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1.
Neurol Med Chir (Tokyo) ; 59(7): 271-280, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31068544

RESUMO

It is known that the cerebrospinal fluid (CSF) pulsation flow sign in the lateral ventricles directly above the foramen of Monro (CPF-M) on axial fluid attenuated inversion recovery (FLAIR) is a normal physiological finding as an artifact of FLAIR. In this study, whether CPF-M can be used as a neuroradiological finding related to pathological conditions in patients with acute aneurysmal subarachnoid hemorrhage (aSAH) was investigated. CPF-M-related clinical features were retrospectively evaluated in 147 aSAH patients who underwent adequate serial MRI examinations without massive intraventricular hemorrhage (IVH) of the lateral ventricle within 48 h of ictus. The frequency of the CPF-M in the control group was 32% (57/178), 33% (40/123), and 38% (45/117) for the normal control, chronic cerebral infarction, and deep white matter lesion (WML) groups, respectively. In aSAH patients, the overall prevalence of the CPF-M was 57% (84/147), significantly higher than in the three control groups. Multivariate analysis showed that age <70 years, lower IVH Hijdra score of the fourth ventricle, absence of T1-FLAIR mismatch, deep WMLs, old infarction, diffuse brain swelling, symptomatic delayed cerebral ischemia (DCI), shunt-dependent chronic hydrocephalus (SDCH), and favorable outcome were significantly associated with the CPF-M. Although limited to SAH patients without massive IVH of the lateral ventricles, one can conclude that, in acute aSAH, the presence of CPF-M on admission MRI suggests that the circulatory dynamics of the CSF from the basal cistern to the ventricles are approximately normal. Thus, this finding may appear to offer an indicator of a good outcome without DCI and SDCH.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Líquido Cefalorraquidiano/fisiologia , Fluxo Pulsátil/fisiologia , Hemorragia Subaracnóidea/diagnóstico por imagem , Hemorragia Subaracnóidea/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/cirurgia , Resultado do Tratamento
2.
Neurol Med Chir (Tokyo) ; 59(4): 133-146, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30814424

RESUMO

The "cerebrospinal fluid (CSF) circulation theory" of CSF flowing unidirectionally and circulating through the ventricles and subarachnoid space in a downward or upward fashion has been widely recognized. In this review, observations of CSF motion using different magnetic resonance imaging (MRI) techniques are described, findings that are shared among these techniques are extracted, and CSF motion, as we currently understand it based on the results from the quantitative analysis of CSF motion, is discussed, along with a discussion of slower water molecule motion in the perivascular, paravascular, and brain parenchyma. Today, a shared consensus regarding CSF motion is being formed, as follows: CSF motion is not a circulatory flow, but a combination of various directions of flow in the ventricles and subarachnoid space, and the acceleration of CSF motion differs depending on the CSF space. It is now necessary to revise the currently held concept that CSF flows unidirectionally. Currently, water molecule motion in the order of centimeters per second can be detected with various MRI techniques. Thus, we need new MRI techniques with high-velocity sensitivity, such as in the order of 10 µm/s, to determine water molecule movement in the vessel wall, paravascular space, and brain parenchyma. In this paper, the authors review the previous and current concepts of CSF motion in the central nervous system using various MRI techniques.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Líquido Cefalorraquidiano/fisiologia , Hidrodinâmica , Imagem por Ressonância Magnética , Espaço Subaracnóideo/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Humanos , Espaço Subaracnóideo/fisiopatologia
3.
J Neurodev Disord ; 10(1): 39, 2018 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-30541429

RESUMO

BACKGROUND: There is currently a renaissance of interest in the many functions of cerebrospinal fluid (CSF). Altered flow of CSF, for example, has been shown to impair the clearance of pathogenic inflammatory proteins involved in neurodegenerative diseases, such as amyloid-ß. In addition, the role of CSF in the newly discovered lymphatic system of the brain has become a prominently researched area in clinical neuroscience, as CSF serves as a conduit between the central nervous system and immune system. MAIN BODY: This article will review the importance of CSF in regulating normal brain development and function, from the prenatal period throughout the lifespan, and highlight recent research that CSF abnormalities in autism spectrum disorder (ASD) are present in infancy, are detectable by conventional structural MRI, and could serve as an early indicator of altered neurodevelopment. CONCLUSION: The identification of early CSF abnormalities in children with ASD, along with emerging knowledge of the underlying pathogenic mechanisms, has the potential to serve as early stratification biomarkers that separate children with ASD into biological subtypes that share a common pathophysiology. Such subtypes could help parse the phenotypic heterogeneity of ASD and map on to targeted, biologically based treatments.


Assuntos
Transtorno do Espectro Autista/líquido cefalorraquidiano , Transtorno do Espectro Autista/fisiopatologia , Encéfalo/crescimento & desenvolvimento , Encéfalo/fisiopatologia , Animais , Transtorno do Espectro Autista/complicações , Biomarcadores/líquido cefalorraquidiano , Ventrículos Cerebrais/patologia , Ventrículos Cerebrais/fisiopatologia , Encefalite/líquido cefalorraquidiano , Encefalite/complicações , Humanos
4.
Curr Med Sci ; 38(5): 880-887, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30341524

RESUMO

The efficacy and applied value of endoscopic hematoma evacuation vs. external ventricular drainage (EVD) in the treatment of severe ventricular hemorrhage (IVH) were explored and compared. From Jan. 2015 to Dec. 2016, the clinical data of 42 cases of IVH were retrospectively analyzed, including 18 patients undergoing endoscopic hematoma evacuation (group A), and 24 patients receiving EVD (group B). The hematoma clearance rate was calculated by 3D Slicer software, and complications and outcomes were compared between the two groups. There were no significant differences in age, sex and Graeb score between groups A and B (P>0.05). The hematoma clearance rate was 70.81%±27.64% in group A and 48.72%±36.58% in group B with a statistically significant difference (P<0.05). The operative time in groups A and B was 72.45±25.26 min and 28.54±15.27 min, respectively (P<0.05). The Glasgow Coma Scale (GCS) score increased from 9.28±2.72 at baseline to 11.83±2.91 at 1 week postoperatively in group A, and from 8.25±2.62 at baseline to 10.79±4.12 at 1 week postoperatively in group B (P<0.05). The length of hospital stay was 12.67±5.97 days in group A and 17.33±8.91 days in group B with a statistically significant difference (P<0.05). The GOS scores at 6 months after surgery were 3.83±1.12 in group A, and 2.75±1.23 in group B (P<0.05). These results suggested that endoscopic hematoma evacuation has an advantage of a higher hematoma clearance rate, fewer complications and better outcomes in the treatment of severe IVH, indicating it is a safe, effective and promising approach for severe IVH.


Assuntos
Hemorragia Cerebral Intraventricular/cirurgia , Ventrículos Cerebrais/cirurgia , Drenagem/métodos , Endoscopia/métodos , Idoso , Hemorragia Cerebral Intraventricular/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Drenagem/efeitos adversos , Endoscopia/efeitos adversos , Feminino , Fibrinolíticos/administração & dosagem , Escala de Coma de Glasgow , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos , Injeções Intraventriculares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
5.
World Neurosurg ; 120: e1120-e1127, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30217783

RESUMO

INTRODUCTION: The pathophysiology of normal-pressure hydrocephalus and the correlation with its symptomatology is not well understood. OBJECTIVE: To monitor and evaluate the enlargement patterns of the ventricular system for each ventricle and its correlation with the presenting symptoms. METHODS: Bilateral kaolin injection into the subarachnoid space overlying the cranial convexities was done in 18 adult rats. Magnetic resonance imaging was performed on an 11.7-T scanner 15, 60, 90, and 120 days after injection. Volumes of the ventricular system were measured for each ventricle and correlated with biweekly behavioral findings. RESULTS: There was a progressive increase in the ventricular volume for the lateral ventricles since day 15 in the kaolin-injected animals. There was a nonsignificant trend in volume growth for the third ventricle, but its enlargement was synchronous with the lateral ventricles. No significant change for the fourth ventricle. No symptoms were detected in the first 60 days. Association was found between the ventricular volume and locomotor changes. In addition, the odds of locomotor symptoms increased by 3% for every additional cubic millimeter of volume in the left (P < 0.001) and right (P = 0.023) ventricles, and for the total magnetic resonance imaging volume by 1% (P = 0.013). CONCLUSIONS: Expansion of the lateral ventricles maintained similar proportions over time, accompanied by a synchronous third ventricular expansion with less proportion and a nonsignificant fourth enlargement. Lateral ventricles enlarged most in those animals that were to develop late locomotor deterioration. Further research using this animal model combined with different radiologic imaging techniques, such as diffusion tensor imaging and perfusion studies, is recommended.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/fisiopatologia , Animais , Ventrículos Cerebrais/patologia , Modelos Animais de Doenças , Progressão da Doença , Feminino , Hidrocefalia/patologia , Caulim , Imagem por Ressonância Magnética , Tamanho do Órgão , Ratos Sprague-Dawley
6.
Neuroimage Clin ; 20: 731-741, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30238917

RESUMO

The aim of the present study was to examine cerebrospinal fluid (CSF) volumetric net flow rate and direction at the cranio-cervical junction (CCJ) and cerebral aqueduct in individuals with idiopathic normal pressure hydrocephalus (iNPH) using cardiac-gated phase-contrast magnetic resonance imaging (PC-MRI). An in-depth, pixel-by-pixel analysis of regions of interest from the CCJ and cerebral aqueduct, respectively, was done in 26 iNPH individuals, and in 4 healthy subjects for validation purposes. Results from patients were compared with over-night measurements of static and pulsatile intracranial pressure (ICP). In iNPH, CSF net flow at CCJ was cranially directed in 17/22 as well as in 4/4 healthy subjects. Estimated daily CSF volumetric net flow rate at CCJ was 6.9 ±â€¯9.9 L/24 h in iNPH patients and 4.5 ±â€¯5.0 L/24 h in healthy individuals. Within the cerebral aqueduct, the CSF net flow was antegrade in 7/21 iNPH patients and in 4/4 healthy subjects, while it was retrograde (i.e. towards ventricles) in 14/21 iNPH patients. Estimated daily CSF volumetric net flow rate in cerebral aqueduct was 1.1 ±â€¯2.2 L/24 h in iNPH while 295 ±â€¯53 mL/24 h in healthy individuals. Magnitude of cranially directed CSF net flow in cerebral aqueduct was highest in iNPH individuals with signs of impaired intracranial compliance. The study results indicate CSF flow volumes and direction that are profoundly different from previously assumed. We hypothesize that spinal CSF formation may serve to buffer increased demand for CSF flow through the glymphatic system during sleep and during deep inspiration to compensate for venous outflow.


Assuntos
Ventrículos Cerebrais/fisiopatologia , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Hidrocefalia de Pressão Normal/fisiopatologia , Adulto , Idoso , Aqueduto do Mesencéfalo/diagnóstico por imagem , Aqueduto do Mesencéfalo/fisiopatologia , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Processamento de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética , Masculino , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/fisiopatologia
7.
Neurología (Barc., Ed. impr.) ; 33(7): 449-458, sept. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-175953

RESUMO

Introducción: Desde la descripción hace 5 décadas de la hidrocefalia crónica del adulto idiopática (HCAi), su fisiopatología ha sido considerada básicamente relacionada con el efecto que la dilatación ventricular ejerce sobre las estructuras adyacentes al sistema ventricular. Sin embargo, las alteraciones en el flujo sanguíneo cerebral (FSC) y, sobre todo, la reducción en el recambio licuoral parecen emerger como componentes fisiopatológicos principales de esta enfermedad. Desarrollo: En la HCAi se observa una compresión del tracto piramidal, de los circuitos cortico-subcorticales fronto-estriatales y fronto-reticulares, y de las fibras profundas del fascículo longitudinal superior. En el cuerpo calloso se objetiva un descenso en el número de fibras comisurales, que son reemplazadas por gliosis. El FSC se encuentra alterado, con un patrón de última pradera en la región subcortical adyacente a los ventrículos, correspondiente a la intersección entre las arterias subependimarias y las arterias perforantes dependientes de los grandes troncos arteriales de la circulación anterior. El recambio diario del LCR se ve disminuido en un 75%, lo que conlleva una reducción del aclaramiento de neurotóxicos y la interrupción de las señalizaciones neuroendocrinas y paracrinas que ocurren a través del LCR. Conclusiones: La HCAi emerge como una entidad nosológica compleja, en la que los efectos de la microangiopatía subcortical y la disminución del recambio de LCR desempeñan un papel fundamental. Esta base fisiopatológica aleja la HCAi del concepto clásico de hidrocefalia y la acerca al perfil de otras enfermedades neurodegenerativas, como la enfermedad de Alzheimer o la enfermedad de Binswanger


Introduction: Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. Development: Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. Conclusions: iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus


Assuntos
Humanos , Hidrocefalia de Pressão Normal/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Circulação Cerebrovascular/fisiologia , Doença Crônica , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Doenças Neurodegenerativas/líquido cefalorraquidiano , Doenças Neurodegenerativas/diagnóstico
8.
Psychiatry Res Neuroimaging ; 279: 14-18, 2018 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-30075347

RESUMO

We aimed to determine whether variation in the body mass index (BMI)­a marker of anorexia nervosa (AN) severity­is associated with brain volume changes longitudinally estimated using registration-based methods on serial high-resolution T1-weighted magnetic resonance images (MRI). Fifteen female patients (mean age = 21 years; standard deviation [SD] = 5.7; range: 15­33 years) with the diagnosis of AN of the restricting type (AN-r)­according to the Diagnostic and Statistic Manual of Mental Disorders, 5th edition criteria­underwent T1-weighted MRI at baseline and after a mean follow-up period of 11 months (SD = 6.4). We used the brain boundary shift integral (BSI) and the ventricular BSI (VBSI) to estimate volume changes after registering voxels of follow-up onto baseline MRI. Very significant and strong correlations were found between BMI variation and the brain BSI, as well as between BMI variation and the VBSI. After adjustment for age at onset, duration of illness, and the BMI rate of change before baseline MRI, the statistical significance of both associations persisted. Registration-based methods on serial MRI represent an additional tool to estimate AN severity, because they provide measures of brain volume change strongly associated with BMI variation.


Assuntos
Anorexia Nervosa/diagnóstico por imagem , Índice de Massa Corporal , Encéfalo/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Adolescente , Adulto , Idade de Início , Anorexia Nervosa/fisiopatologia , Encéfalo/fisiopatologia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Feminino , Seguimentos , Humanos , Tamanho do Órgão , Adulto Jovem
9.
Ultrasound Obstet Gynecol ; 52(4): 467-472, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29607569

RESUMO

OBJECTIVE: Fetal isolated ventricular asymmetry (IVA) is a relatively common finding in pregnancy, but data regarding its effect on neurodevelopmental outcome are scarce and founded principally on ultrasound-based studies. The purpose of this study was to assess the neurodevelopmental outcome of IVA cases in a magnetic resonance imaging (MRI)-based study. METHODS: Cases referred for fetal brain MRI as part of the assessment of IVA without ventriculomegaly (lateral ventricular atrial diameter ≤ 10 mm), identified during routine ultrasound examination, were assessed for possible inclusion. Asymmetry was defined as a difference in width of ≥ 2 mm between the two lateral ventricles. Forty-three cases were included in the study group and compared with a control group of 94 normal cases without IVA. Children were assessed at ages 13-74 months using the Vineland-II Adaptive Behavior Scales (VABS-II). RESULTS: VABS-II scores were within normal range. There was no significant difference in composite VABS-II score between the study and control groups (106.5 vs 108.0; P = 0.454). VABS-II scores did not differ between the groups when matched for gender and age at VABS-II interview (109.6 in study group vs 107.8 in control group; P = 0.690). CONCLUSION: In cases of IVA without ventriculomegaly on MRI, neurodevelopmental test scores were normal and did not differ from cases without IVA. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Adaptação Psicológica/fisiologia , Ventrículos Cerebrais/anormalidades , Imagem por Ressonância Magnética , Transtornos do Neurodesenvolvimento/diagnóstico por imagem , Adulto , Fatores Etários , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Pré-Escolar , Estudos de Coortes , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Transtornos do Neurodesenvolvimento/fisiopatologia , Gravidez
10.
World Neurosurg ; 113: e690-e701, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29501515

RESUMO

OBJECTIVE: To investigate clinical efficacy of and optimal therapeutic strategy for ventricular intracranial pressure monitoring (V-ICPM) in patients with traumatic bifrontal contusions (TBCs). METHODS: From 8760 patients with traumatic brain injury treated between January 2010 and January 2016, a retrospective analysis was performed on 105 patients with TBCs who underwent V-ICPM and 282 patients with TBCs who did not. All patients underwent treatment at the 101st Hospital of PLA, Wuxi, China. Rates of successful conservative treatment, decompressive craniectomy, and bifrontal craniotomy; incidence of neurologic dysfunction; length of stay; and medical expenses were compared between groups. RESULTS: Glasgow Outcome Scale was used to assess all patients during follow-up (range, 6 months to 5.5 years). There were no significant differences in prognosis between the 2 groups (P = 0.100). Compared with the patients who did not undergo V-ICPM, the V-ICPM group had a significantly better successful conservative treatment rate (64.8% vs. 47.2%, P = 0.002), decompressive craniectomy rate (8.1% vs. 22.1%, P = 0.008), and bifrontal craniotomy rate (5.7% vs. 15.6%, P = 0.01); shorter length of stay (P = 0.000); and lower medical expenses (P = 0.004). CONCLUSIONS: Patients with TBCs should be strictly, closely, and dynamically observed by neurosurgery intensive care unit physicians and nurses. Patients should undergo ventricular intracranial pressure probe implantation in a timely manner. V-ICPM can help optimize treatment. Although V-ICPM did not significantly improve the prognosis of patients, it had many other advantages. V-ICPM warrants further clinical research and may be beneficial for patients with TBCs.


Assuntos
Contusão Encefálica/diagnóstico por imagem , Contusão Encefálica/cirurgia , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Pressão Intracraniana/fisiologia , Monitorização Neurofisiológica Intraoperatória/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Contusão Encefálica/fisiopatologia , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/fisiopatologia , Lesões Encefálicas Traumáticas/cirurgia , Ventrículos Cerebrais/fisiopatologia , Criança , Craniectomia Descompressiva/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
11.
Dev Cogn Neurosci ; 30: 60-69, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29328980

RESUMO

Intraventricular Hemorrhage (IVH) is the leading cause of neurological and cognitive impairment in preterm neonates with an incidence that increases with increasing prematurity. In the present study, we tested how preterm neonates with IVH react to external stimulation (i.e. speech syllables). We compared their neural responses measured by electroencephalography (EEG), and hemodynamic responses measured by functional near-infrared spectroscopy (fNIRS), with those of healthy preterms. A neural response to syllables was observed in these infants, but did not induce a vascular response in contrast with healthy neonates. These results clearly demonstrate that the cerebral vascular network in IVH preterm neonates was unable to compensate for the increased metabolism resulting from neuronal activation in response to external stimulation. Optical imaging is thus a sensitive tool to identify altered cerebral hemodynamic in critically ill preterms before behavioral changes are manifested or when only minor abnormalities on other functional monitoring techniques such as EEG are visible. We propose that a multi-modal approach provides unique opportunities for early monitoring of cognitive functions and opens up new possibilities for clinical care and recommended practices by studying the difficulties of the premature brain to adapt to its environment.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Doenças do Prematuro/diagnóstico por imagem , Recém-Nascido Prematuro/fisiologia , Acoplamento Neurovascular/fisiologia , Fala/fisiologia , Estimulação Acústica/métodos , Hemorragia Cerebral/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Eletroencefalografia/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Masculino , Espectroscopia de Luz Próxima ao Infravermelho/métodos
12.
Arch. Soc. Esp. Oftalmol ; 93(1): 35-37, ene. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-170270

RESUMO

Caso clínico: Presentamos el caso de un paciente varón de 73 años que acudió refiriendo visión en blanco y negro. La tomografía computarizada demostró hidrocefalia normotensiva (HNT). No se llegó a realizar resonancia magnética porque el paciente renunció a ser sometido a nuevos exámenes. Discusión: La acromatopsia puede ser la primera o la única clínica de HNT. Puede ser prudente preguntar a los pacientes con HNT con respecto a la visión de color (AU)


Clinical case: The case is presented of a 73-year-old male patient who referred to having black and white vision. Computed tomography showed normal pressure hydrocephalus (NPH). Magnetic resonance imaging was not performed because the patient refused to undergo further examinations. Discussion: Achromatopsia may be the first or only NPH symptom. It may be prudent to ask patients with NPH regarding colour vision (AU)


Assuntos
Humanos , Masculino , Idoso , Defeitos da Visão Cromática/etiologia , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/fisiopatologia , Dano Encefálico Crônico/complicações , Líquido Cefalorraquidiano , Ventrículos Cerebrais/fisiopatologia
13.
Pediatr Res ; 83(1-2): 385-396, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-29028220

RESUMO

There is great interest in the regenerative potential of the neural stem cells and progenitors that populate the germinal zones of the immature brain. Studies using animal models of pediatric brain injuries have provided a clearer understanding of the responses of these progenitors to injury. In this review, we have compared and contrasted the responses of the endogenous neural stem cells and progenitors of the subventricular zone in animal models of neonatal cerebral hypoxia-ischemia, neonatal stroke, congenital cardiac disease, and pediatric traumatic brain injury. We have reviewed the dynamic shifts that occur within this germinal zone with injury as well as changes in known signaling molecules that affect these progenitors. Importantly, we have summarized data on the extent to which cell replacement occurs in response to each of these injuries, opportunities available, and obstacles that will need to be overcome to improve neurological outcomes in survivors.


Assuntos
Encefalopatias/terapia , Lesões Encefálicas Traumáticas/terapia , Lesões Encefálicas/terapia , Hipóxia-Isquemia Encefálica/fisiopatologia , Ventrículos Laterais/citologia , Células-Tronco Neurais/citologia , Animais , Animais Recém-Nascidos , Encéfalo/fisiopatologia , Diferenciação Celular , Ventrículos Cerebrais/fisiopatologia , Cardiopatias Congênitas/terapia , Humanos , Recém-Nascido , Camundongos , Neurônios/citologia , Oligodendroglia , Acidente Vascular Cerebral/terapia
14.
Childs Nerv Syst ; 34(4): 707-715, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29209884

RESUMO

INTRODUCTION: A wide spectrum of etiologies can obstruct foramen of Monro (FOM) and result in hydrocephalus. Congenital occlusion of FOM is a rare entity which may present either in childhood or in adulthood. METHODS: Between 2007 and 2016, we screened all pediatric patients with hydrocephalus of either one or both lateral ventricles. Congenital occlusion of FOM was confirmed in the absence of masses occupying the FOM, prenatal or postnatal central nervous system (CNS) infections, intraventricular hemorrhage, previous cerebral intervention, or associated CNS anomalies affecting the flow of cerebrospinal fluid (CSF). We have performed a comprehensive literature review of the previously reported cases and provided a tentative embryological pathogenesis of FOM occlusion. RESULTS: We introduce 10 new cases of congenital FOM obstruction. The mean age of the patients was 6.65 ± 10.51 months. Two patients underwent ventriculo-peritoneal (VP) shunting as the primary intervention, while endoscopic septostomy was performed in the others. The mean follow-up was 3.05 ± 2.16 years (1-8 years). Although the hydrocephalus was controlled, all patients remained hemiparetic with some degree of developmental and cognitive impairments. Previously, 38 similar cases were reported: 10 of them (26.3%) were adults. Overall, VP shunting was the treatment of choice in 44.7% of patients. While most adults fully recovered, 7.2% of pediatrics remained hemiparetic and 10.7% of them had cognitive and developmental delay. CONCLUSION: Ten cases of congenital obstruction of the foramen of Monro have been managed through a period of 9-year study. Details of these patients in addition to 38 previously reported cases are presented in this study.


Assuntos
Ventrículos Cerebrais/fisiopatologia , Hidrocefalia/etiologia , Obstrução do Fluxo Ventricular Externo/complicações , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/patologia , Ventrículos Cerebrais/cirurgia , Pré-Escolar , Feminino , Humanos , Hidrocefalia/diagnóstico por imagem , Lactente , Recém-Nascido , Estudos Longitudinais , Imagem por Ressonância Magnética , Masculino , Estudos Retrospectivos , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagem , Obstrução do Fluxo Ventricular Externo/cirurgia , Derivação Ventriculoperitoneal/métodos
15.
Neurologia ; 33(7): 449-458, 2018 Sep.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-27296497

RESUMO

INTRODUCTION: Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. DEVELOPMENT: Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. CONCLUSIONS: iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus.


Assuntos
Hidrocefalia de Pressão Normal/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Adulto , Ventrículos Cerebrais/fisiopatologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Circulação Cerebrovascular/fisiologia , Doença Crônica , Humanos , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Hidrocefalia de Pressão Normal/diagnóstico , Doenças Neurodegenerativas/líquido cefalorraquidiano , Doenças Neurodegenerativas/diagnóstico
16.
Handb Clin Neurol ; 145: 39-50, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28987185

RESUMO

Hydrocephalus (HC) is classically defined as dynamic imbalance between the production and absorption of cerebrospinal fluid (CSF) leading to enlarged ventricles. Potential causative factors include various brain disorders like tumors causing obstruction of CSF flow within the ventricular system or the subarachnoid space. Classification of HC is based on the site of CSF flow obstruction guiding optimal treatment, with endoscopic third ventriculostomy in intraventricular obstruction and CSF shunt in communicating HC. Another clinically relevant classification is acute and chronic; the most frequent chronic form is idiopathic normal-pressure hydrocephalus (iNPH). The reported incidence of HC varies according to the study population and classification used. The incidence of congenital HC is approximately 0.4-0.6/1,000 newborns and the annual incidence of iNPH varies from 0.5/100,000 to 5.5/100,000. Radiologically, ventricular dilatation may be nonspecific, and differentiation of iNPH from other neurodegenerative diseases may be ambiguous. There are no known specific microscopic findings of HC but a systematic neuropathologic examination is needed to detect comorbid diseases and possible etiologic factors of HC. Depending on the etiology of HC, there are several nonspecific signs potentially to be seen.


Assuntos
Ventrículos Cerebrais , Líquido Cefalorraquidiano/fisiologia , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/epidemiologia , Animais , Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/fisiopatologia , Ventrículos Cerebrais/cirurgia , Líquido Cefalorraquidiano/diagnóstico por imagem , Modelos Animais de Doenças , Humanos , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Imagem por Ressonância Magnética , Neuropatologia/métodos , Tomógrafos Computadorizados , Ventriculostomia/métodos
17.
Med Hypotheses ; 108: 108-114, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29055382

RESUMO

The human brain loses its volume and its function during aging. The solid part of the brain within the intracranial space, the brain parenchyma, decreases in volume with age; while the cerebrospinal fluid (CSF) volume increases. With progressive loss of brain parenchymal volume (BPV), CSF may shift from cerebral ventricles to the subdural space, forming subdural effusion (SDE), whose role in the brain aging process remains unclear. We hypothesize that damages associated with ventriculomegaly can be lessened after formation of SDE. As the BPV decreases, the enlarged ventricular surface area causes dysfunction of its lining ependymal cells, followed by damages to the periventricular tissue. The periventricular nerve fibers are stretched by the enlarged ventricles. We hypothesize that after the formation of SDE, ventriculomegaly can be stopped or even reversed. By allowing the atrophic brain to reside in a smaller fraction of the intracranial volume, damages associated with ventriculomegaly can be alleviated. If our hypothesis is correct, physicians should continue to maintain a conservative approach for uncomplicated SDE. For focal or global brain parenchymal loss caused by various pathologies, intracranial spacers can be employed to simulate the effect of SDE to protect the brain. For treatment of idiopathic normal pressure hydrocephalus, aggressive ventricular size reduction should be pursued. Finally, the protective effects of SDE have its limits. Extremely enlarged subdural volume can cause acute or chronic subdural hematoma, further damaging the brain.


Assuntos
Envelhecimento , Encéfalo/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Derrame Subdural , Idoso , Atrofia/fisiopatologia , Fenômenos Biomecânicos , Hematoma Subdural Crônico/fisiopatologia , Humanos , Hidrocefalia/fisiopatologia , Hidrocefalia de Pressão Normal , Modelos Biológicos , Tamanho do Órgão , Espaço Subdural
18.
Neurocir.-Soc. Luso-Esp. Neurocir ; 28(3): 141-156, mayo-jun. 2017. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-162774

RESUMO

Introducción: A pesar de la existencia de guías clínicas desde hace más de una década, la complejidad diagnóstica y terapéutica de la hidrocefalia crónica del adulto idiopática hace que la variabilidad en su manejo sea elevada. Desarrollo: Se presenta el protocolo diagnóstico-terapéutico empleado en el Servicio de Neurocirugía del Hospital Universitario Marqués de Valdecilla para evaluar a los pacientes remitidos por sospecha diagnóstica de hidrocefalia crónica del adulto idiopática. El proceso diagnóstico incluye valoración neuropsicológica, RM craneal con secuencias de Cine-RM por contraste de fase, estudio urodinámico, registro continuo de presión intracraneal, hidrodinámica licuoral mediante test de infusión lumbar y medición de la presión intraabdominal. Se consideran candidatos quirúrgicos a los pacientes que cumplen cualquiera de los siguientes criterios: presión intracraneal media >15mmHg u ondas B en >10% del registro nocturno; índice presión-volumen <15ml o resistencia al drenaje del líquido cefalorraquídeo (ROUT) >4,5mmHg/ml/min en el test de bolos; ROUT >12mmHg/ml/min, presión intracraneal >22mmHg o presencia de ondas B de alta amplitud en la meseta del test de Katzman; o respuesta a la evacuación licuoral de alto volumen. Conclusiones: La implementación de protocolos diagnóstico-terapéuticos podría mejorar varios aspectos del proceso asistencial de la hidrocefalia crónica del adulto idiopática, no solo al disminuir la variabilidad en la práctica clínica sino también al optimizar el uso de recursos sanitarios y ayudar a la identificación de áreas de incertidumbre científica, permitiendo dirigir los esfuerzos en investigación de una forma más adecuada (AU)


Introduction: Despite the existence of published guidelines for more than a decade, there is still a substantial variation in the management of idiopathic normal pressure hydrocephalus due to its diagnostic and therapeutic complexity. Development: The diagnostic and therapeutic protocol for the management of idiopathic normal pressure hydrocephalus in use at the Department of Neurosurgery of the University Hospital Marqués de Valdecilla is presented. The diagnostic process includes neuropsychological testing, phase contrast cine MRI, urodynamic evaluation, continuous intracranial pressure monitoring, cerebrospinal fluid hydrodynamics by means of lumbar infusion testing, and intra-abdominal pressure measurement. A patient is considered a surgical candidate if any of the following criteria is met: mean intracranial pressure >15mmHg, or B-waves present in >10% of overnight recording; pressure-volume index <15ml, or resistance to cerebrospinal fluid outflow (ROUT) >4.5mmHg/ml/min in bolus infusion test; ROUT >12mmHg/ml/min, intracranial pressure >22mmHg, or high amplitude B-waves in the steady-state of the continuous rate infusion test; or a clinical response to high-volume cerebrospinal fluid withdrawal. Conclusions: The implementation of a diagnostic and therapeutic protocol for idiopathic normal pressure hydrocephalus management could improve various aspects of patient care. It could reduce variability in clinical practice, optimise the use of health resources, and help in identifying scientific uncertainty areas, in order to direct research efforts in a more appropriate way (AU)


Assuntos
Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/cirurgia , Procedimentos Neurocirúrgicos/métodos , Padrões de Prática Médica , Protocolos Clínicos , Testes Neuropsicológicos , Doença Crônica/terapia , Descompressão Cirúrgica , Punção Espinal , Testes de Função Renal , Urodinâmica/fisiologia , Neuroimagem , Manometria , Hipertensão Intracraniana/terapia , Ventrículos Cerebrais/fisiopatologia
19.
Philos Trans A Math Phys Eng Sci ; 375(2096)2017 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-28507239

RESUMO

The obstruction of ventricular catheters (VCs) is a major problem in the standard treatment of hydrocephalus, the flow pattern of the cerebrospinal fluid (CSF) being one important factor thereof. As a first approach to this problem, some of the authors studied previously the CSF flow through VCs under time-independent boundary conditions by means of computational fluid dynamics in three-dimensional models. This allowed us to derive a few basic principles which led to designs with improved flow patterns regarding the obstruction problem. However, the flow of the CSF has actually a pulsatile nature because of the heart beating and blood flow. To address this fact, here we extend our previous computational study to models with oscillatory boundary conditions. The new results will be compared with the results for constant flows and discussed. It turns out that the corrections due to the pulsatility of the CSF are quantitatively small, which reinforces our previous findings and conclusions.This article is part of the themed issue 'Mathematical methods in medicine: neuroscience, cardiology and pathology'.


Assuntos
Ventrículos Cerebrais/fisiopatologia , Hidrocefalia/líquido cefalorraquidiano , Hidrocefalia/terapia , Modelos Biológicos , Fluxo Pulsátil , Derivação Ventriculoperitoneal , Animais , Cateterismo Periférico , Cateteres de Demora , Ventrículos Cerebrais/cirurgia , Líquido Cefalorraquidiano , Simulação por Computador , Análise de Falha de Equipamento , Humanos , Hidrocefalia/fisiopatologia , Desenho de Prótese , Reologia/métodos
20.
Acta Neurol Scand ; 136(5): 434-439, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28247411

RESUMO

OBJECTIVES: The changes of CSF flow dynamics in idiopathic normal pressure hydrocephalus (iNPH) are not fully elucidated. Most previous studies took the whole cardiac cycle as a unit. In this work, it is divided into systole and diastole phase and compared between iNPH patients and normal elderly and paid special attention to the change of netflow direction. MATERIALS AND METHODS: Twenty iNPH patients according to international guideline and twenty healthy volunteers were included in this study and examined by MRI. Three categories of CSF flow parameters were measured: peak velocity (Vpeak ), stroke volume (SV), and minute flow volume (MinV) covering the whole cycle; peak velocity (Vpeak-s , Vpeak-d ) and flow volume (Vols , Vold ) of the systole and diastole, respectively; net flow. Evans index (EI) was also measured and compared statistically between the two groups. RESULTS: EI, Vpeak , SV, MinV, Vols , Vold , and Vpeak-d significantly increased in iNPH group (P<0.05). Vpeak-s of the two groups were not significantly different (P>0.05). The net flow of 16 iNPH patients (16/20) was in the caudo-cranial direction, while 15 volunteers (15/20) were in the opposite direction, which showed statistically significant differences (P=.001). CONCLUSIONS: INPH patients present hyperdynamic flow with increased velocity and volume both in systole and diastole phase. Degree of rising in diastole phase exceeds that of systole phase. The resulting reversal of netflow direction may play a key role in the occurrence of ventriculomegaly in iNPH patients.


Assuntos
Aqueduto do Mesencéfalo/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Idoso , Idoso de 80 Anos ou mais , Aqueduto do Mesencéfalo/diagnóstico por imagem , Ventrículos Cerebrais/diagnóstico por imagem , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Hidrocefalia de Pressão Normal/fisiopatologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade
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