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Disorders of Circulation of the Cerebrospinal Fluid
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Usual causes of communicating hydrocephalus include: Infection (meningitis, ventriculitis).Inflammation (neurosarcoidosis, lupus cerebritis).Hemorrhage (intraventricular hemorrhage, subarachnoid hemorrhage).
Questions and Answers
Published in David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly, MRCPsych Paper I One-Best-Item MCQs, 2017
David Browne, Brenda Wright, Guy Molyneux, Mohamed Ahmed, Ijaz Hussain, Bangaru Raju, Michael Reilly
Answer: C. Symptoms that occur with a non-communicating hydrocephalus are nausea, vomiting, increased blood pressure and papilloedema. Non-communicating hydrocephalus and increased intracranial pressure are caused by flow obstruction in the third or fourth ventricle. A reduced pulse and headache worse on lying down are also signs. Head injury and meningeal infection can be outruled as there is no evidence of trauma or pyrexia in this scenario. Meningeal infection would give a similar clinical picture. Marchiafava-Bignami disease is a complication of alcohol dependence: it involves degeneration of the corpus callosum with clinical symptoms of recurrent seizures and dementia. Subacute combined degeneration of the cord is due to vitamin B12 deficiency and presents with ataxic gait, upper motor neuron signs in the lower limbs, along with dementia and peripheral neuropathy. [AF. p. 27; H. p. 126; AO. pp. 376–7]
Paediatric neurosurgical disorders
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
From the list of options above, choose which is the most recommended method of treatment for each of the following scenarios. A 2-month-old baby born at 32 weeks had an intraventricular bleed that has now cleared. The baby has increasing head circumference. The anterior fontanelle is bulging and the baby is having episodes of downward gaze. CT scan of the head shows communicating hydrocephalus.A 6-year-old boy presents with sudden onset of headache. He is drowsy but obeying commands. A CT scan of his head shows blood in the ventricles with a small clot in the fourth ventricle and gross hydrocephalus.A 10-year-old girl presents with headaches since the age of 8, which are gradually getting worse. Her fundus examination shows early papilloedema. Her MRI scan shows hydrocephalus due to aqueductal stenosis.
Mechanical filtration of the cerebrospinal fluid: procedures, systems, and applications
Published in Expert Review of Medical Devices, 2023
In Alzheimer’s disease (AD), mechanical dilution of CSF has long been a proposed therapeutic approach [50]. CSF shunts such as ventriculo-peritoneal, ventriculo-pericardial, ventriculo-atrial, and lumbo-peritoneal shunts are the recommended therapy for communicating hydrocephalus. Noteworthy, shunting procedures delay intracerebral deposition of Aβ in patients with communicating hydrocephalus [51]. As mentioned, enhancing CSF flow is not a proper method of CSF filtration or CSF clearance. Anyway, it is worth mentioning the clinical experience with CSF shunts in neurodegenerative diseases, as it is closely related to CSF filtration. On one hand, COGNIShunt is a system for a continuous, low-flow ventriculo-peritoneal shunt (Eunoe, acquired by Integra Lifesciences). Results of the clinical trial showed that the difference between treatment groups, while still favoring the COGNIShunt group, was not statistically significant [52]. On the other hand, Arethusta (Leucadia Therapeutics) is a system based on an implantable device to restore CSF flow across the cribriform plate (conceived for Alzheimer’s disease), and eShunt (CereVasc, Inc.) is an endovascularly implantable device to generate a shunt from the CSF to the venous sinuses (conceived for communicating hydrocephalus).
The intraocular pressure could not be used to determine the intracranial pressure in patients with hydrocephalus
Published in International Journal of Neuroscience, 2019
Wei Wang, Maode Wang, Zhijin Li, Tuo Wang, Rong Da
All of the clinical data mentioned above were reviewed from medical records. Blood pressure was recorded at 7:00 am when the day IOP and ICP were measured. Mean artery pressure (MAP) was calculated by 1/3 systolic pressure plus 2/3 diastolic pressure for individual patient. Obstructive lesions were confirmed by imaging findings. Communicating hydrocephalus was defined as panventricular dilation according to neuroimaging findings. Ophthalmological examinations including fundus examination and IOP measurement were performed by professional ophthalmologists before LP. The IOP was measured by a non-contact tonometer (AT555 auto non-contact tonometer, Depew, NY). The IOP of each eye was measured three times, and the mean value was recorded. The mean IOP (MIOP) was the mean value of IOPs in the right and left eyes for an individual patient. After the measurement of IOP, an ICP was measured by LP opening pressure [16, 17]. The ICP was defined as the cerebrospinal fluid opening pressure measured by lumbar puncture. In briefly, after resting for about 15 to 20 minutes, a patient was positioned in the lateral decubitus position and kept the needle entrance on the same level of patient’s head for LP. After successful puncture, the manometer was connected immediately and the CSF opening pressure was measured within 1 minute. The interval between IOP measurement and ICP measurement was 1 to 3 hours.
The effect of ventricular volume increase in the amplitude of intracranial pressure
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
João Apura, Jorge Tiago, Alexandra Bugalho de Moura, José Artur Lourenço, Adélia Sequeira
However, communicating hydrocephalus, namely NPH, is still not well understood. Several authors relate it to the brain compliance capacity and increased pressure amplitude, while maintaining a normal mean ICP. Back in the late 1970’s, the authors in (Di Rocco et al. 1978) have established a relation between communicating hydrocephalus and the amplitude of ICP, by inducing the increase of the lateral ventricles by means of increased amplitude of the intraventricular CSF pressure. Nevertheless, only recently brain compliance properties have been considered as the possible source of communicant hydrocephalus. Indeed, recently, new approaches have pointed to CSF systemic disequilibria as the main cause for both types of hydrocephalus. One of such approaches advocates that the CSF volume increase may be the result of impaired dynamics between CSF, brain parenchyma and blood compartments (see, for instance (Orešković et al. 2017)). On the other hand, in (Park et al. 2012), the authors concluded that brain compliance plays an important role in absorbing the cardiovascular pulse arriving into the brain. They have shown that the ability to absorb pulsations, quantified as a cardiac pulsation absorbance (CPA) around the heart rate, is inversely related to ICP amplitude. In (Qvarlander et al. 2014), the authors explore the relation between the reduction in compliance capacity and CH using 0 D mathematical models to assess and quantify the impact of CSF compliance malfunction in NPH. In (Butler et al. 2017) it is also advocated that brain ventricles act as compensators to the stroke volume of arterial blood arriving into the rigid cranium. There, the authors argue that even non-communicating hydrocephalus may be related with a mismatch in the arteriovenous pulse wave and the CSF capacity, as relay medium for that pulse.