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Neurology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Hydrocephalus (increased CSF in the brain); classified as: ‘communicating’ (poor absorption of CSF), e.g. after meningitis/SAH‘obstructive’ (CSF flow is blocked), e.g. occlusion of the ventricles by a tumour
Diffuse Intrinsic Pontine Glioma
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Katherine E. Warren, Carolyn R. Freeman, Dannis G. van Vuurden
The classic description is of a tumor with its epicenter in the pons that causes diffuse enlargement and is hypointense on T1-weighted sequences and hyperintense or isointense on T2-weighted or T2 fluid-attenuated inversion recovery (FLAIR) sequences (Figure 13.2). Axial and/or exophytic growth is seen in about two-thirds of patients. Usually there is no significant enhancement at diagnosis, although patchy or ring enhancement within the tumor is seen in one-third4 to two-thirds5 of patients. There may also be evidence of intratumoral hemorrhage. Hydrocephalus is present at diagnosis in less than 10% of patients. Atypical clinical and/or imaging findings should prompt consideration of other tumor types that are occasionally seen in the brainstem, such as primitive neuroectodermal tumor (PNET), ependymoma, or atypical teratoid/rhabdoid tumor.
Neurology and neurosurgery
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
12.32. With regard to spina bifida (myelocoele)prenatal diagnosis is possible.the majority of cases develop hydrocephalus.severe kyphosis and scoliosis are adverse prognostic features.reflex activity is characteristically absent below the neurological level of the lesion.the autonomic nervous system is not involved.
Endoscopic versus open microsurgery for colloid cysts of the third ventricle
Published in British Journal of Neurosurgery, 2023
Dan Farahmand, Johannes Stridh, Doerthe Ziegelitz, Magnus Tisell
Colloid cysts of the third ventricle are rare benign lesions located close to the foramina of Monro. The prevalence of these cysts has been approximated to be 1 in 8500 persons1 with an estimated incidence of 0.9–3.2 per million people2,3. Although benign, they can cause acute obstructive hydrocephalus and sudden death by obstructing the foramina of Monro4,5. The mortality rate from cerebral herniation due to ventricular obstruction has been reported to be 5%1. However, more commonly, the patients develop symptoms of hydrocephalus such as headache, nausea, and vomiting4,6. Headache, often of paroxysmal nature, has been reported to be the most common symptom. This headache is caused by the colloid cyst acting as a ball valve that temporarily obstructs the CSF flow and raises the intracranial pressure (ICP). Some patients report that the headache is relieved in the lying down position, opposite to what is seen in ‘high pressure’ headache. Diagnosis is confirmed using radiologic imaging through computed tomography (CT) or magnetic resonance imaging (MRI)7. Lumbar puncture is not advised in the diagnosis7 and has even been suspected as a cause of sudden death in colloid cyst patients2.
An eye on the future for defeating hydrocephalus, ciliary dyskinesia-related hydrocephalus: review article
Published in British Journal of Neurosurgery, 2022
Amr Ali Hasanain, Mohamed A. R. Soliman, Reem Elwy, Ahmed A. M. Ezzat, Sameh H. Abdel-Bari, Sascha Marx, Alistair Jenkins, Ehab El Refaee, Ahmed Zohdi
Hydrocephalus remains the most prevalent form of developmental central nervous system (CNS) malformation treated by pediatric neurosurgeons.1 Congenital hydrocephalus affects approximately one in 1000 newborn children and is fatal in approximately 50% of untreated cases.2–5 Several hydrocephalus classification systems exist; however, none address the underlying molecular pathogenic mechanism of development of hydrocephalus.6 In many cases of hydrocephalus, the etiology is unknown.7 Also, there is a lack of consensus on management approaches among the neurosurgical community,2–5 yet, the implantation of a ventriculoperitoneal shunt remains the most widely used option, despite the high complication rates reaching 82% in some studies.3,4
Chameleons, red herrings, and false localizing signs in neurocritical care
Published in British Journal of Neurosurgery, 2022
Boyi Li, Tolga Sursal, Christian Bowers, Chad Cole, Chirag Gandhi, Meic Schmidt, Stephan Mayer, Fawaz Al-Mufti
Downbeat nystagmus is an ocular motor disorder of primary gaze position characterized by slow upward drift and fast downward corrective phase.45 This condition is generally indicative of a lesion in the lower brain stem, upper cervical cord or cerebellum, typically caused by Arnold Chiari malformation, Klippel-Feil syndrome, C5–6 cervical spine deformities, alcoholic cerebellar degeneration, multiple sclerosis and brain stem infarction.46 It can be a FLS when occurring due to hydrocephalus. Patients with hydrocephalus may present with similar symptoms, including generalized headache, vomiting, and drowsiness or loss of consciousness, but with downbeat nystagmus without horizontal nystagmus or diplopia and with a full range of eye movements.46 The exact pathophysiology of downbeat nystagmus remains unclear, but it may be a consequence of elevated ICP, as treatment of hydrocephalus with shunt completely resolves the downbeat nystagmus.46 Thus, in patients with the concurrent presentation of hydrocephalus and downbeat nystagmus, lowering the ICP should be prioritized.46 As with most FLS, imaging studies can distinguish between hydrocephalus or a mass lesion.