Liquore

Liquore the expiration of the cerebrospinal fluid (CSF). Cerebrospinal fluid can flow from the nose, ear while bone injuries base of the skull and Dura mater, and after neurosurgical operations in the result of not closing edges of the skin sutures or secondary education liquor fistulas.

Likwore (from lat. liquor - liquid and Greek. rhoia - after - expiration spinal fluid out with skull injuries, injuries of spinal column, after head and spinal operations, sometimes as a complication of a brain tumor, brain hernia, hydrocephaly and other Liquore of subarachnoid spaces or ventricles possible through the wound between the seams after surgery, nose or ear canal fractures of the skull base or through usury covers, for example, when meningocele.
Liquore is manifested by soaking bandages and pillow under the head of the patient clear or bloody fluid (explicit liquore). When damage to the skull base cerebrospinal fluid can get into the nasal passages and drawn out or being swallowed up patients (hidden liquore). It should also distinguish L.: 1) primary or early (comes directly after injury or surgery); 2) secondary, or late (liquor fistula occurs after infectious complications at a later date). Long primary L. can go to the liquor fistula, if will develop meningitis, encephalitis or chorioadenoma.
According to the source of likwore and liquor fistulas are divided into the subarachnoid (including cisternole) and ventricular. The special place occupies the spinal liquore when penetrating injuries of spinal column, after operations on or in congenital deformities, such as ulceration cerebral hernias. Leningrad after the injuries of skull extremely unfavorable; it leads to a massive loss of fluid, creates the threat of intrusion of microflora in liquor space and severe infections.
View wounds when liquore characteristic. The wound is rapidly cleared from the brain detritus and blood is clean and moist. The medullar substance does not tarnish (from drying), and on the contrary, under the influence of constant moisture becomes a characteristic bright luster. After 1-2 minutes, you notice the accumulation of cerebrospinal fluid in any deepening of the wound ("lake"). Samples Pussep, Queckenstedt, Stockea reinforce L.
The General condition of the wounded is usually heavy. In addition to General and focal symptoms, develop dehydration brain and desolation ("collapse") ventricular contributing brain hypotension. The last in the initial stages is strong headaches, aggravated by the rise of the head, a dry mouth, thirst, decreased amount of urine, weakness, and' in the late symptoms of meningitis, pyrexia, development of cachexia and coma, that is more often caused by damage to the ventricles. Lumbar puncture is often dry.
Cisterniga liquore observed in the wounds fronto-temporal-orbital, the mastoid areas or posterior cranial fossa and closed fractures of the skull base, when damaged frontal sinuses, ethmoid bone, the pyramid of the temporal bone and other tanks base of the brain fluid often stands out drop by drop through the nose or expires from the ear. Such L. dangerous development Finogenova or autogennaja meningitis.
Primary ventricular liquore usually accompanied by severe wounds with damage to the deep parts of the brain. In the first day of the expiration of liquid is very abundant; then, as the loss of the liquor, it decreases. The wound channel begins to SIAT, the brain drops in. Rapidly growing depletion of the wounded.
Treatment of primary L. consists first of all in the early radical treatment of craniocerebral wound with the imposition of the deaf seam and chemotherapy (see Traumatic brain injury). Dehydration by indications (often with cisternal HP). In early cases of nasal liquori fractures of the skull base, a good effect gives xerophagy, the appointment of adrenaline, laxatives and diuretics. Sometimes effective lumbar puncture with rich extraction of liquid and introduction into the subarachnoid space of air or oxygen. When resistant HP has to put a permanent vinyl chloride lumbar drainage Century by I. Grebenyuk or to operate (revision fractured bone at the base of the skull, the closure of the defect Dura and bone). In postoperative L. produce lumbar puncture, drug dehydration and (pre pobres hair around the location of fluid outflow) impose additional seam through the entire thickness of the skin or cover the point hole Kolodina bandage.
Liquor fistulas (Fig) - the usual consequence encephalitis, meningitis, abscess, causing the collapse of the brain tissue, and perforation of the ventricle. Phenomena hypotension this is often not the case; the fluid is released abundantly.

Ventricular liquor fistula (schematically)

Usually there is a protrusion of the brain, supporting encephalitis, an infection occurs ventricles and development basilar meningitis. Treatment of liquor fistulas are aimed at elimination of infectious complications that led to the formation of fistulas, and the use of restorative means for struggle with cachexia and dehydration. Antibiotics (including flora, allocated from the wound and CSF), blood transfusion, parenteral introduction of large amounts of fluid before closing the fistula and energetic dehydration when it is closed, attentive care is an integral part of the therapy of this dangerous complications. Locally applied long-term bandages (after subarachnoid fistula) or bandages with hypertonic solution (with ventricular fistula and protrusions of the brain), irradiation wounds ultraviolet rays, protection visualsage brain cotton-gauze "donut hole", etc.
Spinal likwore and liquor fistula require quick surgical treatment - excision of the walls of the fistula and overlay deaf seams on the wound. Necessarily use of antibiotics and dehydrating therapy.
In some cases it is necessary to perform a lumbar puncture 1-2 times a day (before healing wounds), or to put a permanent lumbar drainage for periodic release of the liquor.
Especially dangerous liquore when pitting brain herniation. In these cases it is urgent radical surgical intervention (see brain, hernia, Spina bifida) "under the protection" of antibiotics.