How to Choose a Shunt for Patients with Normal Pressure Hydrocephalus: A Short Guide to Selecting the Best Shunt Assembly.

Most patients with hydrocephalus are still managed with the implantation of a cerebrospinal fluid (CSF) shunt in which the CSF flow is regulated by a differential-pressure valve (DPV). Our aim in this review is to discuss some basic concepts in fluid mechanics that are frequently ignored but that should be understood by neurosurgeons to enable them to choose the most adequate shunt for each patient. We will present data, some of which is not provided by manufacturers, which may help neurosurgeons in selecting the most appropriate shunt. To do so, we focused on the management of patients with idiopathic "normal-pressure hydrocephalus" (iNPH), as one of the most challenging scenarios, in which the combination of optimal technology, patient characteristics, and knowledge of fluid mechanics can significantly modify the surgical results. For a better understanding of the available hardware and its evolution over time, we will have a second look at the design of the first DPV and the reasons why additional devices were incorporated to control for shunt overdrainage and its related complications. We try to persuade the reader that a clear understanding of the physical concepts of the CSF and shunt dynamics is key to understand the pathophysiology of iNPH and to improve its treatment.

[Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury]. / Validacion española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoracion de los cambios de personalidad en pacientes con daño cerebral adquirido.

INTRODUCTION: The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the 'cognitive' executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. AIM: The aim of this study was the Spanish validation of the IRSPC, which evaluates the 'personality changes' secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. PATIENTS AND METHODS: After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. RESULTS: The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). CONCLUSIONS: The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury.

TITLE: Validacion española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoracion de los cambios de personalidad en pacientes con daño cerebral adquirido.Introduccion. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de caracteristicas (enfasis en las funciones motivacionales y emocionales, evaluacion de las funciones ejecutivas 'cognitivas' en la vida cotidiana, estimacion de la personalidad premorbida, valoracion de la fiabilidad del informador) que hacen muy interesante su utilizacion tanto en la clinica como en la investigacion. Objetivo. Validar en castellano la IRSPC para la evaluacion de los 'cambios de personalidad' secundarios a las lesiones cerebrales de la corteza prefrontal en general y del area ventromedial en particular. Pacientes y metodos. Tras el proceso de traduccion y adaptacion de la guia de la escala al castellano, se realizo un estudio de validacion con 31 pacientes con daño cerebral traumatico y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmacion. La validez del instrumento es confirmada por la validez concurrente (comparandolo con el inventario neuropsiquiatrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y despues del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y valido para la exploracion clinica, en el contexto de una evaluacion integral de los sintomas derivados de las enfermedades neurologicas en general, y en particular de aquellas en las que se encuentra involucrada la corteza prefrontal ventromedial.

Validación española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoración de los cambios de personalidad en pacientes con daño cerebral adquirido / Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury

Introducción. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de características (énfasis en las funciones motivacionales y emocionales, evaluación de las funciones ejecutivas ‘cognitivas’ en la vida cotidiana, estimación de la personalidad premórbida, valoración de la fiabilidad del informador) que hacen muy interesante su utilización tanto en la clínica como en la investigación. Objetivo. Validar en castellano la IRSPC para la evaluación de los ‘cambios de personalidad’ secundarios a las lesiones cerebrales de la corteza prefrontal en general y del área ventromedial en particular. Pacientes y métodos. Tras el proceso de traducción y adaptación de la guía de la escala al castellano, se realizó un estudio de validación con 31 pacientes con daño cerebral traumático y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmación. La validez del instrumento es confirmada por la validez concurrente (comparándolo con el inventario neuropsiquiátrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y después del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y válido para la exploración clínica, en el contexto de una evaluación integral de los síntomas derivados de las enfermedades neurológicas en general, y en particular de aquéllas en las que se encuentra involucrada la corteza prefrontal ventromedial (AU)

Introduction. The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the ‘cognitive’ executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. Aim. The aim of this study was the Spanish validation of the IRSPC, which evaluates the ‘personality changes’ secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. Patients and methods. After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. Results. The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). Conclusions. The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury (AU)