Hidrocefalia canina ­ relato de caso / Canine hydrocephalus ­ case report / Hidrocefalia canina ­ relato de caso

Hidrocefalia é o acúmulo de líquido cefalorraquidiano de origens diversas. Tal acúmulo gera aumento da pressão intracraniana e pode causar compressão e danos a tecidos neurológicos. Estes danos são a causa dos sinais clínicos associados a esta afecção. O presente artigo relata um caso de hidrocefalia em uma fêmea canina da raça Shih Tzu de 45 dias de idade. O animal apresentava alterações comportamentais, vocalização excessiva, incoordenação motora, aumento de volume craniano, oligodpsia entre outros. A cadela foi diagnosticada com hidrocefalia por meio de exames de imagem. Foi instituída terapia medicamentosa com acetazolamida e furosemida para controle paliativo da afecção. Ocorreu melhora do quadro clínico após o início da terapêutica e o animal, apresentou sobrevida de aproximadamente um ano.(AU)

Hydrocephalus is the accumulation of cerebrospinal fluid in the brain coming from diverse origins. Such accumulation generates an increase in intracranial pressure and may cause compression and damage to neurological tissues. These damages are the cause of the onset of clinical signs associated with the condition. This study reports a case of hydrocephalus in a 45-day-old Shi Tzu female dog. The animal presented behavioral alterations, excessive vocalization, motor incoordination, cranial volume increase, polydipsia, among other clinical signals. Imaging tests were used for diagnosing it with hydrocephalus. Drug therapy with acetazolamide and furosemide was introduced for palliative control of the condition. The clinical scenario improved after the initiation of therapy and the animal presented a survival of approximately one year.(AU)

Hidrocefalia es el acúmulo de líquido cefalorraquídeo de diversos orígenes. Dicha acumulación genera un aumento en la presión intracraneal y puede causar compresión y daños a los tejidos neurológicos. Estos daños son la causa de los signos clínicos asociados a esta afección. El presente artículo informa sobre un caso de hidrocefalia en una hembra canina de la raza Shih Tzu de 45 días de edad. El animal presentaba alteraciones de comportamiento, vocalización excesiva, falta de coordinación motora, aumento del volumen craneal, oligodipsia entre otros. La perra fue diagnosticada con hidrocefalia por pruebas de imágenes. Se instituyó medicamentos con acetazolamida y furosemida para control paliativo de la enfermedad. El cuadro clínico mejoró después del inicio de la terapia y el animal presentó sobrevida de aproximadamente un año.(AU)

Hidrocefalia congênita bilateral total em felino: relato de caso / Total Congenital Bilateral Hydrocephalus in Feline: case report

O objetivo deste trabalho foi relatar um caso raro de hidrocefalia em um felino doméstico, da raça Persa, de 30 dias de idade. O animal foi atendido com histórico de impossibilidade de manter-se em estação, incoordenação motora, inabilidade para se alimentar sozinho e sustentar o peso da cabeça. No exame clínico, foi observada presença de fontanela aberta, aumento de calota craniana, ataxia, estrabismo unilateral e secreção ocular. A realização de ultrassonografia do crânio levou à confirmação do diagnóstico de hidrocefalia. O paciente permaneceu internado, sendo o protocolo de tratamento empregado constituído de corticosteroide, diurético e protetor gástrico em alta dose, além de alimentação por via oral e fluidoterapia. O animal veio a óbito após 24 horas, sendo encaminhado para realização de necropsia.(AU)

The objective of this work was to report a rare case of hydrocephalus in a domestic Persian feline, 30 days old. The animal was attended with a history of inability to keep in season, incoordination of the motor, inability to feed itself and support the weight of the head. In the clinical examination, the presence of an open fontanelle, an increase in the skull cap, ataxia, unilateral strabismus and ocular secretion were observed. The ultrasound examination of the skull led to confirmation of the diagnosis of hydrocephalus. The patient remained hospitalized, and the treatment protocol consisted of a corticosteroid, diuretic and gastric protector in high dose, besides oral feeding and fluid therapy. The animal died after 24 hours, being referred for necropsy.(AU)

Congenital Hydrocephalus in Mono and Dizygotic Twins

Background: Information regarding the occurrence of hydrocephalus (HC) in twins is important in establishing the significance of environmental factors as well as a genetic basis in congenital HC aetiology. This was the basis for this study. Methods: A single institution retrospective study was conducted between August 1; 2006 and July 31; 2008. Only those cases of hydrocephalus (based on clinical and radiological testscranial Computeried tomographic or Magnetic resonance imaging scan) that required placement of a ventricular shunt or endoscopic third ventriculostomy were included in the study. Data regarding the patient's demographics; clinical history; examination and the maternal demographics were retrieved and analysed. DNA analysis was done to confirm the fraternity of the twins when applicable. Results: Fifty-eight patients with congenital hydrocephalus presented to the unit over the study period. We identified three sets of twins in the study. Only one set were identical (both male) and both had hydrocephalus. In the remaining two sets only one out of each pair had hydrocephalus (one male and one female). Two of the patients (1male; 1female) were twins with discordant HC. All the children had normal thumbs. DNA analysis confirmed identical twins in both the like sex twins. The mothers were not known diabetics; hypertensive or sickle cell patients neither did they smoke or take alcohol. There was no family history of hydrocephalus in all patients. Conclusion: Concordance for HC is likely if the twins are like sex and identical. Congenital hydrocephalus seems to be a multifactorial disorder; triggered by environmental factors in genetically predisposed individuals

Hidrocefalia aguda essencial / Acute essential hydrocephalus

Objetivo: Apresentar discussão sobre o tema hidrocefalia aguda e a necessidade de se identificar os subtipos com a finalidade de proporcionar subsídios para a melhor compreensão e abordagem nessas situações. Considerações: A hidrocefalia é um distúrbio da dinâmica do líquido cefalorraquidiano em que há uma expansão do compartimento liquórico encefálico, notadamente do sistema ventricular. Por meio da revisão de literatura, evidencia-se uma extensa classificação com base em parâmetros diversos. Assim, é possível se definir hidrocefalia congênita e adquirida; obstrutiva e por superprodução de liquor; interna e externa; de alta pressão e de pressão normal; aguda, subaguda e crônica; sintomática e assintomática; comunicante e não-comunicante; mono, bi, tri e tetraventricular; “exvacuo” e “arrested hydrocephalus”. Neste contexto complexo e diversificado, a hidrocefalia aguda tem seu diagnóstico frequentemente estabelecido com base no tempo de evolução da síndrome de hipertensão intracraniana, que normalmente a acompanha. Entretanto, como a ventriculomegalia não é um fenômeno passivamente determinado pela hipertensão liquórica intraventricular, ocorrem casos de dissociação entre o grau de dilatação ventricular e o grau de hipertensão intracraniana. Melhor seria, então, considerar como fator diagnóstico a presença de lesão obstrutiva indiscutivelmente aguda causadora da hidrocefalia. Porém, ainda assim, julgamos necessário distinguir-se um subtipo que exige uma abordagem direta independentemente da conduta adotada para a lesão expansiva inicial, a que denominamos hidrocefalia aguda essencial, em oposição ao subtipo hidrocefalia aguda não-essencial,cuja resolução é dependente da resolução da lesão expansiva que lhe deu origem. Conclusão: O conceito de hidrocefalia aguda essencial é operacional e de apurada precisão técnica, capaz de proporcionar subsídios à melhor abordagem da hidrocefalia aguda. Entretanto, ainda é necessária uma melhor compreensão do papel...

Objective: To discuss the acute hydrocephalus and the necessity of identifying its subtypes to provide more subsidies for understanding and management of the patients in this condition. Background:Hydrocephalus is a disturbance in the CSF dynamics in which there is an expansion of CSF brain compartment especially of ventricular system. It becomes evident by literature revision that there isan extensive classification based on various parameters. Therefore, it is possible to determine many categories of hydrocephalus: congenital and acquired; obstructive and by over production of CSF;internal and external; high pressure and normal pressure; acute, subacute and chronic; symptomatic and asymptomatic; communicant and noncommunicant; mono/bi/tri/tetraventricular; ex vacuo and arrested hydrocephalus. In this complex and variable context, the diagnosis of acute hydrocephalus usually rely on the time of evolution of the intracranial hypertension syndrome that often occurs. However it would be better to consider as a diagnostic factor the presence of unquestionable acute obstructive lesion causative of the hydrocephalus. Even so, we distinguish a subtype that we have named essential acute hydrocephalus, which requires a direct approach to the hydrocephalus independently of the treatment adopted for the initial causative lesion, contrasting with a non-essential acute hydrocephalus subtype,whose resolution is dependent of the resolution of the initial expansive lesion that caused it. Conclusion:The essential acute hydrocephalus concept is operational and technically precise, allowing a betterapproach to the cases of acute hydrocephalus. However, it is still necessary a full understanding aboutthe role played by the brain structural compartments, ventriculomegaly and intraventricular hemorrhage to the physiopathology of hydrocephalus in general, and acute hydrocephalus in particular.

Causas de hidrocefalia en menores de 13 años de edad / Hydrocephaly in children under 13 years of age

Determinar las patologías que inducen hidrocefalia, frecuencia según sexo y grupo etario, procedimientos y complicaciones en niños menores de 13 años durante las gestiones 2000 – 2004 en el Hospital del Niño Dr. OvidioAliaga Uria. Las causas pueden ser prenatales, genéticas o familiares que se asocia a anomalías cromosómicas, siendo estos factores responsables desconocidos para la mayoría de los autores, infecciosas y/o parasitarias y las de causa posnatal que son losprocesos expansivos e infecciosos.

Hydrocephalus in children

The word "hydrocephalus" is derived from two Greek words: hydro meaning water; and cephalus meaning head; also known as "water on the brain". Historically it is believed to result from imbalance between CSF production and absorption, with net accumulation of fluid in the cranial cavity; characterized by increase in size of the cerebral ventricles. It is classified as: Communicating hydrocephalus, in which flow is not obstructed, but CSF is inadequately reabsorbed in the subarachnoid space and the Non-communicating hydrocephalus or the Obstructive type, in which flow of CSF from the ventricles to subarachnoid space is obstructed. This type may also be sub-classified into Congenital and Acquired. The overall incidence of hydrocephalus is not known. Approximately 55% of all hydrocephalus are congenital. The etiology depends upon the age of the child. The clinical features are increase in the size of head, with wide anterior fontanelle, prominent scalp veins, sun-setting eyes, optic nerve atrophy, nystagmus and increased muscle tone in children upto 2 years. Children more than 2 years may present with these as hydrocephalus progresses; or if the fontanelles are closed, head size may be normal. These may present with optic atrophy or papilloedema, abnormal hypothalamic functions [short stature or gigantism, obesity, delayed puberty, primary amenorrhea or menstrual irregularity and diabetes inspidus] and spastic lower limbs. Performance IQ is worse than verbal IQ and learning problems are common. The diagnostic procedures include measurement of head circumference, Plain X ray of head, Ventriculography, Pneumoencephalography, Ultrasonography, Computed Tomography and Magnetic Resonance Imaging. The management may be non-surgical and surgical

Hidrocefalia. Conceito, aspectos históricos, fisiopatologia, classificaçäo e evoluçäo do tratamento / Hydrocephalus - Concept, historical aspects, phisiopathology, classification and evolution of the treatment

Os autores fazem uma revisão sobre o conceito de hidrocefalia e abordam o interesse histórico que essa patologia tem ocasionado desde os escritos de Hipócrates até a realidade atual. A sua fisiopatologia e classificação são revisadas bem como a evolução do tratamento. As dificuldades que as derivações valvulares ainda apresentam nos dias atuais são analisadas e por fim elaboram os fundamentos e tecem considerações históricas no que concerne à utilização da neuroendoscopia em geral e em particular o seu emprego no tratamento das hidrocefalias

Imaging in hydrocephalus and spinal dysraphism.

Hydrocephalus and spinal dysraphism are two commonly encountered clinical entities where imaging plays a vital role. Sonography, Computed Tomography and Magnetic Resonance Imaging are the modalities used for the evaluation of hydrocephalus. Ultrasound is useful in small infants with open fontanella, is non-invasive and can be performed at cribside. However, it has limitation in identifying the etiology. CT is the most cost effective modality in the evaluation of hydrocephalus and gives detailed anatomical information. MRI offers the added advantage of multiplanar display and can also assess stenosis/patency of CSF pathways, using phase contrast cine techniques. MRI is the modality of choice for evaluating spinal dysraphism and gives excellent information regarding contents of back mass, spinal cord status and associated anomalies like Chiari malformation. Myelography coupled with CT should be reserved for equivocal cases or in centres where MRI is not available.

Management of hydrocephalus.

The present study is an analysis of 747 patients with hydrocephalus, treated and followed up in the Hydrocephalus Clinic run by the department of Paediatric Surgery at the All India Institute of Medical Sciences, New Delhi. The distribution of patients was: congenital-46%, post-meningomyelocoele excision-28%, post-meningitic-21% and others-5% (including post haemorrhagic and post encephalocoele excision hydrocephalus. The average age was 7 months in the shunted group and 10 months in the medical group with overall male to female ratio of 2.3:1. The data were analysed to study the effect of treatment on ventriculomegaly and mental development with special reference to the type of treatment (shunt versus medical) and age at starting treatment. The probability of shunt failure was also studied. A comparison of ventricular size in US/CAT scans between the time of starting treatment and last follow-up revealed improvement in ventriculomegaly in 60% of the shunted patients but only 30% of the medically treated patients. A significant difference was particularly noted in patients with severe hydrocephalus, 72% and 22%, respectively. Comparison of the mean Mental Performance Quotient (MPQ) scores in the shunted & medically treated patients also revealed significantly better MPQ scores in the shunted group (p = < 0.001). Probability of shunt survival, as depicted by the Kaplan-Meier survival curve, revealed that there is a high rate of shunt failure in the first 12 months, followed by a dramatic slowing down. Our observations support the contention that CSF shunt surgery offers better outcome than medical management even when ventriculomegaly is severe at the time of presentation.

Congenital hydrocephalus.

Congenital hydrocephalus results from diverse causes which could be developmental, genetic, infective and haemorrhagic in nature; aqueductal stenosis being the most common of all. Altered fluid dynamics results in loss of brain substance and enlargement of CSF spaces with the resultant sequelae. The present article reviews the multifaceted problems of congenital hydrocephalus from the standpoint of its pathophysiology, clinical ramifications & treatment.

Classificaçäo etiológica de 62 casos de hidrocefalia operados no IMIP em 1993 / The etiologic classification for 62 cases of hydrocephalus operated in 1993 at IMIP

Os autores apresentam uma análise de 62 casos de hidrocefalia que receberam uma derivaçäo ventrículo-peritonial (DVP) no Serviço de Neurocirurgia do Instituto Materno Infantil de Pernambuco, no ano de 1993. Säo analisadas as formas clínicas apresentadas e os meios diagnósticos utilizados. A populaçäo estudada foi distribuída em dois grandes grupos: as hidrocefalias congênitas, 78, 5 por cento, e as hidrocefalias adquiridas, 21,5 por cento. Os resultados encontrados foram comparados com outros estudos encontrados na literatura consultada, verificando-se a näo existência de divergências importantes