROUND: One of the most serious risks of epidural anesthesia is total spinal blockade from unintentional dural puncture. We evaluated the glucose test and the thiopental precipitation test to differentiate cerebrospinal fluid (CSF) from local anesthetics (LA). METHODS: (1) Experiment 1: CSF from twenty patients was serially diluted with 2% lidocaine or 0.5% bupivacaine. The ratio of CSF to LA-CSF mixture (CSF/(LA+CSF)) was from 0 to 1.0 at an interval of 0.1. We measured the glucose level of each sample with blood sugar meter. (2) Experiment 2: CSF from a hydrocephalus patient was serially diluted and its glucose level of each sample was measured in the same way as Experiment 1. We performed a urine stick test with each sample. Ten anesthetists blinded to the nature of the sample were asked to identify the results of the tests. (3) Experiment 3: Two milimeters of 2.5% thiopental was respectively mixed with local anesthetics, the amount of which was from 0.1 to 1.0 ml at an interval of 0.1 ml. Sixteen anesthetists blinded to the nature of sample were asked to identify the results of the tests. RESULTS: (1) Experiment 1: We can measure glucose level at CSF/(LA +CSF) of 0.5 in 2% lidocaine group and 0.6 in 0.5% bupivacaine group. (2) Experiment 2: We can detect glucose at lower level of CSF/(LA +CSF) by glucose meter than urine stick test (p<0.05). (3) At least 0.35 ml of 2% lidocaine and 0.29 ml of 0.5% bupivacaine was needed respectively to detect precipitation. CONCLUSION: We suggest that blood glucose meter be used instead of glucose test strip. For thiopental precipitation test, we have to adjust the amount of thiopental depending on the amount of test fluid.
Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Glucose ; Bupivacaine ; Cerebrospinal Fluid* ; Glucose ; Humans ; Hydrocephalus ; Lidocaine ; Punctures ; Thiopental

BACKGROUND: One of the most serious risks of epidural anesthesia is total spinal blockade from unintentional dural puncture. We evaluated the glucose test and the thiopental precipitation test to differentiate cerebrospinal fluid (CSF) from local anesthetics (LA). METHODS: (1) Experiment 1: CSF from twenty patients was serially diluted with 2% lidocaine or 0.5% bupivacaine. The ratio of CSF to LA-CSF mixture (CSF/(LA+CSF)) was from 0 to 1.0 at an interval of 0.1. We measured the glucose level of each sample with blood sugar meter. (2) Experiment 2: CSF from a hydrocephalus patient was serially diluted and its glucose level of each sample was measured in the same way as Experiment 1. We performed a urine stick test with each sample. Ten anesthetists blinded to the nature of the sample were asked to identify the results of the tests. (3) Experiment 3: Two milimeters of 2.5% thiopental was respectively mixed with local anesthetics, the amount of which was from 0.1 to 1.0 ml at an interval of 0.1 ml. Sixteen anesthetists blinded to the nature of sample were asked to identify the results of the tests. RESULTS: (1) Experiment 1: We can measure glucose level at CSF/(LA +CSF) of 0.5 in 2% lidocaine group and 0.6 in 0.5% bupivacaine group. (2) Experiment 2: We can detect glucose at lower level of CSF/(LA +CSF) by glucose meter than urine stick test (p<0.05). (3) At least 0.35 ml of 2% lidocaine and 0.29 ml of 0.5% bupivacaine was needed respectively to detect precipitation. CONCLUSION: We suggest that blood glucose meter be used instead of glucose test strip. For thiopental precipitation test, we have to adjust the amount of thiopental depending on the amount of test fluid.
Anesthesia, Epidural* ; Anesthetics, Local* ; Blood Glucose ; Bupivacaine ; Cerebrospinal Fluid* ; Glucose ; Humans ; Hydrocephalus ; Lidocaine ; Punctures ; Thiopental

We report a case of decreased cerebrospinal fluid glucose with lymphocytic pleocytoisis in a patient with herpes zoster meningoencephalitis. The finding was likely to be confused with that of tuberculous meningoencephalitis. The concentration of CSF glucose is a critical point in the differential diagosis of various causes of nervous system infection. Although the herpes zoster meningoencephalitis isa well recognized, cases with markedly low, level of CSF glucose has been rare. We reviewed such unusual cases in the literature that were accompanied by hypoglycorrhachia. The duration of hypoglycorrhachia was transient. This suggests a differential point from that of tuberculous meningitis.
Cerebrospinal Fluid ; Encephalitis, Varicella Zoster* ; Glucose* ; Herpes Zoster* ; Humans ; Meningoencephalitis ; Nervous System ; Tuberculosis, Meningeal

BACKGROUND: One of the most important physical properties affecting the level of analgesia after intrathecal administration of a local anesthetic is baricity. This study was done to compare the distribution of 0.5% tetracaine in 5% glucose solution and in 10% glucose solution. METHODS: Tetracaine 2.6 ml (0.5% with 5% glucose or 10% glucose) added with 0.1% epinephrine 0.2 ml was administered to each of 20 patients. All patients' heights were within 160 170 cm. The cephalad spread of analgesia, the degree of motor block in the legs and hemodynamic values were assessed at 2-min intervals for the first 10 min and then at 5-min intervals until 30 min. RESULTS: In the 5% glucose and 10% glucose solutions, the maximum sensory level was T5.4 and T4.3, the maximum sensory block time was 128.1 min and 118.2 min and the time to complete motor block was 5.4 min and 5.2 min respectively. It was not statistically significant between groups. But T 8.1 (vs T 9.6 in the 5% glucose solution) of initial sensory level measured at 4 min after injection of drug was significantly higher (P < 0.05) in the 10% glucose solution. Maximum hemodynamic changes from the baseline were not different in two groups. CONCLUSIONS: Tetracaine 0.5% with 5% glucose or 10% glucose solutions showed similar distribution in the cerebrospinal fluid.
Analgesia ; Anesthesia, Spinal* ; Cerebrospinal Fluid ; Epinephrine ; Glucose* ; Hemodynamics ; Humans ; Leg ; Tetracaine*

We experienced 5 cases of acute rubella encephalitis, a serious complication of rubella. The patients presented with convulsions and a deteriorated mental state, both of which occurred with a vanishing maculopapular rash and a low grade fever. The cerebrospinal fluid analysis showed pleocytosis and increased protein and normal glucose levels. We diagnosed the rubella encephalitis by detection of IgM in the serum. Rubella encephalitis is known to be a serious complication of rubella, and with poor prognosis. The mortality rate may reached as high 20%. Our cases recovered without any sequelae.
Cerebrospinal Fluid ; Encephalitis* ; Exanthema ; Fever ; Glucose ; Humans ; Immunoglobulin M ; Leukocytosis ; Mortality ; Prognosis ; Rubella* ; Seizures

PURPOSE: The present study was undertaken to assess whether the results of cerebrospinal fluid (CSF) culture are related to prognosis. METHODS: Subjected to this study were 51 cases admitted to our department who had been diagnosed as bacterial meningitis. They were divided into two groups, Group l (20) with positive CSF culture and Group ll (31) with negative outcome, then both groups were compared. RESULTS: Group l cases tended to be younger than Group ll cases. The male/female ratio was 1.2 in Group l and 1.6 in Group ll. Laboratory findings of CFS were not significantly different in either groups, except for the glucose level, which was markedly lower in Group l than in Group ll. The causative organisms identified from CSF culture were E. coli (5), group B Streptococcus (4) and S. aureus (1) among the 10 cases aged under 2 months. On the other hand, S. pneumoniae were isolated in 7 and H. influenzae in 3 among the 10 older cases. Mortality rate and the incidence of complications were higher in Group l than in Group ll. Mortality rate as related to the causative organism was highest with E. coli, followed by group B Streptococcus, H. influenzae. CONCLUSION: Bacterial meningitis cases with positive CSF culture have significantly lower glucose concentration in the CSF, and also higher rates of mortality and incidence of serious complications than those with negative culture.
Cerebrospinal Fluid* ; Glucose ; Hand ; Incidence ; Influenza, Human ; Meningitis, Bacterial* ; Mortality ; Pneumonia ; Prognosis* ; Streptococcus

Prompt, precise differentiation between various forms of meningitis-aseptic, bacterial and tuberculous-is critical difficult problem for the practicing pediatrician. The present invesigation was carried out to assess the diagnostic usefullness of lactic acid levels in CSF. Fresh samples of CSF and blood were collected from 75 infant and children with meningitis and 25 normal children. CSF lactic acid. CSF sugar, blood lactic acid and blood sugar were estimated from them. These subjects were divided into 4 groups : Group 1 (normal-25 cases), Group 2 (aseptic meningitis-25 cases), Group 3 (purulent meningitis-20 cases), Group 4 (T.B. meningitis-30 cases). The results were as follows : 1. In normal gruop, CSF lactic acid was 5.8mg/dl and blood lactic acid was 7.1mg/dl, The ratio of CSF Lactic acid to blood lactic acid was approximately 0.8. 2. In Group 2. (aseptic meningitis), CSF lactic acid was 8.8mg/dl and blood lactic acid was 7.4mg/dl. The CSF value was slightly increased compare to normal CSF lactic acid levels. CSF suger and lactic acid were not correlated. 3. In the purulent meningitis group, CSF lactic acid was markedly increased to a significant level compare to the normal value. The mean was 36.4mg/dl. Blood lactic acid was 26.2mg/dl. 4. In T.B. meningitis, There as a mederate increase of lactic acid significantly ifferent from normal values. The mean was 25.8mg/dl. Blood lactic acid also increased. The mean was 18.9mg/dl. A positive linear correlation between CSF lactic acid and blood lactic was noted. 5. On the 3rd hospital day, CSF lactic acid level wsa approximately half level of the initial values inpurulent meningitis. It returned to normal level on 6th hospital day. In T.B. meningitis, CSF lactic acid also showeda decrease from the 5th hospital day. And returned to normal values on 20th hospital day. Concerning the above results, CSF lactic acid could be a possiblely be a good index in differential diagnosis of meningitis and in evaluation of it's clinical course.
Blood Glucose ; Cerebrospinal Fluid* ; Child* ; Diagnosis, Differential ; Humans ; Infant* ; Lactic Acid* ; Meningitis* ; Reference Values

To determine the effects of central nervous system (CNS) involvement in systemic Lupus erythematosus (SLE) on cerebrospinal fluid (CSF), CSF studies of 35 cases of SLE (22 cases with CNS involvement and 13 cases without CNS involvement) were analyzed and compared with 20 normal CSF studies. The mean values of several CSF parameters were significantly changed in the group of SLE with CNS involvement (increased protein, white blood cell (WBC) counts and pressure, and decreased glucose contents), but not in the group of SLE without CNS involvement. In 22 case of SLE with CNS involvement, 10 cases (45.5%) were more than 4 WBC's in CSF, 12 cases (54.6%) more than 40 mg/dl of CSF protein and 8 cases (36.4%) less than 40 mg/dl of CSF glucose. CSF pressure was increased more than 200 mm CSF in 41.2%. On the other hand, in 13 cases of SLE without CNS involvement, the CSF studies were almost normal except 4 cases (30.8%) of more than 40 mg/dl in CSF protein.
Central Nervous System ; Cerebrospinal Fluid* ; Glucose ; Hand ; Leukocytes ; Lupus Erythematosus, Systemic*

Cerebrospinal fluid rhinorrhea can be caused by head trauma, brain or sinus surgery or neoplastic sinonasal disease. In addition, CSF rhinorrhea may develop spontaneously in some cases. We experienced two cases of spontaneous CSF rhinorrhea caused by idiopathic bony defect. The first case was a 47-year old female who complained of a persistent rhinorrhea for 2 months without surgical or traumatic history. The second case was a 40-year old female. Having no surgical or traumatic history, she also suffered from a persistent rhinorrhea for thirteen years. For diagnosis of CSF rhinorrhea, we carried out endoscopic examination, glucose test of rhinorrhea, computed tomograph, magnetic resonance imaging and (99m)Tc-DTPA cisternography. We found bony defect in the cribriform plate of the two cases. Patients were treated successfully with endoscopic approach. Leak sites were repaired with free graft materials. There has not been any recurrence or complications since the endoscopic closure.
Brain ; Cerebrospinal Fluid Rhinorrhea ; Craniocerebral Trauma ; Ethmoid Bone ; Female ; Glucose ; Humans ; Magnetic Resonance Imaging ; Recurrence ; Transplants

A 52-year-old woman with a history of at least 5 attacks of benign recurrent aseptic meningitis for the past 2 years is presented. Three of 5 attacks were afrebrile. In cerebrospinal fluid examinations, there was increased protein, normal or reduced glucose, and pleocytosis including endothelial cells, lymphocytes or leukocytes. Brain computed tomography revealed slight ventricular dilatation. No causative organism was found with available techniques. This is believed to be the first reported case of Mollaret's meningitis in Korea.
Brain ; Cerebrospinal Fluid ; Dilatation ; Endothelial Cells ; Female ; Glucose ; Humans ; Korea ; Leukocytes ; Leukocytosis ; Lymphocytes ; Meningitis ; Meningitis, Aseptic ; Middle Aged