Pseudo-Froin's syndrome, xanthochromia with high protein level of cerebrospinal fluid

Kwon, Soon Kul; Kim, Mi Woon

doi:10.4097/kjae.2014.67.s.s58

Cited by 12 publications

(6 citation statements)

References 4 publications

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“…In the extensive search in the medical literature, only two spinal anesthesia were found in the same patient after the appearance of xanthochromic CSF in Letter to the Editor [13]. In the present case report, there were two subarachnoid punctures with the appearance of xanthochromic CSF, with a failure on the 1 st attempt and success on the 2 nd attempt.…”

Section: Discussionmentioning

confidence: 45%

“…Physicians and anesthesiologists alike should bear in mind that xanthochromia unrelated to subarachnoid hemorrhage Annals of Anesthesia and Pain Medicine may be detected in traumatic lumbar puncture that have a high red blood cell count [11,12]. In a patient with Froin's syndrome that is characterized by marked CSF xanthochromia, he underwent a urological procedure under spinal anesthesia and later a second spinal anesthesia was performed for bladder-cancer, without complications [13]. CSF composition tests are often used to monitor brain metabolism, evaluate the functions of transport and permeability of barrier, and pharmacokinetic parameters of medicines in the brain and identify biomarkers, to help in the diagnosis and prognosis of CNS diseases [9].…”

Section: Discussionmentioning

confidence: 99%

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Intradural and Intramedullary Melanotic Schwannoma of the Lumbar Spine, After Spinal Anesthesia - A Case Report

Imbelloni¹,

Silva²,

Vieira³

et al. 2022

AnnAnesthPainMed

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Spinal anesthesia is one of the most used techniques in elderly patients, with doses varying according to the proposed surgery and the surgeons [1]. Schwannomas are benign, encapsulated, slow-growing neoplasms. made up of neoplastic schwann cells differentiated [2]. The most used diagnosis is Magnetic Resonance Imaging (MRI) and confirmation is obtained through histological and immunohistochemical studies [2]. In order to study the reclassification of Melanotic Schwannomas (MS), a study was carried out in 40 clinicopathologic, immunohistochemical, and gene expression cases [3]. The purpose of this case report was diagnosed after the appearance of paresis in a patient undergoing urologic treatment under spinal anesthesia, two days after the procedure requiring hospitalization, and explain the possibility of performing spinal anesthesia in a patient with xanthochromic puncture.

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Section: Discussionmentioning

confidence: 45%

Section: Discussionmentioning

confidence: 99%

Intradural and Intramedullary Melanotic Schwannoma of the Lumbar Spine, After Spinal Anesthesia - A Case Report

Imbelloni¹,

Silva²,

Vieira³

et al. 2022

AnnAnesthPainMed

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“…Higher protein contents in CSF may also produce coagulum, which may occlude CSF flow across arachnoid granulations, resulting in an early increase in intracranial pressure without early radiological hydrocephalus. 23 24 25 Fukuda et al, in their study, found high CSF protein as a main responsible factor for hydrocephalus, and as the tumor grows, CSF protein level rises. 26 This cause and effect relationship is proven by the work of Miyakoshi et al, which demonstrated normalization of CSF protein contents and pressure after tumor removal.…”

Section: Discussionmentioning

confidence: 97%

Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World

et al. 2022

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Objective Visual impairment in vestibular schwannomas is an underreported entity. The plethora of literature focuses primarily on facial and hearing preservation. This study aims to describe our experience and find the possible reasons for visual impairment. Materials and Methods This is a retrospective observational study. We evaluated 114 patients with vestibular schwannoma, operated during 2015 to 2020. Eight parameters were studied—age, gender, maximum tumor size, hydrocephalus, economic status, duration of symptoms, visual loss, and ease of access to the tertiary neurosurgical facility. JASP software (version 0.14.1, Amsterdam) was used for statistical analysis. Results A total of 42/114 (36.84%) patients had a varying degree of impairment. Patients with impaired vision had significantly larger tumors (4.31 vs. 4.12 cm, p = 0.02), longer duration of symptoms (19.14 vs. 16.45 months, p = 0.02), hydrocephalus (p = 0.03), and were from remote areas (p = 0.009). In stepwise logistic regression analysis, longer duration of symptoms and difficult access to neurosurgical facility stand out as decisive factors for visual impairment. The follow-up data were available for 35/42 (83.33%) cases of visual impairment. Vision improved in 14/35 (40%) of cases. Vision improved in a significantly higher number of patients when a preoperative ventriculoperitoneal shunt was placed (p = 0.03). Conclusion The visual handicap occurs in a significant number of patients with vestibular schwannoma. Delayed arrival at the neurosurgical facility due to difficult access appears to be the primary factor leading to blindness. Strengthening our healthcare systems in rural areas would go a long way in the timely detection and prevention of blindness in such cases.

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“…Under these conditions, if one aims to bind all free Hb based on an average molecular weight for Hp monomers of 52.18 kDa within the Hp preparation used in this study, a CSF Hp concentration of 0.522g/L would need to be achieved. Protein levels in the CSF in healthy individuals vary in the range 0.3-0.4 g/L [66,67], increasing to 0.7-0.8 g/L after SAH [68]. There is an association between high CSF protein and poor outcome after SAH, linked to higher rates of SBI [43].…”

Section: Discussionmentioning

confidence: 99%

Functional effects of haemoglobin can be rescued by haptoglobin in anin vitromodel of subarachnoid haemorrhage

Warming

Deinhardt

Garland

et al. 2023

Preprint

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During subarachnoid haemorrhage, a blood clot forms in the subarachnoid space releasing extracellular haemoglobin (Hb), which causes oxidative damage and cell death in surrounding tissues. High rates of disability and cognitive decline in SAH survivors is attributed to loss of neurons and functional connections during secondary brain injury. Haptoglobin sequesters Hb for clearance, but this scavenging system is overwhelmed after a haemorrhage. Whilst exogenous haptoglobin application can attenuate cytotoxicity of Hb in vitro and in vivo, the functional effects of sub-lethal Hb concentrations on surviving neurons and whether cellular function can be protected with haptoglobin treatment remain unclear. Here we use cultured neurons to investigate neuronal health and function across a range of Hb concentrations to establish the thresholds for cellular damage and investigate synaptic function. Hb impairs ATP concentrations and cytoskeletal structure. At clinically relevant but sublethal Hb concentrations, synaptic AMPAR-driven currents are reduced, accompanied by a reduction in GluA1 subunit expression. Haptoglobin co-application can prevent these deficits by scavenging free Hb to reduce it to sub-threshold concentrations and does not need to be present at stoichiometric amounts to achieve efficacy. Haptoglobin itself does not impair measures of neuronal health and function at any concentration tested. Our data highlight a role for Hb in modifying synaptic function after SAH, which may link to impaired cognition or plasticity, and support the development of haptoglobin as a therapy for subarachnoid haemorrhage.

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Pseudo-Froin's syndrome, xanthochromia with high protein level of cerebrospinal fluid

Cited by 12 publications

References 4 publications

Intradural and Intramedullary Melanotic Schwannoma of the Lumbar Spine, After Spinal Anesthesia - A Case Report

Intradural and Intramedullary Melanotic Schwannoma of the Lumbar Spine, After Spinal Anesthesia - A Case Report

Preoperative Visual Impairment in Vestibular Schwannoma Patients: An Overlooked Entity of Developing World

Functional effects of haemoglobin can be rescued by haptoglobin in anin vitromodel of subarachnoid haemorrhage

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