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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
Although recumbent headache is the typical symptom taught in medical school, in clinical practice, the patient's symptoms are often fairly nonspecific and may overlap with many other clinical disorders. When obstructive hydrocephalus is clinically suspected, imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is indicated with the clinical urgency dictating the choice of examination. Although MRI is the preferred modality of imaging obstructive hydrocephalus, CT is indicated if the problem is severe enough to require immediate action.
Neurosurgical Techniques and Strategies
Published in David A. Walker, Giorgio Perilongo, Roger E. Taylor, Ian F. Pollack, Brain and Spinal Tumors of Childhood, 2020
Jonathan E. Martin, Ian F. Pollack, Robert F. Keating
Endoscopic third ventriculostomy is the most broadly utilized technique for patients with obstructive hydrocephalus. Individuals with non-obstructive hydrocephalus (i.e., blood, infection, tumor metastases) do not benefit from an endoscopic third ventriculostomy. The procedure involves creating a fenestration in the floor of the third ventricle (Figure 6.3), bypassing obstructions to spinal fluid flow at the level of the cerebral aqueduct and/or fourth ventricle.22 The fenestration is most commonly created with a blunt instrument or endoscope, with some dilating the hole created with a 3 French balloon. The procedure allows for the preservation of normal physiologic spinal fluid absorption at the level of arachnoid granulations, and avoids indwelling hardware with its attendant risk of mechanical and infectious complications. Complications of this technique are rare, but potentially serious, and include basilar artery injury/stroke, direct brainstem injury, neurocognitive impairment due to forniceal injury, and transient neuroendocrine dysfunction. Success rates as high as 80–90% in the patient with obstructive hydrocephalus have been reported. The potential for further improvement in procedural success with the addition of choroid plexus cauterization23 has yet to be determined in the neuro-oncology patient population.
A Case of Toxoplasmosis in Pregnancy
Published in Meera Chand, John Holton, Case Studies in Infection Control, 2018
Patches of calcification affecting cerebral cortex, basal ganglia, or cerebellum may be seen on radiological imaging or postmortem samples in congenital infection. Obstructive hydrocephalus may be apparent. Periaqueductal and periventricular vasculitis with large areas of necrosis are typical histological findings in brain specimens. Focal necrosis of heart and skeletal muscle may be seen. Tachyzoites and tissue cysts may occasionally be demonstrated in tissue specimens and may be found in any organ.
H3K27-altered diffuse midline glioma: a paradigm shifting opportunity in direct delivery of targeted therapeutics
Published in Expert Opinion on Therapeutic Targets, 2023
Julian S. Rechberger, Blake T. Power, Erica A. Power, Cody L. Nesvick, David J. Daniels
Among pediatric high-grade gliomas, H3K27-altered diffuse midline glioma (DMG), formerly known as diffuse intrinsic pontine glioma (DIPG), is associated with an abysmal prognosis and 5-year survival rate (<2%) [1, 2]. About 300 children are diagnosed with brainstem DMG per year in the United States, comprising 10% of all primary pediatric brain tumors and 80% of brainstem tumors in this age group, most commonly in middle childhood (5–10 years old) [1, 3, 4]. Reflective of the anatomical localization and diffusely infiltrative growth pattern (Figure 1a), patients with DMG may present with a wide range of symptoms including headache, nausea, and the triad of cranial nerve dysfunction (i.e. diplopia and facial asymmetry), cerebellar signs (i.e. ataxia and dysmetria), and long-tract signs (i.e. hyperreflexia and paresis) [5, 6]. Obstructive hydrocephalus is a common late manifestation of disease [5, 7].
First reported case of hydrocephalus in jointly diagnosed bacterial meningitis and a colloid cyst: how Ockham’s razor became Hickam’s dictum
Published in British Journal of Neurosurgery, 2022
Gareth May, Simon Lammy, Aditaya Kumar, Ajay Hegde, Edward Jerome St. George
Cyst enlargement, haemorrhage and positional obstruction of the interventricular foramen of Munro can cause ventriculomegaly and raised intracranial pressure (ICP).2,3,9 Most symptomatic patients will present with signs and symptoms of raised ICP, e.g. non-specific headache, vomiting, and papilloedema.2 Due to a peduncular attachment to the roof of the third ventricle a colloid cyst can intermittently occlude the interventricular foramen of Munro (in a ball-valve mechanism). This can result in sudden onset headaches and loss of consciousness (or drop attacks).3 Irreversible obstruction to CSF flow results in obstructive hydrocephalus. Without prompt neurosurgical intervention death can occur.2 Risk factors for being symptomatic include: age <50 years, presence of headaches, cyst diameter >8 mm, large cyst volume and presence of ventriculomegaly.2
Survival status and predictors of mortality among children who underwent ventriculoperitoneal shunt surgery at public hospitals in Addis Ababa, Ethiopia
Published in International Journal of Neuroscience, 2023
Azene Bantie Wubie, Girum Sebsibe Teshome, Wudie Eneyew Ayele, Fikirtemariam Abebe, Tewodros Mulugeta Nigussie, Yalemgeta Biyazin Alemu, Migbar Sibhat Mekonnen
The study result showed that 117 (34.7%) study subjects were diagnosed as having hydrocephalus using CT scan, 95 (28.2%) with the help of MRI, 70 (20.8%) by U/S, and 55 (16.3%) were diagnosed by using both MRI and CT. Among 269 (79.9%) children investigated for CSF culture, 130 (48.3%) were found to be culture-positive, of those 31 (23.8%, n = 130) caused by gram-negative microbes. Moreover, 210 (62.3%) children developed hydrocephalus congenitally, of which 51 (22.9%) died. Again, 112 (33.2%) acquired from secondary causes, with 44 (39.3%) deaths recorded. The majority of the participants, 214 (63.5%), were diagnosed with obstructive hydrocephalus. Nevertheless, the proportion of death was higher among children with communicative hydrocephalus (31.1%) (Table 2).