Cerebrospinal fluid myelin basic protein in hydrocephalus

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✓ Immunoreactive myelin basic protein (MBP) levels were measured in cerebrospinal fluid (CSF) samples taken from 57 patients with active hydrocephalus (age range 3 weeks to 60 years). Of these patients, 28 (49%) had elevated MBP values (> 4.5 ng/ml). Elevated MBP levels were found in 44% of patients with congenital hydrocephalus, 75% of patients with posttraumatic hydrocephalus, 80% of patients with normal-pressure hydrocephalus, and 83% of patients with porencephaly. Also associated with abnormal MBP levels was the ventricular size as measured by computerized tomography scanning (χ2: p < 0.05): 36% of the patients with small ventricles (ventricle:brain ratio 0 to 0.4:1) had elevated MBP in the CSF, whereas 61% of those with moderate ventricles (0.41 to 0.6:1 ratio) and 100% of those with large ventricles (0.61 to 0.85:1 ratio) had abnormal values. Only 33% of those with maximal hydrocephalus (0.86 to 1.0:1 ratio) had elevated MBP levels, perhaps because of dilution effects. In three patients in whom CSF was obtained simultaneously by ventricular and lumbar punctures, the ventricular fluid had a consistently higher concentration of MBP, suggesting a cerebral origin. It is concluded that active hydrocephalus produces significant periventricular demyelination, probably as the result of mechanical stretching.

Article Information

Address for Dr. Wood: Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia 30322.

Address for Dr. Brooks: Department of Neurology, University of Wisconsin School of Medicine, 600 Highland Avenue, Madison, Wisconsin 53792.

Address for Dr. Barrer: Department of Neurosurgery, Graduate Hospital, Philadelphia, Pennsylvania 19146.

Address for Mr. Kline: Department of Neurosurgical Research, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104.

Address for Dr. Cohen: Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, 1721 East Madison Street, Baltimore, Maryland 21205.

Address reprint requests to: Leslie N. Sutton, M.D., Department of Neurosurgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, Pennsylvania 19104.

© AANS, except where prohibited by US copyright law.

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Figures

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    Myelin basic protein (MBP) levels shown in relation to ventricular size (see text). The shaded area indicates normal values for MBP (< 4.5 ng/ml). The relationship between the two is significant (χ2 = 8.79, p < 0.05).

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    Graph showing myelin basic protein (MBP) levels as a function of the ventricle:brain ratio. The relationship is best fit by an inverted parabola with a maximum MBP level occurring at a ventricular ratio of 0.6:1 (A0 = −12.08, A1 = 79.77, A2 = −62.79, F = 2.39, p < 0.05).

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