ABSTRACT
Introduction. Les pathologies neurochirurgicales sont un ensemble d'affections qui touche le cerveau, la moelle épinière, et les paires crâniennes nécessitant une prise en charge médico-chirurgicale. Leur incidence en Afrique sub-saharienne et plus particulièrement au Gabon est mal connue. Objectif. Décrire les aspects épidémiologiques et évolutifs des pathologies neurochirurgicales chez l'enfant de moins 5 ans à Libreville. Patients et méthodes. Il s'agit d'une étude rétrospective descriptive et analytique, multicentrique portant sur des patients de moins de 5ans pris en charge pour une affection neurochirurgicale de Janvier 2019 à Décembre 2021 à Libreville. Résultats. Sur 4811 enfants hospitalisés, 130 répondaient aux critères d'inclusion (prévalence : 2,7%). L'âge moyen était de 13,1 mois. Le sex-ratio était de 1,3. Les grossesses étaient mal suivies dans 72,2% des cas. Les pathologies neurochirurgicales malformatives représentaient 63,5%. L'hydrocéphalie était la plus observée dans 71,2%. Sur les 115 enfants, 71 ont bénéficié d'un traitement chirurgical, soit un taux de 61,7% et le taux de mortalité globale était de 6,1%. Dans le groupe des enfants présentant une malformation congénitale, 8,2% n'avaient pas été traités, le taux de mortalité était de 8,2%. Les complications à court termes étaient dominées par les infections. Conclusion. Les pathologies neurochirurgicales sont en fréquentes dans notre contexte. Une prise en charge immédiate reste de mise, nécessitant donc un plateau technique de pointe pour améliorer l'évolution à court terme voire à moyen et long terme de ces affections.
Introduction. Neurosurgical pathologies are a set of conditions that affect the brain, spinal cord, and cranial pairs requiring medical and surgical management. Their incidence in subSaharan Africa and more particularly in Gabon is poorly known. Objective. To describe the epidemiological and evolutionary aspects of neurosurgical pathologies in children under 5 years old in Libreville. Patients and methods. This is a retrospective descriptive and analytical, multicenter study of patients under 5 years of age treated for a neurosurgical condition from January 2019 to December 2021 in Libreville. Results. Of the 4811 hospitalized children, 130 met the inclusion criteria (prevalence of 2.7%) and 15 were excluded for incomplete records. The average age was 13.1 months. The age group of 28 days-1 year was the most observed. The sex ratio was 1.3. Pregnancies were poorly followed in 72.2% of cases. Malformative neurosurgical pathologies accounted for 63.5% of cases. Hydrocephalus was the most observed in 71.2%. Of the 115 children, 71 received surgical treatment, a rate of 61.7% and the overall mortality rate was 6.1%. In the group of children with congenital malformation, 8.2% had not been treated, the mortality rate was 8.2%. Short-term complications were dominated by infections. Conclusion. Neurosurgical pathologies are frequent in our context. Immediate care remains essential, therefore requiring a cutting-edge technical platform to improve the short-term or even medium- and long-term evolution of these conditions.
Subject(s)
Humans , Male , Female , Child, Preschool , Spinal Dysraphism , Neurosurgical Procedures , Craniocerebral Trauma , Hydrocephalus , NeurosurgeryABSTRACT
Le pseudokyste abdominal est une complication rare pouvant survenir chez les sujets porteurs d'une dérivation ventriculo-péritonéale (DVP). Nous rapportons le cas d'un adolescent de 11 ans, chez qui une DVP a été réalisée pour une hydrocéphalie congénitale. Il présentait une distension abdominale progressive sans notion de troubles de transit. L'imagerie (échographie, urosacnner) a permis de mettre en évidence un épanchement péritonéal de grande abondance organisé, à paroi fine et régulière, exerçant un effet de masse sur la vessie et les uretères, responsable d'une urétérohydronéphrose bilatérale. Le bout distal du cathéter de DVP a été visualisé dans la collection
The abdominal pseudocyst is a rare complication that can occur in subjects with a ventriculoperitoneal drain (VPD). We report the case of an 11-year-old adolescent with congenital hydrocephalus antecedent, for whom a ventriculoperitoneal shunt was made. He presented a progressive abdominal distension without notion of transit disorders. Abdominal ultrasound and uroscanner revealed an organized peritoneal effusion of great abundance, thin and regular wall, exerting a mass effect on the bladder and the ureters responsible for bilateral uretero-hydronephrosis. Above all, it has made it possible to individualize the distal ventriculo-peritoneal bypass catheter projecting in the effusion
Subject(s)
Urinary Bladder Diseases , Ventriculoperitoneal Shunt , Cysts , Hydrocephalus , UreterABSTRACT
Background: Hippocampus is a neural structure in the temporal lobe that plays a crucial role in learning and memory. Cognitive impairment with learning disabilities is a common feature in hydrocephalus and is more prominent in adult-onset hydrocephalus. The aim of this study is to describe the morphological alterations in the pyramidal cells of the hippocampus of adult hydrocephalic mice. Method: Hydrocephalus was induced in adult albino mice by intra-cisternal injection of kaolin suspension (250 mg/ml in sterile water). They were sacrificed 7, 14 and 21 days post-induction. Morphological analysis was carried out on hematoxylin and eosin stained coronal sections of the hippocampus: the pyramidal neurons (normal and pyknotic) in the CA1 and CA3 subregions were counted and the pyknotic index (PI) was calculated. The somatic and dendritic features of Golgi stained pyramidal neurons were examined by light microscopy in both hydrocephalic and control mice. Result: The PI was significantly greater in the CA1 region of the hippocampus in the hydrocephalic groups compared to the age matched controls. The dendritic processes of pyramidal neurons in the CA1 region were fewer with shorter terminal branches in the hydrocephalic mice than in controls; this was pronounced at 7 days post-induction. In the CA3 region, there was no difference in dendritic arborization between hydrocephalic and control mice. Conclusion: Acute adult-onset hydrocephalus was associated with increased pyknosis and reduced dendritic arborization in hippocampal pyramidal cells in the CA1 but not CA3 region
Subject(s)
Golgi Apparatus , Hydrocephalus , Pyramidal CellsABSTRACT
Introduction: L'importance des malformations congénitales dans la morbidité et la mortalité périnatales est telle que, cette pathologie constitue un problème de santé publique. Cette étude vise à établir la cartographie des malformations congénitales visibles à la Maternité des Cliniques Universitaires de Kinshasa.Méthodologie:Etude transversaledescriptive, réalisée à la Maternité des Cliniques Universitaires de Kinshasa a été conduitede Janvier 2009 à Décembre 2011, à partir de 1513 dossiers des accouchées. Nous avons analysé les paramètres concernant les nouveau-nés portant des malformations congénitales visibles ainsi que leurs mères. Résultats: 5,1% des nouveau-nésavaient desmalformations congénitales visibles. Les malformations congénitales visibles étaient plus rencontrées chez les nouveau-nés des mères d'âges extrêmes. Le sexe masculin est plus représenté (60,8%). L'hydrocéphalie (24,1%), suivie de l'imperforation anale (17,7%), l'Omphalocele (15,2%) et le Spina bifida (8,9%) sont les malformations les plus rencontrées dans cette série. Conclusion: Cette étude montre que les malformations congénitales visiblessont un fléau à la Maternité des Cliniques Universitaires de Kinshasa et pousse donc àmener d'autres études pour en rechercher les causes
Subject(s)
Congenital Abnormalities/mortality , Democratic Republic of the Congo , Hydrocephalus , Infant, Newborn , Maternal Age , Spina Bifida OccultaABSTRACT
Background:Hydrocephalus has been known since antiquity. It has been defined as an increase in size of the ventricular system of the brain; resulting from raised cerebrospinal fluid volume. Objective: The purpose of this study is to determine the various ocular disorders that may be associated with hydrocephalus in children seen in the University of Nigeria Teaching Hospital (UNTH) Enugu.Patients and Methods: This study was carried out on 15 patients attending the neurosurgical outpatient clinic of the University of Nigeria Teaching Hospital Enugu. All patients who met the criteria for inclusion in the study of hydrocephalus; aged less than two years and attended the neurosurgical outpatient clinic between January and December 1998 were included. The diagnosis of hydrocephalus was made based on the history; clinical examination and brain ultrasonography. The data was analysed with a scientific calculator Casio FX-82 Lb and Epi info version 6 software.Results: Fifteen children with un-operated hydrocephalus confirmed by transfontanelle ultrasonography were examined at presentation for ocular complications of hydrocephalus. The mean age at presentation was 29.8 weeks. The peak age group of presentation was 11-20 weeks. The male/female ratio was 1:1. Ocular complications of hydrocephalus included setting sun appearance; nystagmus; optic disc palor and hyperaemia. Conclusion: The Ophthalmologist has a well established role to play in assisting the paediatric neurosurgeon in the long term management of children with hydrocephalus if the risk of blindness is not to be added to their other physical disabilities
Subject(s)
Child , Hospitals , Hydrocephalus/diagnosis , TeachingABSTRACT
Background: Information regarding the occurrence of hydrocephalus (HC) in twins is important in establishing the significance of environmental factors as well as a genetic basis in congenital HC aetiology. This was the basis for this study. Methods: A single institution retrospective study was conducted between August 1; 2006 and July 31; 2008. Only those cases of hydrocephalus (based on clinical and radiological testscranial Computeried tomographic or Magnetic resonance imaging scan) that required placement of a ventricular shunt or endoscopic third ventriculostomy were included in the study. Data regarding the patient's demographics; clinical history; examination and the maternal demographics were retrieved and analysed. DNA analysis was done to confirm the fraternity of the twins when applicable. Results: Fifty-eight patients with congenital hydrocephalus presented to the unit over the study period. We identified three sets of twins in the study. Only one set were identical (both male) and both had hydrocephalus. In the remaining two sets only one out of each pair had hydrocephalus (one male and one female). Two of the patients (1male; 1female) were twins with discordant HC. All the children had normal thumbs. DNA analysis confirmed identical twins in both the like sex twins. The mothers were not known diabetics; hypertensive or sickle cell patients neither did they smoke or take alcohol. There was no family history of hydrocephalus in all patients. Conclusion: Concordance for HC is likely if the twins are like sex and identical. Congenital hydrocephalus seems to be a multifactorial disorder; triggered by environmental factors in genetically predisposed individuals
Subject(s)
Hydrocephalus/classification , Hydrocephalus/congenital , Twinning, Monozygotic , TwinsABSTRACT
"An 89-year-old white male presented with memory impairment; slowness in responsiveness; and frequent falls over a two-year duration. Six months earlier; the patient was believed to have had a ""dementia with parkinsonian features;"" but showed no response to incrementing doses of both donepezil and carbidopa-levodopa. Urinary urgency was believed to have been due to prostate hypertrophy. A head CT with contrast revealed moderate ventriculomegaly in the setting of mild diffuse cortical atrophy. A diagnosis of idiopathic normal-pressure hydrocephalus (INPH) was made."
Subject(s)
Aged , Case Reports , Hydrocephalus , Urinary TractABSTRACT
Background: The emotional stress of a young couple whose child has hydrocephalus can be immense. When a shunt has to be inserted without the parents being thoroughly educated on every aspect of the procedure; the situation can be overwhelming and significant psychosocial problems can develop. Aim: To report the case of behavioural change in the father of a hydrocephalic child who underwent shunt placement and the threat of family collapse due to misconceptions about the procedure. Method : The records of the child; including history; examination; investigations and treatment were evaluated. The mother was extensively interviewed during follow-up out-patient visits. Relevant literature on shunt complications was reviewed. Result: Following shunt insertion for hydrocephalus in an only child of a young couple born after 3 years of marriage; the father started withdrawing from his family and gradually began to manifest symptoms of depressive illness. Recommendations: The parents of every child scheduled to have shunt insertion should be properly counselled together on all aspects of the procedure preoperatively. This would help ensure that any consent given is on the basis of their mutual understanding and acceptance of the situation. Where problems are anticipated; it might be necessary to take pre-emptive measures to forestall their occurrence
Subject(s)
Child , Family Relations , Hydrocephalus , Stress, Physiological , Ventriculoperitoneal ShuntABSTRACT
Les aspects radiologiques de l'hydrocéphalie ont été décrits chez les nourrissons de 0 a 26 mois; d'octobre 1992 à décembre 1995: une série rétrospective de 55 cas d'hydrocéphalie ont été diagnostiques sur 120 enfants (45;8 pour cent) adresses a la radiologie pour échographie transfontanellaire au cours du bilan de méningite; de souffrance cérébrale ou de prématurité. Les nourrissons étaient âgés de 0 a 26 mois. La tranche d'âge la plus touchée a été celle des nourrissons de 0 a 6 mois (18/55 cas soit 32;7 pour cent). Le sexe ratio était de 0;34 en faveur des filles (14/41). L'étiologie la plus fréquente a été la méningite bactérienne. En plus de l'échographie transfontanellaire deux enfants ont bénéficié de la radiographie du crâne. La dilatation des ventricules latéraux a été plus fréquente (44/55 soit 80 pour cent des cas); et 20 pour cent des cas restants étaient des dilatations triventriculaires (ventricules latéraux et troisième ventricule). Les aspects échographiques sont dominés par une collection anechogene. Rarement il a été retrouve l'aspect hypoéchogène contenant de fins échos ou l'aspect hyperéchogène periventriculaire témoignant d'une ventriculite. Le traitement de l'étiologie méningitique a été essentiellement médical. Les grosses hydrocéphalies ne sont pas traitées faute de neurochirurgie