Hydrocephalus at the University Hospital of the West Indies

OBJECTIVES: To define the aetiology of hydrocephalus and to investigate the presumed high frequency of post meningitic hydrocephalus at the University Hospital of the West Indies (UHWI). To study whether the pattern of hydrocephalus seen at UHWI may be amenable to alternative treatment (neuroendoscopy). METHODS: A retrospective review was carried out between August 2000 and July 2001. The department of Surgery's operative audit and admissions database along with the personal database of one of the authors (IC) were accessed. From this, we were able to retrieve 100 patient logs from the records department of UHWI. RESULTS: The male to female ratio was 1:1 and the age range was from one day to 70 years (mean 15 years). The leading causes of hydrocephalus were aqueduct stenosis (20), and tumour associate hydrocephalus (17). These were followed by post haemorrhagic (14), post meningitic (9) and communicating hydrocephalus not otherwise specified. The more common presenting complaints were enlarging head (32), headache (22), vomiting (21), seizures (11), papilloedema (9), ataxia (9) and neck stiffness (3). CONCLUSION: Aqueductal stenosis was the most common aetiological factor giving rise to hydrocephalus whereas post meningitic hydrocephalus was not very common. Neuroendoscopy is now well accepted in the management obstructive hydrocephalus. Given the frequency of aqueductal stenosis, neuroendoscopy maybe a feasible alternative in the treatment of hydrocephalus at UHWI. (AU)

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12-month period between September 1986 and August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop. (AU)

A cluster of central nervous system defects in Jamaica

Information was collected on all stillbirths and neonatal deaths on the island of Jamaica during the 12 month period September 1986 to August 1987. There were 33 such deaths with anencephaly, spina bifida and hydrocephalus out of an estimated population of 54,400 total births. There was a statistically significant cluster in respect to time of conception in one small rural area of the island. There were no obvious differences between parents involved in the cluster and the rest of the population, but particular Jamaican fruit and vegetables have been shown to be teratogenic in animals. It is postulated that the cluster may have been associated with an unripe crop (AU)

A comparison of early versus delayed surgery for ruptured intracranial aneurysms - abstract

The timing of surgical clipping for ruptured intracranial aneurysms has been a subject of debate for many years. Initial attempts at early surgery (within 24-72 hours) had disastrous results and led to the standard practice of delaying surgery for 7-10 days. The use of antifibrinolytic agents during this waiting period was shown to decrease the incidence of rebleeding but also seemed to cause increased frequency of ischaemic deficits and hydrocephalus. With the refinement of microneurosurgical techniques, early surgery for intracranial aneurysms underwent a rebirth in many centres over the last few years. This paper presents the experiences with aneurysm surgery at the Neurosurgical Unit Halifax, Nova Scotia over the four-year period 1984-1987. Ruptured aneurysms lead to subarachnoid haemorrhage in over 50 percent of the cases, arteriovenous malformations comprised 10 percent, and subarachnoid haemorrhage with normal angiography 25 percent of the total cases. During the period under review 25 patients presented with ruptured vertebrobasilar aneurysms and 211 patients presented with ruptured supratentorial aneurysms. The latter group form the basis for comparing results of early vs. delayed clipping for ruptured aneurysms. Despite the fact that the series comprised a consecutive, unmatched group of patients without any attempt at randomization, there were striking similarities in the mean ages, sex distribution and distribution of aneurysms at the various sites in the two groups being compared. Sixty-nine patients presented in good clinical condition after aneurysmal subarachnoid haemorrhage (Hunt & Hess Grades I and II). Twenty-nine patients (mean age 44.5 years) underwent early surgery and 40 (mean age 45 years) had delayed surgery. Despite the higher rebleed rate in the delayed group (12.5 percent vs. 0 percent) there was no statistically significant difference in the eventual outcome between the two groups (mortality rate and the quality of survival). Eighty-five of the patients had excellent outcomes. However, the length of hospital stay was significantly shorter in the patients operated on early (17 days vs. 30 days). Symptomatic vasospasm (40 percent) and hydrocephalus (10 percent) occurred with similar frequencies in both groups. Fifty-two patients presented in poor clinical condition after aneurysmal subarachnoid haemorrhage (Hunt & Hess Grades III and IV). Twenty-three patients (mean age 49.5 years) had early surgery and 29 patients (mean age 53 years) had delayed surgery. The mortality rate (approximately 25 percent) was similar in both groups. Rebleeding was the culprit in the delayed group (24 percent) whereas the surgical mortality was 26 percent in the early group. There was an equally high incidence of symptomatic vasospasm and hydrocephalus in both groups. The quality of survival was better in the early group but achieved statistical significance only in the number of patients making "excellent" recoveries (43 percent vs. 17 percent). The numbers of patients however were small. Aggressive treatment of acute hydrocephalus by ventricular drainage played a large part in improving the clinical status prior to surgery in the early group. As with previous studies (including a large co-operative series), we have been unable to show a really convincing advantage of early aneurysm surgery over delayed surgery if mortality rate and quality of survival are used as the basis of comparison. Clearly, a large scale randomized trial would have to be launched to answer this question conclusively. To answer the criticisms of ardent proponents of delayed surgery, however, we have confirmed that early surgery provides at least as good results. We have not found early surgery technically more difficult. It allows removal of large collections of subarachnoid blood and aggressive treatment of cerebral vasospasm and hydrocephalus and at the same time prevents rebleeding from the aneurysm. We feel early surgery will become more frequently used as newer methods of preventing cerebral vasospasm are discovered. The implications of our experiences to the situations that obtain in the Caribbean will be discussed (AU)

Massive congenital intracranial teratoma: report of a case in an hydrocephalic foetus

A large intracranial teratoma which replaced the entire brain is described in an hydrocephalic foetus which was aborted at the 25th week of gestation. This very rare condition is reported for the first time in the Caribbean literature (AU)

Pregnancy and progeny in rats treated with the pyrrolizidine alkaloid fulvine

The pyrrolizidine alkaloids are naturally-occurring plants toxins which are considered significant in the etiology of certain liver diseases, particularly in some tropical and sub-tropical regions. Fulvine, a hepatotoxic alkloid present in the medicinal herb Crotolaria fulva, was observed to be fetotoxic and highly teratogenic in rats. The occurrence of fetal resorptions showed a dose-effect relationship. The highest incidence of developmental defects was induced by fulvine at a dose-level of 80 mg/kg which in other studies produced significant chromosomal damage. Microscopic examination of fetal liver, following maternal exposure of fulvine, did not reveal hepatic lesions.(Summary)

The teratogenicity of barbital sodium in mice

The teratogenic activity of sodium barital in pregnant mice of the Rockfeller strain was investigated. A high incidence of foetal resorption and congenital malformations were observed following the i.p. administration of the barbiturate. (Summary)