Natural history of ventriculomegaly in adults: a cluster analysis

OBJECTIVEChronic ventriculomegaly in the absence of raised intracranial pressure (ICP) is a known entity in adult hydrocephalus practice. The natural history and indication for treatment is, however, poorly defined. A highly heterogeneous group, some adults with ventriculomegaly are asymptomatic, while others have life-threatening deteriorations. The authors hypothesized that the various presentations can be subtyped and represent different stages of decompensation. A cluster analysis was performed on a cohort of patients with chronic ventriculomegaly with the aim of elucidating typical clinical characteristics and outcomes in chronic ventriculomegaly in adults.METHODSData were collected from 79 patients with chronic ventriculomegaly referred to a single center, including demographics, presenting symptoms, and 24-hour ICP monitoring (ICPM). A statistical cluster analysis was performed to determine the presence of subgroups.RESULTSFour main subgroups and one highly dissimilar group were identified. Patients with ventriculomegaly commonly have a perinatal event followed by one of four main presentations: 1) incidental ventriculomegaly with or without headache; 2) highly symptomatic presentation (including reduced consciousness) and raised ICP; 3) early presenting with symptoms of headache and nausea (with abnormal pulsatility); and 4) late presenting with features common to normal pressure hydrocephalus. Each symptomatic group has characteristic radiological features, ICPM, and responses to treatment.CONCLUSIONSCluster analysis has identified subgroups of adult patients with ventriculomegaly. Such groups may represent various degrees of decompensation. Surgical interventions may not be equally effective across the subgroups, presenting an avenue for further research. The identified subtypes provide further insight into the natural history of this lesser studied form of hydrocephalus.

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Adult Presentation of a Familial-Associated Vein of Galen Aneurysmal Malformation: Case Report

Neurosurgery ◽

10.1227/neu.0b013e3181fa00d8 ◽

2010 ◽

Vol 67 (6) ◽

pp. E1845-E1851 ◽

Cited By ~ 14

Author(s):

David S Xu ◽

Asad A Usman ◽

Michael C Hurley ◽

Christopher S Eddleman ◽

Bernard R Bendok

Keyword(s):

Case Report ◽

Natural History ◽

Vein Of Galen ◽

Review Of The Literature ◽

Time Resolved ◽

Presenting Symptoms ◽

First Case ◽

Life Threatening ◽

History Of ◽

Asymptomatic Adult

Abstract BACKGROUND AND IMPORTANCE: Vein of Galen aneurysmal malformations (VGAMs) arise from persistent arteriovenous shunting from primitive choroidal vessels into the median prosencephalic vein of Markowski, the embryonic precursor of the vein of Galen. VGAMs rarely present past infancy, and their natural history in adults is unknown. We report the first case of a familial-associated VGAM in an asymptomatic adult female patient. The clinical features of this case are presented alongside a systematic review of the literature on adult VGAM cases to assess the natural history, clinical management, and genetic basis of this rare neurovascular lesion. CLINICAL PRESENTATION: A previously healthy 44-year-old woman with a family history of a VGAM in a stillborn presented with an 8-week onset of dizziness and vertigo that spontaneously resolved. Time-resolved magnetic resonance angiography identified a choroidal VGAM. No intervention was undertaken at this time because of the patient's asymptomatic status after 9 months of follow-up. CONCLUSION: Based on our review of the literature, this is the first case report of a familial-associated VGAM in an adult patient and suggests that VGAM development can be genetically linked. Of 15 adult VGAM cases previously reported, all patients were either symptomatic or treated, thus precluding determination of VGAM natural history in adults. Patient outcomes correlated with the severity of presenting symptoms, which ranged from asymptomatic to immediately life-threatening. We hypothesize that self-selection may render VGAMs to be more benign for them to persist past childhood. Further investigation of the molecular biology underlying VGAM development is warranted.

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The spontaneous resolution of a vortex vein varix: case report

BMC Ophthalmology ◽

10.1186/s12886-021-01861-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sara L Weidmayer ◽

Hakan Demirci

Keyword(s):

Case Report ◽

Natural History ◽

Extended Period ◽

Spontaneous Resolution ◽

Case Presentation ◽

Clinical Resolution ◽

History Of ◽

Vortex Vein ◽

Insight Into

Abstract Background The natural course of a vortex vein varix, though not well understood, has been known to remain stable. However, here we report a novel case of a vortex vein varix that resolved after an extended period of monitoring. Case presentation An asymptomatic 96-year-old Caucasian man was found to have a vortex vein varix. At his previous examination 13 months prior, his fundus was normal. At 13 months of observation, his vortex vein varix become clinically undetectable. Further follow-up confirmed continued absence of the varix. Conclusion This case demonstrates the development then clinical resolution of a vortex vein varix with no clear identifiable factors for its evolution. This case is novel and offers new insight into the natural history of some vortex vein varices, implicating venous congestion as an instigator and venous collateralization as its alleviator, suggesting that vortex vein varices are likely more common than previously reported since some may be temporary and under-identified.

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Otitis Media in Infancy: Tympanometric Findings

PEDIATRICS ◽

10.1542/peds.63.3.435 ◽

1979 ◽

Vol 63 (3) ◽

pp. 435-442

Author(s):

Jessie R. Groothuis ◽

Sarah H. W. Sell ◽

Peter F. Wright ◽

Judith M. Thompson ◽

William A. Altemeier

Keyword(s):

Otitis Media ◽

Acute Otitis Media ◽

Chronic Otitis Media ◽

Normal Pressure ◽

Pressure Curve ◽

Type B ◽

History Of ◽

Life Type ◽

Insight Into

Ninety-one normal infants were followed longitudinally for varying periods from November 1975 to April 1977 to assess the correlation between tympanometry and pneumatic otoscopy and to study the pathogenesis of acute and chronic otitis media early in life. Type A (normal) tympanograms correlated with normal otoscopic findings in 92% of instances. Type B tympanograms, indicating reduced drum compliance with a relatively flat pressure curve, were associated with abnormal otoscopic findings in 93% of cases. The A8 (reduced compliance, normal pressure) and C (normal compliance, negative pressure) tympanograms were less consistent predictors of otoscopic findings. The correlation of tympanometric and otoscopic findings were similar in infants above and below 7 months of age. Tympanometry provided some insight into the natural history of otitis in 71 infants followed 12 to 17 months. Infants who failed to develop otitis had type B curves in only one of 240 determinations (0.4%). This pattern did not appear in those who developed acute otitis media (AOM) until the month preceding the first attack; nine of 29 tests (31%) made under these circumstances were type B. When a type B curve appeared in an asymptomatic study infant who had not previously had otitis, AOM developed within a month in nine of ten instances. At the time of diagnosis of first AOM, 87% of tympanograms were type B with the remainder type A8 or C. Sixty-three percent of tympanograms obtained from 25 infants during the six months following first AOM were type B, indicating that abnormal middle ear function was often prolonged. Fifteen of these 25 developed recurrent otitis during follow-up.

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Case Report: Poor oral hygiene leading to an emergency condition: A case report of Ludwig’s angina

F1000Research ◽

10.12688/f1000research.74692.1 ◽

2021 ◽

Vol 10 ◽

pp. 1219

Author(s):

Prashant Pant ◽

Oshan Shrestha ◽

Pawan Budhathoki ◽

Nebula Devkota ◽

Prabin Kumar Giri ◽

...

Keyword(s):

Case Report ◽

Oral Hygiene ◽

Common Source ◽

Poor Oral Hygiene ◽

Presenting Symptoms ◽

Dental Procedures ◽

Life Threatening ◽

History Of ◽

Ludwig’S Angina ◽

Ludwig's Angina

Ludwig’s angina (LA) is a rapidly spreading and potentially life-threatening infection having an odontogenic infection as the most common source. It involves the floor of the mouth and neck. Modernization in medical care has made this entity rare and of low mortality at the present but it is still feared as a lethal entity due to rapidly progressive airway obstruction that follows. Here we report a case of a 15-year-old male who suffered from LA. Presenting symptoms and findings of the examination helped in the clinical diagnosis. Immediate intubation, use of broad-spectrum antibiotics, and treatment of complications aided the patient’s recovery. LA should be considered for differential diagnosis in the case of neck swelling especially in those having a history of poor oral hygiene and recent dental procedures. Management of LA and its complications should always involve doctors from multiple disciplines.

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Early Airway Pathological Changes in Children: New Insights into the Natural History of Wheezing

Journal of Clinical Medicine ◽

10.3390/jcm8081180 ◽

2019 ◽

Vol 8 (8) ◽

pp. 1180 ◽

Cited By ~ 1

Author(s):

Matteo Bonato ◽

Mariaenrica Tiné ◽

Erica Bazzan ◽

Davide Biondini ◽

Marina Saetta ◽

...

Keyword(s):

Natural History ◽

Genetic Background ◽

Current Knowledge ◽

Persistent Asthma ◽

Epidemiological Studies ◽

Airflow Limitation ◽

Clinical Expression ◽

Heterogeneous Condition ◽

History Of ◽

Insight Into

Asthma is a heterogeneous condition characterized by reversible airflow limitation, with different phenotypes and clinical expressions. Although it is known that asthma is influenced by age, gender, genetic background, and environmental exposure, the natural history of the disease is still incompletely understood. Our current knowledge of the factors determining the evolution from wheezing in early childhood to persistent asthma later in life originates mainly from epidemiological studies. The underlying pathophysiological mechanisms are still poorly understood. The aim of this review is to converge epidemiological and pathological evidence early in the natural history of asthma to gain insight into the mechanisms of disease and their clinical expression.

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Insight into the natural history of primary biliary cirrhosis: A systemic review of data from placebo-controlled clinical trials

The Turkish Journal of Gastroenterology ◽

10.5152/tjg.2016.15535 ◽

2016 ◽

Vol 27 (4) ◽

pp. 342-348 ◽

Cited By ~ 1

Author(s):

Ping Xu ◽

Lan Li ◽

Chaohui Yu ◽

Youming Li

Keyword(s):

Clinical Trials ◽

Primary Biliary Cirrhosis ◽

Natural History ◽

Systemic Review ◽

Biliary Cirrhosis ◽

Controlled Clinical Trials ◽

History Of ◽

Insight Into

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The Sense-organs and Perceptions of Fishes; with Remarks on the Supply of Bait

Journal of the Marine Biological Association of the United Kingdom ◽

10.1017/s0025315400072118 ◽

1890 ◽

Vol 1 (3) ◽

pp. 225-256 ◽

Cited By ~ 73

Author(s):

W. Bateson

Keyword(s):

Natural History ◽

Sense Organs ◽

Marine Animals ◽

Practical Solution ◽

Biological Association ◽

Marine Biological ◽

Marine Biological Association ◽

History Of ◽

Insight Into

The Council of the Marine Biological Association appointed me, in 1889, to make observations on the perceptions of fishes, and especially on those which constitute the modes by which they hunt for and recognise their food. It was suggested that this subject should be treated in as wide a manner as possible, and in accordance with this suggestion I have endeavoured to utilize any opportunities which presented themselves of getting an insight into the natural history of marine animals. In addition to this I have also made some experiments towards the practical solution of the bait question, both by making artificial baits, and by endeavouring to preserve materials which are already in use for bait.

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Evolution of the treatment of cerebral vasospasm

Neurosurgical FOCUS ◽

10.3171/foc.2006.20.6.4 ◽

2006 ◽

Vol 20 (6) ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Scott Y. Rahimi ◽

John H. Brown ◽

Samuel D. Macomson ◽

Michael A. Jensen ◽

Cargill H. Alleyne

Keyword(s):

Subarachnoid Hemorrhage ◽

Natural History ◽

Cerebral Vasospasm ◽

Successful Treatment ◽

Aneurysmal Subarachnoid Hemorrhage ◽

Disease Process ◽

Acute Setting ◽

The Past ◽

History Of ◽

Insight Into

✓ Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a disease process for which the lack of effective treatments has plagued neurosurgeons for decades. Historically, successful treatment after SAH in the acute setting was often followed by a rapid, uncontrollable deterioration in the subacute interval. Little was known regarding the nature and progression of this condition until the mid-1800s, when the disease was first described by Gull. Insight into the origin and natural history of cerebral vasospasm came slowly over the next 100 years, until the 1950s. Over the past five decades our understanding of cerebral vasospasm has expanded exponentially. This newly discovered information has been used by neurosurgeons worldwide for successful treatment of complications associated with vasospasm. Nevertheless, although great strides have been made toward elucidating the causes of cerebral vasospasm, a lasting cure continues to elude experts and the disease continues to wreak havoc on patients after aneurysmal SAH.

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Intracerebral Bleeding and Massive Pericardial Effusion as Presenting Symptoms of Myxedema Crisis

Case Reports in Emergency Medicine ◽

10.1155/2017/8512147 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

M. Kirsch ◽

C. Rimpau ◽

C. H. Nickel ◽

P. Baier

Keyword(s):

Pericardial Effusion ◽

Neurological Impairment ◽

Pericardial Tamponade ◽

Intracerebral Bleeding ◽

Presenting Symptoms ◽

Adverse Health Outcomes ◽

Life Threatening ◽

History Of ◽

Tremendous Importance ◽

Work Up

The endocrinological emergency of a fully blown myxedema crisis can present as a multicolored clinical picture. This can obscure the underlying pathology and easily lead to mistakes in clinical diagnosis, work-up, and treatment. We present a case of an unconscious 39-year-old patient with a medical history of weakness, lethargy, and findings of hyponatremia, intracerebral bleeding, and massive pericardial effusion. Finally, myxedema crisis was diagnosed as underlying cause. Replacement therapy of thyroid hormone and conservative management of the intracerebral bleeding resulted in patient’s survival without significant neurological impairment. However, diagnostic pericardiocentesis resulted in life-threatening pericardial tamponade. It is of tremendous importance to diagnose myxoedema crisis early to avoid adverse health outcomes.

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