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Cerebrospinal Fluid Vasopressin in Neurological and Psychiatric Disorders

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Cerebrospinal Fluid Vasopressin in Neurological and Psychiatric Disorders J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.48.1.50 on 1 January 1985. Downloaded from Journal ofNeurology, Neurosurgery, and Psychiatry 1985;48:50-57 Cerebrospinal fluid vasopressin in neurological and psychiatric disorders PER SOELBERG SORENSEN,* ANNETTE GJERRIS,t MOGENS HAMMERt From the University Departments ofNeurology, * Neurosurgery, * Psychiatry,t and Medicine P, t Rigshospitalet, Copenhagen, Denmark SUMMARY Vasopressin was determined in CSF and plasma of 243 patients with different neurological and psychiatric disorders, including control patients. CSF vasopressin was significantly higher in patients with high pressure hydrocephalus, intracranial tumour, benign intracranial hypertension, intracranial haemorrhage, ischaemic stroke, and craniocerebral trauma. In patients with primary degenerative dementia, CSF vasopressin was lower than in control patients. Among patients with psychiatric disorders, CSF vasopressin was increased in manic patients, while in patients with depression CSFVconcentration of this hormone did not differ from that found in controls. However, an increase in CSF vasopressin level was found in patients recovering from a depression. The clinical significance of changes in CSF vasopressinguest. Protected by copyright. concentrations in groups of patients with neurological and psychiatric disorders is still unknown. The neurohypophyseal hormone arginine vasopres- and plasma have been measured in an extended sin (AVP) has been demonstrated in various number of patients with dementia and intracranial extrahypothalamic locations within the central hypertension, and we have included several other nervous sytem'-5 and AVP is found in the cerebros- groups of patients with neurological and psychiatric pinal fluid (CSF) of normally hydrated subjects in disorders and control patients with no signs of cen- concentrations similar to or lower than the corres- tral nervous system disease. ponding plasma concentrations.6-8 However, in a number of neurological disorders a diverging ratio Materials and methods of CSF/plasma concentration has been found indi- cating a separate regulation of the release of AVP Control patients into the CSF.9-" This group comprised 52 patients, 22 men and 30 women, Several on aged 21-76 years, median age 46 years (table 1). Twenty- hypotheses the function of AVP within eight patients had symptoms of a cervical or lumbar disc the central nervous system have been offered. Vas- syndrome and were admitted for diagnostic myelography. opressin in the CSF has been suggested to have an Eleven patients had headache or common migraine. Seven on brain effect water permeability'2 and on the patients had diffuse neurological symptoms as dizziness or http://jnnp.bmj.com/ intracranial pressure,'3 and a direct relationship paraesthesia, but no signs of organic disease were found. between the intracranial pressure and CSF AVP Six patients had minor peripheral neurological symptoms. concentration has been proposed." Several results No patients had signs indicating central nervous system from animal studies have suggested that AVP might lesions and no endocrine disorders were suspected. No influence leaming and memory functions, and low medication was given at the time of examination. CSF and blood samples were taken between 8 and 11 am in connec- CSF concentrations of AVP have been found in tion with the myelography in patients with disc syndromes patients with dementia.'617 Gold et al. have prop- and at a diagnostic lumbar puncture in the other patients. osed the AVP hypothesis that is implicated in All patients were fasting overnight and were kept supine on September 26, 2021 by changes of mood in manic-depressive illness.'8 for 30 min before the lumbar puncture which was per- In the present study AVP concentrations in CSF formed using local anaesthesia and with the patients in the Address for reprint requests: Per Soelberg Sorensen, M.D. Univer- lateral recumbent position. The CSF pressure was meas- sity Department of Neurosurgery, Rigshospitalet, DK-2100 ured before removal of CSF. All patients had normal CSF Copenhagen, Denmark. pressure, protein concentration, and cell count. Venous Received 21 February 1984 and in revised form 7 June 1984. blood samples were obtained just before the lumbar punc- Accepted 11 June 1984. ture. Informed consent was obtained from all patients. 50 J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.48.1.50 on 1 January 1985. Downloaded from Cerebrospinal fluid vasopressin in neurological and psychiatric disorders 51 Table 1 Age and sex distribution in groups ofpatients with neurological and psychiatric disorders and controls. Diagnosis N Age (yr) Sex Median Range Male Female Normal pressure hydrocephalus 29 65 37-72 19 10 High pressure hydrocephalus 6 29 2-62 2 4 Intracranial tumour 14 47 7-73 9 5 Benign intracranial hypertension 18 35 13-53 4 14 Intracranial haemorrhage 9 52 28-66 2 7 Ischaemic stroke 10 61 42-70 7 3 Cranio-cerebral trauma 5 52 12-60 3 2 Multiple sclerosis 8 39 15-59 5 3 Basal ganglia disorders 5 42 20-63 2 3 Primary degenerative dementia 25 56 30-71 19 6 Ehdogenous depression 32 46 18-82 16 16 Non-endogenous depression 14 47 22-66 6 8 Mania 7 34 30-49 1 6 Schizophrenia 9 29 19-40 6 3 Controls 52 46 21-76 22 30 Patients with diseases ofthe central nervous system patients fulfilling the following diagnostic criteria: All patients with neurological disorders were admitted to raised intracranial pressure, papilloedema, normal or the Neurological og Neurosurgical Clinics, Rigshospitalet. diminished ventricular size on CT. The intracranial pres- Age and sex distribution in the different patient groups is sure, measured by epidural pressure monitoring in 12 given in table 1. None of the patients received any medica- patients, and via a lumbar cannula in six patients, was guest. Protected by copyright. tion and none had clinical signs of endocrine diseases. CSF increased (-18 mm Hg) in 13 of the 18 patients. All had and blood samples were taken using the same procedure as low or normal CSF protein concentration. in the control patients. However, in two patients with high Intracranial haemorrhage. This group comprised nine pressure hydrocephalus, in all patients with intracranial patients with either recent subarachnoid haemorrhage (six tumour or cranio-cerebral trauma, and in seven patients patients) or intracerebral haematoma (three patients). The with intracranial haemorrhage ventricular CSF specimens intracranial pressure was measured by intraventricular were obtained due to the hazards of lumbar puncture in pressure monitoring in seven patients and by lumbar punc- these patients. ture in two. Six patients had increased ( 18 mm Hg) Normal pressure hydrocephalus. Twenty nine patients had intracranial pressure. clinical symptoms of normal pressure hydrocephalus: Ischaemic stroke. Ten patients were examined during the dementia, gait disturbances, and/or urinary incontinence. week following an ischaemic stroke. The diagnosis was All had ventricular enlargement in CT-scan, some with confirmed by CT which showed a lesion compatible with a periventricular lucency. The intraventricular pressure was cerebral infarct. The intracranial pressure was elevated normal (<12 mm Hg), and all had decreased conductance (a18 mm Hg) in two patients. None of the patients had to CSF-outflow measured by a lumbar-ventricular perfu- haemorrhagic CSF. sion study.'9 In 17 patients lumbar and ventricular CSF Cranio-cerebral trauma. This group comprised five samples were taken simultaneously in connection with the patients, of whom three had cerebral contusion, one perfusion study. traumatic subarachnoid haemorrhage, and one epidural High pressure hydrocephalus. Six patients had high pres- haematoma. The intraventricular pressure was increased sure hydrocephalus: two had communicating high pressure (a 18 mm Hg) in three patients. hydrocephalus as a complication to subarachnoid haemor- Multiple sclerosis. Eight patients had multiple sclerosis http://jnnp.bmj.com/ rhage, one as a complication to an ependymoma of the diagnosed according to the criteria of Schumacher et al,20 cauda equina, and one was suspected to have congenital and the diagnosis was confirmed by abnormalities in visual stenosis of the aqueduct of Sylvius. The last two patients or somatosensory evoked potentials and/or signs of were children with congenital hydrocephalus and obstruc- intrathecal IgG production. The lumbar CSF pressure was tion of a previously placed ventriculo-atrial shunt. In all normal. patients the intraventricular pressure was increased Miscellaneous basal ganglia disorders. The group com- (;18 mm Hg). prised five patients, of whom two had Parkinson's disease, Intracranial tumour. Fourteen patients had intracranial one Huntington's chorea, one torsibn dystonia, and one tumours, including five acoustic neuromas, two cerebellar Gilles de la Tourette syndrome. Normal lumbar CSF pres- on September 26, 2021 by astrocytomas, one cerebellar haemangioblastoma, one sure was found in all patients. fourth ventricle papilloma of the choroid plexus, two Primary degenerative dementia. Twenty five patients with a pinealomas, two cerebral gliomas, and one history of progressive dementia were studied. The diag- craniopharyngeoma. Seven of the patients had complicat- nosis primary degenerative dementia was made by history, ing obstructive hydrocephalus. Eleven patients had neuropsychological examination, metabolic screening, and increased intraventricular pressure ( 18 mm Hg). CT.
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