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NEUROIMAGE
Year : 2020  |  Volume : 68  |  Issue : 2  |  Page : 525-527

High-Lipid Cerebrospinal Fluid: A Case Report


1 Department of Neurosurgery, Zhongshan City People's Hospital, Zhongshan City Guangdong Province, China
2 Department of Critical Care Medicine, Zhongshan City People's Hospital, Zhongshan City Guangdong Province, China

Date of Web Publication15-May-2020

Correspondence Address:
Liu Huijiao
Department of Critical Care Medicine, Zhongshan City People's Hospital, Zhongshan City Guangdong Province
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.284355

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How to cite this article:
Jiahao S, Yueyang B, Sitao L, Huijiao L. High-Lipid Cerebrospinal Fluid: A Case Report. Neurol India 2020;68:525-7

How to cite this URL:
Jiahao S, Yueyang B, Sitao L, Huijiao L. High-Lipid Cerebrospinal Fluid: A Case Report. Neurol India [serial online] 2020 [cited 2020 Jun 1];68:525-7. Available from: http://www.neurologyindia.com/text.asp?2020/68/2/525/284355




Sir,

Cerebrospinal fluid (CSF) is a fluid in the brain and spinal cord, which plays an important role in buffering, transporting, and regulating intracranial pressure.[1] It consists of water, various proteins, and glucose.[2] Normal CSF contains small amounts of lipids, mainly phospholipids. The triglyceride content is extremely low, with no lipoprotein and other components.[3] However, in the rare cases of cerebral and subarachnoid hemorrhage, fat in the CSF can be seen with the naked eye. This study aimed to report the case of a patient with hyperlipidemia of CSF caused by ventricular hemorrhage.

A 37-year-old male patient was admitted to the intensive care unit of Zhongshan People's Hospital on October 21, 2018, with “coma for three hours.” The patient had undergone resection of craniopharyngioma in the hospital ten years ago. The cerebral computed tomography scanning revealed ventricular system blood accumulation and dilation and brain swelling. The physical examination showed GCS 6, bilateral pupil diameter of 3 mm, slow reflection of light, and neck stiffness. The patient accepted bilateral ventricular drainage in an emergency.

The patient was routinely sterilized in the supine position, 3 cm behind the hairline and 3 cm beside the midline. The skin and subcutaneous tissue were cut to the bone surface, the skull was drilled, the dura was cut, and the ventricle was punctured on both sides. The strawberry milk–like CSF was sprayed out. The CSF was continuously drained after the surgery [Figure 1].
Figure 1: (a) Intraoperative image of CSF; (b) strawberry milk–like CSF sample; (c) preoperative computed tomography scan; and (d) postoperative computed tomography scan

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CSF and blood samples (during surgery, 1 day after the surgery, and before discharge) were evaluated using a microscope (Olympus CX31) and Cobas 8000 automatic analyzer (Japan) [Table 1].
Table 1: Laboratory results of the CSF and blood sample

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The patient underwent DSA examination the next day. It showed three aneurysms in the A1 segment of the left anterior cerebral artery, and the largest volume was about 12 mm. A coil and an LVIS 3. × 30 mm stent was used to seal the bleeding aneurysms [Figure 2].
Figure 2: (a) DSA aneurysm sagittal position; (b) DSA aneurysm coronal position; (c) post-embolization sagittal position; and (d) post-embolization coronal position

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On January 22, 2019, the patient accepted ventriculoperitoneal shunt due to hydrocephalus. On February 28, 2019, the patient was discharged with GCS 12.

The serum may appear milky after blood coagulation in patients with severe hyperlipidemia.[4] Normal CSF contains a very small amount of lipids.[5] In the present case, the CSF in the extraventricular drainage had a strawberry milk–like appearance after a cerebral hemorrhage. Also, the mixing of blood and CSF, blood cell coagulation, and mixing of serum and CSF were observed. The blood lipid content was still very high after mixing with the CSF. The blood clots mixed with the blood cells, giving the CSF a strawberry milk–like appearance.

Very few reports have been published in this regard. In 1974, Younes et al. reported that patients with cerebral hemorrhage had a large amount of lipids in the lumbar CSF.[6] In 1981, a British doctor Burke also analyzed CSF in a patient using protein electrophoresis.[7] Lipoproteins assist in the diagnosis of hyperlipidemia in patients. Thus, it was confirmed that the lipid levels in CSF change in cerebral hemorrhage, and blood lipids enter the CSF. In the present case, the patient's symptoms were typical.

Hyperlipidemia can lead to systemic atherosclerosis. It causes a decrease in vascular elasticity and accommodation capacity.[8] Also, it results in vascular and cerebrovascular infarction in the central nervous system. It is associated with spontaneous cerebral hemorrhage.[9]

This patient was treated with atorvastatin for hyperlipidemia. A previous study showed that statin use increased the risk of long-term cerebral hemorrhage.[10] However, a recent study found that statin use can reduce the risk of rupture of aneurysms.[11] An observational study of Asian patients found that excessive use of statin did not increase the risk of rebleeding.[12] Statin therapy is still necessary for patients with severe hyperlipidemia.

This study reported the case of a patient with high-lipid CSF having a strawberry milk–like appearance. The patient was diagnosed with right anterior communicating artery aneurysm and hyperlipidemia. He was healed after extraventricular drainage, interventional surgery, and ventriculoperitoneal shunt. Lumbar puncture and neurosurgery indicated hyperlipidemia, and statin therapy was safe and necessary.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

This study was funded by the Zhongshan Social Welfare Science and Technology Research Project (2018B1004).

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Srivastava R, Murphy MJ, Jeffery J. Cerebrospinal fluid: The role of biochemical analysis[J]. Br J Hosp Med (Lond) 2008;69:218-21.  Back to cited text no. 1
    
2.
Kay AD, Day SP, Nicoll JAR, Packard CJ, Caslake MJ. Remodelling of cerebrospinal fluid lipoproteins after subarachnoid hemorrhage[J]. Atherosclerosis 2003;170:141-6.  Back to cited text no. 2
    
3.
Banks WA, Farr SA, Salameh TS, Niehoff ML, Rhea EM, Morley JE,et al. Triglycerides cross the blood-brain barrier and induce central leptin and insulin receptor resistance[J]. Int J Obes (Lond) 2018;42:391-7.  Back to cited text no. 3
    
4.
Mao EQ, Tang YQ, Zhang SD. Formalized therapeutic guideline for hyperlipidemic severe acute pancreatitis[J]. World J Gastroenterol 2003;9:2622-6.  Back to cited text no. 4
    
5.
Vymazal J, Tichy J, Vyskocilova L, Vonková J. [Lipids in serum and cerebrospinal fluid in acute cerebrovascular disorders][J]. Psychiatr Neurol Med Psychol Beih 1977;22-23:67-75.  Back to cited text no. 5
    
6.
Younes F, Just R, Ranganath KA, Tourtellotte WW. Lipid cerebrospinal fluid in a patient with cerebral hemorrhage[J]. Neurology 1974;24:701-3.  Back to cited text no. 6
    
7.
Burke BJ, Mckee JI, Hargreaves T. Hyperlipidaemia diagnosed at lumbar puncture[J]. Postgrad Med J 1981;57:113-4.  Back to cited text no. 7
    
8.
Montalcini T, Gorgone G, Gazzaruso C, Pujia A. Carotid distension and distensibility impairment in individuals affected by familial combined hyperlipidemia[J]. ATHEROSCLEROSIS, 2010;212:177-80.  Back to cited text no. 8
    
9.
Shigematsu K, Watanabe Y, Nakano H; Kyoto Stroke Registry Committee. Influences of hyperlipidemia history on stroke outcome; A retrospective cohort study based on the Kyoto Stroke Registry[J]. BMC Neurol 2015;15:44.  Back to cited text no. 9
    
10.
Vuorio A, Kaste M, Kovanen PT. Combination of intracerebral haemorrhage and familial hypercholesterolemia in the acute hospital setting – A challenge for statin treatment?[J]. Int J Stroke 2015;10:467-8.  Back to cited text no. 10
    
11.
Yoshimura Y, Murakami Y, Saitoh M, Yokoi T, Aoki T, Miura K, et al. Statin use and risk of cerebral aneurysm rupture: A hospital-based case–control study in Japan[J]. J Stroke Cerebrovasc Dis 2014;23:343-8.  Back to cited text no. 11
    
12.
Chang C, Lin C, Caffrey JL, Lee YC, Liu YC, Lin JW, et al. Risk of intracranial hemorrhage from statin use in Asians[J]. Circulation 2015;131:2070-8.  Back to cited text no. 12
    


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