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Prevention in the era of optimized patient flow, criminalization of serious neuropsychiatric disease, and anemic occupational and student health services
Published in John A. Liebert, William J. Birnes, Psychiatric Criminology, 2016
John A. Liebert, William J. Birnes
CD(D)DC (coma, delirium, pseudodementia, dementia, confusion) I ntraventricular (i.e., low-pressure hydrocephalus)C ongenital (i.e., epilepsy)T raumaI ntracranialV itamin deficiencyE ndocrineM etal poisoning (i.e., mercury and lead)A noxiaD rugs
Post-traumatic hydrocephalus – incidence, risk factors, treatment, and clinical outcome
Published in British Journal of Neurosurgery, 2022
Teodor Svedung Wettervik, Anders Lewén, Per Enblad
Since complications are common following shunt surgery (28% required shunt revision in our study), it is important to improve patient selection. Particularly, in poor-grade patients or in case of atypical symptoms with suspected PTH,12 additional diagnostic tools should be considered. Studies on CSF pressure dynamics may help in determining if the patient has high-pressure hydrocephalus, low-pressure hydrocephalus (low ICP, but high CSF outflow resistance), or atrophy (low ICP and low CSF outflow resistance). Although the CSF pressure dynamics in the PTH group is not fully elucidated, some studies have found promising results to identify candidates that could benefit from shunt surgery based on e.g., the rate of CSF outflow resistance.10,32,33 MRI diagnostics of CSF flow in the cerebral aqueduct could also be useful for the PTH diagnosis and in the prediction of shunt-response.34
Post-traumatic hydrocephalus: unknown knowns and known unknowns
Published in British Journal of Neurosurgery, 2022
Ashwin Kumaria, Christos M. Tolias
The majority of PTH patients (66%; 19 out of 29) improved following CSF diversion. Often this improvement was subjective as it did not change Extended Glasgow Outcome Scale or modified Rankin Scale. This is not unexpected given patients can have clinically important improvement (reported by family/carers or patients’ self-reporting) without objective increases in outcome scales. In this series all patients with low-pressure hydrocephalus (i.e. low ICP but high CSF outflow resistance) improved following shunt placement, in keeping with previous studies. However, patients already in a vegetative state did not improve in response to shunt implantation, again in keeping with previous studies.21 While distinguishing ventriculomegaly from PTH in this patient group could potentially be more challenging, it may also be that potential for recovery is already impeded owing to low GCS, perhaps as a result of severe TBI and its sequelae.