scholarly journals Anatomical configurations associated with posthemorrhagic hydrocephalus among premature infants with intraventricular hemorrhage

2016 ◽  
Vol 41 (5) ◽  
pp. E5 ◽  
Author(s):  
Hannah M. Tully ◽  
Tara L. Wenger ◽  
Walter A. Kukull ◽  
Dan Doherty ◽  
William B. Dobyns
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Surgical Planning ◽  
Surgical Intervention ◽  
Brain Mri ◽  
Mr Images ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
The Mean ◽  
Grade Iii

OBJECTIVE Intraventricular hemorrhage (IVH) is a complication of prematurity often associated with ventricular dilation, which may resolve over time or progress to posthemorrhagic hydrocephalus (PHH). This study investigated anatomical factors that could predispose infants with IVH to PHH. METHODS The authors analyzed a cohort of premature infants diagnosed with Grade III or IV IVH between 2004 and 2014. Using existing ultrasound and MR images, the CSF obstruction pattern, skull shape, and brain/skull ratios were determined, comparing children with PHH to those with resolved ventricular dilation (RVD), and comparing both groups to a set of healthy controls. RESULTS Among 110 premature infants with Grade III or IV IVH, 65 (59%) developed PHH. Infants with PHH had more severe ventricular dilation compared with those with RVD, although ranges overlapped. Intraventricular CSF obstruction was observed in 36 (86%) of 42 infants with PHH and 0 (0%) of 18 with RVD (p < 0.001). The distribution of skull shapes in infants with PHH was similar to those with RVD, although markedly different from controls. No significant differences in supratentorial brain/skull ratio were observed; however, the mean infratentorial brain/skull ratio of infants with PHH was 5% greater (more crowded) than controls (p = 0.006), whereas the mean infratentorial brain/skull ratio of infants with RVD was 8% smaller (less crowded) than controls (p = 0.004). CONCLUSIONS Among premature infants with IVH, intraventricular obstruction and infratentorial crowding are strongly associated with PHH, further underscoring the need for brain MRI in surgical planning. Prospective studies are required to determine which factors are cause and which are consequence, and which can be used to predict the need for surgical intervention.

External ventricular drainage for control of posthemorrhagic hydrocephalus in premature infants

1981 ◽  
Vol 55 (5) ◽  
pp. 766-770 ◽  
Author(s):  
Robert E. Harbaugh ◽  
Richard L. Saunders ◽  
William H. Edwards
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Medical Problems ◽  
Posthemorrhagic Hydrocephalus ◽  
Content Type ◽  
The Mean ◽  
Tunneled Catheter ◽  
Initial Method

✓ Over a 3-year period, 11 premature infants with intraventricular hemorrhage and posthemorrhagic hydrocephalus were managed initially with prolonged external ventricular drainage via a subcutaneously tunneled catheter. The mean duration of drainage for this group was 20.7 days. Although two patients died before shunting was considered, no morbidity or mortality was observed to result from this technique. Seven patients required a shunt after stabilization of their medical problems. Two patients, followed for 24 and 40 months, have not required shunting procedures. External ventricular drainage via a subcutaneously tunneled catheter has been found to be a safe and reliable initial method of treating posthemorrhagic hydrocephalus in premature infants.

Blood Pressure and Intraventricular Hemorrhage in Premature Infants

PEDIATRICS ◽  
1990 ◽  
Vol 86 (6) ◽  
pp. 1006-1007
Author(s):  
EDWARD H. PERRY ◽  
HENRIETTA S. BADA ◽  
JOHN D. DAY ◽  
SHELDON B. KORONES ◽  
KRISTOPHER L. ARHEART ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Birth Weight ◽  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Stability Boundary ◽  
Mean Blood Pressure ◽  
Pressure Increase ◽  
Blood Pressure Increase ◽  
The Mean

In Reply.— We appreciate the interest and comments of Drs Puccio and Soliani regarding our article "Blood Pressure Increase, Birth Weight Dependent Stability Boundary and Intraventricular Hemorrhage."1 In response, we address the following points: 1. Although mean blood pressure (BP) values greater than 100 mm Hg were observed in some of our patients, these were quite rare. The mean BP was found to be less than 60 mm Hg 99% of the time. Thus, unless one is recording BPs through long periods and sampling quite often, the brief spikes likely would not be observed.

Ventricular reservoirs and ventriculoperitoneal shunts for premature infants with posthemorrhagic hydrocephalus: an institutional experience

2009 ◽  
Vol 3 (2) ◽  
pp. 94-100 ◽  
Author(s):  
Brian Willis ◽  
Vijayakumar Javalkar ◽  
Prasad Vannemreddy ◽  
Gloria Caldito ◽  
Junko Matsuyama ◽  
...  
Keyword(s):  
Birth Weight ◽  
Surgical Treatment ◽  
Premature Infants ◽  
Preterm Neonates ◽  
Posthemorrhagic Hydrocephalus ◽  
Vp Shunt ◽  
Shunt Group ◽  
Institutional Experience ◽  
Csf Diversion ◽  
The Mean

Object The aim of the study was to analyze the outcome of surgical treatment for posthemorrhagic hydrocephalus in premature infants. Methods From 1990 to 2006, 32 premature infants underwent surgical treatment for posthemorrhagic hydrocephalus, and their charts were retrospectively reviewed to analyze the complications and outcome with respect to shunt revisions. Multivariate analysis and time series were used to identify factors that influence the outcome in terms of shunt revisions. Results The mean gestational age was 27 ± 3.3 weeks, and mean birth weight was 1192 ± 660 g. Temporary reservoir placement was performed in 15 patients, while 17 underwent permanent CSF diversion with a ventriculoperitoneal (VP) shunt. In 2 patients, reservoir tapping alone was sufficient to halt the progression of hydrocephalus; 29 patients received VP shunts. The mean follow-up period was 37.3 months. The neonates who received VP shunts first were significantly older (p = 0.02) and heavier (p = 0.04) than those who initially underwent reservoir placement. Shunts were revised in 14 patients; 42% of patients in the reservoir group had their shunts revised, while 53% of infants who had initially received a VP shunt required a revision. The revision rate per patient in the reservoir group was half that in the direct VP shunt group (p = 0.027). No patient in the reservoir group had > 2 revisions. Shunt infections developed in 3 patients (10.3%), and 2 patients in the reservoir group died of nonneurological issues related to prematurity. Conclusions Birth weight and age are useful parameters in decision making. Preterm neonates with low birth weights benefit from initial CSF drainage procedures followed by permanent CSF diversion with respect to the number of shunt revisions.

scholarly journals Premature Infants with Intraventricular Hemorrhage and Perioperative Management of Neonatal Posthemorrhagic Hydrocephalus

2013 ◽  
Vol 22 (4) ◽  
pp. 276-282
Author(s):  
Masakazu Miyajima ◽  
Takaoki Kimura ◽  
Akihide Kondo ◽  
Kazuaki Shimoji ◽  
Hajime Arai
Keyword(s):  
Premature Infants ◽  
Intraventricular Hemorrhage ◽  
Perioperative Management ◽  
Posthemorrhagic Hydrocephalus

A Potential Mechanism of Pathogenesis for Early Posthemorrhagic Hydrocephalus in the Premature Newborn

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 19-21
Author(s):  
Alan Hill ◽  
Gary D. Shackelford ◽  
Joseph J. Volpe
Keyword(s):  
Particulate Matter ◽  
Posterior Fossa ◽  
Intraventricular Hemorrhage ◽  
Ventricular System ◽  
Potential Mechanism ◽  
Ultrasound Scanning ◽  
Csf Flow ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Expected Time

Ventricular dilation is common following intraventricular hemorrhage. Neuropathologic studies have demonstrated that chronic posthemorrhagic hydrocephalus most commonly is a result of an obliterative arachnoiditis in the posterior fossa or is due to obstruction of flow of CSF within the ventricular system. Recent use of ultrasound scanning has demonstrated the occurrence of ventricular dilation within days of intraventricular hemorrhage (prior to the expected time of development of arachnoiditis). In the case described, serial realtime ultrasound scans demonstrated small mobile particles within dilated ventricles seven days following intraventicular hemorrhage. There was no obstruction of CSF flow within the ventricular system. Thus, in this case, ventricular dilation may have been secondary to plugging of arachnoid villi by the small particulate matter and, as a consequence, decrease in CSF reabsorption.

Intraventricular Hemorrhage in the Term Infant

2000 ◽  
Vol 19 (7) ◽  
pp. 13-18 ◽  
Author(s):  
Stacy Fink
Keyword(s):  
Intraventricular Hemorrhage ◽  
Term Infant ◽  
Labor And Delivery ◽  
Posthemorrhagic Hydrocephalus ◽  
Term Newborn ◽  
Grade Iii

Intraventricular hemorrhage (IVH) in the term infant is an uncommon and unexpected diagnosis. This article examines the frequency of IVH in the term newborn; the pathogenesis behind IVH; the presentation according to the location, extent, and cause of the hemorrhage; the diagnosis, associated complications, management, and outcomes of infants with IVH; and nursing responsibilities. A case study is offered of a term infant who presented with seizures after a normal labor and delivery, was found to have bilateral Grade III hemorrhages, and proceeded to develop posthemorrhagic hydrocephalus. Her management and outcome to date are discussed.

Ventricular Dilation Following Periventricular-Intraventricular Hemorrhage: Outcome at Age 1 Year

PEDIATRICS ◽  
1984 ◽  
Vol 73 (2) ◽  
pp. 158-162
Author(s):  
Walter C. Allan ◽  
Douglas A. Dransfield ◽  
Alison M. Tito
Keyword(s):  
Intraventricular Hemorrhage ◽  
Neonatal Period ◽  
Neurodevelopmental Outcome ◽  
Expectant Management ◽  
Ventricular Size ◽  
Ventricular Dilation ◽  
Posthemorrhagic Hydrocephalus ◽  
Neurodevelopmental Delay ◽  
Ventriculoperitoneal Shunting ◽  
Neurodevelopmental Abnormalities

Ventricular dilation following periventricular-intraventricular hemorrhage can be managed without ventriculoperitoneal shunting in most cases. Twenty-six patients who had periventricular-intraventricular hemorrhage with subsequent ventricular dilation were examined at 1 year of age for neurodevelopmental outcome and hydrocephalus. As previously reported, ventricular dilation may be divided into two groups: ventriculomegaly and posthemorrhagic hydrocephalus. Fourteen patients with ventriculomegaly were followed up with serial ultrasound observations only, and 12 patients with posthemorrhagic hydrocephalus had temporary drainage of ventricular fluid. Only three patients with posthemorrhagic hydrocephalus required ventriculoperitoneal shunting in the neonatal period. Neurodevelopmental abnormalities were found in eight infants who had posthemorrhagic hydrocephalus and two who had ventriculomegaly. Six of these infants had intraparenchymal injury demonstrated by ultrasound, five as a result of the original hemorrhage and 1 by infection. A single infant with posthemorrhagic hydrocephalus, discharged from the hospital with stable ventricular size, developed hydrocephalus and neurodevelopmental delay after the neonatal period. This reversed with ventriculopenitoneal shunting at 1 year of age. It is suggested that even in patients developing ventricular dilation following periventricular-intraventricular hemorrhage, it is the primary intraparenchymal injury that is responsible for subsequent morbidity. Thus, provided serial reevaluations are possible, an expectant management of ventricular dilation is justified.

scholarly journals Comparison of Gadovist and Magnevist in brain Magnetic resonance imaging of multiple sclerosis patients with an acute attack

2021 ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Multiple Sclerosis ◽  
Brain Mri ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Mr Images ◽  
Contrast Injection ◽  
P Values ◽  
Contrast Enhanced ◽  
The Mean

Objective: The use of an appropriate contrast agent performs a major role in brain magnetic resonance imaging (MRI) of multiple sclerosis (MS) patients. The present study aimed to make a comparison between the diagnostic values of Gadovist and Magnevist considering the successive imaging times in contrast-enhanced brain MRI of MS patients. Materials and Methods: A total of 62 relapsing-remitting MS patients (56 females, mean age of 31 years) were enrolled in the present study. All of them underwent two sessions of standard contrast-enhanced brain MRI upon enrollment and 48 h later. The participants were randomly assigned to each contrast agent. T1-weighted (T1W) images were taken 30 sec, as well as 5, 10, 15, and 30 min after the contrast injection. For all of the images, two neuro-radiologists who were blinded to the contrast type counted the number of plaques in the brain. In addition, for the enhanced plaques larger than 10 mm, the signal intensity (SI) was determined using its region of interest. Results: The mean plaque number significantly increased from 30 sec to 15 min for both contrasts separately (P<0.001). Nonetheless, the slight increases in the mean plaque number from 15-30 min for both Gadovist and Magnevist were not statistically significant (both P-Values>0.25). The mean plaque number in the Gadovist group was higher, compared to that in the Magnevist group at both 15 and 30 min, and the differences were statistically on the borderline (both P-Values=0.07). The mean SI of enhanced plaques gradually increased in the course of imaging in both contrast groups. Except for 30 sec, in all other time sessions, the mean SI was higher in Gadovist-enhanced MR images, compared to Magnevist-enhanced MR images (P<0.01). Conclusion: As evidenced by the obtained results, Gadovist showed a relatively better diagnostic value for brain MRI of MS patients. Furthermore, the findings suggested that it is cost-effective to take MRI only up to 15 min (instead of 30 min) after contrast injection in both agents.

scholarly journals Functional outcomes at 2 years of age following treatment for posthemorrhagic hydrocephalus of prematurity: what do we know at the time of consult?

2020 ◽  
Vol 25 (5) ◽  
pp. 453-461 ◽  
Author(s):  
Samuel G. McClugage ◽  
Nicholas M. B. Laskay ◽  
Brian N. Donahue ◽  
Anastasia Arynchyna ◽  
Kathrin Zimmerman ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Visual Impairment ◽  
Premature Infants ◽  
Logistic Regression Analysis ◽  
Gestational Age ◽  
Functional Outcomes ◽  
Independent Predictor ◽  
Posthemorrhagic Hydrocephalus ◽  
Grade Iii

OBJECTIVEPosthemorrhagic hydrocephalus of prematurity remains a significant problem in preterm infants. In the literature, there is a scarcity of data on the early disease process, when neurosurgeons are typically consulted for recommendations on treatment. Here, the authors sought to evaluate functional outcomes in premature infants at 2 years of age following treatment for posthemorrhagic hydrocephalus. Their goal was to determine the relationship between factors identifiable at the time of the initial neurosurgical consult and outcomes of patients when they are 2 years of age.METHODSThe authors performed a retrospective chart review of premature infants treated for intraventricular hemorrhage (IVH) of prematurity (grade III and IV) between 2003 and 2014. Information from three time points (birth, first neurosurgical consult, and 2 years of age) was collected on each patient. Logistic regression analysis was performed to determine the association between variables known at the time of the first neurosurgical consult and each of the outcome variables.RESULTSOne hundred thirty patients were selected for analysis. At 2 years of age, 16% of the patients had died, 88% had cerebral palsy/developmental delay (CP), 48% were nonverbal, 55% were nonambulatory, 33% had epilepsy, and 41% had visual impairment. In the logistic regression analysis, IVH grade was an independent predictor of CP (p = 0.004), which had an estimated probability of occurrence of 74% in grade III and 96% in grade IV. Sepsis at or before the time of consult was an independent predictor of visual impairment (p = 0.024), which had an estimated probability of 58%. IVH grade was an independent predictor of epilepsy (p = 0.026), which had an estimated probability of 18% in grade III and 43% in grade IV. The IVH grade was also an independent predictor of verbal function (p = 0.007), which had an estimated probability of 68% in grade III versus 41% in grade IV. A higher weeks gestational age (WGA) at birth was an independent predictor of the ability to ambulate (p = 0.0014), which had an estimated probability of 15% at 22 WGA and up to 98% at 36 WGA. The need for oscillating ventilation at consult was an independent predictor of death before 2 years of age (p = 0.001), which had an estimated probability of 42% in patients needing oscillating ventilation versus 13% in those who did not.CONCLUSIONSIVH grade was consistently an independent predictor of functional outcomes at 2 years. Gestational age at birth, sepsis, and the need for oscillating ventilation may also predict worse functional outcomes.

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