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1.
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
3.
World Neurosurg ; 132: e314-e323, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479789

RESUMO

OBJECTIVE: Very long-term outcomes are rarely reported for patients with shunted pediatric hydrocephalus. This study aimed to determine the functional, social, and neurocognitive outcomes of such patients after transition to adulthood. METHODS: Adult patients with pediatric hydrocephalus who underwent their first shunt operation between 1982 and 1992 were included. Functional, social, educational, working aspects, and verbal intelligence were evaluated. In patients with average or above average verbal intelligence, detailed neuropsychological testing was performed and memory, executive functioning, selective attention, and concentration were assessed. RESULTS: Overall, 137 patients underwent primary surgery because of pediatric hydrocephalus, 53 (38.7%) of whom died during the follow-up period. Of the 84 long-term survivors, 65 (77.4%) agreed to participate and were included for further analysis. Forty-five patients (69.2%) had completed secondary school, but only 34 (52.3%) were integrated in the open labor market. Although the verbal intelligence of 31 patients (47.7%) was within the normal range, 19 (29.2%) had a severe mental handicap. Shunt infections (P = 0.0025), epilepsy (P < 0.0001), and the number of shunt operations (P = 0.0082) were associated with reduced verbal intelligence. Most patients with average or above average verbal intelligence had deficits in detailed neuropsychological testing. In 23 patients, detailed neuropsychological testing was performed. CONCLUSIONS: The overall long-term outcome of patients with shunted pediatric hydrocephalus is poor. These results highlight the importance of lifelong routine controls to avoid later complications. Further, repeated neuropsychological examinations might be important to understand the patient's special needs to optimize professional support.


Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/etiologia , Adulto , Criança , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica , Estudos Retrospectivos , Sobreviventes , Tempo
4.
Med Hypotheses ; 130: 109293, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31383334

RESUMO

Tarlov cysts (TCs) consist of dilated nerve root sheaths filled with cerebrospinal fluid (CSF) and are most frequently found in the sacrum. It is estimated that 25% of detected TCs cause chronic pain and intestinal and urogenital symptoms due to compression of the sacral nerve root fibers inside the TC. Unfortunately, symptomatic TCs are frequently overlooked. It is assumed that TCs result from pathologically increased hydrostatic pressure (HP) in the dural sac that forces CSF into the nerve root sheaths. We hypothesize that in patients with TCs, increased spinal hydrostatic pressure is always associated with increased intracranial pressure. This hypothesis of increased cerebrospinal pressure might explain why patients with sacral TCs frequently report distant symptoms, such as headaches and pain in the neck and arms. In this paper, we describe a case report that provides evidence for this hypothesis. A 30-year-old man presented for the first time in our clinic complaining of lower back, leg, thoracic, neck, and arm pain; headaches; and bladder, bowel, and sphincter symptoms. He was born prematurely and suffered cerebral intraventricular bleeding followed by progressive hydrocephalus. Progression was stabilized with acetazolamide and lumbar punctures. At 19 years of age, his head circumference had further increased and he reported back pain and headaches. Fundoscopy showed no papilledema, and lumbar puncture for CSF evacuation improved the headaches and back pain. The former medical team chose not to insert a ventriculo-external shunt. Brain magnetic resonance imaging (MRI) showed significant dilation of all the ventricles. No CSF flow obstruction between the ventricles was observed. Surprisingly, MRI of the lumbar and sacral spine showed multiple large TCs. This case report indicates that hydrocephalus with a patent aqueduct may be associated with TCs because the increased intracranial pressure is transferred to the spinal canal. While increased intracranial pressure causes dilation of the ventricles, the associated increased spinal pressure may cause dilation of multiple spinal nerve root sheaths to form TCs. Furthermore, while the increased volume of the ventricles gradually compresses the neurons and axons of the brain against the bony skull, simultaneously, the increased pressure inside the nerve sheaths may also gradually compress the neurons and axons located inside the dorsal root ganglia and spinal nerves, resulting in neuropathic pain, sensory abnormalities, and neurogenic bladder and bowel symptoms. Hydrocephalus patients reporting neuropathic pain should be screened for the presence of TCs.


Assuntos
Encéfalo/diagnóstico por imagem , Hidrocefalia/complicações , Cistos de Tarlov/complicações , Adulto , Axônios/metabolismo , Dor Crônica , Progressão da Doença , Humanos , Hidrocefalia/fisiopatologia , Pressão Hidrostática , Hipertensão Intracraniana/fisiopatologia , Pressão Intracraniana , Vértebras Lombares/diagnóstico por imagem , Masculino , Neurônios/metabolismo , Sacro/diagnóstico por imagem , Cistos de Tarlov/fisiopatologia
5.
Pediatr Neurosurg ; 54(4): 233-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31291639

RESUMO

INTRODUCTION: Ventriculoperitoneal (VP) shunt is a commonly performed neurosurgical procedure in pediatric surgical practice. This study is aimed at determining the outcome of congenital hydrocephalus patients who underwent shunt surgery at our center. MATERIALS AND METHODS: A total of 278 operated cases of congenital hydrocephalus with a minimum follow-up of 6 months were analyzed in terms of complications. Hydrocephalus associated with intracranial hemorrhage, neural tube defects, and ventriculitis were excluded from the study. RESULTS: Complications were observed in 32.0% (89/278) of cases. Shunt block and chamber migration were the most common complications (29.21%). Abdominal wound complications were seen in 4.49% of cases. Shunt exposure due to erosion of overlying skin was noted in 6 patients. Shunt infection was diagnosed in only 9 patients (4.4%). New-onset seizures were seen in 4 cases. Overall, 21% of patients required redo shunt and there were 2 mortalities. CONCLUSION: VP shunt continues to have high complication rates. Shunt migration and new-onset seizure disorders are important late complications. In spite of inherent problems, shunt surgery is the procedure of choice until a safer effective alternative is available.


Assuntos
Hidrocefalia/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias , Derivação Ventriculoperitoneal/efeitos adversos , Feminino , Humanos , Hidrocefalia/complicações , Índia , Lactente , Recém-Nascido , Masculino , Procedimentos Neurocirúrgicos , Reoperação , Estudos Retrospectivos , Centros de Atenção Terciária
6.
World Neurosurg ; 131: 19-20, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31362102

RESUMO

In some rare cases, long-standing hydrocephalus can cause "high-pressure" cerebrospinal fluid fistulas. We report the case of a young overweight woman with rhinorrhea secondary to hydrocephalus with a fistula into the frontal sinus. Brain imaging studies revealed aqueduct stenosis. Ventriculocisternostomy treated the hydrocephalus but did not cure the rhinorrhea, and additional multilayer surgical skull base repair was necessary. In these cases, the CSF leakage acts as a safety valve, and closure will worsen the patient's condition if the causative lesion has not been treated first. Moreover, identifying the exact location of the fistula can be challenging and will usually require high-resolution bone computed tomography.


Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Seio Frontal/cirurgia , Hidrocefalia/cirurgia , Fístula do Sistema Respiratório/cirurgia , Adulto , Rinorreia de Líquido Cefalorraquidiano/diagnóstico por imagem , Rinorreia de Líquido Cefalorraquidiano/etiologia , Feminino , Seio Frontal/diagnóstico por imagem , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem , Ventrículos Laterais/diagnóstico por imagem , Imagem por Ressonância Magnética , Procedimentos Cirúrgicos Reconstrutivos , Fístula do Sistema Respiratório/diagnóstico por imagem , Fístula do Sistema Respiratório/etiologia , Base do Crânio/cirurgia , Tomografia Computadorizada por Raios X , Ventriculostomia
7.
Pediatr Neurosurg ; 54(3): 207-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238324

RESUMO

Fungal infections of the central nervous system and pediatric brain abscess are rare but serious conditions in terms of morbidity and mortality that need immediate diagnosis and treatment. It can be seen in congenital or acquired immunosuppressed patients as opportunistic infections as well as in low-birth-weight, premature infants with ventriculoperitoneal shunt, external ventricular drainage, or with a history of craniotomy. Our aim is to emphasize the giant cerebral Candida abscess of a 13-month-old female infant who previously had eight ventriculoperitoneal shunt operations due to hydrocephalus. The patient was taken to pediatric emergency care with complaints of feeding difficulty and discomfort and was hospitalized due to the detection of an intracranial mass by contrast-enhanced brain tomography. After total excision of the mass with its capsule, the patient was pathologically diagnosed with Candida abscess, and the treatment was started. The patient was discharged by the end of the 6th week.


Assuntos
Abscesso Encefálico/cirurgia , Candida , Candidíase/tratamento farmacológico , Fluconazol/uso terapêutico , Hidrocefalia/complicações , Encéfalo , Feminino , Humanos , Hidrocefalia/cirurgia , Lactente , Derivação Ventriculoperitoneal/efeitos adversos
8.
World Neurosurg ; 128: 454-457, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31132484

RESUMO

BACKGROUND: Endoscopic third ventriculostomy (ETV) is an option for hydrocephalus treatment in patients with myelomeningocele, mostly after a previous shunt dysfunction. Late failure of ETV is a rare event, traditionally associated with dramatic symptoms of intracranial hypertension. In patients with myelodysplasia and neurogenic bladder dysfunction, urodynamic deterioration can be a signal of neurologic worsening as a consequence of tethered cord or shunt problems. CASE DESCRIPTION: We describe here a rare case of a 12-year-old female patient with myelomeningocele and evidence of a failure 10 years after a previously successful ETV whose initial symptoms were worsening of urinary complaints. After 2 months, she was admitted to the emergency department with seizures and acute hydrocephalus and was shunted. CONCLUSIONS: Pediatric neurosurgeons must follow myelomeningocele patients with successful ETV for a long time and take care of subtle alterations of organic functions that have a close relationship with central nervous system integrity. A multidisciplinary approach can facilitate this strategy and avoid a tragic outcome.


Assuntos
Hidrocefalia/cirurgia , Neuroendoscopia , Terceiro Ventrículo/cirurgia , Bexiga Urinaria Neurogênica/etiologia , Ventriculostomia , Criança , Feminino , Humanos , Hidrocefalia/complicações , Meningomielocele/complicações , Meningomielocele/cirurgia , Disrafismo Espinal/complicações , Disrafismo Espinal/cirurgia , Falha de Tratamento , Derivação Ventriculoperitoneal
9.
Ginekol Pol ; 90(3): 148-153, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30950004

RESUMO

OBJECTIVES: To estimate the prevalence, associated anomalies, and postnatal outcomes in infants prenatally diagnosed with ventriculomegaly. MATERIAL AND METHODS: All cases of ventriculomegaly that were examined and treated by the 1st Department of Obstet- rics and Gynecology, at the Medical University of Warsaw, from August 2007 until November 2017 were included in this study. Ultrasound data, and information on perinatal outcomes and long-term postnatal follow up were retrospectively collected by a standardised telephone survey. Ventriculomegaly was diagnosed when the atrial width of the lateral ventri- cles was ≥ 10 mm. The cases analyzed were divided into two subgroups: isolated ventriculomegaly (IVM) and non-isolated ventriculomegaly (NIVM). Neurodevelopmental complications were differentiated as either moderate or severe and were compared within each group and between groups. RESULTS: There were 118 cases of prenatally diagnosed ventriculomegaly. Complete follow up records were collected for 54 cases (45.8%). IVM was diagnosed in 29/54 (53.7%) cases, while NIVM was diagnosed in the remaining 25 (46.3%). The mean ventricular width for IVM was 16.93 mm (range 10.0 mm-73.0 mm) and 14.08 mm (range 9.0 mm-27.1 mm) for NIVM (p = 0.28). The mean gestational age at delivery for the IVM cases was 36 + 4 weeks and in the NIVM group 33 + 4 weeks (p = 0.022). Mild VM (10-12 mm) was diagnosed in 22/54 cases (40.7%), moderate VM (13-15 mm) in 12/54 (22.3%) and severe (≥ 15 mm) in 20/54 (37%). Among the infants with IVM the rate of severe medical complications was 29.6% (8/28) and for NIVM 667% (8/12) (p = 0.041). Less severe medical conditions affected 6/28 of the infants with IVM (21.4%) vs 9/12 NIVM cases (75%) (p = 0.012). CONCLUSIONS: In terms of prenatal diagnosis, treatment of ventriculomegaly remains challenging due to a lack of specific prognostic factors and the significant risk of neurodevelopmental disorders. Nevertheless, isolated ventriculomegaly has significantly better long-term outcomes compared with non-isolated ventriculomegaly. In our material, the rate of severe neurodevelopmental disorders in the non-isolated ventriculomegaly cases was associated with a 52% rate of adverse perinatal outcomes. On the other hand, less severe medical conditions occurred in 21.4% of the infants with IVM and in 75% of the NIVM cases. Furthermore, obstetrical data suggest that the risks of premature delivery and caesarean section are significantly higher in cases of non-isolated ventriculomegaly.


Assuntos
Doenças Fetais , Hidrocefalia , Adulto , Cesárea/estatística & dados numéricos , Pré-Escolar , Feminino , Doenças Fetais/diagnóstico , Doenças Fetais/epidemiologia , Feto/diagnóstico por imagem , Idade Gestacional , Humanos , Hidrocefalia/complicações , Hidrocefalia/diagnóstico , Hidrocefalia/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Transtornos do Neurodesenvolvimento/complicações , Transtornos do Neurodesenvolvimento/epidemiologia , Polônia , Gravidez , Estudos Retrospectivos , Ultrassonografia Pré-Natal , Adulto Jovem
10.
Neuroimage Clin ; 22: 101787, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30991622

RESUMO

Preterm infants are at high risk for brain injury during the perinatal period. Intraventricular hemorrhage and periventricular leukomalacia, the two most common patterns of brain injury in prematurely-born children, are associated with poor neurodevelopmental outcomes. The hippocampus is known to be critical for learning and memory; however, it remains unknown how these forms of brain injury affect hippocampal growth and how the resulting alterations in hippocampal development relate to childhood outcomes. To investigate these relationships, hippocampal segmentations were performed on term equivalent MRI scans from 55 full-term infants, 85 very preterm infants (born ≤32 weeks gestation) with no to mild brain injury and 73 very preterm infants with brain injury (e.g., grade III/IV intraventricular hemorrhage, post-hemorrhagic hydrocephalus, cystic periventricular leukomalacia). Infants then underwent standardized neurodevelopmental testing using the Bayley Scales of Infant and Toddler Development, 3rd edition at age 2 years, corrected for prematurity. To delineate the effects of brain injury on early hippocampal development, hippocampal volumes were compared across groups and associations between neonatal volumes and neurodevelopmental outcomes at age 2 years were explored. Very preterm infants with brain injury had smaller hippocampal volumes at term equivalent age compared to term and very preterm infants with no to mild injury, with the smallest hippocampi among those with grade III/IV intraventricular hemorrhage and post-hemorrhagic hydrocephalus. Further, larger ventricle size was associated with smaller hippocampal size. Smaller hippocampal volumes were related to worse motor performance at age 2 years across all groups. In addition, smaller hippocampal volumes in infants with brain injury were correlated with impaired cognitive scores at age 2 years, a relationship specific to this group. Consistent with our preclinical findings, these findings demonstrate that perinatal brain injury is associated with hippocampal size in preterm infants, with smaller volumes related to domain-specific neurodevelopmental impairments in this high-risk clinical population.


Assuntos
Hemorragia Cerebral Intraventricular/complicações , Ventrículos Cerebrais/patologia , Hipocampo/crescimento & desenvolvimento , Hipocampo/patologia , Hidrocefalia/complicações , Lactente Extremamente Prematuro , Leucomalácia Periventricular/complicações , Imagem por Ressonância Magnética , Ventrículos Cerebrais/diagnóstico por imagem , Pré-Escolar , Feminino , Hipocampo/diagnóstico por imagem , Humanos , Recém-Nascido , Estudos Longitudinais , Masculino
12.
Br J Neurosurg ; 33(4): 402-408, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30829548

RESUMO

Background: Papilloedema and visual failure can occur as a consequence of vestibular schwannoma without evidence of hydrocephalus on imaging. Conventional treatment usually includes CSF diversion procedures. We describe here the novel use of optic nerve sheath fenestration in these patients. Methods: A case series of three patients who underwent optic nerve sheath fenestration for visual complications of vestibular schwannoma. Results: Patients A and B were both 23 year old females, with visual symptoms and papilloedema at the time of presentation with a large vestibular schwannoma. Patient A had progressive, severe visual failure despite treatment with an external ventricular drain and tumour resection. She therefore went on to have bilateral optic nerve sheath fenestration surgery, which restored central vision, improved peripheral vision and resolved papilloedema. Patient B underwent optic nerve sheath fenestration as first line surgical management for visual symptoms from a large vestibular schwannoma. This resulted in resolution of visual symptoms and papilloedema and she went on to have the lesion resected at a later date. Patient C was a 54 year old male who developed visual symptoms and papilloedema following the resection of a vestibular schwannoma. This was found to be secondary to a transverse venous sinus thrombosis and he underwent an optic nerve sheath fenestration to treat the complications of this. He also had restored vision and resolution of papilloedema. Conclusion: We demonstrate, with 3 differing cases, that optic nerve sheath fenestration can be a useful and safe treatment choice for patients with visual failure and papilloedema secondary to vestibular schwannoma.


Assuntos
Cegueira/cirurgia , Neuroma Acústico/cirurgia , Nervo Óptico/cirurgia , Cegueira/etiologia , Cegueira/fisiopatologia , Feminino , Humanos , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Neuroma Acústico/complicações , Neuroma Acústico/fisiopatologia , Papiledema/etiologia , Papiledema/cirurgia , Campos Visuais/fisiologia , Adulto Jovem
14.
World Neurosurg ; 127: 530-533, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30851465

RESUMO

BACKGROUND: Triventricular hydrocephalus is caused by an obstruction of cerebrospinal fluid flow causing increased intracranial pressure (ICP). Common treatment options include ventricular shunting or endoscopic third ventriculocisternostomy. Spontaneous third ventriculocisternostomy is a rare phenomenon in patients with obstructive triventricular hydrocephalus. We present the case of a patient with triventricular hydrocephalus and evidence of spontaneous third ventriculocisternostomy. CASE DESCRIPTION: A 33-year-old female patient was referred to our outpatient clinic for triventricular hydrocephalus diagnosed on imaging. Magnetic resonance imaging (MRI) of her brain showed a triventricular obstructive hydrocephalus owing to a possible aqueductal stenosis. No clinical or diagnostic signs of elevated ICP were present. Repeat imaging showed no changes in cerebral ventricular size and MRI flow imaging demonstrated flow voids in the third ventricle extending through the floor of the third ventricle to the prepontine cistern. We concluded that the cause of hydrocephalus was likely to be a compensated aqueductal stenosis. CONCLUSIONS: Spontaneous third ventriculocisternostomy is seen in patients with chronic hydrocephalus. MRI sensitive to flow artefacts can be useful in the diagnosis of patients with apparent compensated hydrocephalus, and phase-contrast imaging can prove cerebrospinal fluid flow across the stoma. Resolution of symptoms owing to elevated ICP is regularly observed in patients with a spontaneous ventriculocisternostomy.


Assuntos
Hidrocefalia/complicações , Hipertensão Intracraniana/etiologia , Terceiro Ventrículo , Adulto , Feminino , Humanos , Hipertensão Intracraniana/diagnóstico , Imagem por Ressonância Magnética , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/etiologia
16.
World Neurosurg ; 125: 371-373, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30822582

RESUMO

We present an unusual association between Noonan syndrome and tetraventricular hydrocephalus, caused by fourth ventricle outlet obstruction, in a 5-year-old boy. Magnetic resonance imaging showed a diverticular enlargement of the left foramen of Luschka, with compression of the facial nerve that resolved following treatment of hydrocephalus by endoscopic third ventriculostomy.


Assuntos
Encefalopatias/complicações , Divertículo/complicações , Quarto Ventrículo/patologia , Síndrome de Noonan/complicações , Pré-Escolar , Humanos , Hidrocefalia/complicações , Hipertrofia/complicações , Masculino , Neuroendoscopia/métodos , Terceiro Ventrículo/cirurgia
17.
J Vet Intern Med ; 33(2): 403-412, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30747447

RESUMO

BACKGROUND: Several case series and case reports have been published about idiopathic hydrocephalus treatment in dogs and cats using ventriculoperitoneal shunts (VPS). OBJECTIVES: To determine the risk and type of complications in dogs and cats after VPS placement. ANIMALS: Sixteen papers were included. Sixty dogs and 13 cats with idiopathic hydrocephalus treated by VPS placement were identified. METHODS: The databases CAB, Scopus, and Medline were used. Idiopathic/congenital hydrocephalus, feline/canine patients, ventriculoperitoneal shunting, complications, and outcomes were inclusion criteria. The focus was on complication type and time frame within which they arose. RESULTS: Complications in dogs (n = 60) were shunt obstruction (6/60; 10%), pain (4/60; 5.5%), shunt infection (3/60; 4.1%), disconnection (3/60; 4.1%), excessive shunting (2/60; 2.7%), and kinking (1/60; 1.6%). Complications in cats (n = 13) were coiling of the shunt in the SC tissue (2/13; 15.4%); kinking (1/13; 7.7%); and shunt obstruction (1/13; 7.7%). Complications were most likely during the first 6 months after shunt placement. CONCLUSION AND CLINICAL IMPORTANCE: Ventriculoperitoneal shunting is considered a viable treatment option for patients with hydrocephalus. Potential complications should be discussed with the owner. Early diagnosis of complications is essential.


Assuntos
Doenças do Gato/cirurgia , Doenças do Cão/cirurgia , Hidrocefalia/veterinária , Derivação Ventriculoperitoneal/veterinária , Animais , Gatos , Cães , Hidrocefalia/complicações , Hidrocefalia/cirurgia , Complicações Pós-Operatórias/veterinária , Resultado do Tratamento
18.
Stroke ; 50(3): 595-601, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30776998

RESUMO

Background and Purpose- Predicting long-term functional outcomes after intracranial aneurysmal rupture can be challenging. We developed and validated a scoring system-the Southwestern Aneurysm Severity Index-that would predict functional outcomes at 1 year after clipping of ruptured aneurysms. Methods- Ruptured aneurysms treated microsurgically between 2000 and 2014 were included. Outcome was defined as Glasgow Outcome Score (ranging from 1, death, to 5, good recovery) at 1 year. The Southwestern Aneurysm Severity Index is composed of multiple prospectively recorded patient demographic, clinical, radiographic, and aneurysm-specific variables. Multivariable analyses were used to construct the best predictive models for patient outcomes in a random 50% of the cohort and validated in the remaining 50%. A scoring system was created using the best model. Results- We identified 527 eligible patients. The Glasgow Outcome Score at 1 year was 4 to 5 in 375 patients (71.2%). In the multivariable logistic regression, the best predictive model for unfavorable outcome included intracerebral hemorrhage (odds ratio [OR], 2.53; 95% CI, 1.55-4.13), aneurysmal size ≥20 mm (OR, 6.07; 95% CI, 1.92-19.2), intraventricular hemorrhage (OR, 2.56; 95% CI, 1.15-5.67), age >64 (OR, 3.53; 95% CI, 1.70-7.35), location (OR, 1.82; 95% CI, 1.10-3.03), and hydrocephalus (OR, 2.39; 95% CI, 1.07-5.35). The Southwestern Aneurysm Severity Index predicts Glasgow Outcome Score at 1 year with good discrimination (area under the receiver operating characteristic curve, derivation: 0.816, 95% CI, 0.759-0.873; validation: 0.803, 95% CI, 0.746-0.861) and accurate calibration ( R2=0.939). Conclusions- The Southwestern Aneurysm Severity Index has been internally validated to predict 1 year Glasgow Outcome Scores at initial presentation, thus optimizing patient or family counseling and possibly guiding therapeutic efforts.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma Intracraniano/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/mortalidade , Ventrículos Cerebrais , Estudos de Coortes , Feminino , Escala de Resultado de Glasgow , Humanos , Hidrocefalia/complicações , Hidrocefalia/mortalidade , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Resultado do Tratamento , Adulto Jovem
19.
J Int Med Res ; 47(3): 1353-1358, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30732509

RESUMO

Hydrocephalus is one of the lesser known causes of central olfactory loss. The pathogenesis of hydrocephalus involves the olfactory bulbs or tracts, and more rarely, other frontotemporal cortical regions. We describe a case of olfactory dysfunction in a macrocephalic 63-year-old female patient with arrested hydrocephalus. Her olfactory function was assessed by using the Sniffin' Sticks test, olfactory event-related potentials (OERPs), and 3-Tesla magnetic resonance imaging (MRI). An OERP examination suggested partial impairment of the central olfactory pathways and central parietal regions where OERP amplitude is maximal. Indeed, we found an evident olfactory potential trace with an increased latency only on Pz derivation. However, structural MRI showed important cortical brain thinning and large expansion of the third ventricle, with evident damage of the olfactory frontotemporal areas. The Sniffin' Sticks test and MRI supported the diagnosis of anosmia, while OERP findings indicated partial preservation of olfactory function, likely due to an adaptation of the central olfactory system. These findings highlight the importance of a multi-integrated approach to detect olfactory impairment.


Assuntos
Potenciais Evocados , Hidrocefalia/complicações , Transtornos do Olfato/diagnóstico , Bulbo Olfatório/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Transtornos do Olfato/etiologia
20.
World Neurosurg ; 125: 19-22, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30716495

RESUMO

BACKGROUND: Hyponatremia in the neonatal population is an uncommon occurrence and can be associated with significant increase in morbidity and mortality. In the neonatal population, it is typically associated with an excess of antidiuretic hormone and rarely has been found to be associated with hydrocephalus, short of being caused by the subsequent treatment of hydrocephalus. CASE DESCRIPTION: We present a case report of a patient with neonatal hydrocephalus, secondary to intraventricular hemorrhage in the setting of prematurity, treated at our institution, in whom sodium levels reached a nadir as head circumference peaked and subsequent treatment of hydrocephalus resolved the associated hyponatremia. CONCLUSIONS: Hydrocephalus secondary to intraventricular hemorrhage is a notable complication in the premature neonatal population. Physicians should be aware of its potential association with hyponatremia and consider early neurosurgical intervention when other etiologies of the electrolyte disturbance cannot be identified.


Assuntos
Progressão da Doença , Hidrocefalia/complicações , Hidrocefalia/diagnóstico por imagem , Hiponatremia/complicações , Hiponatremia/diagnóstico por imagem , Adulto , Feminino , Humanos , Hidrocefalia/cirurgia , Hiponatremia/cirurgia , Lactente , Recém-Nascido
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