Cerebrospinal Fluid in Diseases of the Nervous System.

Small stains on the cover. Otherwise good and clean. - Einband berieben und eingerissen. Sonst gut und sauber. - Preface: Clinicians interested in diseases of the central nervous system have long envied their colleagues in other fields of medicine. Not only do they have ready access to blood, urine, and the other body effluents, they can even examine biopsy specimens of liver, kidney, or muscle in the pursuit of knowledge about systemic diseases. In contrast, the student of diseases of the brain and spinal cord generally has to make do with indirect methods and postmortem material. The introduction of lumbar puncture into clinical medicine almost 90 years ago at last provided access to a fluid in close proximity to the central nervous system. Ever since then, the cerebrospinal fluid (CSF) has been analyzed extensively to elucidate the physiological and biochemical bases of neurological disease. The data derived from such investigations comprise a major part of this book. For many years, the CSF was studied chiefly by clinicians, neurologists, and neurosurgeons, who asked mainly clinical questions. Recently, there has been a gratifying increase in attention to the CSF by physiologists, neurochemists, and neurobiologists, because of its unique composition and its special relevance to neurological function. In the last 15 years, the plethora of publications dealing with basic and clinical aspects of the fluid has made it difficult to keep abreast of important advances in our knowledge. There have been extensive modifications and additions to our understanding of the physiology and chemistry of the CSF. Major technical advances in the analysis of biological fluids have been applied to the study of the CSF. The goal of this book is to summarize and interpret our expanding knowledge of the CSF, emphasizing data which are derived from patient studies and are of special relevance to the understanding of neurological disease. It is intended for neurologists and neurosurgeons, as well as for internists, pediatricians, neuroradiologists, and other physicians interested in diseases of the nervous system. Following a brief historical introduction, the early chapters review the anatomy, physiology, and chemistry of the CSF and its special relationship to the brain, including the blood-brain barrier. The normal and disordered physiology of the intracranial pressure is discussed, with application to the clinical problems of intracranial hypertension, pseudotumor, hydrocephalus, and brain edema. The technical aspects of spinal puncture and its indications, contraindications, and complications are reviewed. The composition of the CSF is described in detail, including its physical features, cytology, and chemical constituents, using data from patient studies. The last part of the book deals with alterations of the composition of the CSF in specific diseases of the nervous system, emphasizing the data that are clinically useful. A rather lengthy bibliography has been included, the selection of which posed special problems. About 1500 relevant papers have been published yearly for the last 20 years, in addition to the extensive earlier literature, and it was impossible to include all of these references. In compiling the bibliography, therefore, I tried to choose papers which contained primary data or had good bibliographies, but papers of historic importance were also included. In the text, I made extensive use of tables to condense ano summarize data on various topics. In writing this book, I often returned affectionately to the classic monograph bj Merritt and Fremont-Smith (1938), "The Cerebrospinal Fluid", for many years the authoritative clinical sourcebook, published more than 40 years ago by Saunders. I: contained the copious data collected by the CSF laboratory of the Boston City Hospital between 1926 and 1938, based on the study of 21,000 samples of fluid. Some of these data are unique (e.g., the findings in purulent meningitis, poliomyelitis, and pernicious anemia) and are still quite relevant to clinical practice. I tried to salvage them (and to pay homage to my teacher, the late H. Houston Merritt) by including some of the well- validated information in the present book. Much of this book was written in London during a sabbatical leave in 1978 spent at the National Hospital, Queen Square, and the Institute of Neurology. I am most gratefm to Professor Roger W. Gilliat, Dean Peter Gautier-Smith, and their associates for their very kind hospitality. The preparation of the book was helped greatly by a grant from the Commonwealth Fund of New York, for which I express my appreciation to Dr. Reginald H. Fitz, Vice President. Joan M. Mello of San Francisco and Norma Walker of London provided very expert assistance in the production of the manuscript. The staff of the W. B. Saunders Company has been very helpful, and I wish to thank Mrs. Anna Congdon for editorial assistance and Mr. Albert E. Meier, editor-in-chief for health sciences, for his guidance. I am in debt to the many authors who kindly gave me permission to use their published figures. I also wish to thank my colleagues and students who stimulated me to write this book. Finally, I wish to express my special gratitude to my wife, Peggy, who encouraged the effort, cheerfully tolerated the preoccupied weekend and evening hours, and assisted greatly in preparation of the text. ISBN 9780721636863