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Neonatal high pressure hydrocephalus is associated with elevation of pro-inflammatory cytokines IL-18 and IFNgamma in cerebrospinal fluid.
[hydrocephalus with stenosis of the aqueduct of sylvius]
In
human
neonatal
high
pressure
hydrocephalus
(
HPHC
)
,
diffuse
white
matter
injury
and
gliosis
predispose
to
poor
neuro-
developmental
outcome
.
The
underlying
mechanism
for
diffuse
white
matter
damage
in
neonatal
HPHC
is
still
unclear
.
Analogous
to
inflammatory
white
matter
damage
after
neonatal
hypoxemia
/
ischemia
,
we
hypothesized
that
pro-
inflammatory
cytokines
could
be
involved
in
neonatal
HPHC
.
If
so
,
early
anti-
inflammatory
therapy
could
ameliorate
white
matter
damage
in
HPHC
,
before
irreversible
apoptosis
has
occurred
.
In
HPHC
and
control
neonates
,
we
therefore
aimed
to
compare
cerebrospinal
fluid
(
CSF
)
concentrations
of
IL
18
,
IFNgamma
and
sFasL
(
interleukin
18
,
interferon
gamma
and
apoptosis
marker
soluble-
Fas
ligand
,
respectively
)
.
In
neonatal
HPHC
(
n
=
30
)
and
controls
(
n
=
15
)
,
we
compared
CSF
concentrations
of
IL
18
,
IFNgamma
and
sFasL
using
sandwich
ELISA
.
HPHC
was
grouped
according
to
etiology
:
spina
bifida
aperta
(
n
=
20
)
,
aqueduct
stenosis
(
n
=
4
)
,
and
fetal
intra-
cerebral
haemorrhage
(
n
=
6
)
.
Neonatal
control
CSF
was
derived
from
otherwise
healthy
neonates
(
n
=
15
)
,
who
underwent
lumbar
puncture
for
exclusion
of
meningitis
.
In
all
three
HPHC
groups
,
CSF
IL
18
concentrations
were
significantly
higher
than
control
values
,
and
the
fetal
intracranial
haemorrhage
group
was
significantly
higher
than
SBA
group
.
Similarly
,
in
all
HPHC
groups
CSF-IFNgamma
concentrations
significantly
exceeded
the
control
group
.
In
both
HPHC
and
control
neonates
,
CSF
FasL
concentrations
remained
within
the
range
of
reference
values
.
Independent
of
the
pathogenesis
,
neonatal
HPHC
is
associated
with
the
activation
of
the
pro-
inflammatory
cytokines
(
IL
-
18
and
IFNgamma
)
in
the
CSF
,
whereas
CSF
apoptosis
biomarkers
(
sFasL
)
were
unchanged
.
This
suggests
that
anti-
inflammatory
treatment
(
in
addition
to
shunting
)
could
be
helpful
to
preserve
cerebral
white
matter
.
Diseases
Validation
Diseases presenting
"fetal intra-cerebral haemorrhage"
symptom
hydrocephalus with stenosis of the aqueduct of sylvius
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