scholarly journals Acute Subdural Hematoma After Lumboperitoneal Shunt Placement in Patients With Normal Pressure Hydrocephalus-Four Case Reports-

2003 ◽  
Vol 43 (4) ◽  
pp. 197-200 ◽  
Author(s):  
Takanori KAMIRYO ◽  
Jun-ichiro HAMADA ◽  
Isao FUWA ◽  
Yukitaka USHIO
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Subdural Hematoma ◽  
Case Reports ◽  
Normal Pressure ◽  
Acute Subdural Hematoma ◽  
Shunt Placement ◽  
Lumboperitoneal Shunt

scholarly journals Intraoperative ventricular volume restoration by intraventricular Ringer solution injection in a normal-pressure hydrocephalus patient with traumatic bilateral acute subdural hematoma and ventricular system collapse caused by cerebrospinal fluid shunt overdrainage: illustrative case

2021 ◽  
Vol 1 (22) ◽  
Author(s):  
Dalibor Sila ◽  
Karim Morsi ◽  
Markus Lenski ◽  
Stefan Rath
Keyword(s):  
Cerebrospinal Fluid ◽  
Treatment Option ◽  
Normal Pressure Hydrocephalus ◽  
Subdural Hematoma ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Ringer Solution ◽  
Intraventricular Injection ◽  
Acute Subdural Hematoma ◽  
Hematoma Evacuation

BACKGROUND The authors report a case of a patient with normal-pressure hydrocephalus treated with a ventriculoperitoneal shunt who developed a traumatic hemispheric bilateral acute subdural hematoma caused by quick cerebrospinal fluid (CSF) overdrainage. The authors present active ventricular CSF volume restoration as a novel treatment option. CSF overdrainage in patients with shunts may facilitate acute subdural hematoma formation even in cases of minor head trauma. Therapeutic options include CSF shunt function restriction or ligation, hematoma evacuation, or a combination of both. OBSERVATIONS In this case, the authors performed emergency surgery with hematoma evacuation through a bilateral craniotomy and actively restored the volume of the ventricular system with a slow intraventricular injection of 37°C warmed Ringer solution through a shunt burr hole reservoir. LESSONS In addition to hematoma evacuation and restriction of shunt function, the intraoperative restoration of ventricular volume could be a treatment option to prevent postoperative rebleeding or a space-occupying air collection in the subdural space. The risk of possible complications, such as ventricular or parenchymal bleeding, shunt dysfunction, or infections, requires further investigation. Restoration of the ventricular CSF volume by intraventricular injection of Ringer solution was in this case an efficient treatment method to prevent subdural rebleeding and a space-occupying air collection after subdural hematoma evacuation.

Motor cortex disinhibition in normal-pressure hydrocephalus

2012 ◽  
Vol 116 (2) ◽  
pp. 453-459 ◽  
Author(s):  
Andrei V. Chistyakov ◽  
Hava Hafner ◽  
Alon Sinai ◽  
Boris Kaplan ◽  
Menashe Zaaroor
Keyword(s):  
Motor Cortex ◽  
Healthy Volunteers ◽  
Normal Pressure Hydrocephalus ◽  
Close Association ◽  
Motor Evoked Potential ◽  
Normal Pressure ◽  
Corticospinal Excitability ◽  
Conduction Time ◽  
Shunt Placement ◽  
Resting Motor Threshold

Object Previous studies have shown a close association between frontal lobe dysfunction and gait disturbance in idiopathic normal-pressure hydrocephalus (iNPH). A possible mechanism linking these impairments could be a modulation of corticospinal excitability. The aim of this study was 2-fold: 1) to determine whether iNPH affects corticospinal excitability; and 2) to evaluate changes in corticospinal excitability following ventricular shunt placement in relation to clinical outcome. Methods Twenty-three patients with iNPH were examined using single- and paired-pulse transcranial magnetic stimulation of the leg motor area before and 1 month after ventricular shunt surgery. The parameters of corticospinal excitability assessed were the resting motor threshold (rMT), motor evoked potential/M-wave area ratio, central motor conduction time, intracortical facilitation, and short intracortical inhibition (SICI). The results were compared with those obtained in 8 age-matched, healthy volunteers, 19 younger healthy volunteers, and 9 age-matched patients with peripheral neuropathy. Results Significant reduction of the SICI associated with a decrease of the rMT was observed in patients with iNPH at baseline evaluation. Ventricular shunt placement resulted in significant enhancement of the SICI and increase of the rMT in patients who markedly improved, but not in those who failed to improve. Conclusions This study demonstrates that iNPH affects corticospinal excitability, causing disinhibition of the motor cortex. Recovery of corticospinal excitability following ventricular shunt placement is correlated with clinical improvement. These findings support the view that reduced control of motor output, rather than impairment of central motor conduction, is responsible for gait disturbances in patients with iNPH.

scholarly journals Rapid Spontaneous Resolution of Acute Subdural Hematoma Occurs by Redistribution. Two Case Reports.

2001 ◽  
Vol 41 (3) ◽  
pp. 140-143 ◽  
Author(s):  
Noriyuki KATO ◽  
Takashi TSUNODA ◽  
Akira MATSUMURA ◽  
Kiyoyuki YANAKA ◽  
Tadao NOSE
Keyword(s):  
Subdural Hematoma ◽  
Case Reports ◽  
Spontaneous Resolution ◽  
Acute Subdural Hematoma

scholarly journals Prevalence of Cervical Stenosis and Myelopathy in Patients With Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan M Naylor ◽  
Karina Lenartowicz ◽  
Jonathan Graff-Radford ◽  
Jeremy Cutsforth-Gregory ◽  
Benjamin D Elder
Keyword(s):  
Cervical Spine ◽  
Normal Pressure Hydrocephalus ◽  
Cervical Myelopathy ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Decompression Surgery ◽  
Consecutive Series ◽  
Cervical Stenosis ◽  
Shunt Placement

Abstract INTRODUCTION Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. It is possible that some of the patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical stenosis with or without myelopathy in patients with iNPH. METHODS We screened a consecutive series of patients who underwent shunt placement for iNPH for comorbid cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis based on previously published criteria, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS A total of 42 patients with iNPH were included for analysis. Slightly more patients were male (65%), with a mean age of 75 yr (SD 7 yr) for the entire cohort. All patients presented with gait disturbances and underwent cervical spine MRI. 30/42 (71%) had at least cervical stenosis, while 7/42 (17%) had significant (grade 2-3) cervical stenosis with myelopathy requiring surgical decompression. All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSION Clinically significant cervical stenosis is highly prevalent in patients with iNPH, though this finding requires validation in a larger population. Based on these results, cervical imaging should be considered preoperatively or in patients whose gait does not improve after shunt placement.

Unilateral hearing loss following shunt placement for normal pressure hydrocephalus with a unilateral patent cochlear aqueduct

2007 ◽  
Vol 109 (9) ◽  
pp. 799-802 ◽  
Author(s):  
Sun-Ho Lee ◽  
Seong-Hyun Park ◽  
Jaechan Park ◽  
Sung-Kyoo Hwang
Keyword(s):  
Hearing Loss ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Unilateral Hearing Loss ◽  
Shunt Placement ◽  
Cochlear Aqueduct

Acute subdural hematoma due to minor head trauma in patients with a lumboperitoneal shunt

1988 ◽  
Vol 29 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Nobuhiko Aoki ◽  
Hiroshi Mizutani
Keyword(s):  
Head Trauma ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Minor Head Trauma ◽  
Lumboperitoneal Shunt

scholarly journals Phase-contrast magnetic resonance imaging reveals net retrograde aqueductal flow in idiopathic normal pressure hydrocephalus

2016 ◽  
Vol 124 (6) ◽  
pp. 1850-1857 ◽  
Author(s):  
Geir Ringstad ◽  
Kyrre Eeg Emblem ◽  
Per Kristian Eide
Keyword(s):  
Flow Rate ◽  
Normal Pressure Hydrocephalus ◽  
Phase Contrast ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Conservative Group ◽  
Shunt Placement ◽  
Before And After ◽  
Shunt Group ◽  
Antegrade Flow

OBJECT The objective of this study was to assess the net aqueductal stroke volume (ASV) and CSF aqueductal flow rate derived from phase-contrast MRI (PC-MRI) in patients with probable idiopathic normal pressure hydrocephalus (iNPH) before and after ventriculoperitoneal shunt surgery, and to compare observations with intracranial pressure (ICP) scores. METHODS PC-MRI at the level of the sylvian aqueduct was undertaken in patients undergoing assessment for probable iNPH. Aqueductal flow in the craniocaudal direction was defined as positive, or antegrade flow, and net ASV was calculated by subtracting retrograde from antegrade aqueductal flow. Aqueductal flow rate per minute was calculated by multiplying net ASV by heart rate. During the same hospital admission, clinical examination was performed using NPH score and overnight continuous ICP monitoring. Twelve patients were followed prospectively 12 months after shunt placement with clinical assessment and a second PC-MRI. The study also included 2 healthy controls. RESULTS Among 21 patients examined for iNPH, 17 (81%) received a shunt (shunt group), and 4 were treated conservatively (conservative group). Among the patients with shunts, a clinical improvement was observed in 16 (94%) of the 17. Net ASV was negative in 16 (76%) of 21 patients before shunt placement and in 5 (42%) of 12 patients after shunt placement, and increased from a median of −5 μl (range −175 to 27 μl) to a median of 1 μl (range −61 to 30 μl; p = 0.04). Among the 12 patients with PC-MRI after shunt placement, 11 were shunt responders, and in 9 of these 11 either a reduced magnitude of retrograde aqueductal flow, or a complete reversal from retrograde to antegrade flow, occurred. Net ASV was significantly lower in the shunt group than in the conservative group (p = 0.01). The aqueductal flow rate increased from −0.56 ml/min (range −12.78 to 0.58 ml/min) to 0.06 ml/min (range −4.51 to 1.93 ml/min; p = 0.04) after shunt placement. CONCLUSIONS In this cohort of patients with iNPH, retrograde net aqueductal flow was observed in 16 (76%) of 21 patients. It was reversed toward the antegrade direction after shunt placement either by magnitude or completely in 9 (75%) of 12 patients examined using PC-MRI both before and after shunt placement (p = 0.04); 11 of the 12 were shunt responders. The study results question previously established concepts with respect to both CSF circulation pathways and CSF formation rate.

scholarly journals Dopaminergic Degeneration and Small Vessel Disease in Patients with Normal Pressure Hydrocephalus Who Underwent Shunt Surgery

2020 ◽  
Vol 9 (4) ◽  
pp. 1084
Author(s):  
Tze-Wei Chang ◽  
Pao-Hui Tseng ◽  
Yi-Cheng Wang ◽  
Guo-Fang Tseng ◽  
Tsung-Lang Chiu ◽  
...  
Keyword(s):  
White Matter ◽  
Normal Pressure Hydrocephalus ◽  
Small Vessel Disease ◽  
Normal Pressure ◽  
Small Vessel ◽  
Karnofsky Performance Score ◽  
Vessel Disease ◽  
Lumboperitoneal Shunt ◽  
Shunt Treatment ◽  
Dopaminergic Degeneration

The diagnosis of idiopathic normal pressure hydrocephalus (iNPH) and the outcome of lumboperitoneal shunt treatment remains to be systematically explored. Here, we aim to evaluate whether the severity of dopaminergic degeneration and white matter small vessel disease could be predictors of outcome for iNPH patients subjected to lumboperitoneal shunt treatment. This is a single center retrospective study with 39 patients with probable iNPH undergoing programmable surgical lumboperitoneal shunt from June 2016 to March 2018 at Hualien Tzu Chi Hospital. In all patients, dopaminergic degeneration was determined with 99mTc- TRODAT-1 SPECT scan, while white matter small vessel disease (Fazekas scale) was assessed with Brain MRI. The iNPH grading scale (iNPHGS) score and Karnofsky Performance Score (KPS) pre- and post-operation (6-month follow-up) were available for all patients. Linear regression was used to correlate the severities of dopaminergic degeneration and small vessel disease with lumboperitoneal shunt treatment outcomes. Their iNPHGS score improved significantly after surgery (pre-operatively, 7.8 ± 2.6; post-operatively, 5.7 ± 2.6 (26.9% improvement) (p < 0.05)). Moreover, the KPS was also improved significantly after surgery, by a mean of 24.6% from the baseline score (p < 0.05). A significant correlation was observed between the severity of dopaminergic degeneration and a poorer improvement of iNPHGS score (p = 0.03). However, improvement of the iNPHGS score was not correlated with white matter small vessel disease. Dopaminergic degeneration comorbidity neutralized the degree of improvement after surgery. Although white matter small vessel disease was correlated with iNPH incidence, it may not be a prognostic factor for shunt operation. These findings have implications for the use of dopaminergic imaging, as they might help predict the surgical outcome of patients with iNPH, while vascular mechanisms seem to be involved in iNPH pathophysiology.

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