Transient receptor potential melastatin 6 and 7 channels, magnesium transport, and vascular biology: implications in hypertension. Turkoglu OF, Eroglu H, Okutan O, Tun MK, Bodur E, Sargon MF, Oner L, Beskonakli E. A comparative study of treatment for brain edema Magnesium sulphate versus dexamethasone sodium phosphate. Taniguchi M, Yamashita T, Kumura E, Tamatani M, Kobayashi A, Yokawa T, Maruno M, Kato A, Ohnishi T, Kohmura E, Tohyama M, Yoshimine T. Induction of aquaporin-4 water channel mRNA after focal cerebral ischemia in rat. =DBe a good critic and correct us if something went wrong :|Go ahead. Take thin layer of gauze piece and soak it in the solution just made, 3. Check Interpret Media out if you are looking for an illustrator. Last updated on Dec 17, 2022. Table 1 Results of investigations in case 1 and case 2 Decits in brain-CSF magnesium result in cerebrovasospasm and rupture of cerebral microvessels: Possible relation to stroke. When regulating its own activities, the mature BBB receives support from at least three different cell types: 1) pericytes which share the same basement membrane with endothelial cells; 2) astrocytes which envelope 99% of the abluminal face of endothelial cells; and 3) neurons (Guo and Lo, 2009; Correale and Villa, 2009). It is composed of three carbon atoms, five hydrogen atoms, and three hydroxy or OH groups [9]. Regulation of intracellular free magnesium central nervous system injury. Accumulated data indicate that magnesium administration improves functional outcome following BBB disruption and decreases brain edema (Okiyama et al., 1995; Feldman et al., 1996; Kaya et al., 2004; Esen et al., 2005; Euser et al., 2008). Copyright 2006-2023 Scientific Research Publishing Inc. All Rights Reserved. Nakahama K, Nagano M, Fujioka A, Shinoda K, Sasaki H. Effect of TPA on aquaporin 4 mRNA expression in cultured rat astrocytes. 2. 38 (76%) out of them majority of 21 (84%) and 17 (68%) of the respondents were cannulated with 20 G cannula in HPA and MSG group respectively. Kaptanoglu E, Beskonakli E, Okutan O, Selcuk Surucu H, Taskin Y. Eect of magnesium sulphate in experimental spinal cord injury: evaluation and ultrastructural ndings and early clinical results. The other types of edema are interstitial edema, which is observed in patients with hydrocephalus, and osmotic edema caused by imbalances of osmotically active substances, promoting water influx into cells. The impairment of BBB integrity during sepsis has been shown in several studies, and magnesium administration in the early stages of sepsis reduced BBB permeability and brain edema (Papadopoulos et al., 2005; Esen et al., 2005). Medicinal forms. In this study, phlebitis means a painful swelling and raised temperature at the intravenous infusion site along with hardness (induration), redness (erythema), and palpable vein as measured of Visual Infusion Phlebitis Scale (VIP Scale). Saatman KE, Bareyre FM, Grady MS, McIntosh TK. Altura BM, Gebrewold A, Altura BT, Gupta RK. In addition, magnesium treatment protects the blood-spinal cord barrier, improves clinical recovery, and preserves normal spinal cord ultrastructure in experimental spinal cord injury in rats (Kaptanoglu et al., 2003). Epsom salt is one of many naturally occurring mineral salts, a compound of magnesium and sulfate in rock-like formations. 14 (28%), 7 (14%) 1 (2%) of them had advanced or severe, early/mild and advanced thrombophlebitis or very severe phlebitis respectively. Magnesium sulphate decreases the limb edema. COMPARISON BETWEEN DRESSING OF CELLULITIS WITH GLYCERIN AND MAGNESIUM SULFATE VERSUS NORMAL SALINE. Magnesium sulphate with glycerine dressing: It refers to a gauze pad soaked in warm magnesium sulphate granules saturated with glycerin, topically applied and secured with roller bandage three times a day, continuously for two days to evaluate the effectiveness of magnesium sulphate with glycerin dressing versus heparinoid ointment application Magnesium sulphate paste better known as Epsom salts is a popular but old-fashioned remedy for infections of the skin. Comparision of the effectiveness of magnesium sulphate with glycerine and heparinoid ointment application on phlebitis (n = 50). Aquaporin (AQP)-4, a bidirectional transmembrane water channel expressed mainly in astrocytes and to a lesser extent in barrier type of endothelial cells and pial membranes, may play a crucial role in the pathogenesis of cytotoxic and vasogenic brain edema and aggravation/resolution of ischemic and traumatic brain edema (Amiry- Moghaddam et al., 2003; Zador et al., 2009). Hoane MR. Assessment of cognitive function following magnesium therapy in the traumatically injured brain. Out of 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one health care-associated infection [6]. Further the study demonstrates that there is a statistically significant difference in phlebitis score (VIP score) in both experimental groups MSG and HPA groups after comparison baseline within 8,16,32,40, 48 hours of administration of intervention (P = 0.05). Population: All the patients admitted in medical and surgical wards of B. P. Koirala Institute of Health Sciences with phlebitis having peripheral intravascular cannula (PIC) in situ constitute the population of the study. Gauze dressings dry out early and needs change 2-3 times in a day. Confidentiality and anonymity were maintained by writing code number instead of name of participants. Patients have VIP score 2 or above were only as study samples. Romani AM, Scarpa A. Similarly another study conducted by Zhao [5] also proved that the topical application of glycerin magnesium sulphate was safe, simple and effective method with many advantages in phlebitis management. There is only one study in the current literature that evaluates the effects of magnesium in hydrocephalus, and a mild protection against brain damage was shown using MgSO4 therapy in a rat model of childhood-onset hydrocephalus (Khan et al., 2003). Abbott NJ, Patabendige AA, Dolman DE, Yusof SR, Begley DJ. Peripheral venous catheters are commonly used in hospitals to deliver intravenous therapy [1]. The finding of the study is consistent with others studies. It is also used as a soaking solution to relieve minor sprains, bruises, muscle aches or discomfort, joint stiffness or soreness, and tired feet. Table 5 depicts reduction in mean, standard deviation and rank score from pre-score to post-score. A Quasi-experimental design was used for the study. However the study finding is contradictory to the findings from other studies Singh [7] reported that phlebitis was higher if inserted in forearm 65.5%, followed by dorsum of hand 54.7% and wrist joint 53.3%. **Multiple Response, Fishers Exact Test*. Okiyama K, Smith DH, Gennarelli TA, Simon RP, Leach M, McIntosh TK. So from study finding, it is supposed that gender has no significant role in phlebitis. Glycerin, also called glycerol, can be used for both cosmetic purposes and as a treatment for medical conditions of the skin. Magnesium salts, such as magnesium sulphate (MgSO4) or magnesium chloride were shown to penetrate the BBB and cause enhancement of brain intracellular free Mg2+ concentration following TBI (Heath and Vink, 1999). Magnesium sulfate for neuroprotection after traumatic brain injury: a randomised controlled trial. These enzymes are important for the survival of various cell types including endothelial cells of the BBB. Manufacturer advises paste should be stirred before use. Cannula related factors of the participants (n = 50). It is characterised by localised erythema, swelling, heat and localised pain. Glycerin is an odorless, thick, sweet-tasting, syrupy liquid with a very short molecule, having the chemical formula C3H8O3. Wolf FI, Trapani V. Cell (patho) physiology of magnesium. In glycerine magnesium sulphate group after the initial assessment a dressing with glycerine magnesium sulphate paste soaked on a sterile gauze pad was applied over the site Simple random sampling technique was used to allocate the wards to each interventional group and purposive sampling technique to select samples where instruments baseline Performa and observation scale was used to collect data. There was homogenous distribution of age, gender, marital status and education in both experimental groups with significance p-value of 0.663, 0.258, 0.3006 and 0.978 respectively. Sen AP, Gulati A. ^__^Ask about something you don't understand @_@?Compliment Say something nice! Zador Z, Stiver S, Wang V, Manley GT (2009) Role of aquaporin-4 in cerebral edema and stroke. Likewise a study found out the most effective applicant for reduction of phlebitis in comparison of Heparinoid and Ichthammol glycerine. Role of brain [Mg2+]i in alcohol-induced hemorrhagic stroke in a rat model: a 31P-NMR in vivo study. Touyz RM. Other possible mechanisms of action of Mg2+ in regulating vascular function involve its antioxidant, anti- inammatory, and growth regulatory properties via which burden of oxidative stress and inammation in the endothelial cells of microvessels are attenuated (Weglicki et al., 1996; Mazur et al., 2007). In addition, the BBB harbours transport mechanisms that provide bidirectional control of exchange of nutrients, electrolytes and neurotoxins, and thus establishes an optimum milieu that is strictly essential to neuronal survival. Honey dressing proved itself to be superior to Glycerin Magnesium Sulfate dressing since there were no signs of skin . Approximately 90% participants among both groups cannula were inserted frequently which was more than twice among them majority of 92% and 84% in MSG and HPA groups respectively. Ethical Clearance: Written ethical clearance was obtained from Institutional Review Committee (IRC) of BPKIHS with IRC approval number IRC 143/074/075. Types of illness, days of hospital stay, cannula insertion site, size of cannula and frequency of insertion shows no statistical significance so both groups are homogenously significant with P-value of (0.05). Kaya M, Ahishali B. Part III: It consists of check-list and grading scale to assess severity of phlebitis based on Visual Infusion Phlebitis (VIP) scale. University of Adelaide Press, Adelaide (AU). Preeclampsia-eclampsia: Clinical and neuroradiographic correlates and insights into the pathogenesis of hypertensive encephalopathy. transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise Based on the findings of the study, both magnesium sulphate with glycerin dressing and heparinoid ointment application were effective in management of peripheral cannula induced phlebitis (p < 0.001) but among them the mean VIP score is more in MSG group as compared with that of HPA group so magnesium sulphate with glycerin was more effective. Bara M, Guiet-Bara A. Potassium, magnesium and membranes. However, a variety of pathological conditions, such as sepsis, multiple sclerosis and epilepsia disrupt the BBB integrity and lead to the development of brain edema. To find out the association between magnesium sulphate with glycerin dressing and heparinoid ointment application on management of phlebitis with selected cannula and related factors. Musso CG. It shows that there is more reduction of VIP score in Magnesium Sulphate with Glycerin (MSG) group. Hallak M, Berman RF, Irtenkauf SM, Evans MI, Cotton DB. A single dose of ethanol (2 g/kg) injected to mice significantly decreased total Mg2+ concentration in serum (Papierkowski et al., 1998). There was homogenous distribution of age, gender, marital status and education in both experimental groups with significance p-value of 0.663, 0.258, 0.3006 and 0.978 respectively as there was no significant difference of demographic characteristics among both experimental groups (considering a P-value of 0.05). Using magnesium sulfate capsules or Epsom salts may help discourage water retention and promote elimination, decrease bloating and help to reduce edema tied to inflammation. Frequent monitoring of cannula site, early identification of cannula induced phlebitis and prompt intervention is essential for treatment and prevention of further complication. Imer M, Omay B, Uzunkol A, Erdem T, Sabanci PA, Karasu A, Albayrak SB, Sencer A, Hepgul K, Kaya M. Effect of magnesium, MK-801 and combination of magnesium and MK-801 on blood-brain barrier permeability and brain edema after experimental traumatic diffuse brain injury. Vink R, Cernak I. Table 2 depicts majority of 40 (80%) participants days of hospital stay was below 1 week among both MSG and HPA group, majority about two fifth 10 (40%) of cannula was inserted in wrist in HPA group and equal number of the participants (16%) of cannula was on forearm from both groups and equal (28%) in both dorsum of hand and cubital fossa in MSG group. The average score has been reduced on post r score in both groups score. It is clear from the discussion above that magnesium plays a variety of essential roles within the cell by modulating the activity of more than 325 enzymes as a cofactor. The grading of severity of phlebitis was done based on scores obtained by using VIP scale. relieve migraine headaches. When used as a suppository and applied to anal canal it induces evacuation. Magnesium in the Central Nervous System [Internet]. It's a chemical compound made up of magnesium, sulfur, and oxygen. Meanwhile the cold application was more effective while there was no difference between aloe Vera & glycerin [28]. Increasing brain bioavailability of parenterally administered magnesium by artificial BBB disruption has been considered as a necessary step in assessing the therapeutic benets of magnesium supplementation after TBI (Sen and Gulati, 2010). Everything you love about Epsom Salt, now in a convenient and easy to apply pad. It is becoming a common practice in hospitals. Magnesium therapy has been shown to be effective in a variety of animal models of experimental BBB disruption. Another similar study to find effectiveness of Magnesium sulphate crystal fomentation versus paste application for phlebitis in Regional Advanced Care Center, Mangalore reported that Glycerin magnesium sulphate paste was more effective compared to magnesium sulphate crystal fomentation in reducing swelling and induration [27]. Multivariate analysis for risk factors for phlebitis done by Oliveira [22] showed that KCL infusion and IV antibiotics to be important risk factor which is supported by a study Saini [23]. Coding/decoding: Serial number was given for each sample result. Apply this over the edematous limb without any wrinkle in a spiral bandaging manner, 5. Although the BBB appears to possess a static structure, it has the ability to adapt readily to sudden changes. Low Mg2+ concentration in the circulation is associated with increase in endothelial permeability, decrease in vasodilator capacity and an increase in the production of vasoconstrictor substances, cytokines and oxidative products (Touyz, 2003; Maier et al., 2004). Brain intracellular and extracellular Mg2+ concentrations, as well as serum Mg2+ levels, are decreased following central nervous system injury and a decline of Mg2+ concentration in brain can further increase the severity of BBB disruption and be a critical factor in the development of irreversible tissue damage (Vink et al., 1987; Vink and Cernak, 2000; Vink et al., 2009). WellTell us something you know better. Edema in Infants. Maier JA, Bernardini D, Rayssiguier Y, Mazur A. The purpose of this study was to evaluate the effects of wet dressing with 50% magnesium sulfate (MgSO 4) solution on decreasing eyelid swelling and bruising after blepharoplasty.Fifty-eight patients (23 male and 35 female) who underwent bilateral blepharoplasty were enrolled in our randomized clinical trial. Similarly, a study on Hospital of Vadodara to evaluate the effectiveness of Magnesium Sulphate with Glycerin dressing on Phlebitis among patients undergoing Peripheral Intravenous Infusion by Ravindra [25] revealed that magnesium sulphate with glycerin dressing was highly effective to decrease phlebitis level to the patients. An equal number of participants were taken having medical and surgical problems. Methods: This is an observational study consisting of 20 patients (sample size) who presented at N and Hospital, Vasna - Bhayli, Vadodara . The invention relates to sterilized magnesium sulfate wet dressing agent. It is beneficial in improving the texture and pigmentation of hair growth. Magnesium can modulate hypoxic-ischemic events in the cerebral cortex by blocking the action of local putative excitatory amino acid neurotransmitters and consequently, high extracellular Mg2+ has been shown to be effective in blocking the pathophysiological mechanisms of rupture and spasm in the brain microvasculature (Huang et al., 1994; Chaon et al., 2006). Place the paste on a . Eect of magnesium on traumatic brain edema in rats. Finally, alterations in endothelial cells, which are protagonists in the vascular changes during inflammation, are reversible upon magnesium supplementation (Mazur et al., 2007). Decrease in total and free magnesium concentration following traumatic brain injury in rats. Keywords: Glycerin magnesium sulphate dressing, Phlebitis patients, Peripheral Intravenous infusion, Effectiveness. A small gender difference was observed in the participants in the present study with the findings of 48% in male and 52% in females from both groups. ALL comments that are not spam will be published on the website. Feeling of leg heaviness. review as permitted under the Copyright Act, no part may be reproduced, stored in a retrieval system, or Tight junctions (TJs) between adjacent brain capillary endothelial cells possess occludin and claudin proteins that serve to preserve junctional integrity. Swelling was observed in 72% and 88% in MSG and HPA groups respectively. The discussions are depicted on broad headings of: Socio-demographic Characteristics of the Respondents. Improvement in swelling was seen in the next 10 days. A reduction of Mg2+ level within the cell in pathological states can be considered as an injury factor in the brain and may lead to serious biological and metabolic dysfunction. Fisher M. Pericyte signaling in the neurovascular unit. A 1999 study published in "Biology of the Neonate" found that when pregnant rats were given a magnesium-deficient diet, the mortality rate of their pups increased. Magnesium and aging. Esen F, Erdem T, Aktan D, Orhan M, Kaya M, Eraksoy H, Cakar N, Telci L. Effect of magnesium sulfate administration on blood-brain barrier in a rat model of intraperitoneal sepsis: A randomized controlled experimental study. Pathology and new players in the pathogenesis of brain edema. Heparinoid Application: It refers to application of thrombophob ointment (containing heparin) by gentle massage, three times a day at the site of phlebitis continuously for two days which reduce inflammation, stiffness and, thus alleviate pain and promote tissue metabolism as well as the process of healing. Low extracellular magnesium ions induce lipid peroxidation and activation of nuclear factor-kappa B in canine cerebral vascular smooth muscle: possible relation to traumatic brain injury and strokes. Pre-testing was performed before intervention. Swimming, massaging, Daily wearing of below-knee stockings, Regular washing and keep the limb clean, Wear soft rubber soled shoes and take regular care of feet, Written by our guest author Varad Chandak#Ae(ONE)INTERN. Association between socio-demographic variables and severity score (n = 50). Thyroxine dose was adjusted, a gluten-free diet was advised, and basal-bolus treatment with glargine and lispro was started. Table 7. Patients whose phlebitis score was only in upper limbs with visual infusion phlebitis score of two or more and had not received any intervention from staffs for management were included in research. Furthermore, acute or chronic alcohol consumption impairs Mg2+ transport and homeostasis at the capillary level in the brain (Romani, 2008). The passage of many circulating substances from the capillary bed into the brain parenchyma is tightly controlled by physical and enzymatic barriers provided by the endothelial cells of capillaries in the brain parenchyma (Abbott et al., 2010; Cardoso et al., 2010). Nepalese Army Institute of Health Sciences, College of Nursing, Sanobharyang, Kathmandu, Nepal, Department of Medical-Surgical Nursing, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, Creative Commons Attribution 4.0 International License. Phlebitis is the inflammation of the tunica intima of the vein. Ionized magnesium (Mg2+) is . Background: Phlebitis is the inflammation of the tunica intima of the vein. A study conducted by Cicoloni33 also found first degree thrombophlebitis to be the highest (84.4%). Ionized magnesium (Mg2+) is a crucial cofactor that plays an essential role within the cell and regulates a variety of biochemical reactions. Severity of phlebitis based on VIP score of the participants (n = 50). Magnesium sulfate combined with water causes reverse osmosis. Glycerine soothes the irritated skin so it is used as a component of cough mixtures. [. Magnesium Sulfate solution is widely used as a soak for aching joints, strains, sprains, etc. The authors showed that the increased serum Mg2+ concentrations yielded only a marginal increase of total and ionized Mg2+ in CSF and they concluded that the regulation of magnesium by the constituents of the BBB remains largely intact following brain injuries. A decrease in Mg2+ level in the microcirculation of the cortical structures causes a rapid and progressive damage to microvessels, leading to focal haemorrhages and brain edema (Altura et al., 1991). Systemic delivery of Mg2+ may constitute an alternative approach in the future, both to improve BBB integrity and to decrease brain edema in the course of a variety of diseases involving brain tissue. Although pharmacokinetic and pharmacodynamic studies in rats have shown Mg2+ entry into the brain upon systemic treatment (Hallak et al., 1992; Hoane, 2007), no concomitant rise of Mg2+ in CSF was noted following parenteral administration in humans with brain insults (McKee et al., 2005). Effectiveness of magnesium sulphate with glycerin dressing (MSG) and heparinoid ointment application (HPA) on management of phlebitis. Papierkowski A, Pasternak K. The effect of a single dose of morphine and ethanol on magnesium level in blood serum and tissues in mice. All the ethics in research were followed and maintained strictly. The tool consisted of the following items. Table 9 shows there is no association between the phlebitis severity score of both groups and treatment-related variables. Changes in intra- and extracellular Mg2+ concentrations influence the functions of cells and tissues. The observation that blockade of NMDA or AMPA receptors could attenuate BBB disruption in focal cerebral ischemia suggest that ionotropic glutamate receptors are involved, at least partly, in BBB disruption (Liu et al., 2010). Thus it was concluded that both the applications were effective in reducing level of phlebitis. Haorah J, Knipe B, Leibhart J, Ghorpade A, Persidsky Y. Alcohol-induced oxidative stress in brain endothelial cells causes blood-brain barrier dysfunction. Experimental studies focusing on the treatment of brain edema showed beneficial effects of magnesium administered in combination with various pharmacological drugs in animal models (Royo et al., 2003; Sen and Gulati, 2010). You are a brilliant mind. Temkin NR, Anderson GD, Winn HR, Ellenbogen RG, Britz GW, Schuster J, Lucas T, Newell DW, Manseld PN, Machamer JE, Barber J, Dikmen SS. Matsui T, Kobayashi H, Hirai S, Kawachi H, Yano H. Magnesium deficiency stimulated mRNA expression of tumor necrosis factor-a in skeletal muscle of rats. Descriptive statistics such as mean, standard deviation, rank were used to present socio-demographical, health-related, cannula and infusion-related variables. Khan OH, Enno T, Del Bigio MR. Magnesium sulfate therapy is of mild benefit to young rats with kaolin-induced hydrocephalus. Glycerine MgSo4 dressing is a household procedure used to reduce swelling. Vink R, McIntosh T K, Demediuk P, Faden AI. Magnesium homeostasis and alcohol consumption. Magnesium Sulfate for the Treatment of Eclampsia. The blood-brain barrier (BBB) is constituted primarily of brain capillary endothelial cells and is a pre- requisite for the maintenance of brain homeostasis that is essential for optimal brain function. Phlebitis: It is the inflammation of the veins. In association with demographic variables there was a significant difference found between these alovera, glycerin and cold application. Monitoring: Data was taken and sequential coding was done. In the normally functioning BBB, oxygen, carbon dioxide, nicotine, ethanol, lipid-soluble substances such as heroin, and amphiphilic drugs (containing both hydrophobic and hydrophilic moieties) are carried by this route. These cells contain many mitochondria, but harbour very few caveola (pinocytotic vesicles) in their luminal surfaces. The sodium channel blocker and glutamate release inhibitor BW1003C87 and magnesium attenuate regional cerebral edema following experimental brain injury in the rat. Yes, you are! The reasons for such differences are hard to explain and have no satisfactory explanation for such findings [16]. Glycerin magnesium sulphate paste was effective in reducing swelling and in duration when compared to magnesium sulphate crystal fomentation.2 A study was conducted by Junia.D. Blood-brain-barrier delivery. Soak it completely so that no part of gauze is dry, 4. Baseline performa, was used to assess the subjective symptoms and observation scale to observe the objective symptoms. Table 5. Stretched or shiny skin. Table 6. Glycerine acts as a moisturiser. Part II: It consists of information regarding cannula and related factors. Treatment with magnesium and MK- 801 (dizocilpine), a noncompetitive NMDA receptor antagonist, either alone or in combination, can reduce brain edema development and help to restore BBB permeability after experimental diffuse brain injury (Feng et al., 2004; Imer et al., 2009). Reduction in brain intracellular free Mg2+ is also associated with brain intracellular acidosis and a concomitant reduction of brain energy stores (Vink et al., 1988; Altura et al., 1995). Similarly, majority of participants 72% and 84% in MSG group and HPA group respectively were married. Meanwhile, magnesium deficiency leads to or worsens a variety of central nervous system pathologies by increasing inflammatory cytokines and reactive oxygen species and disturbing the activity of transporters in neurons, astrocytes, pericytes and capillary endothelial cells, which together constitute the neurovascular unit of the brain. Under certain pathological conditions, such as traumatic brain injury (TBI), cerebral ischemia and acute hypertension, thebrain edema, which is initially cytotoxic, acquires a vasogenic character in the following stages. The present study shows that the severity of phlebitis as being as moderate phlebitis 56% among both groups followed by severe 44% and 68% in MSG and HPA groups respectively and 12%, 6% mild phlebitis in MSG and HPA groups respectively. Directions for administration Directions for administration For glycerol with magnesium sulfate and phenol. Guo S, Lo EH. In contrast to the animal studies mentioned above, McKee and colleagues (McKee et al., 2005) described the functional characteristics of the BBB in patients with TBI by using MgSO4 infusions initiated at an average of 5 days after injury. The present study shows there is no association between socio-demographic variables which included age, gender, marital education and educational level with severity score which include after complete interventions scores (8, 16, 24, 32, 40, 48 hours) of participants in both experimental groups. In a study involving a total of 21 patients with normal- pressure hydrocephalus, a slight plasma-like protein pattern has been demonstrated in CSF in 38% of the patients prior to surgical intervention, indicating BBB dysfunction (Wikkels and Blomstrand, 1982).

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