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Spontaneous intracranial hypotension (SIH) is a condition that has become increasingly recognized, necessitating more widespread familiarity with diagnosis and management. This chapter reviews the clinical presentation, pathogenesis, approach to brain and spinal imaging, and use of image-guided intervention for treatment of SIH. Specialized imaging techniques for problem-solving difficult cases are discussed, and procedural details of how to perform epidural patching are provided.

This chapter outlines the safe execution of lumbar puncture with or without drain placement by skilled advanced providers. The authors delve into common indications, contraindications, complications, and anatomical review with a focus on the step by step procedure. An overview of basic cerebral spinal fluid interpretation is discussed with special attention to antibiotic coverage. Additionally, procedure codes, tips from skilled proceduralists, and further video references to aid the novice advanced provider are included.

This seems to be the time to gain new knowledge about the meningeal lymphatic system and a deeper understanding of its anatomy and physiology. Although it is known that the meningeal lymphatics present in the layers of the brain, limited information is available about the role of this system in brain function. Here, for the first time we clearly demonstrate that the meningeal lymphatic pathway is involved in brain clearing from the blood after intracranial hemorrhage associated with hypoxia and forms a connective bridge between interstitial, cerebral spinal fluid and peripheral lymphatics. We also show that the development of methods to stimulate meningeal lymph flow after hemorrhagic evidence in the brain might be a neuroprotective strategy for effective recovery of the brain after a cerebrovascular catastrophe.

The Chiari I malformation in humans and Chiari-like malformation in dogs (CLM) is a condition in which the cerebellum descends out of the foramen magnum affecting normal cerebral spinal fluid (CSF) flow. It is considered to be a developmental abnormality and is commonly confused with many other conditions. Chiari-like malformation in dogs affected approximately 85 % of Cavalier King Charles Spaniels evaluated, as reported in the most recent studies. The specific cause has not been determined; however, because of an abnormal shape or reduced skull size in the caudal occipital region, part of the cerebellum is forced through the foramen magnum, altering CSF flow patterns. Changes in CSF dynamics result in an abnormal accumulation of fluid within the substance of the spinal cord called a “syrinx.” The diagnosis of CLM in dogs and Chiari type I in humans can only be confirmed by MRI which is essential for determining the cause of syringomyelia. Current concepts in the diagnosis and treatment of Chiari-like malformation in dogs will be discussed.

The concept of liquid biopsy has emerged into the cancer lexicon to describe detected alterations of tumor biomarkers within body fluids which reflect the presence and the biology of cancer. This is typically performed by assessing circulating tumor cells (CTCs), circulating tumor DNAs (ctDNAs), tumor-derived extracellular vesicles (EVs), microRNAs (miRNAs), and proteins. Although plasma, urine, and cerebral spinal fluid (CSF) are all viable biofluids, growing attention has recently been cast on saliva. Saliva is readily available, can be obtained noninvasively, is easily collected and stored, and also demonstrates compelling pathophysiological association with systemic diseases. Importantly, saliva liquid biopsy delivers the best clinical performance to detect ctDNAs in lung cancer patients. In conjunction with validated biomarkers, and reliable and robust analytical detection tools, saliva has the potential to pioneer a new landscape of real-time point-of-care testing in personalized medicine. This chapter will review the salivaomics, the disease-related biomarker properties of saliva, and the scientific advances in the pathophysiological foundations which make saliva an ideal candidate for noninvasive liquid biopsy. Moreover, a novel liquid biopsy technology termed electric field-induced release and measurement (EFIRM), which works in tandem with the technological advances to extract crucial disease information in saliva, is reviewed.

The history and key concepts of bioanalysis are discussed. Historically, the scientific need driving the development of bioanalytical methodology was the evolution of the science of pharmacology as well as the field of pharmacokinetics. Similarly, the ability to actually perform bioanalysis was linked to the development of analytical methodology/instrumentation. Each of these historical aspects of bioanalysis is discussed in this chapter. Key attributes of molecules quantitated in bioanalytical procedures for small molecules and protein therapeutics are described. Topics discussed in this regard include plasma protein binding, free drug versus total drug measurements, prodrugs versus active moieties, metabolites, minimum required dilution, and parallelism. In addition, important considerations with respect to different types of study samples are described. These factors include the influence of dosing vehicle and collection methodology. Matrices discussed include whole blood, urine, cerebral spinal fluid, tissues, and dried blood spots.

Epilepsy is the most common neurologic disorder of childhood with 5 % of all children and adolescents experiencing a seizure by the age of 20. This chapter discusses the different types of epilepsy, surgical management, and selection criteria for each type, preoperative preparation, and postoperative nursing considerations, including nursing care in the epilepsy monitoring unit (EMU). The importance of a multidisciplinary team approach is emphasized, particularly nursing’s role as communicator and family advocate. Quality of life outcomes with a patient case study illustrate the goals of surgical management.

Obstruction of the cerebral spinal fluid (CSF) pathways, accumulation of CSF within the skull, dilation of the cerebral ventricles, and increased intracranial pressure all result in what is known as “hydrocephalus.” This condition has been found to affect the visual pathway and present with multiple neuro-ophthalmic complications (Chou and Digre, Neurosurg Clin N Am 10:587–608, 1999; Clinical ophthalmology. A systematic approach, Oxford, 1999; Persson et al., Childs Nerv Syst 23:1111–1118, 2007).

Toxoplasmosis refers to both asymptomatic and symptomatic infection due to toxoplasma gondii parasite. Infection when symptomatic is usually short lived, rather acute and self-limited. In the chronic form the parasite causes persistent or recurrent clinical manifestations. The disease has many clinical manifestations, which are beyond this paper. A few examples are

Guillain-Barre Syndrome (GBS) is a clinical condition resulting from acute inflammatory demyelinating polyneuropathy (radiculopathy). It most frequently occurs after infection and immunizations and after malignancy. Allogenic bone marrow transplantation (BMT) is an important source.

Osteogenesis imperfecta (OI) is heterogeneous group of congenital disorders of collagen synthesis, characterized by generalized osteoporosis and multiple fractures. It is caused by a genetic mutation in abnormal production of type-I collagen. The major clinical characteristics of OI

This is a condition in which syringomyelia cavity results from an intramedullary metastatic lesion.

Malignant sweat gland tumors are extremely rare, representing less than 0.01 % of all primary skin lesions. Malignant eccrine neoplasms can be divided into two main categories

A 56 year old male who recently immigrated from Equador presents with scattered plaques on his chest.