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A study of neuropeptides related to headaches in children with meningeal irritation signs

Korean Journal of Pediatrics 2006;49(5):533-538.
Published online May 15, 2006.
A study of neuropeptides related to headaches in children with meningeal irritation signs
Bo Gil Seo, Myung Hwan Yoo, Jae Won Shim, Jung Yeon Shim, Hye Lim Jung, Moon Soo Park, Deok-Soo Kim
Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seou
수막 자극 증상으로 내원한 환자에서 두통과 관련된 신경 펩타이드에 대한 연구
서보길, 유명환, 심재원, 심정연, 정혜림, 박문수, 김덕수
성균관대학교 의과대학 강북삼성병원 소아과
Correspondence: 
Deok-Soo Kim, Email: dskim@skku.edu
Abstract
Purpose
: The headache, one of the symptoms of meningitis, is related to abrupt elevation of intracranial pressure(ICP) or stimulation of intracranial nociceptive structure. However, in cases of mild elevation of ICP or normal findings of cerebrospinal fluid(CSF) analysis, patients sometimes complain of headaches. Therefore, other pathways may contribute to the occurrence of headaches in aseptic meningitis or meningismus. We intend to investigate the role of substance P(SP) and calcitonin gene-related peptide(CGRP) in aseptic meningitis or meningismus.
Methods
: We measured leukocyte count, the concentration of protein and glucose in CSF and ICP of patients with meningeal irritation sign. We also measured SP and CGRP levels by using immunoassay. We analyzed the relationship between the presence of headache and the value of SP and CGRP.
Results
: The concentrations of CGRP(18.8¡¾10.5 ng/mL) in CSF and ICP(14.8¡¾4.5 cmH2O) in aseptic meningitis group were significantly higher than in those(14.1¡¾7.4 ng/mL and 12.0¡¾5.1 cmH2O, respectively) of the meningismus group(P<0.05). There was no significant difference in the SP levels between the two groups. In the aseptic meningitis group, the concentrations of SP and CGRP were significantly higher in the normal ICP group than in the elevated ICP group(P<0.05).
Conclusion
: Headaches in children with aseptic meningitis or meningismus is considered to be related to the elevation of the CSF levels of SP and CGRP.
Key Words: Aseptic meningitis , Meningismus , Headache , Substance P , Calcitonin gene-related peptide


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