China
Africa
Explore chapters and articles related to this topic
Contour of Pressure and Flow Waves in Arteries
Published in Wilmer W Nichols, Michael F O'Rourke, Elazer R Edelman, Charalambos Vlachopoulos, McDonald's Blood Flow in Arteries, 2022
Changes in flow patterns within cerebral arteries, using transcranial Doppler have been described for 1020 subjects in Shanghai (Xu et al., 2012; Kim et al., 2017) and show similar changes to those described for the ascending aortic pressure waveforms. Cerebral vascular impedance recorded from the waveform shows low modulus and phase, consistent with a vasodilated bed with low wave reflection and so different from the lower body. Data have been recorded from patients undergoing neurosurgical procedures for post-traumatic brain injury and cerebrospinal fluid shunting for normal pressure hydrocephalus (NPH) (Kim et al., 2016; Evensen et al., 2018). This new information canvases the prospect of alleviating the cause of cerebrovascular damage as seen in secondary stroke following head injury or subarachnoid hemorrhage and as the cause of “spasm” following acute cerebral events (Kim et al., 2015) and pulse wave encephalopathy over years, causing dementia (O'Rourke and Safar, 2005; Stone et al., 2015) and is set out further in Chapter 14.
Psychiatric Misdiagnosis
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Normal pressure hydrocephalus is characterized by a triad of dementia, ataxia, and incontinence, although the symptoms vary rather widely.66 Patients with this disorder may present with behavior problems, persucatory delusions,67 or psychotic depression.68 Normal pressure hydrochephalus may be reversible by a ventricular shunting procedure.66
Other diseases (transverse myelitis, tropical spastic paraparesis, progressive multifocal leukoencephalopathy, Lyme’s disease)
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Druschky et al.54 reported about a 57-year-old patient suffering from the typical symptoms of normal pressure hydrocephalus (NPH) including gait disturbance, urinary incontinence, and mental deterioration. CSF analysis established the diagnosis of chronic active Lyme neuroborreliosis with lymphocytic pleocytosis and intrathecal B.a burgdorferi antibody production. After several weeks of i.v. antibiotic treatment, we observed normalization of CSF parameters as well as a clear improvement of clinical symptoms so that surgical shunting was no longer indicated. Interference with subarachnoid CSF flow may be a possible cause of the observed symptomatic NPH in a patient with chronic Lyme neuroborreliosis.
Mechanistic reasoning in neursourgery
Published in British Journal of Neurosurgery, 2019
Mechanistic reasoning is based on building models of disease processes and treatments, then applying those models to individual patients and recommending treatment according to what the models predict. Shaw’s swipe at operating is not so much based on the process of mechanistic reasoning, but rather on the simplicity of the models that surgeons often use. The familiar simple model of hydrocephalus is a pretty bad one. It fails to explain Normal Pressure Hydrocephalus and benign intracranial hypertension. It fails to explain why hydrocephalus develops as slowly as it does, and fails to predict who will and won’t respond to third ventriculostomy, and it’s not much better at predicting who will and won’t respond to shunting. Is there anything that it does explain? Improved models do perform better but even the cleverest mechanistic models are pretty unreliable. The History of Medicine is littered with examples of how oh-so reasonable sounding mechanistic arguments that turned out to be completely wrong. Fluoride supplements increase bone density. Surely then, they must reduce osteoporotic fractures? No. In trials they increase them. Similarly, cardiac arrhythmias are associated with death after myocardial infarction. Surely the, antiarrhythmics would reduce deaths? No. In trials they increased them.
Characteristics of apathy in treatment-naïve patients with Parkinson’s disease
Published in International Journal of Neuroscience, 2019
Hiroo Terashi, Yuki Ueta, Haruhisa Kato, Hiroshi Mitoma, Hitoshi Aizawa
Patients who were included in the present study were treatment-naïve idiopathic PD patients <80 years of age who visited the Outpatient Clinic of the Department of Neurology at Tokyo Medical University Hospital (Tokyo, Japan) between July 2009 and May 2017 and provided verbal consent to participate. Patients who were excluded were those with other concomitant neurodegenerative disorders, a history of treatment for mental illness, a history of stroke, or concomitant arthralgia or spinal disease interfering with activities of daily living. PD was diagnosed according to the criteria published by the United Kingdom Parkinson’s Disease Society Brain Bank [9]. Head magnetic resonance imaging was performed in all patients to confirm the absence of other degenerative disorders, stroke, and idiopathic normal pressure hydrocephalus. This study was performed after securing the approval of the Medical Ethics Committee of Tokyo Medical University Hospital.
Endoscopic neuroendoscopy using a novel ventricular access port
Published in British Journal of Neurosurgery, 2018
Andrew John Gauden, Calum Pears, Andrew Parker, Kelvin Woon, Helge Köck, Martin Hunn, Warren Symons, Agadha Wickremesekera
Of the 86 patients 28 patients (32.5%) had a diagnosis of cerebral aqueductal stenosis. Of the remaining causes, hydrocephalus secondary to a neoplastic lesion was the most common cause in 30 patients (34.8%). Of these patients 9 patients (10.4%) had histological confirmation of a high-grade glioma and 4 patients had evidence of cerebral metastatic lesions (4.6%). 10 patients (11.6%) had a subsequent diagnosis of normal pressure hydrocephalus and four patients (4.7%) had evidence of prior shunt blockage. Three patients (3.5%) had evidence of hydrocephalus secondary to ventriculitis/meningitis and two patients (2.3%) had evidence of intraventricular haemorrhage. The remaining 9 patients (10.5%) had hydrocephalus of unknown aetiology.