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1.
Fluids Barriers CNS ; 17(1): 33, 2020 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349763

RESUMO

BACKGROUND: Symptomatic or active hydrocephalus in children is linked to an elevation in intracranial pressure (ICP), which is likely to be multifactorial in origin. The CSF outflow resistance, venous sinus resistance and total cerebral blood flow are likely factors in the ICP elevation. The purpose of this paper is to define the incidence, site and significance of venous sinus stenosis and/or cerebral hyperemia in a cohort of children diagnosed with hydrocephalus at a tertiary referral hospital. METHODS: The imaging database was reviewed over a 10 year period and the index MRI of all children between the ages of 4 months and 15 years, who were diagnosed with treatment naive hydrocephalus of any type (excluding secondary to tumor) and had magnetic resonance venography (MRV) and flow quantification were selected. Patients were compared with children undergoing an MRI with MRV and flow quantification who were subsequently shown to have no abnormality. The cross-sectional area and circumference of the sinuses were measured at 4 levels. The hydraulic and effective diameters were calculated. An area stenosis of 65% or greater was deemed significant. A total cerebral blood flow greater than two standard deviations above the mean for controls was taken to be abnormal. RESULTS: There were a total of 55 children with hydrocephalus compared to 118 age matched control MRV's and 35 control flow quantification studies. A high grade stenosis occurred in 56% of patients but in none of the controls (p < 0.0001). The commonest site of narrowing was in the distal sigmoid sinus. Cerebral hyperemia occurred in 13% of patients but did not occur in the controls. CONCLUSIONS: The elevation in ICP in symptomatic hydrocephalus is multifactorial. Both high grade venous stenosis and cerebral hyperemia are common in childhood hydrocephalus. High grade stenosis was noted to be a risk factor for conservative management failure. Hyperemia was a good prognostic indicator.


Assuntos
Transtornos Cerebrovasculares/epidemiologia , Cavidades Cranianas/patologia , Hidrocefalia/diagnóstico , Hidrocefalia/epidemiologia , Hiperemia/epidemiologia , Hipertensão Intracraniana/epidemiologia , Adolescente , Criança , Pré-Escolar , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Cavidades Cranianas/diagnóstico por imagem , Feminino , Humanos , Incidência , Lactente , Angiografia por Ressonância Magnética , Masculino , Flebografia , Prognóstico , Estudos Retrospectivos
3.
World Neurosurg ; 138: 390-397, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32200017

RESUMO

BACKGROUND: Dilatation of Virchow-Robin spaces (dVRS) have been described in the development of hydrocephalic syndromes. We report an unusual case of a type III dVRS presenting as a mimic of normal pressure hydrocephalus (NPH), due to distortion at the level of the cerebral aqueduct. CASE DESCRIPTION: A 59-year-old woman presented with mild traumatic brain injury and possible NPH, due to a history of progressive gait disturbance, recurrent falls, and cognitive decline over a year, in the context of ventriculomegaly. Detailed structural imaging of the brain revealed multiple dilated cystic lesions consistent with dVRS causing distortion at the level of the cerebral aqueduct. Cerebrospinal fluid examination was negative for infection. The patient was treated with endoscopic third ventriculostomy; at 12 months postoperatively, she demonstrated a sustained improvement in gait and stabilization of cognitive decline. CONCLUSIONS: This is an illustrative case of a subacute obstructive hydrocephalus due to a collection of periaqueductal dVRS, leading to an insidious clinical presentation mimicking NPH. We reviewed the literature for key clinical presentations and describe neuroanatomical considerations as well as primary treatment strategies. Various hydrocephalic syndromes may present with classic symptoms from Hakim's triad; such symptoms are not specific to idiopathic NPH. Both endoscopic third ventriculostomy and shunting may be efficacious. In our case, dVRS may serve as both a cause of and compensatory mechanism in a subacute obstructive hydrocephalus of unknown etiology. Our case highlights the need to understand the neuroanatomy of aberrant cerebrospinal fluid spaces in hydrocephalic syndromes. Further studies of dVRS would provide valuable insights into the pathogenesis of hydrocephalus.


Assuntos
Aqueduto do Mesencéfalo/patologia , Sistema Glinfático/patologia , Hidrocefalia/patologia , Mesencéfalo/patologia , Ponte/patologia , Diagnóstico Diferencial , Dilatação Patológica/patologia , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia de Pressão Normal/diagnóstico , Pessoa de Meia-Idade , Ventriculostomia
4.
J Stroke Cerebrovasc Dis ; 29(5): 104765, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32173227

RESUMO

OBJECTIVE: The pathophysiology of delayed cerebral ischemia (DCI) following aneurysmal subarachnoid hemorrhage (aSAH) has not been fully evaluated. The aim of this study was to evaluate the dynamics of lactate and lactate dehydrogenase (LDH) in carotid cisternal cerebrospinal fluid (CSF), and to discuss their effectiveness as markers of early brain injury (EBI) and DCI following aSAH. PATIENTS AND METHODS: Among 91 consecutive aSAH patients treated between January 2012 and March 2019 at National Hospital Organization Beppu Medical Center, 19 patients (20.9%) were eligible for this retrospective study. Concentrations of lactate and LDH in carotid cisternal CSF within 14 days after onset of aSAH were evaluated. RESULTS: Six of the 19 patients (31.6%) had a history of DCI. Both lactate and LDH levels in carotid cisternal CSF were significantly higher in the DCI group than in the non-DCI group on postbleeding day (PBD) 1-2, 3-4, and 5-6. Interestingly, neither lactate nor LDH levels in blood differed significantly between DCI and non-DCI groups on PBD 1-2. CONCLUSIONS: Lactate and LDH concentrations in carotid cisternal CSF may vividly reflect the EBI and may thus represent predictive biomarkers of DCI following aSAH.


Assuntos
Isquemia Encefálica/líquido cefalorraquidiano , Hidrocefalia/líquido cefalorraquidiano , L-Lactato Desidrogenase/líquido cefalorraquidiano , Ácido Láctico/líquido cefalorraquidiano , Hemorragia Subaracnóidea/líquido cefalorraquidiano , Idoso , Biomarcadores/líquido cefalorraquidiano , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiologia , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/cirurgia , Fatores de Tempo
5.
Taiwan J Obstet Gynecol ; 59(1): 127-129, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32039780

RESUMO

OBJECTIVE: We present prenatal diagnosis of mosaic trisomy 8 by amniocentesis in a fetus with central nervous system abnormalities. CASE REPORT: A 39-year-old woman was found to have fetal bilateral ventriculomegaly and enlargement of the third ventricle on prenatal ultrasound at 32 weeks of gestation. Fetal magnetic resonance imaging examination confirmed bilateral ventriculomegaly and dysgenesis of the corpus callosum. Amniocentesis was performed subsequently. Array comparative genomic hybridization (aCGH) analysis on the DNA extracted from uncultured amniotic cells revealed trisomy 8 mosaicism with a result of arr [GRCh37] (8) × 3[0.19], (X,Y) × 1. Conventional cytogenetic analysis on cultured amniocytes showed that among 108 cells in 12 colonies of three cultures, only one cell was abnormal with trisomy 8, trisomy 9 and monosomy 13, while the rest 107 cells had a normal karyotype. Repeat amniocentesis and cord blood sampling revealed a result of arr 8p23.3q24.3 (191,530-146,280,020) × 2.3 with a log2 ratio of 0.2 compatible with 20-30% mosaicism for trisomy 8 on the uncultured amniocytes, and a result of arr 8p23.3q24.3 (191,530-146,280,020) × 2.1 with a log2 ratio of 0.08 compatible with <10% mosaicism for trisomy 8 on the cord blood lymphocytes. Polymorphic DNA marker analysis excluded uniparental disomy 8. A malformed 2440-g dead fetus was delivered at 34 weeks of gestation with facial dysmorphism. CONCLUSION: Cytogenetic discrepancy can occur between cultured and uncultured amniocytes in mosaic trisomy 8 at amniocentesis. aCGH analysis on uncultured amniocytes is useful for confirmation of mosaic trisomy 8 at amniocentesis. Fetuses with low-level mosaicism for trisomy 8 may prenatally present ventriculomegaly and dysgenesis of the corpus callosum.


Assuntos
Agenesia do Corpo Caloso/diagnóstico , Amniocentese/métodos , Hidrocefalia/diagnóstico , Trissomia/diagnóstico , Dissomia Uniparental/diagnóstico , Adulto , Agenesia do Corpo Caloso/embriologia , Agenesia do Corpo Caloso/genética , Cromossomos Humanos Par 8/genética , Corpo Caloso/embriologia , Feminino , Humanos , Hidrocefalia/embriologia , Hidrocefalia/genética , Mosaicismo/embriologia , Gravidez , Trissomia/genética , Dissomia Uniparental/genética
6.
Eur J Paediatr Neurol ; 25: 106-112, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32014392

RESUMO

OBJECTIVES: To systematically investigate chromosomal abnormalities and copy number variants (CNVs) in fetuses with different types of ventriculomegaly (VM) by karyotyping and/or chromosomal microarray analysis (CMA). METHODS: This retrospective study included 312 fetuses diagnosed with VM. Amniotic fluid and umbilical blood samples were collected by amniocentesis and cordocentesis, respectively, and subjected to karyotyping and/or CMA. Subgroup analysis by VM type, including mild VM (MVM) and severe VM (SVM), unilateral and bilateral VM, isolated VM (IVM), and non-isolated VM (NIVM), was performed. RESULTS: The detection rate of chromosomal abnormalities was 12.1% (34/281) by karyotyping and 20.6% when CMA was additionally performed (P < 0.05). Abnormalities were identified by CMA in 17.4% (38/218) of fetuses and pathogenic CNVs in 5.0% (11/218). Notably, CMA detected CNVs in 10.6% (23/218) of fetuses with normal karyotypes. The incidence of chromosomal abnormalities by karyotyping was higher in bilateral than in unilateral VM (20.5% versus 6.5%), whereas the incidence detected by CMA was higher in NIVM than in IVM (21.4% versus 10.3%; both P < 0.05). In NIVM, CMA provided an additional detection rate of 11.4% (16/140) and a detection rate of 10.0% for pathogenic CNVs and aneuploidies. Central nervous system (CNS) abnormalities were the most common other ultrasonic abnormalities. CONCLUSIONS: CMA is highly recommended for prenatal diagnosis of fetal VM together with karyotyping, especially in fetuses with bilateral VM and NIVM with abnormal CNS findings. Further study is necessary to explore the relationships between genotypes and phenotypes to facilitate prenatal diagnosis of fetal VM.


Assuntos
Ventrículos Cerebrais/anormalidades , Malformações do Sistema Nervoso/diagnóstico , Malformações do Sistema Nervoso/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Diagnóstico Pré-Natal/métodos , Aberrações Cromossômicas , Variações do Número de Cópias de DNA , Feminino , Feto/anormalidades , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Cariotipagem/métodos , Malformações do Sistema Nervoso/complicações , Gravidez , Estudos Retrospectivos
7.
Dev Med Child Neurol ; 62(7): 799-805, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32060907

RESUMO

AIM: To evaluate the impact of risk factors for intracranial hypertension (ICH) on cerebral cortex thickness in syndromic craniosynostosis. METHOD: ICH risk factors including papilloedema, hydrocephalus, obstructive sleep apnea (OSA), cerebellar tonsillar position, occipitofrontal circumference (OFC) curve deflection, age, and sex were collected from the records of patients with syndromic craniosynostosis (Apert, Crouzon, Pfeiffer, Muenke, Saethre-Chotzen syndromes) and imaging. Magnetic resonance images were analysed and exported for statistical analysis. A linear mixed model was developed to determine correlations with cerebral cortex thickness changes. RESULTS: In total, 171 scans from 107 patients (83 males, 88 females [including repeated scans], mean age 8y 10mo, range 1y 1mo-34y, SD 5y 9mo) were evaluated. Mean cortical thickness in this cohort was 2.78mm (SD 0.17). Previous findings of papilloedema (p=0.036) and of hydrocephalus (p=0.007) were independently associated with cortical thinning. Cortical thickness did not vary significantly by sex (p=0.534), syndrome (p=0.896), OSA (p=0.464), OFC (p=0.375), or tonsillar position (p=0.682). INTERPRETATION: Detection of papilloedema or hydrocephalus in syndromic craniosynostosis is associated with significant changes in cortical thickness, supporting the need for preventative rather than reactive treatment strategies. WHAT THIS PAPER ADDS: Papilloedema is associated with thinning of the cerebral cortex in syndromic craniosynostosis, independently of hydrocephalus.


Assuntos
Córtex Cerebral/patologia , Craniossinostoses/diagnóstico , Hidrocefalia/diagnóstico , Hipertensão Intracraniana/diagnóstico , Papiledema/diagnóstico , Adolescente , Adulto , Córtex Cerebral/diagnóstico por imagem , Criança , Pré-Escolar , Craniossinostoses/diagnóstico por imagem , Craniossinostoses/patologia , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/patologia , Lactente , Hipertensão Intracraniana/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Papiledema/diagnóstico por imagem , Papiledema/patologia , Fatores de Risco , Síndrome , Adulto Jovem
9.
Neurosurg Rev ; 43(2): 681-685, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31079320

RESUMO

We previously introduced a novel noninvasive technique of intracranial pressure (ICP) monitoring in children with open fontanelles. Within this study, we describe the first clinical implementation and results of this new technique in management of children with hydrocephalus caused by intraventricular hemorrhage (IVH). In neonates with posthemorrhagic hydrocephalus (PHH), an Ommaya reservoir was implanted for initial treatment of hydrocephalus. The ICP obtained noninvasively with our new device was measured before and after CSF removal and correlated to cranial ultra-sonographies. Six children with a mean age of 27.3 weeks and mean weight of 1082.3 g suffering from PHH were included in this study. We performed an overall of 30 aspirations due to ventricular enlargement. Before CSF removal, the mean ICP was 15.3 mmHg and after removal of CSF the mean ICP measured noninvasively decreased to 3.4 mmHg, p = 0.0001. The anterior horn width (AHW), which reflects early expansion of the ventricles, was before and after CSF removal 15.1 mm and 5.5 mm, respectively, p < 0.0006. There was a strong correlation between noninvasively measured ICP values and sonographically obtained AHW, r = 0.81. Ultimately, all children underwent ventriculoperitoneal shunt procedures. This is the first study providing proof for a noninvasively ICP-based approach for management of posthemorrhagic hydrocephalus in newborn children.


Assuntos
Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/cirurgia , Vazamento de Líquido Cefalorraquidiano , Hidrocefalia/diagnóstico , Hidrocefalia/cirurgia , Doenças do Prematuro/diagnóstico , Hemorragia Cerebral/complicações , Ventrículos Cerebrais , Estudos de Coortes , Feminino , Humanos , Hidrocefalia/etiologia , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/cirurgia , Pressão Intracraniana , Masculino
10.
Turk Neurosurg ; 30(4): 550-556, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31736037

RESUMO

AIM: To determine the effect of using three concurrent measures (2% chlorhexidine gluconate +70% alcohol for skin cleaning, changing the dressing every 48 hours, and observing the operating room) for patients who had venriculoperitoneal shunt (VPS) implantations on the infection rate. MATERIAL AND METHODS: This was a prospective interventional study. Using infection prevention compliance control lists, patients who had a VPS implanted between November 2012 and November 2013 were compared to those who had a VPS implanted between October 2011 and October 2012. The data included information about the patients, follow-up, and infection prevention. These data were obtained for the pre-, peri-, and postoperative periods. RESULTS: Triple bundle prevention in the applied protocol significantly reduced the VPS infection rate in the study group compared to the control group (p < 0.005). CONCLUSION: These findings revealed the importance of creating a prevention protocol and following it regularly in a way for all surgery, operating room, and service teams fully comply to prevent VPS infections.


Assuntos
Contaminação de Equipamentos/prevenção & controle , Hidrocefalia/cirurgia , Controle de Infecções/métodos , Derivação Ventriculoperitoneal/métodos , Adolescente , Criança , Pré-Escolar , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Feminino , Humanos , Hidrocefalia/diagnóstico , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Fatores de Risco , Derivação Ventriculoperitoneal/efeitos adversos
11.
Neurosurg Rev ; 43(1): 249-258, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30406318

RESUMO

Neuroendoscopy enables diagnostic biopsy of intraventricular and/or paraventricular tumors and the simultaneous treatment of associated hydrocephalus in selected cases. The objective of this paper was to analyze the effectiveness and safety of this procedure. This retrospective study included 80 patients between 2 months and 78 years old diagnosed with intraventricular and/or paraventricular expansive lesion who underwent neuroendoscopic biopsy from 2004 to 2016. Collected variables were gender, age at diagnosis, clinical presentation, tumor location, surgical technique, management of hydrocephalus, pathological findings, procedure-related complications, and follow-up time. Neuroendoscopic biopsy was performed in 80 patients. Mean age at diagnosis was 27 years, and 52.5% were men. According to the Depreitere Classification, 71 were level I (conclusive diagnosis), 1 level III (problematic categorization), and 8 level IV (non-interpretable diagnosis). The most frequent diagnosis was grade I astrocytoma (14%). Diagnostic success per patient was 88.7%. Sixty-nine patients had hydrocephalus at diagnosis, 37 of whom were treated with endoscopic third ventriculostomy (ETV), with septostomy (SPT) in 14, and only SPT in 4. Twenty-eight patients underwent ventricular peritoneal shunt (VPS), with SPT in 20. The ETV success rate was 70.9%. The complication rate per patient was 11%: five patients presented intraventricular hemorrhage, three of whom died; one patient presented cerebrospinal fluid fistula; three presented transient oculomotor impairment. Postoperative follow-up was from 1 month to 12.4 years (mean 45 months). Neuroendoscopy is an effective procedure for the pathological diagnosis of intraventricular and paraventricular tumors, allowing the treatment of associated hydrocephalus. Nevertheless, it is not exempt from serious complications and requires proper training.


Assuntos
Biópsia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Hidrocefalia/etiologia , Neuroendoscopia , Adolescente , Adulto , Idoso , Astrocitoma/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Hidrocefalia/diagnóstico , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Ventriculostomia , Adulto Jovem
12.
Sci Rep ; 9(1): 18442, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31804566

RESUMO

Twenty-seven previously healthy (of 36 consecutive eligible patients), HIV-negative cryptococcal meningoencephalitis (CM) patients underwent comprehensive neuropsychological evaluation during the late post-treatment period (1.3-4 years post diagnosis), assessing attention, language, learning, memory, visuospatial, executive function, information processing, psychomotor functioning, as well as mood symptoms. Seven of eight domains (all except attention) showed increased percentages of CM patients scoring in the less than 16th percentile range compared to standardized normative test averages, adjusted for education level and age. Comparison with a matched archival dataset of mild cognitive impairment/Alzheimer's disease patients showed that CM patients exhibited relative deficits in psychomotor and executive function with fewer deficits in memory and learning, consistent with a frontal-subcortical syndrome. MRI evaluation at the time of testing demonstrated an association of lower neuropsychological functioning with ventriculomegaly. These studies suggest that CM should be included in the list of treatable causes of dementia in neurological work ups. Future studies are needed to identify diagnostic and treatment regimens that may enhance neurological function after therapy.


Assuntos
Transtornos Cognitivos/diagnóstico , Cryptococcus neoformans/isolamento & purificação , Lobo Frontal/fisiopatologia , Meningite Criptocócica/complicações , Meningoencefalite/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/complicações , Doença de Alzheimer/fisiopatologia , Antifúngicos/uso terapêutico , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/fisiopatologia , Conjuntos de Dados como Assunto , Função Executiva/fisiologia , Feminino , Lobo Frontal/diagnóstico por imagem , Gliose/diagnóstico , Gliose/microbiologia , Gliose/fisiopatologia , HIV-1/isolamento & purificação , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/microbiologia , Hidrocefalia/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Meningite Criptocócica/tratamento farmacológico , Meningite Criptocócica/microbiologia , Meningite Criptocócica/fisiopatologia , Meningoencefalite/tratamento farmacológico , Meningoencefalite/microbiologia , Meningoencefalite/fisiopatologia , Pessoa de Meia-Idade , Testes Neuropsicológicos/estatística & dados numéricos , Síndrome , Adulto Jovem
13.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 30(6): 300-304, nov.-dic. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186960

RESUMO

Presentamos el caso de una paciente de 72 años de edad sin antecedentes de interés que consultó en urgencias por un cuadro de 2 semanas de evolución de alteración de la marcha, cefalea y vómitos. El TAC craneal reveló la presencia de hidrocefalia obstructiva secundaria a una lesión pineal con impronta en el tercer ventrículo. La resonancia magnética mostró, además de la lesión ya referida, otra más pequeña situada en el foramen de Lushcka derecho. Se llevó a cabo una ventriculostomía endoscópica del suelo del tercer ventrículo y la biopsia endoscópica de la lesión, cuyo resultado fue de metástasis compatible con carcinoma de pulmón. Se realizó un TAC toracoabdominopélvico que mostró una masa pulmonar compatible con el carcinoma primario. Se decidió tratamiento sistémico de la enfermedad. La paciente falleció 2 meses tras el diagnóstico


A 72-year-old female with no relevant medical history consulted in the emergency room for a two-week history of headache, vomiting and gait disturbance. Head CT scan revealed obstructive hydrocephalus secondary to a pineal mass with compression of the third ventricle. Magnetic Resonance showed another mass located in the right Lushcka foramen. Endoscopic third-ventriculostomy and biopsy of pineal mass were performed. Pathological analysis was consistent with metastasis of carcinoma. Full-body CT scan showed a lung mass related to primary carcinoma. The patient received systemic treatment for metastatic lung cancer. She died two months after diagnosis


Assuntos
Humanos , Feminino , Idoso , Ventriculostomia/métodos , Hidrocefalia/diagnóstico , Glândula Pineal/patologia , Hidrocefalia/cirurgia , Hidrocefalia/fisiopatologia , Espectroscopia de Ressonância Magnética , Biópsia
14.
Curr Neurol Neurosci Rep ; 19(12): 94, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31773310

RESUMO

PURPOSE OF REVIEW: The optimal management of external ventricular drains (EVD) in the setting of acute brain injury remains controversial. Therefore, we sought to determine whether there are optimal management approaches based on the current evidence. RECENT FINDINGS: We identified 2 recent retrospective studies on the management of EVDs after subarachnoid hemorrhage (SAH) which showed conflicting results. A multicenter survey revealed discordance between existing evidence from randomized trials and actual practice. A prospective study in a post-traumatic brain injury (TBI) population demonstrated the benefit of EVDs but did not determine the optimal management of the EVD itself. The recent CLEAR trials have suggested that specific positioning of the EVD in the setting of intracerebral hemorrhage with intraventricular hemorrhage may be a promising approach to improve blood clearance. Evidence on the optimal management of EVDs remains limited. Additional multicenter prospective studies are critically needed to guide approaches to the management of the EVD.


Assuntos
Lesões Encefálicas/terapia , Gerenciamento Clínico , Drenagem/métodos , Medicina Baseada em Evidências/métodos , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico , Derivações do Líquido Cefalorraquidiano/métodos , Derivações do Líquido Cefalorraquidiano/normas , Drenagem/normas , Medicina Baseada em Evidências/normas , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/terapia , Estudos Prospectivos , Estudos Retrospectivos , Hemorragia Subaracnóidea/diagnóstico , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/terapia
15.
Sci Rep ; 9(1): 16479, 2019 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-31712649

RESUMO

A two-year old rat, R222, survived a life-time of extreme hydrocephaly affecting the size and organization of its brain. Much of the cortex was severely thinned and replaced by cerebrospinal fluid, yet R222 had normal motor function, could hear, see, smell, and respond to tactile stimulation. The hippocampus was malformed and compressed into the lower hindbrain together with the hypothalamus midbrain and pons, yet R222 showed normal spatial memory as compared to age-matched controls. BOLD MRI was used to study the reorganization of R222's brain function showing global activation to visual, olfactory and tactile stimulation, particularly in the brainstem/cerebellum. The results are discussed in the context of neuroadaptation in the face of severe hydrocephaly and subsequent tissue loss, with an emphasis on what is the "bare minimum" for survival.


Assuntos
Comportamento Animal , Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Neuroimagem Funcional , Plasticidade Neuronal , Animais , Encéfalo/fisiopatologia , Mapeamento Encefálico , Conectoma , Modelos Animais de Doenças , Feminino , Neuroimagem Funcional/métodos , Hidrocefalia/diagnóstico , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Camundongos Knockout , Ratos
16.
Neurosurg Focus ; 47(4): E2, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31574474

RESUMO

OBJECTIVE: The goal of this study was to analyze the factors that have an impact on morbidity and mortality in patients with myelomeningocele (MMC). METHODS: A retrospective cohort study was conducted to analyze factors associated with MMC that influence the morbidity and mortality of the disease. Data were collected from medical records of children who underwent the primary repair of MMC at the Fernandes Figueira Institute-Oswaldo Cruz Foundation (IFF-Fiocruz) between January 1995 and January 2015, with a minimum follow-up of 1 year. The following variables were analyzed: demographic characteristics (gestational age, sex, and birth weight); clinical features (head circumference at birth, anatomical and functional levels of MMC, hydrocephalus, symptomatic Chiari malformation type II, neurogenic bladder, and urinary tract infection [UTI]); and surgical details such as timing of repair of MMC, age at first shunt placement, shunt surgery modality (elective or emergency), concurrent surgery (correction of MMC and shunt insertion in the same surgical procedure), incidence and cause of shunt dysfunction, use of external ventricular drain, transfontanelle puncture, surgical wound complications prior to shunting, and endoscopic treatment of hydrocephalus. RESULTS: A total of 231 patients with MMC were included in the analysis. Patients were followed for periods ranging from 1 to 20 years, with a mean of 6.9 years. The frequency of shunt placement was observed mainly among patients with MMC at the highest spinal levels (p < 0.01). The main causes of morbidity and mortality in patients with MMC were shunt failures, diagnosed in 91 of 193 cases (47.2%) of hydrocephalus, and repeated UTIs, in 129 of 231 cases (55.8%) of MMC; these were the main causes of hospitalization and death. Head circumference ≥ 38 cm at birth was found to be a significant risk factor for shunt revision (p < 0.001; 95% CI 1.092-1.354). Also, the lumbar functional level of MMC was associated with less revision than upper levels (p < 0.014; 95% CI 0.143-0.805). There was a significant association between recurrent UTI and thoracic functional level. CONCLUSIONS: Macrocephaly at birth and higher levels of the defect have an impact on worse outcome and, therefore, are a challenge to the daily practice of pediatric neurosurgery.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Hidrocefalia/cirurgia , Meningomielocele/diagnóstico , Meningomielocele/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Idade Gestacional , Humanos , Hidrocefalia/diagnóstico , Masculino , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Prognóstico , Estudos Retrospectivos , Derivação Ventriculoperitoneal/efeitos adversos , Derivação Ventriculoperitoneal/métodos
18.
Zhonghua Yi Xue Yi Chuan Xue Za Zhi ; 36(9): 897-900, 2019 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-31515785

RESUMO

OBJECTIVE: To explore the genetic basis for a case of recurrent fetal congenital hydrocephalus. METHODS: Next-generation sequencing was carried out for the fetus, the gravida and two of her sisters. RESULTS: The fetus was found to harbor a c.1765T>C (p.Tyr589His) mutation in exon 14 of the L1CAM gene, which was derived from the gravida. CONCLUSION: Male fetuses with recurrent hydrocephalus should be subjected to testing of the L1CAM gene to facilitate genetic counseling and prenatal diagnosis.


Assuntos
Doenças Genéticas Ligadas ao Cromossomo X/diagnóstico , Hidrocefalia/genética , Molécula L1 de Adesão de Célula Nervosa/genética , Análise Mutacional de DNA , Feminino , Feto , Doenças Genéticas Ligadas ao Cromossomo X/genética , Humanos , Hidrocefalia/diagnóstico , Masculino , Mutação , Linhagem , Gravidez
19.
Med Hypotheses ; 133: 109401, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542612

RESUMO

JacquelineduPré (26 January 1945-19 October 1987) is one of the greatest cellists in the 20th century. Her musical career was terminated at age 28, allegedly due to multiple sclerosis (MS). MS is an immune-mediated demyelinating disease of the central nervous system with axonal involvement, characterized by the dissemination in time and space of the lesions (plaques). Diverse neurological symptoms may occur in MS, and a variety of symptoms relentlessly accumulated in her case after the diagnosis in 1973, which is concordant with primary progressive rather than relapsing-remitting form of MS. No radiological confirmation was however possible in her days and the diagnosis should be reconsidered, because her symptoms had some unusual features in MS. First, her principal symptoms, aside from transient visual and urological problems noticed earlier, began in the upper and lower limbs, often only in the upper limbs, then followed by the involvement of lower cranial nerves, and by the cognitive decline with changes in character. Hence the pattern of progression was ascending from the cervical spinal cord to the brainstem and to the cerebrum, which is not the pattern of dissemination in space typical of MS. Her clinical status appeared steroid-dependent temporarily in the early stage of the disease, which is also unusual in MS and some different etiology deserves consideration. We suppose that Uhthoff phenomenon, i.e. worsening of symptoms by the elevation of body temperature, may have been negative contrary to the previous interpretation, and if we are correct the absence of this sign does not support the demyelinating pathophysiology of her disease. Now that there is no objective medical information sufficiently disclosed, another scenario may be hypothesized, although MS is still a likely possibility. We discuss that syringomyelia/syringobulbia associated with Chiari malformation type I and obstructive hydrocephalus can be an alternative diagnosis.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Hidrocefalia/diagnóstico , Esclerose Múltipla Crônica Progressiva/diagnóstico , Música/história , Siringomielia/diagnóstico , Corticosteroides/uso terapêutico , Malformação de Arnold-Chiari/complicações , Neoplasias Encefálicas/diagnóstico , Transtornos Cognitivos/etiologia , Depressão/etiologia , Diagnóstico Diferencial , Progressão da Doença , Tolerância a Medicamentos , Feminino , História do Século XX , Humanos , Hidrocefalia/etiologia , Hipestesia/etiologia , Debilidade Muscular/etiologia , Doenças do Sistema Nervoso/diagnóstico , Avaliação de Sintomas , Siringomielia/complicações
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