Cerebrospinal Fluid Shunting

Abstract BackgroundIdiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, urinary incontinence and cognitive decline. Symptoms are potentially reversible and treatment is based on cerebrospinal fluid shunting. The tap test (TT) is used to identify patients that will benefit from surgery. This procedure consists on the withdrawal of 20 to 50 mL of cerebrospinal fluid (CSF) through a lumbar puncture (LP) after which the symptoms of the triad are tested. Improvement in the quality and speed of gait are already recognized but cognitive improvement depends on several factors such as tests used, time elapsed after LP for re-testing, and number of punctures. Serial punctures may trigger similar conditions as external lumbar drainage (ELD) to the organism. ObjectiveThis study aimed to identify how serial punctures affect cognition in order to increase the sensitivity of the test and consequently the accuracy of surgical indication. MethodsSixty-one patients with INPH underwent baseline memory and executive tests repeatedly following the 2-Step Tap Test protocol (2-STT – two procedures of 30 mL lumbar CSF drainage separated by a 24-hour interval). The baseline scores of INPH patients were compared with those of 55 healthy controls, and with intragroup post-puncture scores of the 2-STT. ResultsThe group with INPH had lower performance than the control group in all cognitive tests (RAVLT, Stroop, CFT, FAR-COWA, FAB, MMSE, orientation, mental control), except for the forward digit span test (p = 0.707). After conducting LP procedures, the Stroop test (words, colors and errors), RAVLT (stage A1, A6 and B1), and CFT (immediate and delayed R) scores were equal to those of the control group (p > 0.05). The INPH group presented significant improvement after the first puncture in MMSE (p = 0.031) and in the Stroop Test (points) (p < 0.001). After the second puncture, subjects improved in orientation, MMSE, RAVLT (B1), Stroop (points, words, errors) and CFT (IR). ConclusionProgressive cognitive improvement occurred over the 2-STT and changes were more significant after the second LP in all cognitive domains except for RAVLT (A7). Encephalic alert system ‘arousal’ seems to participate in early improvements observed during 2-STT. The second LP increased the sensitivity of the drainage test to detect changes in cognitive variables, and consequently improved the quality of the method.

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FREQUENCY OF INFECTION AFTER CEREBROSPINAL FLUID SHUNTING PROCEDURES

10.1101/2020.04.01.20050096 ◽

2020 ◽

Author(s):

Kashif Ramooz ◽

Eesha Yaqoob ◽

Nadeem Akhtar ◽

Fraz Mehmood ◽

Saad Javed

Keyword(s):

Cerebrospinal Fluid ◽

Age Distribution ◽

Age Groups ◽

Csf Shunts ◽

Ethical Approval ◽

The Central Nervous System ◽

Rate Study ◽

Cerebrospinal Fluid Shunting ◽

Prolonged Hospital

ABSTRACTHydrocephalus is routinely treated by surgical procedures. Cerebrospinal fluid shunt placement is a critical therapeutic intervention for hydrocephalus.CSF shunting has multiple complications among which infection is very common. The major cause of morbidity and mortality in patients with CSF shunts is theinfection of the central nervous system (CNS).It can lead to prolonged hospital stay, increase the number of operative procedures 03 times more than then none infected cases and has twice the fatality rate. Study of such type of complication will help the patients to improve their health and also improve our sterilization techniques and reduce burden of hospital and patients expenditures. The objective of the study was to determine the frequency of infection after cerebrospinal fluid shunting procedures.Case series study was used as study design.Study was conducted from 10-2010 to 10-06-2011.One hundred and forty four patients with both genders of all age groups undergoing cerebrospinal fluid shunting, meeting inclusion and exclusion criteria, were selected for the present study after informed consent of patient or guardian and approval by the hospital ethical committee. Follow up was ensured by taking the telephonic contact and address of patient.Total no of patients were 144 among which, 89 were males and 55 were females. Age distribution was from 01 month to 75 years with the mean age of 15.280 and standard deviation was ± 20.450. Post-operative infection was present in 20(13.9%) patients.Author’s approvalAll the authors have seen the manuscript and approved it.Declaration of interestNoneConflict/Competing of InterestNone.Disclosure of FundingNone.Ethical ApprovalAttached

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