Persisting Intraventricular Fat-Fluid Levels following Surgery on a Ruptured Dermoid Cyst of the Posterior Fossa

Intracranial dermoid cysts occasionally rupture spontaneously into the ventricles or into the subarachnoid space. In such cases, intraventricular fat-fluid levels are invariably evident at computed tomography and may even be visible on a conventional radiograph of the skull. A case is described in which fat was observed to remain in the ventricles long after surgical removal of a dermoid cyst. We think that this fat, by causing obstruction of the cerebrospinal fluid pathways, should be regarded as a potential cause of intermittent elevation of intracranial pressure.

Download Full-text

Hemangioma Calcificans in the Fourth Ventricle

Neurosurgery ◽

10.1227/00006123-198406000-00016 ◽

1984 ◽

Vol 14 (6) ◽

pp. 737-739 ◽

Cited By ~ 7

Author(s):

Kobayashi Hidenori ◽

Kawano Hirokazu ◽

Ito Haruhide ◽

Hayashi Minoru ◽

Yamamoto Shinjiro

Keyword(s):

Computed Tomography ◽

Intracranial Pressure ◽

Posterior Fossa ◽

Clinical Picture ◽

Fourth Ventricle ◽

Obstructive Hydrocephalus ◽

Increased Intracranial Pressure ◽

X Ray ◽

4Th Ventricle

Abstract A case of hemangioma calcificans in the 4th ventricle is reported. Skull x-ray films demonstrated a dense calcification in the posterior fossa. Computed tomography disclosed a hyperdense mass in the 4th ventricle. The clinical picture was of increased intracranial pressure due to obstructive hydrocephalus. An hemangioma calcificans in the 4th ventricle was removed successfully.

Download Full-text

Increased Intracranial Pressure

Pediatrics in Review ◽

10.1542/pir.2.9.269 ◽

1981 ◽

Vol 2 (9) ◽

pp. 269-276

Author(s):

John F. Griffith ◽

Jimmy C. Brasfield

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Subarachnoid Space ◽

Buffering Capacity ◽

Raised Intracranial Pressure ◽

Cranial Cavity ◽

Increased Intracranial Pressure ◽

Underlying Process ◽

Spinal Subarachnoid Space ◽

Rate Of Absorption

The infant or child with increasing pressure within the cranial cavity must be identified early and treated promptly in order to prevent serious complications or death. When the pressure elevation is gradual it is frequently well tolerated, and the patient may seem deceptively well. There is a critical point, however, beyond which any further increase in pressure leads to a catastrophic deterioration in the patient's condition.1 When this occurs, the outlook for quality survival is poor despite the best therapy. Unfortunately, this can occur when the underlying process is benign and would have been reversible if recognized and treated promptly. For prompt recognition and treatment, the physician must be familiar with the pathophysiology of raised intracranial pressure. PATHOPHYSIOLOGY The intracranial compartment contains blood vessels, cerebrospinal fluid (CSF), brain, and leptomeninges which include the rigid dural membranes forming the falx and tentorium. Whenever there is an increase in the volume of any one of these intracranial components (brain, CSF, blood) there must be a corresponding reduction in the size of the others in order for the intracranial pressure to remain normal. This type of compensation or buffering capacity is particularly important in the early stages of intracranial disease. As the pressure mounts from any type of mass lesion, the CSF is displaced caudally into the spinal subarachnoid space and there is a corresponding increase in the rate of absorption of CSF.2

Download Full-text

Ventricular Obstruction Secondary to Vascular Malformations

Neurosurgery ◽

10.1227/00006123-198305000-00018 ◽

1983 ◽

Vol 12 (5) ◽

pp. 572-575 ◽

Cited By ~ 13

Author(s):

Sang U. Hoi ◽

Charles Kerber

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Arteriovenous Malformation ◽

Clinical Picture ◽

Vascular Malformations ◽

Increased Intracranial Pressure ◽

Venous Varix

Abstract Enlarged veins in two vascular malformations blocked the cerebrospinal fluid outflow pathways, causing hydrocephalus. Both patients presented not with the usual clinical picture (hemorrhage, seizure, etc.), but with signs of increased intracranial pressure. Computed tomography and angiography were necessary to understand the pathophysiology. An arteriovenous malformation was responsible for the first patient's headache, and a venous varix was the causative lesion in the second patient. Hydrocephalus caused by a venous varix has not been reported before.

Download Full-text

Altered Cerebrospinal Fluid Clearance and Increased Intracranial Pressure in Rats 18 h After Experimental Cortical Ischaemia

Frontiers in Molecular Neuroscience ◽

10.3389/fnmol.2021.712779 ◽

2021 ◽

Vol 14 ◽

Author(s):

Steven W. Bothwell ◽

Daniel Omileke ◽

Rebecca J. Hood ◽

Debbie-Gai Pepperall ◽

Sara Azarpeykan ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Lymph Nodes ◽

Subarachnoid Space ◽

Ex Vivo ◽

Bimodal Distribution ◽

Cervical Lymph Nodes ◽

Post Stroke ◽

Spinal Subarachnoid Space

Oedema-independent intracranial pressure (ICP) rise peaks 20–22-h post-stroke in rats and may explain early neurological deterioration. Cerebrospinal fluid (CSF) volume changes may be involved. Cranial CSF clearance primarily occurs via the cervical lymphatics and movement into the spinal portion of the cranio-spinal compartment. We explored whether impaired CSF clearance at these sites could explain ICP rise after stroke. We recorded ICP at baseline and 18-h post-stroke, when we expect changes contributing to peak ICP to be present. CSF clearance was assessed in rats receiving photothrombotic stroke or sham surgery by intraventricular tracer infusion. Tracer concentration was quantified in the deep cervical lymph nodes ex vivo and tracer transit to the spinal subarachnoid space was imaged in vivo. ICP rose significantly from baseline to 18-h post-stroke in stroke vs. sham rats [median = 5 mmHg, interquartile range (IQR) = 0.1–9.43, n = 12, vs. −0.3 mmHg, IQR = −1.9–1.7, n = 10], p = 0.03. There was a bimodal distribution of rats with and without ICP rise. Tracer in the deep cervical lymph nodes was significantly lower in stroke with ICP rise (0 μg/mL, IQR = 0–0.11) and without ICP rise (0 μg/mL, IQR = 0–4.47) compared with sham rats (4.17 μg/mL, IQR = 0.74–8.51), p = 0.02. ICP rise was inversely correlated with faster CSF transit to the spinal subarachnoid space (R = −0.59, p = 0.006, Spearman’s correlation). These data suggest that reduced cranial clearance of CSF via cervical lymphatics may contribute to post-stroke ICP rise, partially compensated via increased spinal CSF outflow.

Download Full-text

Posterior Fossa Subdural Hemorrhage in the Newborn

PEDIATRICS ◽

10.1542/peds.65.1.40 ◽

1980 ◽

Vol 65 (1) ◽

pp. 40-43 ◽

Cited By ~ 1

Author(s):

C. L. Serfontein ◽

S. Rom ◽

S. Stein

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Posterior Fossa ◽

Subdural Hematoma ◽

Head Circumference ◽

Cranial Nerves ◽

Subdural Hemorrhage ◽

Anterior Fontanelle ◽

Hematoma Formation ◽

Diagnostic Delays

Posterior fossa subdural hematoma formation in the newborn is an infrequently reported event. It is characterized by a complicated delivery, usually at term, followed by developing lethargy and irritability within the first few days of life. Respiratory irregularities, tense anterior fontanelle, and increasing head circumference ensue, accompanied by a falling hemoglobin and blood-stained cerebrospinal fluid. Various cranial nerves may also be involved. Previously reported cases have been marked by diagnostic delays that affected the subsequent outcome of some of the patients. Computed tomography (CT) allows for earlier confirmation of the diagnosis, especially where coronal views are employed. Three cases are reported here to illustrate the above features.

Download Full-text

Computed Tomography Measurement and Evaluation of the Subarachnoid Space Over Cerebral Convexities in Infants Aged 1-24 Months

Journal of Child Neurology ◽

10.1177/0883073820977998 ◽

2020 ◽

pp. 088307382097799

Author(s):

Ke Yu ◽

Minggang Yi ◽

Ruodi Cui ◽

Tao Gong ◽

Chunhua Dong ◽

...

Keyword(s):

Computed Tomography ◽

Cerebrospinal Fluid ◽

Subarachnoid Space ◽

Ct Images ◽

Temporal Region ◽

Stable Range ◽

Upper Limit ◽

Measurement And Evaluation ◽

Definition Of ◽

Space Width

A widened subarachnoid space might be pathologic, potentially pathologic, or simply a normal developmental variant. However, the definition of a normal subarachnoid space width in infants remains unclear, especially on computed tomography (CT) images. To determine the physiological subarachnoid space width among infants aged 1-24 months, its upper limit, and changes with age, we measured the cerebrospinal fluid width on 538 CT images. Measurements were obtained at fixed planes and fixed positions to prevent variance and increase comparability between patients. We observed an asymmetry in the cerebrospinal fluid width of the temporal region. The width increased in all positions until 4-6 months of age, after which it began to decrease, reaching a relatively stable range in infants aged 13-24 months. We suggest considering the 95th percentile of the cerebrospinal fluid width as the upper limit. The correlation between age and the subarachnoid space width should be considered during clinical diagnosing.

Download Full-text

Seizure Prophylaxis in Traumatic Brain Injury: A Comparative Study of Levetiracetam and Phenytoin Cerebrospinal Fluid Levels in Trauma Patients with Signs of Increased Intracranial Pressure Requiring Ventriculostomy

Cureus ◽

10.7759/cureus.5784 ◽

2019 ◽

Author(s):

Bailey Zampella ◽

Tye Patchana ◽

James G Wiginton ◽

James Brazdzionis ◽

Marc Billings ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Cerebrospinal Fluid ◽

Brain Injury ◽

Intracranial Pressure ◽

Comparative Study ◽

Trauma Patients ◽

Increased Intracranial Pressure ◽

Cerebrospinal Fluid Levels ◽

Seizure Prophylaxis ◽

Fluid Levels

Download Full-text

Extraneural Metastatic Medulloblastoma during Childhood

Neurosurgery ◽

10.1227/00006123-198111000-00010 ◽

1981 ◽

Vol 9 (5) ◽

pp. 548-551 ◽

Cited By ~ 28

Author(s):

Gordon J. McComb ◽

Richard L. Davis ◽

Hart Isaacs

Keyword(s):

Cerebrospinal Fluid ◽

Los Angeles ◽

Posterior Fossa ◽

Subarachnoid Space ◽

Surgical Intervention ◽

Cerebellar Vermis ◽

Childrens Hospital ◽

Neck Masses ◽

Tumor Involvement

Abstract From 1960 to 1977, 59 patients with histologically confirmed medulloblastoma were initially treated at Childrens Hospital of Los Angeles. Of this group, 49 have died and, of these, 34 were autopsied. Among the autopsied cases, 2 infants had neck masses that proved to be medulloblastoma that had spread from the cerebellar vermis before any surgical intervention. Four additional patients who had undergone a posterior fossa craniectomy without either the pre- or postoperative placement of a cerebrospinal fluid-diverting shunt were found to have extraneural metastatic medulloblastoma at autopsy. The extraneural metastatic medulloblastoma rate in the autopsied cases was 17.6% (6 of 34). Our series shows that the incidence of the extraneural spread of medulloblastoma is associated with being young, being male, and having diffuse tumor involvement of the subarachnoid space.

Download Full-text