scholarly journals Two cases of normal pressure hydrocephalus caused by ependymoma of the cauda equina

2021 ◽  
Vol 12 ◽  
pp. 8
Author(s):  
Isamu Miura ◽  
Motoo Kubota ◽  
Nobuhiko Momozaki ◽  
Masahito Yuzurihara
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Cauda Equina ◽  
Normal Pressure ◽  
Gait Disturbance ◽  
Myxopapillary Ependymoma ◽  
Tumor Excision ◽  
Vp Shunt ◽  
Brain Ct ◽  
First Case ◽  
Intradural Tumor

Background: Normal pressure hydrocephalus (NPH) associated with tumors of the cauda equina is rare. Here, we report two cases of NPH attributed to cauda equina ependymomas. Case Description: A 63-year-old male presented with progressive gait disturbance, dementia, and urinary incontinence. When the lumbar MR documented an intradural tumor involving the cauda equina at the L2-L3 level; the tumor was excised; pathologically, it proved to be a myxopapillary ependymoma. Postoperatively, however, the patient’s continued gait disturbance led to a brain CT that documented ventricular dilation consistent with NPH; following ventriculoperitoneal (VP) shunt placement his symptoms improved. A 65-year-old female also presented with gait disturbance, dementia, and urinary retention. Here, procedures were performed in reverse. When a brain CT showed hydrocephalus, a VP shunt was placed. When symptoms persisted, a lumbar MR demonstrated a T12-L2 intradural tumor; following a lumbar laminectomy for tumor excision, symptoms stabilized. The pathological diagnosis was also consistent with a conus/cauda equina ependymoma. Over the next 10 years, the patient had residual bladder dysfunction (e.g., requiring straight catheterization), but had no shunt dysfunction. Conclusion: We observed two cases of ependymomas of the cauda equina and brain CTs documenting NPH that was successfully surgically managed with stabilization of neurological deficit. In the first case, L2-L3 laminectomy for tumor removal was succeeded by shunting for NPH, while in the second case, initial VP shunting for NPH was followed by a T12-L2 laminectomy for tumor excision.

scholarly journals Cauda Equina Neurinoma Associated with Normal Pressure Hydrocephalus

1990 ◽  
Vol 30 (4) ◽  
pp. 258-262 ◽  
Author(s):  
Kenki NISHIDA ◽  
Shin UEDA ◽  
Keizou MATSUMOTO ◽  
Kazumasa KUSAKA ◽  
Renichi TAKEUCHI
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Cauda Equina ◽  
Normal Pressure

Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 129-134 ◽  
Author(s):  
Michelangelo Gangemi ◽  
Francesco Maiuri ◽  
Simona Buonamassa ◽  
Giuseppe Colella ◽  
Enrico de Divitiis
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Gait Disturbance ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Duration Of Symptoms ◽  
Cerebrospinal Fluid Flow

Abstract OBJECTIVE: To define the role and indications for an endoscopic third ventriculostomy (ETV) in patients with idiopathic normal pressure hydrocephalus (INPH). A series of 25 patients treated by endoscopic technique was analyzed, and the results were compared with those of 14 studies reporting patients treated by shunting. METHODS: Twenty-five patients with INPH were treated by ETV from January 1994 through December 2000. All were younger than 75 years of age, had a preoperative clinical history of 1 year or less, had prevalence of gait disturbance with scarce or mild dementia, had marked ventricular enlargement on magnetic resonance imaging (MRI), and had intracranial pressure values ranging from 8 to 12 mm Hg. All were studied by a phase-contrast MRI flow study 1 month after ETV. The 14 reviewed series of patients treated by shunting (all published after 1980) each include more than 25 patients, for a total of 777 patients. RESULTS: The overall rate of neurological improvement after ETV in our series was 72% (including two patients reoperated on because of absence of flow in the MRI scan); this percentage is slightly higher than that found in the 14 series of shunted patients (66%). Gait disturbance showed a high rate of improvement when compared with other symptoms, both in our ETV study and in other shunting series. Postoperative complications occurred only in one patient (4%) with an intracerebral frontal hemorrhage and in 37.9% of patients from the series including shunted patients. CONCLUSION: In patients with INPH showing short duration of symptoms, prevalence of gait disturbance, and slight mental impairment, ETV provides similar results to those of shunting. We suggest performing ETV in these patients and reserving shunting only for those who do not improve after ETV, despite the presence of cerebrospinal fluid flow through the ventriculostomy on MRI flow studies. The good results after ETV in our series indirectly confirm that the cerebrospinal fluid absorption is good or at least sufficient in selected patients with INPH.

Disability risk or unimproved symptoms following shunt surgery in patients with idiopathic normal-pressure hydrocephalus: post hoc analysis of SINPHONI-2

2016 ◽  
Vol 126 (6) ◽  
pp. 2002-2009 ◽  
Author(s):  
Shigeki Yamada ◽  
Teruo Kimura ◽  
Naoto Jingami ◽  
Masamichi Atsuchi ◽  
Osamu Hirai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Normal Pressure Hydrocephalus ◽  
Symptom Severity ◽  
Disease Duration ◽  
Normal Pressure ◽  
Gait Disturbance ◽  
Shunt Surgery ◽  
Tap Test ◽  
Relative Risks

OBJECTIVEThe study aim was to assess the influence of presurgical clinical symptom severity and disease duration on outcomes of shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH). The authors also evaluated the cerebrospinal fluid tap test as a predictor of improvements following shunt surgery.METHODSEighty-three patients (45 men and 38 women, mean age 76.4 years) underwent lumboperitoneal shunt surgery, and outcomes were evaluated until 12 months following surgery. Risks for poor quality of life (Score 3 or 4 on the modified Rankin Scale [mRS]) and severe gait disturbance were evaluated at 3 and 12 months following shunt surgery, and the tap test was also conducted. Age-adjusted and multivariate relative risks were calculated using Cox proportional-hazards regression.RESULTSOf 83 patients with iNPH, 45 (54%) improved by 1 point on the mRS and 6 patients (7%) improved by ≥ 2 points at 3 months following surgery. At 12 months after surgery, 39 patients (47%) improved by 1 point on the mRS and 13 patients (16%) improved by ≥ 2 points. On the gait domain of the iNPH grading scale (iNPHGS), 36 patients (43%) improved by 1 point and 13 patients (16%) improved by ≥ 2 points at 3 months following surgery. Additionally, 32 patients (38%) improved by 1 point and 14 patients (17%) by ≥ 2 points at 12 months following surgery. In contrast, 3 patients (4%) and 2 patients (2%) had worse symptoms according to the mRS or the gait domain of the iNPHGS, respectively, at 3 months following surgery, and 5 patients (6%) and 3 patients (4%) had worse mRS scores and gait domain scores, respectively, at 12 months after surgery. Patients with severe preoperative mRS scores had a 4.7 times higher multivariate relative risk (RR) for severe mRS scores at 12 months following surgery. Moreover, patients with severe gait disturbance prior to shunt surgery had a 46.5 times greater multivariate RR for severe gait disturbance at the 12-month follow-up. Patients without improved gait following the tap test had multivariate RRs for unimproved gait disturbance of 7.54 and 11.2 at 3 and 12 months following surgery, respectively. Disease duration from onset to shunt surgery was not significantly associated with postoperative symptom severity or unimproved symptoms.CONCLUSIONSPatients with iNPH should receive treatment before their symptoms become severe in order to achieve an improved quality of life. However, the progression of symptoms varies between patients so specific timeframes are not meaningful. The authors also found that tap test scores accurately predicted shunt efficacy. Therefore, indications for shunt surgery should be carefully assessed in each patient with iNPH, considering the relative risks and benefits for that person, including healthy life expectancy.

scholarly journals Case Report: Lesson Learned from Rehabilitation Medicine Point of View for an Elderly with Normal Pressure Hydrocephalus

2021 ◽  
Vol 9 (C) ◽  
pp. 133-135
Author(s):  
Irma Ruslina Defi ◽  
Andre Andre ◽  
Sunaryo Barki Sastradimadja ◽  
Ahmad Faried
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Normal Pressure Hydrocephalus ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Normal Pressure ◽  
Gait Disturbance ◽  
Physical Medicine ◽  
Rehabilitation Intervention ◽  
Physical Medicine And Rehabilitation

BACKGROUND: Normal pressure hydrocephalus (NPH) is characterized by an abnormal buildup of cerebrospinal fluid in the ventricles or cavities of the brain. The objective of the case report was to define the importance of physical medicine and rehabilitation intervention as an approach for an elderly patient with NPH. CASE REPORT: A 75-year-old woman presented with a balance and gait disturbance after injury from a motor vehicle accident. The patient experience Hakim’s triad (gait disturbance, urinary frequency, and mild cognitive impairment), and her computed tomography scan of the head revealed ventriculomegaly, multiple lacunar infarctions on the paraventricle, and cerebral atrophy, which could indicate NPH. Balance and gait training, cardiopulmonary training, and environment modification were interventions from physical medicine and rehabilitation provided to this patient. CONCLUSION: An elderly patient with NPH should receive physical medicine and rehabilitation intervention to prevent falls, improve functional ability, and improve quality of life.

scholarly journals Outcome in Normal Pressure Hydrocephalus after Ventriculoperitoneal Shunt in Tertiary Care Hospital

2021 ◽  
Vol 24 (4) ◽  
pp. 343-349
Author(s):  
Abdul Samad Panezai ◽  
Aurangzeb Kalhoro ◽  
Sher Hassan ◽  
Farrukh Javeed ◽  
Lal Rehman
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Normal Pressure ◽  
Care Hospital ◽  
Vp Shunt ◽  
Excellent Outcome ◽  
Ct Brain ◽  
Biochemical Analyses

Objective:  To determine the outcome of the ventriculoperitoneal shunt in normal pressure hydrocephalus. Material and Methods:  This study was conducted at Jinnah Postgraduate Medical Centre, a tertiary care hospital in Karachi. Patients with idiopathic normal pressure hydrocephalus (NPH) were included. Gender distribution, presentation of symptoms and post-operative outcome based on the Stein Langfitt Scale were assessed. CSF was sent for microbiological and biochemical analyses. All patients were evaluated preoperatively and compared postoperatively during 6 months duration for improvement and any associated complication. Results:  In this study, we had 47 patients, 38 were male and 9 were female. 22 patients presented with dementia, 18 with urinary incontinence, 17 with gait disturbance 17, while 21 had headache based on Stein and Langfitt Scale. The 78.8% patients had an excellent outcome, 17% had a good outcome and 4.2% had poor results. Conclusion:  Ventriculoperitoneal (VP) shunt had promising results selected on history and examination of normal pressure hydrocephalus and improved radiological in Evan’s ratio CT brain scan. Keywords:  Normal Pressure Hydrocephalus (NPH), VP Shunt, Stein and Langfitt Scale.

scholarly journals Idiopathic Normal Pressure Hydrocephalus: Surgical Outcome of Endoscopic Third Ventriculostomy Comparing VP Shunt

2020 ◽  
pp. 54-58
Author(s):  
Md. Moshiur Rahman ◽  
K. M. Ziaur Rahman
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Surgical Outcome ◽  
Endoscopic Third Ventriculostomy ◽  
Scoring Systems ◽  
Normal Pressure ◽  
Third Ventriculostomy ◽  
Arachnoid Granulation ◽  
Vp Shunt ◽  
Csf Absorption ◽  
Good Success Rate

Background: Normal-pressure hydrocephalus (NPH) affects the older people and the presentations are gait disturbance, incontinence and dementia. The reason is still unknown and there is increased CSF volume causing pressure to the periventricular brain causing the symptoms where there is no evidence of absorption failure or obstruction of the CSF pathway. Aims: The main objective of this study is to compare the surgical outcome of endoscopic third ventriculostomy (ETV) and VP shunt (VPS) in NPH. Methodology: A total of 24 patients were included in the study where 12 patients underwent ETV and 12 patients VPS. Patients having a definite cause of hydrocephalus and multiple co-morbid diseases were excluded from the study. Various Scoring systems were studied to see the efficiency of ETV. Results: About 60% of patients were successfully recovered. 40% needed to revision surgery either VP shunt or LP shunt. Some scales showed higher effieciency of ETV. Conclusion: ETV in NPH is a safe and effective procedure. Whether the CSF absorption is hampered at arachnoid granulation is doubtful for failure cases. ETV is a short procedure with a good success rate in selected patients.

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