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1.
Neurosciences (Riyadh) ; 26(1): 26-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33530040

RESUMO

OBJECTIVES: To assess the etiology of status epilepticus (SE) among the pediatric patients of a tertiary center in Jeddah, Kingdom of Saudi Arabia (KSA). METHODS: Data from 88 cases was obtained retrospectively from 2006 to 2017 from King Abdulaziz University Hospital (KAUH). Patients aged between 28 days and 14 years with the symptoms of SE were selected for this study. RESULTS: The data show that the proportions of SE etiologies were 30.5% for febrile seizure, 11.9% for electrolytes imbalance, 8.5% for hydrocephalus, 6.8% for CNS infections, and 6.8% for neoplasm. The other etiologies of SE were trauma, fever, intractable epilepsy, cerebrovascular accident, hemorrhagic stroke, etc. There were no clear etiologies in 8 cases. Most of the patients were not of Saudi origin (64.3%), boys (67.8%), and had generalized epilepsy types (91.8%), and 58.6% of the patients complied with epilepsy medications. CONCLUSION: The most prevalent etiology of convulsive status epilepticus was a febrile seizure, followed by electrolyte imbalance and hydrocephalus. However, a nationwide study in KSA must be conducted to determine the major etiologies of SE for its effective management and prevention. Educating families and patients regarding antiepileptic drugs is necessary.


Assuntos
Hidrocefalia/complicações , Convulsões Febris/complicações , Estado Epiléptico/etiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Risco , Arábia Saudita , Centros de Atenção Terciária
2.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370982

RESUMO

There are several causes for sudden onset unilateral mydriasis, however impending transtentorial uncal herniation needs to be ruled out. This unique case highlights an uncommon adverse response to a common mode of treatment that leads to a diagnostic dilemma. A 3-year-old boy with a ventriculoperitoneal (VP) shunt for an obstructive hydrocephalus presented with an acute respiratory distress. He developed unilateral mydriasis with absent light reflex during treatment with nebulisers. An urgent CT scan of the brain did not show any new intracranial abnormality. A case of pharmacological anisocoria was diagnosed that resolved completely within 24 hours of discontinuation of ipratropium bromide. Although ipratropium-induced anisocoria has been reported in children, but to our knowledge none in a child with VP shunt for hydrocephalus. This emphasises the urgency in evaluating unilateral mydriasis to rule out life-threatening conditions. Clinicians should remember that ipratropium administered through ill-fitting face masks could cause this completely reversible adverse effect.


Assuntos
Anisocoria/induzido quimicamente , Hidrocefalia/cirurgia , Ipratrópio/efeitos adversos , Midríase/induzido quimicamente , Derivação Ventriculoperitoneal , Administração por Inalação , Anisocoria/diagnóstico , Encéfalo/diagnóstico por imagem , Pré-Escolar , Humanos , Hidrocefalia/complicações , Ipratrópio/administração & dosagem , Masculino , Midríase/diagnóstico , Nebulizadores e Vaporizadores , Tomografia Computadorizada por Raios X
3.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(4): 165-72, jul.-ago. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-193897

RESUMO

INTRODUCCIÓN: La neuroendoscopia se ha posicionado como un tratamiento eficaz y seguro en los quistes aracnoideos en la edad pediátrica. Realizamos una revisión de los pacientes pediátricos con quistes aracnoideos tratados mediante neuroendoscopia en nuestro servicio y analizamos los resultados. MATERIAL Y MÉTODOS: Análisis retrospectivo de una serie de 20 pacientes intervenidos entre los años 2005 y 2018. Las variables recogidas son: género, edad, presentación clínica, localización del quiste, presencia de hidrocefalia o colecciones extraaxiales, maniobras endoscópicas realizadas y complicaciones. Se consideró éxito del procedimiento cuando se produjo mejoría de los síntomas y reducción del tamaño del quiste, manteniéndose esta situación hasta final de seguimiento. RESULTADOS: La serie consta de 13 varones y 7 mujeres (edad media: 64,6 meses; rango 4-172 meses). La localización más repetida fue supraselar/prepontina (7), seguida de intraventricular (6), después cuadrigeminales (3), interhemisféricos (2) y silvianos (2). Un 70% (14/20) de pacientes asociaba hidrocefalia en el momento del diagnóstico, elevándose hasta el 85% en quistes supraselares/prepontinos o el 100% en cuadrigeminales. Solo 4/14 pacientes precisaron un sistema de derivación ventriculoperitoneal (mediana de edad al diagnóstico: 12,5 meses). De estos 4, 3 desarrollaron un sobredrenaje valvular grave. Se consideró éxito del procedimiento en 12/20 pacientes (60%) de la serie. Diferenciando por localización: 4/7 en supraselares (57%), 1/3 en cuadrigeminales (33%), 4/6 en intraventriculares (66%), 2/2 en interhemisféricos (100%) y 1/2 en silvianos (50%). Por tanto, se registraron 8 fallos de tratamiento, con un tiempo medio hasta el fallo de 12,12 meses (rango: 0-45). De esos 8 pacientes, en 4 se realizó una nueva neuroendoscopia (éxito de 2/4), en 2 casos se optó por la colocación de derivación ventriculoperitoneal, en un caso por la colocación de derivación cistoperitoneal y en el restante se mantuvo una actitud conservadora. El seguimiento medio fue de 52,45 meses (rango 3-129 meses). CONCLUSIONES: El tratamiento neuroendoscópico es efectivo y seguro en el tratamiento de los quistes aracnoideos en edad pediátrica, permitiendo además en muchos casos el control de la hidrocefalia asociada. El tipo de procedimiento neuroendoscópico y el porcentaje de éxito dependen de la localización del quiste. Se observa una tendencia de mayor dependencia valvular en pacientes de menor edad. En esos casos, sería recomendable la aplicación de medidas de prevención de sobredrenaje


INTRODUCTION: Neuroendoscopy has become an effective and safe treatment for arachnoid cysts in the paediatric population. We review the paediatric patients with arachnoid cysts treated by neuroendoscopy in our hospital and analyse the results. MATERIAL AND METHODS: A retrospective analysis of 20 patients operated on from 2005 to 2018. The variables assessed are: gender, age, clinical presentation, cyst site, presence of hydrocephalus and/or extra-axial collections, endoscopic procedures and complications. Procedure success is defined as an improvement in symptoms and reduction in cyst size until end of follow-up. RESULTS: Our series comprised 13 males and 7 females (mean age: 64.6 months, range: 4-172 months). The most frequent site was suprasellar-prepontine (7), followed by intraventricular (6), quadrigeminal (3), interhemispheric (2) and Sylvian (2). A total of 70% (14/20) of patients had hydrocephalus at diagnosis, which increased to 85% in suprasellar-prepontine cysts and 100% in quadrigeminal cysts. Only 4/14 patients with required a ventriculoperitoneal shunt (median age at diagnosis: 12.5 months). Of these 4 patients, 3 developed severe shunt overdrainage. The procedure was successful in 60% (12/20) of the patients in the series. Success by location was 57% (4/7) in suprasellar cysts, 33% (1/3) in quadrigeminal cysts, 66% (4/6) in intraventricular cysts, 100% (2/2) in interhemispheric cysts and 50% (1/2) in Sylvian cysts. Treatment thus failed in 8 cases, with a mean time to failure of 12.12 months (range: 0-45 months). A new neuroendoscopic procedure was performed in 4 of these 8 cases (success in 2/4), a ventriculoperitoneal shunt was placed in 2 cases, a cystoperitoneal shunt was placed in 1 case and the remaining case was managed conservatively. Mean follow-up time was 52.45 months (range: 3-129 months). CONCLUSIONS: Neuroendoscopy is an effective and safe treatment for arachnoid cysts in paediatric patients that also enables managing associated hydrocephalus in most cases. The choice of neuroendoscopic procedure and success rate depend on cyst location. Younger patients have been found to have a higher shunt dependency rate. In these cases, measures to prevent shunt overdrainage are recommended


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Cistos Aracnóideos/diagnóstico por imagem , Cistos Aracnóideos/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Estudos Retrospectivos , Cistos Aracnóideos/complicações , Hidrocefalia/complicações , Procedimentos Neurocirúrgicos/métodos , Neoplasias do Ventrículo Cerebral/cirurgia
4.
Cochrane Database Syst Rev ; 6: CD012726, 2020 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-32542676

RESUMO

BACKGROUND: Hydrocephalus is a common neurological disorder, caused by a progressive accumulation of cerebrospinal fluid (CSF) within the intracranial space that can lead to increased intracranial pressure, enlargement of the ventricles (ventriculomegaly) and, consequently, to brain damage. Ventriculo-peritoneal shunt systems are the mainstay therapy for this condition, however there are different types of shunt systems. OBJECTIVES: To compare the effectiveness and adverse effects of conventional and complex shunt devices for CSF diversion in people with hydrocephalus. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (2020 Issue 2); Ovid MEDLINE (1946 to February 2020); Embase (Elsevier) (1974 to February 2020); Latin American and Caribbean Health Science Information Database (LILACS) (1980 to February 2020); ClinicalTrials.gov; and World Health Organization International Clinical Trials Registry Platform. SELECTION CRITERIA: We selected randomised controlled trials or quasi-randomised trials of different types of ventriculo-peritoneal shunting devices for people with hydrocephalus. Primary outcomes included: treatment failure, adverse events and mortality. DATA COLLECTION AND ANALYSIS: Two review authors screened studies for selection, assessed risk of bias and extracted data. Due to the scarcity of data, we performed a Synthesis Without Meta-analysis (SWiM) incorporating GRADE for the quality of the evidence. MAIN RESULTS: We included six studies with 962 participants assessing the effects of standard valves compared to anti-syphon valves, other types of standard valves, self-adjusting CSF flow-regulating valves and external differential programmable pressure valves. All included studies started in a hospital setting and offered ambulatory follow-up. Most studies were conducted in infants or children with hydrocephalus from diverse causes. The certainty of the evidence for most comparisons was low to very low. 1. Standard valve versus anti-syphon valve Three studies with 296 randomised participants were included under this comparison. We are uncertain about the incidence of treatment failure in participants with standard valve and anti-syphon valves (very low certainty of the evidence). The incidence of adverse events may be similar in those with standard valves (range 0 to 1.9%) and anti-syphon valves (range 0 to 2.9%) (low certainty of the evidence). Mortality may be similar in those with standard valves (0%) and anti-syphon valves (0.9%) (RD 0.01%, 95% CI -0.02% to 0.03%, low certainty of the evidence). Ventricular size and head circumference may be similar in those with standard valves and anti-syphon valves (low certainty of the evidence). None of the included studies reported the quality of life of participants. 2. Comparison between different types of standard valves Two studies with 174 randomised participants were included under this comparison. We are uncertain about the incidence of treatment failure in participants with different types of standard valves (early postoperative period: RR 0.41, 95% CI 0.13 to 1.27; at 12 months follow-up: RR 1.17, 95% CI 0.72 to 1.92, very low certainty of the evidence). None of the included studies reported adverse events beyond those included under "treatment failure". We are uncertain about the effects of different types of standard valves on mortality (range 2% to 17%, very low certainty of the evidence). The included studies did not report the effects of these interventions on quality of life, ventricular size reduction or head circumference. 3. Standard valve versus self-adjusting CSF flow-regulating valve One study with 229 randomised participants addressed this comparison. The incidence of treatment failure may be similar in those with standard valves (42.98%) and self-adjusting CSF flow-regulating valves (39.13%) (low certainty of the evidence). The incidence of adverse events may be similar in those with standard valves (range 0 to 1.9%) and those with self-adjusting CSF flow-regulating valves (range 0 to 7.2%) (low certainty of the evidence). The included study reported no deaths in either group in the postoperative period. Beyond the early postoperative period, the authors stated that nine patients died (no disaggregated data by each type of intervention was available, low certainty of the evidence). The included studies did not report the effects of these interventions on quality of life, ventricular size reduction or head circumference. 4. External differential programmable pressure valve versus non-programmable valve One study with 377 randomised participants addressed this comparison. The incidence of treatment failure may be similar in those with programmable valves (52%) and non-programmable valves (52%)  (RR 1.02, 95% CI 0.84 to 1.24, low certainty of the evidence). The incidence of adverse events may be similar in those with programmable valves (6.19%) and non-programmable valves (6.01%) (RR 0.97, 95% CI 0.44 to 2.15, low certainty of the evidence). The included study did not report the effect of these interventions on mortality, quality of life or head circumference. Ventricular size reduction may be similar in those with programmable valves and non-programmable valves (low certainty of the evidence). AUTHORS' CONCLUSIONS: Standard shunt valves for hydrocephalus compared to anti-syphon or self-adjusting CSF flow-regulating valves may cause little to no difference on the main outcomes of this review, however we are very uncertain due to the low to very low certainty of evidence. Similarly, different types of standard valves and external differential programmable pressure valves versus non-programmable valves may be associated with similar outcomes. Nevertheless, this review did not include valves with the latest technology, for which we need high-quality randomised controlled trials focusing on patient-important outcomes including costs.


Assuntos
Hidrocefalia/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Criança , Desenho de Equipamento , Humanos , Hidrocefalia/complicações , Hidrocefalia/mortalidade , Lactente , Microcomputadores , Ensaios Clínicos Controlados Aleatórios como Assunto , Falha de Tratamento , Incerteza , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/mortalidade
5.
Am J Med Sci ; 359(6): 372-377, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32317167

RESUMO

Tuberculosis is a global burden with an unacceptably high mortality rate, especially in low- and middle-income countries. We reported the case of 34-year-old Somali female with no significant risk factors who initially presented with headache and blurred vision. The patient subsequently developed altered mental status and significant vision changes. Initial lumbar puncture showed lymphocytic pleocytosis with negative gram stain, acid-fast bacilli stain, and culture. Initial polymerase chain reaction for tuberculosis was negative. The patient worsened despite receiving broad-spectrum antibiotics. The patient had a prolonged hospital course and eventually required lumbar drain placement for hydrocephalus. Repeated polymerase chain reactions for Mycobacterium tuberculosis from the lumbar drain samples was positive, and the diagnosis of tuberculous meningitis was confirmed. The patient improved after lumbar drain placement and treatment with isoniazid, rifampin, pyrazinamide, ethambutol and steroid tapering. This case illustrated the challenge of diagnosing tuberculous meningitis.


Assuntos
Tuberculose Meníngea/diagnóstico por imagem , Tuberculose Meníngea/tratamento farmacológico , Adulto , Antituberculosos/administração & dosagem , Asma/complicações , Etambutol/administração & dosagem , Feminino , Cefaleia/complicações , Hospitalização , Humanos , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Isoniazida/administração & dosagem , Leucocitose , Imagem por Ressonância Magnética , Reação em Cadeia da Polimerase , Pirazinamida/administração & dosagem , Rifampina/administração & dosagem , Somália , Punção Espinal , Tuberculose Meníngea/complicações , Estados Unidos , Transtornos da Visão/complicações
6.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 31(2): 53-63, mar.-abr. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-190373

RESUMO

BACKGROUND: During the microsurgical exploration of trigeminal root in the pontocerebellar angle in patients with primary trigeminal neuralgia (TN) without an evident arterial compression, the surgeon is in an engaged situation because there are not well-established surgical strategies. The aim of this study is to describe in these cases the surgical maneuver we call "trigeminal root massage" (TRM). METHODS: 52 consecutive patients with primary trigeminal neuralgia who had undergone a microsurgical suboccipital retrosigmoid exploration of trigeminal root were reviewed. Among them we found 10 patients without an evident arterial compression after a thorough microsurgical exploration. In the great majority of these 10 cases, we noticed a venous contact to the trigeminal root along this cisternal trajectory, in most cases we have had to coagulate the compressive vein/s and then cut. All underwent a simple trigeminal root massage, without interposition of any material implant. RESULTS: All 10 patients experienced immediate pain disappearance and the postoperative course was uneventful except one case with a severe complication: cerebellar swelling, meningitis and hydrocephaly. The recurrence rate was 40%. Six patients achieved pain relief without specific medication with an average follow-up period of 5 years. There have been no mortalities nor any postoperative anesthesia dolorosa. CONCLUSIONS: The described maneuver provides an easy and simple alternative way in cases where during a microsurgical exploration of trigeminal root, where we don't find a clear arterial compression, with similar results than other possibilities such as partial sensory rhizotomy or more complicated and time consuming surgery as "nerve combing". Nevertheless, a 40% of pain recurrence after an average follow-up of 5 years means that is a good alternative, but not a definitive technique at the moment for permanent cure of trigeminal neuralgia without arterial compression


INTRODUCCIÓN Y OBJETIVOS: Durante la exploración microquirúrgica de la raíz trigeminal en el ángulo pontocerebeloso en pacientes con neuralgia del trigémino (NT) primaria sin una evidente compresión arterial, el cirujano se encuentra en una situación comprometida, ya que no existe una estrategia quirúrgica establecida. El objetivo de este estudio es la de describir en esos casos una maniobra quirúrgica que llamamos «masaje de la raíz trigeminal» (MRT). MÉTODOS: Se revisan un total de 52 pacientes consecutivos con NT primaria a quienes se ha realizado una exploración de la raíz trigeminal por vía suboccipital retrosigmoidea. Entre ellos hemos encontrado 10 pacientes sin una evidente compresión arterial durante la exploración microquirúrgica. En 8 de los 10 casos ha existido un contacto venoso de la raíz trigeminal a lo largo de su trayectoria cisternal, procediendo a la coagulación y sección de la/s vena/s. En los 10 casos se ha procedido, finalmente, a un suave masaje de la raíz trigeminal sin interposición de ningún material. RESULTADOS: Los 10 pacientes experimentaron una inmediata desaparición de la neuralgia y el curso postoperatorio fue favorable excepto por un caso de complicación severa con edema cerebeloso, meningitis e hidrocefalia. La recidiva fue del 40%. Seis pacientes obtuvieron una desaparición completa de la neuralgia, sin medicación específica, en un seguimiento medio de 5 años. No ha habido mortalidad ni anestesia dolorosa postoperatoria. CONCLUSIONES: La maniobra quirúrgica descrita es una alternativa útil y sencilla en casos donde, durante la exploración microquirúrgica de la raíz trigeminal, no encontramos una clara compresión arterial, con resultados similares a otras posibilidades como la rizotomía parcial o más laboriosas como la llamada nerve combing. En cualquier caso, un 40% de recidiva dolorosa a los 5 años significa que, aunque es una buena alternativa, no es una técnica definitiva en la curación de todos los enfermos con NT sin conflicto arterial


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neuralgia do Trigêmeo/cirurgia , Cirurgia de Descompressão Microvascular/métodos , Microcirurgia/métodos , Complicações Pós-Operatórias , Meningite/complicações , Hidrocefalia/complicações , Estudos Retrospectivos
7.
Rev. esp. anestesiol. reanim ; 67(4): 204-207, abr. 2020.
Artigo em Espanhol | IBECS | ID: ibc-198029

RESUMO

La hidrocefalia es una distensión activa del sistema ventricular del cerebro. Las mejores tasas de supervivencia de los pacientes con enfermedad neuroquirúrgica se acompañan de un mayor número de procedimientos no neuroquirúrgicos en pacientes que tienen dispositivos neuroquirúrgicos terapéuticos. No está clara la verdadera incidencia del embarazo en pacientes con hidrocefalia obstructiva controlada con derivación ventriculoperitoneal (DVP). Presentamos un caso de una mujer embarazada de 34 años con una DVP para hidrocefalia obstructiva. Debido a la obstrucción de la DVP secundaria al volumen del útero, ella presentó varios episodios de deterioro neurológico durante el embarazo. Se planificaron una cesárea electiva y una revisión de la DVP para el mismo tiempo operatorio. Este caso inusual representa un desafío al que el anestesiólogo debe enfrentarse para proporcionar el mejor manejo simultáneo del delicado bienestar de la madre, su cerebro, y el feto


Hydrocephalus is an active distension of the ventricular system of the brain. The improved survival rates of patients with neurosurgical pathology is accompanied by a greater number of non-neurosurgical procedures in patients who have therapeutic neurosurgical devices. The real incidence of pregnancy in patients with obstructive hydrocephalus controlled with ventriculoperitoneal shunt (VPS) is unclear. We present a case of a pregnant 34-year-old female with a VPS for obstructive hydrocephalus. Due to VPS obstruction secondary to uterus volume, she presented several episodes of neurological impairment during pregnancy. An elective caesarean section (C-section) and VPS review were planned for the same operative time. This rare case reflects the challenge that the anaesthesiologist has to face in order to provide the best and simultaneous management of the wellbeing of the mother, the mother's brain and the foetus


Assuntos
Humanos , Feminino , Gravidez , Adulto , Derivação Ventriculoperitoneal , Hidrocefalia/complicações , Cesárea/métodos , Anestesia Geral , Rocurônio/uso terapêutico , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Sevoflurano/uso terapêutico , Anestésicos Inalatórios/uso terapêutico , Anestésicos Gerais/uso terapêutico , Fentanila/uso terapêutico , Propofol/uso terapêutico , Sugammadex/uso terapêutico , Hidrocefalia/cirurgia
8.
Turk Neurosurg ; 30(2): 194-198, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32153000

RESUMO

AIM: To define the optimal time of shunt insertion in patients with neural tube defects and hydrocephalus. MATERIAL AND METHODS: In total, 71 patients who underwent operation for neural tube defects and hydrocephalus were retrospectively evaluated between 2012 and 2018. The first group comprised 43 patients who underwent operation at different times (in 10 days after the repair of defect), and the second group comprised 28 patients who underwent operation at the same time. Ruptured and unruptured sacs were immediately considered and operated within 72 hours. RESULTS: In the first group, 43 patients underwent operation for neural tube defect after birth. Ventriculoperitoneal shunt insertion was performed 10 days after wound healing. Five (11.6%) patients were diagnosed with meningitis on follow-up. Shunt infection or meningitis was not observed on follow-up in the second group, which comprised patients who underwent operation at the same time. CONCLUSION: The lowest complication rate existed in hydrocephalus management when shunt insertion and myelomeningocele repair procedures were performed at the same time.


Assuntos
Hidrocefalia/complicações , Hidrocefalia/cirurgia , Meningomielocele/complicações , Meningomielocele/cirurgia , Derivação Ventriculoperitoneal , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo , Derivação Ventriculoperitoneal/efeitos adversos
9.
World Neurosurg ; 138: 163-168, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32156596

RESUMO

BACKGROUND: Posttraumatic syringomyelia is a significant source of disability following spinal cord injury (SCI). Despite this, its etiology and optimal treatment remain controversial. Early identification of and intervention at a presyrinx state may halt progression. Here, we present a unique case illustrating the continuum between presyrinx and syrinx in an adult following severe distraction cervical SCI and traumatic brain injury, resulting in both tethered spinal cord and posttraumatic hydrocephalus and subsequent isolated fourth ventricle. The interplay between these etiologic factors and their therapeutic implications are discussed. CASE DESCRIPTION: A 48-year-old female developed rapidly progressive cervical spinal cord edema and hydromyelia almost 6 months after severe SCI and traumatic brain injury, with an initial Glasgow Coma Scale score of 3. Imaging demonstrated both ventral tethering of her cord at the site of injury (C5/6), as well as a trapped fourth ventricle following lateral ventricular shunting for posttraumatic hydrocephalus, with diminished flow of cerebrospinal fluid at the craniocervical junction. Additional shunting of the fourth ventricle led to significant clinical improvement and dramatic radiologic regression of her cord abnormality. CONCLUSIONS: Cognizance of the possible presence of multiple etiologic contributors to posttraumatic syringomyelia and an intricate understanding of their interplay are crucial to the optimal management of this complex pathology.


Assuntos
Hidrocefalia/complicações , Defeitos do Tubo Neural/complicações , Traumatismos da Medula Espinal/complicações , Siringomielia/etiologia , Lesões Encefálicas Traumáticas/complicações , Feminino , Quarto Ventrículo/patologia , Quarto Ventrículo/cirurgia , Humanos , Hidrocefalia/cirurgia , Pessoa de Meia-Idade , Derivação Ventriculoperitoneal
12.
World Neurosurg ; 137: e118-e125, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31954895

RESUMO

OBJECTIVE: To assess whether mean platelet volume (MPV) is associated with functional outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). METHODS: We retrospectively collected and analyzed data from patients with aSAH who were treated at our institution between January 2015 and January 2019. The patients were divided into 2 groups according to their modified Rankin Scale (mRS) score at 3 months. Univariate and multivariate analyses were performed to investigate whether MPV was associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis was performed to indicate the value of MPV for the prediction of functional outcome in these patients. RESULTS: A total of 262 patients were included in this study. Multivariate logistic regression analysis identified MPV as an independent predictor of poor functional outcome (odds ratio, 2.777; 95% confidence interval [CI], 1.255-6.145; P = 0.012). ROC analysis revealed that MPV could predict poor functional outcome at 3 months, with an area under the curve of 0.803 (95% CI, 0.739-0.867; P < 0.001). Patients with higher MPV values on admission tended to have a higher Hunt-Hess grade (P < 0.001) and Fisher grade (P < 0.001); higher rates of acute hydrocephalus (P = 0.001), shunt-dependent hydrocephalus (P < 0.001), and delayed cerebral ischemia (P < 0.001); and higher mortality (P < 0.001). CONCLUSIONS: MPV is an independent predictor of unfavorable functional outcome at 3 months in patients with aSAH.


Assuntos
Isquemia Encefálica/complicações , Hidrocefalia/complicações , Volume Plaquetário Médio , Hemorragia Subaracnóidea/complicações , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos
13.
Urology ; 137: 200-204, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31734348

RESUMO

OBJECTIVE: To assess and analyze the contemporary causes of in-hospital deaths of spina bifida patients. METHODS: It was a cross-sectional observational study of the longitudinal national cohort of all patients hospitalized in French public and private hospitals. We analyzed the data from the French hospital discharge database (Programme de Médicalisation des Systemes d'Information, PMSI) from 2009 to 2014. The number of in-hospital deaths was extracted using the combination of the ICD-10 codes "Q05" or "Q760" and a discharge code = 9. RESULTS: There were 138 in-hospital deaths of spina bifida patients over the 6-year study period. The median age at death was 41 years (IQR: 25-52). The median age at death was significantly lower in patients with vs without hydrocephalus (26.6 vs 45.5 years; P <.0001). The leading cause of in-hospital death was urologic disorders (n = 24; 17.3%). Other main causes of death were pulmonary disorders (n = 23; 16.7%), neurologic disorders (n = 19; 13.8%), and bowel disorders (n = 15; 10.9%). Upper urinary tract damage accounted for most of the urologic causes of death: 8 patients died from urinary tract infections (33.3%), 7 patients died from renal failure (29.2%), 4 died from bladder cancer (16.7%), and 5 from other urologic causes. The only variable significantly associated with a death from urologic causes was the absence of hydrocephalus (OR = 0.26; P = .009). CONCLUSION: Urologic disorders remain the leading cause of in-hospital death in spina bifida patients in France. The present study highlights that efforts to improve the urologic management of the spina bifida population are still greatly needed.


Assuntos
Causas de Morte , Hidrocefalia , Disrafismo Espinal , Doenças Urológicas , Adulto , Estudos Transversais , Feminino , França/epidemiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Hidrocefalia/complicações , Hidrocefalia/mortalidade , Estudos Longitudinais , Masculino , Mortalidade , Determinação de Necessidades de Cuidados de Saúde , Disrafismo Espinal/complicações , Disrafismo Espinal/terapia , Doenças Urológicas/classificação , Doenças Urológicas/diagnóstico , Doenças Urológicas/etiologia , Doenças Urológicas/mortalidade
14.
Neurol Clin ; 38(1): 171-183, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31761057

RESUMO

Since the clinical syndrome of progressive gait disturbance, urinary incontinence, and dementia in the setting of occult hydrocephalus responsive to cerebrospinal fuid (CSF) shunting was first reported in 1965, the existence of a potentially reversible cause for a form of a dementia illness has generated extensive clinical research and numerous clinical trials. Idiopathic normal pressure hydrocephalus (iNPH) continues to be a heavily debated clinical syndrome. This paper reviews guidelines and imaging findings most often associated with iNPH and the relationship of the neuroimaging findings to some of the theories for this complex syndrome.


Assuntos
Encéfalo/diagnóstico por imagem , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Neuroimagem/métodos , Demência/diagnóstico por imagem , Demência/etiologia , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem , Hidrocefalia de Pressão Normal/complicações
15.
Neurosurgery ; 86(6): 783-791, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31501896

RESUMO

BACKGROUND: Subarachnoid hemorrhage (SAH) is most commonly caused by a ruptured vascular lesion. A significant number of patients presenting with SAH have no identifiable cause despite extensive cerebrovascular imaging at presentation. Significant neurological morbidity or mortality can result from misdiagnosis of aneurysm. OBJECTIVE: To generate a model to assist in predicting the risk of aneurysm in this patient population. METHODS: We conducted a retrospective study of all patients aged ≥18 yr admitted to a single center from March 2008 to March 2018 with nontraumatic SAH (n = 550). Patient information was compared between those with and without aneurysm to identify potential predictors. Odds ratios obtained from a logistic regression model were converted into scores which were summed and tested for predictive ability. RESULTS: Female sex, higher modified Fisher or Hijdra score, nonperimesencephalic location, presence of intracerebral hemorrhage, World Federation of Neurosurgical Societies (WFNS) score ≥3, need for cerebrospinal fluid diversion on admission, and history of tobacco use were all entered into multivariable analysis. Greater modified Fisher, greater Hijdra score, WFNS ≥3, and hydrocephalus present on admission were significantly associated with the presence of an aneurysm. A model based on the Hijdra score and SAH location was generated and validated. CONCLUSION: We show for the first time that the Hijdra score, in addition to other factors, may assist in identifying patients at risk for aneurysm on cerebrovascular imaging. A simple scoring tool based on patient sex, SAH location, and SAH burden can assist in predicting the presence of an aneurysm in patients with nontraumatic SAH.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/diagnóstico por imagem , Adulto , Idoso , Hemorragia Cerebral/complicações , Estudos de Coortes , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem , Aneurisma Intracraniano/etiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Hemorragia Subaracnóidea/complicações
16.
J Clin Neurosci ; 71: 286-289, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31537463

RESUMO

Corticobasal degeneration (CBD) has substantial overlap of clinical features with other neurodegenerative diseases including Parkinson's disease (PD). Its clinical diagnostic accuracy is the lowest among the common neurodegenerative diseases, and its antemortem diagnosis is more challenging when CBD is comorbid with another brain disease. We report an elderly male patient with multiple medical conditions and a family history of essential tremor. He presented with progressive tremor that was initially thought to be essential tremor and later diagnosed as PD despite head computerized tomography showing bilateral intraventricular masses and other minor changes. The clinical diagnosis of PD was supported by his responsiveness to low-dose levodopa. However, postmortem neuropathological examination revealed CBD and bilateral choroid plexus xanthogranulomas with mild ventricular enlargement and multifocal ependymal lining injury presumably due to mild hydrocephalus. CBD is typically levodopa-unresponsive, but hydrocephalus-associated parkinsonism is commonly levodopa-responsive. We raise awareness of the present comorbidity and atypical parkinsonism due to the choroid plexus xanthogranuloma-induced hydrocephalus for the clinical diagnosis and management of parkinsonism.


Assuntos
Doenças dos Gânglios da Base/complicações , Levodopa/uso terapêutico , Transtornos Parkinsonianos/tratamento farmacológico , Transtornos Parkinsonianos/etiologia , Xantomatose/complicações , Idoso , Antiparkinsonianos/uso terapêutico , Plexo Corióideo/patologia , Granuloma/complicações , Humanos , Hidrocefalia/complicações , Masculino
17.
Neurosurg Rev ; 43(4): 1173-1178, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31332702

RESUMO

Loss of consciousness (LOC) at presentation with aneurysmal subarachnoid hemorrhage (aSAH) has been associated with early brain injury and poor functional outcome. The impact of LOC on the clinical course after aSAH deserves further exploration. A retrospective analysis of 149 aSAH patients who were prospectively enrolled in the Cerebral Aneurysm Renin Angiotensin Study (CARAS) between 2012 and 2015 was performed. The impact of LOC was analyzed with emphasis on patients presenting in excellent or good neurological condition (Hunt and Hess 1 and 2). A total of 50/149 aSAH patients (33.6%) experienced LOC at presentation. Loss of consciousness was associated with severity of neurological condition upon admission (Hunt and Hess, World Federation of Neurosurgical Societies (WFNS), Glasgow Coma Scale (GCS) grade), hemorrhage burden on initial head CT (Fisher CT grade), acute hydrocephalus, cardiac instability, and nosocomial infection. Of Hunt and Hess grade 1 and 2 patients, 21/84 (25.0%) suffered LOC at presentation. Cardiac instability and nosocomial infection were significantly more frequent in these patients. In multivariable analysis, LOC was the predominant predictor of cardiac instability and nosocomial infection. Loss of consciousness at presentation with aSAH is associated with an increased rate of complications, even in good-grade patients. The presence of LOC may identify good-grade patients at risk for complications such as cardiac instability and nosocomial infection.


Assuntos
Hemorragia Subaracnóidea/complicações , Inconsciência/etiologia , Adulto , Idoso , Estudos de Coortes , Infecção Hospitalar/complicações , Infecção Hospitalar/epidemiologia , Feminino , Seguimentos , Escala de Coma de Glasgow , Cardiopatias/complicações , Cardiopatias/epidemiologia , Humanos , Hidrocefalia/complicações , Hidrocefalia/epidemiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Hemorragia Subaracnóidea/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Inconsciência/epidemiologia
18.
Neuroimage Clin ; 24: 102031, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31795043

RESUMO

OBJECTIVES: Injury to the preterm lateral ventricular perimeter (LVP), which contains the neural stem cells responsible for brain development, may contribute to the neurological sequelae of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus of prematurity (PHH). This study utilizes diffusion MRI (dMRI) to characterize the microstructural effects of IVH/PHH on the LVP and segmented frontal-occipital horn perimeters (FOHP). STUDY DESIGN: Prospective study of 56 full-term infants, 72 very preterm infants without brain injury (VPT), 17 VPT infants with high-grade IVH without hydrocephalus (HG-IVH), and 13 VPT infants with PHH who underwent dMRI at term equivalent. LVP and FOHP dMRI measures and ventricular size-dMRI correlations were assessed. RESULTS: In the LVP, PHH had consistently lower FA and higher MD and RD than FT and VPT (p<.050). However, while PHH FA was lower, and PHH RD was higher than their respective HG-IVH measures (p<.050), the MD and AD values did not differ. In the FOHP, PHH infants had lower FA and higher RD than FT and VPT (p<.010), and a lower FA than the HG-IVH group (p<.001). While the magnitude of AD in both the LVP and FOHP were consistently less in the PHH group on pairwise comparisons to the other groups, the differences were not significant (p>.050). Ventricular size correlated negatively with FA, and positively with MD and RD (p<.001) in both the LVP and FOHP. In the PHH group, FA was lower in the FOHP than in the LVP, which was contrary to the observed findings in the healthy infants (p<.001). Nevertheless, there were no regional differences in AD, MD, and RD in the PHH group. CONCLUSION: HG-IVH and PHH results in aberrant LVP/FOHP microstructure, with prominent abnormalities among the PHH group, most notably in the FOHP. Larger ventricular size was associated with greater magnitude of abnormality. LVP/FOHP dMRI measures may provide valuable biomarkers for future studies directed at improving the management and neurological outcomes of IVH/PHH.


Assuntos
Lesões Encefálicas/diagnóstico por imagem , Hidrocefalia/diagnóstico por imagem , Ventrículos Laterais/diagnóstico por imagem , Lesões Encefálicas/etiologia , Derivações do Líquido Cefalorraquidiano , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Hidrocefalia/complicações , Processamento de Imagem Assistida por Computador , Lactente , Lactente Extremamente Prematuro , Recém-Nascido Prematuro , Doenças do Prematuro/diagnóstico por imagem , Masculino , Estudos Prospectivos , Substância Branca/diagnóstico por imagem
19.
Neurology ; 93(24): e2237-e2246, 2019 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-31719134

RESUMO

OBJECTIVE: To determine the frequency of high-convexity tight sulci (HCTS) in a population-based sample and whether the presence of HCTS and related features influenced participants' cognitive status and classification within the new Alzheimer-biomarker framework. METHODS: We analyzed 684 participants ≥50 years of age who were enrolled in the prospective population-based Mayo Clinic Study of Aging and underwent structural MRI, amyloid PET imaging, and tau PET imaging. A fully automated machine-learning algorithm that had been developed previously in house was used to detect neuroimaging features of HCTS. On the basis of PET and MRI measures, participants were classified as having normal (A-) or abnormal (A+) amyloid, normal (T-) or abnormal (T+) tau, and normal (N-) or abnormal (N+) neurodegeneration. The neuropsychological battery assessed domain-specific and global cognitive scores. Gait speed also was assessed. Analyses were adjusted for age and sex. RESULTS: Of 684 participants, 45 (6.6%) were classified with HCTS according to the automated algorithm. Patients with HCTS were older than patients without HCTS (mean [SD] 78.0 [8.3] vs 71.9 [10.8] years; p < 0.001). More were cognitively impaired after age and sex adjustment (27% vs 9%; p = 0.005). Amyloid PET status was similar with and without HCTS, but tau PET standard uptake value ratio (SUVR) was lower for those with HCTS after age and sex adjustment (p < 0.001). Despite a lower tau SUVR, patients with HCTS had lower Alzheimer disease (AD) signature cortical thickness. With the amyloid-tau-neurodegeneration framework, HCTS was overrepresented in the T-(N)+ group, regardless of amyloid status. CONCLUSION: The HCTS pattern represents a definable subgroup of non-AD pathophysiology (i.e., T-[N]+) that is associated with cognitive impairment. HCTS may confound clinical and biomarker interpretation in AD clinical trials.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Disfunção Cognitiva/etiologia , Hidrocefalia/diagnóstico por imagem , Neuroimagem/métodos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/patologia , Cognição/fisiologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/patologia , Interpretação de Imagem Assistida por Computador/métodos , Aprendizado de Máquina , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons/métodos , Espaço Subaracnóideo/patologia
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