Drenski, V.

Todorov, S.

English

Varna Medical University Press: Journals

ON T H E I N F O R M A T I V E V A L U E O F C E R E B R O S P I N A L - F L U I D S Y N D R O M E IN L A T E R A L A N D M E D I A N D I S C A L H E R N I A V. Drenski, S. Todorov Key-words: lateral discal hernia — median discal hernia — cerebrospinal fluid — diagnosis The problem of the diagnosis of lumbar discal hernia remains in everyday neurological and neurosurgical practice. Patient's complaints are genetically related with pathological changes in intervertebral discs when most diseases of the lumbo-sacral region of the vertebral column, i . e. no less than in 80 per cent of the cases, are concerned (2). The concept that the diagnosis «lumbar discal hernia» sho-uld be mainly a clinical one is not warrantable. Sacloradiculography and recent-ly , body scanning is introduced into the clinical practice although not rather asccessible in our country yet. Data from the clinical examination, especially in some atypical cases, are insufficient and that is why one requires additional labolatory examinations. The question of the diagnostic value of lumbar punc-ture and cerebrospinal-fluid syndrome in lumbar discal hernia is sti l l dispu-table, indeed. Kitov (1966, cited after 3) finds a normal cerebrospinal fluid in more than the half of the patients with lateral discal hernia and considers, therefore, the examination of the cerebrospinal lfuid incapable to solve the problem of the differential kind diagnosis of discal hernia. Petrov (1980) accepts that lumbar puncture possesses not only a topical but also a kind diagnostic value in median discal hernia. Zlotnik (1£60) and Brotmann (1962, both cited after 1) report an albumin-cellular dissociation expressed to one or another extent in most of their patients (in 90 per cent of the cases) with lumbar discal hernia. Material and methods In the present work we report the results from the analysis of the cerebro-spinal-fluid syndrome concerning its informative value in 120 lumbar discal hernia patients hospitalized in the Neurological and in the Neurosurgical C l i -nic of the Higher Institute of Medicine, Varna. Discal hernia is proved by sa-culoradiculography and in one fourth of the patients (30 cases) — additionally by a surgical intervention. The following methods are used to study the cere-brospinal fluid: cytology — native microscopy in Fuchs-Rosental's chamber; proteins — nephelcmetry; sugars — orthotoluidine method; chlorides after the method of Schalles-Schalles (mercurimetric); microelectrophoresis after Chankov (1969) and immunoglobulins IgG and IgA after Mancini in Tzveta-aova's modification (1974). 104 V . Drenski , S. Todorov Results and discussion Patients' distribution according to age and sex is demonstrated on table 1. There are 80 males (67.3 per cent) and 40 females (32.7 per cent). It is evident that patients in the age groups between 30 and 50 years (the most active age) predominate. 70 patients (58.3 per cent of the cases) are with lateral and 50 <' '•' ^ / ; ' H I W LV/t J Ml :i \t Л У I 1U№<] T a b l e 1 Patients' distribution according to age and sex Age (years) males Sex-females total Up to 20 21 — 30 31 - 40 41 — 50 61 - GO Over 60 4 15 22 21 12 0 5 20 15 37 10 31 0 • 3-ii ИМ,;': i8 T o t a l 80 40 120 atients (41.7 per cent of the cases) are with median discal hernia. A «storey» tincture is performed in 30 patients while lumbar puncture below the level of he discal hernia is carried out in 90 cases. I . Lateral discal hernia Cerebrospinal fluid pressure was normal. The fluid was clear, colourless end without any fibrin network. Normal cytosis was established in 65 cases (93.3 per cent) ( i . e. up to 5 cells/mm^). Pleccytosis (between 10 and 40cells/mm 3 was observed in 4 cases (5.7 per cent) and up to 100 cells/ m 3 in one case only. Meningogram indicated lymphocytes and monocytes. Proteinorachia was nor­mal in 56 cases (80 per cent) ( i . e. up to 0.45 g/1). A slightly expressed hyper-proteinorachia (up to 0.55 g/1) was found out in 11 cases (15.7 per cent) and hyperproteinorachia between 0.55 and 1.0 g/1 was estimated in 3 cases only (4.3 per cent). Both chlorides and sugars were in normal limits. Electrophoretic examination revealed unspecific changes in most cases with normally distri­buted protein fractions. Immunoglobulins IgG, IgA and IgM were studied in 30 patients and were within normal limits. Colloid curves were normal, too (table 2). I I . Median discal hernia A normal cellular composition of the cerebrospinal fluid was established in 35 cases (70 per cent). A slighly expressed pleocytosis (between 20 and 50 cells mm3) was observed in 12 cases (24 per cent) while pleocytosis between 50 and 100 cells/mm 3 was found out in 3 cases only (6 per cent). Meningogram demon­strated lymphocytes, mohocytes and single polynuclear leukocytes. There was On the informative value of. . . ]05 агтг-чуугг л" '" i I . ' "" T ' j . . • • w 1 _ •—- _ - - _ a normal proteinorachia in 25 cases (50 per cent) ( i . e. up to 0.45 g/1). A slight­ly expressed proteinorachia (up to 0,5 g/1) was seen in 4 cases (8 per cent). Hyperproteinorachia (between 0.5 and КО g/1) was established in 10 cases (20 per cent) but that one between 1.0 and 1.5 g/1 — in 11 cases (22 per cent). Both chlorides and sugars showed normal levels. Colloidal curves possessed an outlin­ed left peak in 5 cases (10 per cent). Electrophoretically, gamma globulins were mere slightly or more significantly increased in 7 cases (14 per cent). Immuno­globulins IgG, IgA and IgM were studied in 20 patients. There was an IgG in­crease up to 65 mg/1 (with ncrmal levels between 5 and 50 mg/1) in 5 cases (25 per cent) and an IgM increase up to 0,7 mg/1 (IgM is normally absent in the cere­brospinal fluid) in 6 cases (30 per cent). IgA levels were within normal limits (up to 5 mg/1) (table 3). The examination of the cerebrospinal fluid taken by «storey» puncture revealed a more strongly expressed pleocytosis and hyperproteinorachia than that of the material taken below the level of the discal hernia. Shamburov (1954) established a slightly increased cerebrospinal fluid pres­sure (between 200 and 250 mm Hg) and a moderate hyperproteinorachia. Frid-man (1969) reported a protein-cellular dissociation in discal hernia patients. Vanev (1972) found out a normal protein content in 73.5 per cent and a normal cellular composition in 94,7 per cent of the cases with lateral discal hernia. He found out a normal protein content in 44 per cent and hyperalbuminorachia (between 0.5 and 2.0 g/1) in 43 per cent of the cases with median discal hernia. Therefore, our results are rather similar to Vanev's ones. Tzvetanova established a slightly elevated cellular number (up to 50 cells/mm3) and predominantly lymphocytes and monocytes as well as hyperproteinorachia (up to 0.7 g/1 and more seldom — up to 1.5 g/1) in patients with discal hernia (1980). Chankov (1969) reported gamma-globulin increase in 10 out of 22 discal hernia patients. We can conclude that the analysis of numerical data demonstrates convinc­ingly that cerebrospinal fluid changes pessess a smaller topical and kind diffe­rential diagnostic value when lateral discal hernia is concerned. The results with the median discal hernia indicate a more strongly expressed protein-cellular dissociation, a more significant proteinorachia combined with moderate elec-trophoretic and immunologic alterations. That is why the examination of the cerebrospinal fluid possesses a greater informative value for the median discal hernia and, therefore, helps kind and topical diagnosis of the disease. R E F E R E N C E S 1. В а н е в , M. Диекогёини радикулити. София, Медицина и физкултура, 1972, 135—139. — 2. П е т р о в, П. Диагностика и лечение на неврохирургичните заболявания. София, Медицина и физкултура, 1973, 346—356. — 3. П е т р о в , П. Поясно-дискова болеет. София, Медицина и физкултура, 1980, 87—91. - 4 . Ф р и д м а н , А. П. Основы ликворологии. Москва, Медицина, 1969, 581—583. - 5. Ц в е т а н о в а , Е . Ликвороло-гия. София, Медицина и физкултура, 1980. 218 с, - 6, Ц в е т а н о в а , Е . Ликворологии. София, Медицина и физкултура, 1984. 188 с. — 7. Ч а н к о в, И. Електрофореза на мо­зъчната течност и нейното клинично значение в неврологията и психиатрията. П л о в д и ^ Хр . Г. Данов , 1969, с. 83. — 8. Ш а м б у р о в , Д . И. Спинномозговая жидкость. Москву 1954, 231—232. f -Г 106 V.Drenski , S, fodoroV < с 'C/J CuD "o U с о О. U и 3 - 1 о ~ Е о. 3 о ю - 1 1 о л Е X СМ т}* CU CM ^ J 4 "° см У* CM и см о —« с 11 : з о о g г- о 4: о 3 — ^ ° 2 8 00 3 « ^ CU с та о со СМ с О с _ си-*-* си 5"е . -я f- (/} I - «•-» W QJ О . С со 1> « С сл э о Q N ~ Q та та с_.: 3 | e g CU —, < О С/} та ЬиО С/3 -о О О С ' о о а и 3 о U о о с SSI! 3 Е Б о о ~ а. £ ю CD о — см „ " l a с см с С о си с Ш> та Е с см о см с ^ ь «я и 3 си та . ^ о си *& о та с Е ~ Е .Е та •— ао d л *ьс та <=> с — о о , * та £ Г — _,., р с _ — C U -ел о —i си (Т? ^ Е Ю И 3 t о КлО О 2 та CU СМ U О «3 < си . С и _ и СМ >-"ч-> 0 ч-* з с £ • о Е;0 си^Ь— •—• С и О 3 —< * 1 о вв о _ I и _2 «л си та и, Си _ о си Си Си 3 СО *jjs с I си 1 си 6 n the informative value of.. * 16? ОБ ИНФОРМАТИВНОЙ ЦЕННОСТИ Л Й К В О Р Н О Г О СИНДРОМА П Р И БОКОВОЙ И СЕРЕДИННОЙ Г Р Ы Ж А Х М Е Ж П О З В О Н О Ч Н Ы Х Д И С К О В В. Д ре иски, С. Тодоров Р Е З Ю М Е Лпгоры прослеживают изменения ликпора у 120 больных," 70 из которых с боковой грыжей поясничных позвонков и 50 — с серединной грыжей этих позвонков. ИспользуютсА современные ликворологические методики как агаровый электрофорез и исследование имму­ноглобулинов ИгГ, ИгА и ИгМ по методу Цвета новой. В случаях боковой грыжи поясничных позвонков устанавливается гиперпротеинрахн* от 0,55 г/л до 1,0 г/л с нормальными фореграммами и иммуноглобулинами. При серединной грыже поясничных позвонков устанавливается умеренный плеоцитоз до 50 клеток в 1 мм 3 , а также гиперпротеинрахия до 1,5 г/л; Фореграммы показывают повышение гамма-глобу. линов и умеренное увеличение ИгГ до 65 мг/л и ИгМ до 0,7 мг/л, Устанавливется, что ликвооное исследование серединной грыжи поясничных позвон­ков имеет большую информативную ценность для видовой и топической диагностики. 

ON THE INFORMATIVE VALUE OF CEREBROSPINAL-FLUID  SYNDROME IN LATERAL AND MEDIAN DISCAL HERNIA

https://journals.mu-varna.bg/index.php/ssm/article/download/3761/3243

ON THE INFORMATIVE VALUE OF CEREBROSPINAL-FLUID SYNDROME IN LATERAL AND MEDIAN DISCAL HERNIA

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