Effects of Subjective Memory Complaints, Depression and Executive Function on Activities of Daily Living in Individuals with Mild Cognitive Impairment / 재활간호학회지

PURPOSE: This study aimed to examine the effects of subjective memory complaints, depression and cognitive function on performance of activities of daily living (ADL) in individuals with mild cognitive impairment (MCI). METHODS: A total sample consisted of 250 MCI patients diagnosed within one year. All participants were assessed with a battery of standardized neuropsychological tests, self-report measures of subjective memory complaints and depression, and performance of basic and instrumental ADL. Correlational and multiple linear regression analyses were conducted to identify the factors associated with performance of basic and instrumental ADL, respectively. RESULTS: Executive function and depression explained 9.4% of the variance in basic ADL. Reduced executive function and greater depressed mood were associated with worse performance on basic ADL. Executive function, subjective memory complaints, and time since onset of cognitive symptoms accounted for 22.2% of the variance in instrumental ADL in individuals with MCI. Lower executive function (t=−2.02, p=.044), greater memory complaints (t=5.36, p<.001), and longer periods of experiencing cognitive symptoms (t=2.24, p=.026) were associated with worse instrumental ADL performance. CONCLUSION: These results may help healthcare professionals develop interventions to improve cognitive outcomes with better understanding of the relationship among cognition, mood, and behavioral performance in individuals with MCI.

Effects of a Cognitive Training Program on Cognitive Function and Activities of Daily Living in Patients with Acute Ischemic Stroke

PURPOSE: The purpose of this study was to examine the effects of a cognitive training program on neurocognitive task performance and activities of daily living (ADL) in patients who had a stroke. METHODS: The research design for this study was a nonequivalent control group non-synchronized design. Patients were assigned to the experimental (n=21) or control group (n=21). The experimental group received a 4-week cognitive training program and usual care (i.e., rehabilitation service), while the control was received usual care only. Cognitive function was measured with a standardized neurocognitive test battery and ADL was assessed at baseline and one and two months after completion of the intervention. Repeated measures ANOVA was used to determine changes in cognitive function and ADL over 2 months. RESULTS: The interaction of group and time was significant indicating that the experimental group showed improvement in attention, visuospatial function, verbal memory, and executive function compared to the control group which had a sustained or gradual decrease in test performance. A significant group by time interaction in instrumental ADL was also found between the experimental group with gradual improvement and the control group showing no noticeable change. CONCLUSION: Findings show that the cognitive training program developed in this study is beneficial in restoring cognitive function and improving ADL in patients following a stroke. Further study is needed to investigate the long-term relationship between cognitive training participation and cognitive improvement and effective functioning in daily living.

Discussion Meeting

No abstract available.

Discussion Meeting

No abstract available.

Comparison of Serum Interleukin-8 and Regulated on Activation in Normal T-Cell Expressed and Secreted Levels in Atopic and Non-Atopic Children with Lower Respiratory Tract Infections / 소아알레르기및호흡기학회지

PURPOSE: Several studies have shown that viral respiratory infections induce more severe respiratory symptoms in atopic patients than in normal subjects. We attempted to investigate if there is any difference in the viral etiology, clinical manifestations, production of interleukin (IL)-8, and regulated on activation in normal T-cell expressed and secreted (RANTES) between atopic and non-atopic subjects with lower respiratory infections. METHODS: Sera and nasopharyngeal aspirates (NPA) were collected from 97 children with lower respiratory infections who were admitted to the pediatric ward. Seventy-one children were classified as atopic subjects. We detected respiratory viruses with multiplex reverse transcriptase-polymerase chain reaction in NPA and measured total immunoglobulin E (IgE) and specific IgE in sera. IL-8 and RANTES levels measured in sera by enzyme-linked immunosorbent assay, etiology, and clinical manifestations were compared between atopic and non-atopic subjects. Atopic patients were defined as having elevated specific IgE to more than one allergen or age-matched, high serum total IgE levels. RESULTS: Both serum IL-8 and RANTES levels were significantly higher in atopic than in non-atopic patients. There was no significant difference in viral etiology and clinical diagnosis between the two groups. The frequency of wheezing was higher in atopic than in non-atopic patients. CONCLUSION: Our study showed that both serum IL-8 and RANTES levels and the frequency of wheezing were significantly higher in atopic than in non-atopic patients. That suggests that chemokine responses to viral respiratory infection may be different between atopic and non-atopic patients and may be associated with a difference in clinical manifestation, such as wheezing, between the two groups. However, further prospective large-scaled studies are required to clarify our conclusion.

Relationship between Neuropsychiatric Symptoms and Activities of Daily Living in Alzheimer's Disease

BACKGROUND: In Alzheimer's disease (AD), cognitive impairment is associated with functional impairment; and neuropsychiatric symptoms are common in AD patients. However, there have been few studies about the relationship between neuropsychiatric symptoms and functional state in AD. The objective of this study is to investigate the effects of neuropsychiatric symptoms on activities of daily living in AD. METHODS: We reviewed the medical records of 60 AD patients meeting the criteria of the Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) for probable AD (mean age, 75.4+/-7.0 years; 13 men, 47 women). The relationships between the Neuropsychiatric Inventory (NPI) and two functional measures, instrumental activities of daily living (IADL) and the Barthel Index, were analysed. RESULTS: The total NPI score was significantly associated with both functional measures (IADL: r=0.543; Barthel Index: r=-0.515), as were the NPI subscale scores of delusion, hallucination, agitation, depression, anxiety, and irritability. Multivariate regression analyses showed that total NPI score and duration of dementia were significant predictive factors for both IADL and the Barthel Index. In addition, the total NPI score still significantly influenced the two functional measures after controlling for age, duration of dementia, and Mini-Mental State Examination. CONCLUSION: The total NPI score was a significant predictive factor for functional status beyond the contribution of cognitive impairment in AD. Neuropsychiatric symptoms are associated with increased functional impairments in AD. Screening and management of neuropsychiatric symptoms during the course of AD would be helpful in improving functional status.

A Case of Leptomeningeal Carcinomatosis Presenting as a Neurological Complication of Stomach Cancer

Leptomeningeal carcinomatosis, an important and serious neurological complication of malignant cancers, is asso- ciated with severe disability and high mortality. It is most commonly seen in patients with breast cancer, lung cancer and malignant melanoma. However, leptomeningeal carcinomatosis induced by gastric cancer has been rarely reported, although gastric cancer is one of the most common causes of cancer-related deaths in Korea. We report a case of a 76- year-old woman with leptomeningeal carcinomatosis presenting as a neurological complication of gastric cancer and con- firmed by cytology examination of the cerebrospinal fluid and brain magnetic resonance imaging with gadolinium enhan-cement.

Childhood Predictors of Deliberate Self-Harm Behavior and Suicide Ideation in Korean Adolescents: A Prospective Population-Based Follow-Up Study

The aim of this study was to investigate predictors of adolescence suicidality in a longitudinal study. Additionally, the prevalence of deliberate self-harm behavior and suicide ideation at age 7 and during middle school were examined. Initial assessment data was obtained from 1998 to 2000, and a follow-up assessment was performed in 2006 when the original subjects became middle school students. The addresses and names of 1,857 subjects were located from the original data; they were 910 boys and 947 girls. The subjects were evaluated with the Korean version of the Child Behavior Checklist (K-CBCL), which was administered by the parents of the children, and by various demographic and psychosocial factors. They were reassessed using self reports on the Korea Youth Self Report (K-YSR); in particular, replies to items related to self-harm behavior and suicide ideation were recorded. A logistic regression analysis showed that the factors of gender, economic status, the overall amount of behavior problems, the tendency to internalizing and externalizing problems, somatic problems, thought problems, delinquent behavior, and aggressive behavior were independent predictors of adolescent suicide ideation and self-harm behavior. The importance of total behavior problems suggested that adolescent difficulty is a consequence of an accumulation of various risk factors. Accordingly, clinicians must consider a range of internalizing and externalizing issues, especially overall adaptation, for suicide intervention.

Clinical Aspects of Functional Articulation Disorder

PURPOSE: Speech and language development is an useful indicator of the overall development of children. Since speech and language delay can lead to emotional, social, and learning problems, the early intervention is very important. We examined 137 children with speech or language problems including 22 children of functional articulation disorders of their clinical features. METHODS: 137 children with speech or language problems in the Department of Pediatrics, Uijeongbu St. Mary's Hospital from January 2004 to December 2007 were reviewed for sex, age, developmental and language test findings retrospectively. Especially, in 22 children diagnosed with functional articulation disorders, articulation test findings were analyzed. RESULTS: 1) The mean age of 137 children was 46.8 months, the ratio of male to female was 2.5:1, and the most frequent age group was 24-35 months. The chief complaints included language delay(67.2%), mispronouncing speech sound(27%), stuttering(3.6%), learning disability(2.2%). The diagnoses of them were developmental language disorder(70.8%), functional articulation disorders(16.1%), mental retardation(5.8%), stuttering(2.9%), tongue tie(0.7%), normal language pattern(3.6%). 2) The mean age of 22 patients with functional articulation disorders was 63 months, the ratio of male to female was 1.4:1, and the most frequent age group was 60-71 months. The mean percentage of consonant correct of Picture Consonant Articulation Test was higher in older age group. In the types of phonetic errors substitutions were most common. Distortions, omissions, and additions were followed in the order of frequency. Substitutions and distortions were common in word initial and medial but omissions in word final. It is appeared that the patients had the difficulties in pronouncing alveolar fricative, palatal affricate, liquid, and velar plosive which mature lately in older children. Mainly palatal affricate, alveolar fricative, and velar plosive were substituted for alveolar plosive and the liquid and alveolar fricative were distorted as gliding. CONCLUSION: Categorizing the cause of language and speech delay is essential to make an adequate treatment plans and decrease the late complications. The future studies for the early screening, more suitable tests in Korean, treatment guidelines or prognosis are needed.

Clinical Features of Moyamoya Disease in Children

PURPOSE: Moyamoya disease, is a chronic progressive cerebrovascular occlusive disorder that can lead to permanent neurologic deficit. The aim of this study is to analyze clinical features, radiologic findings, and prognosis of Moyamoya disease comparing with previous studies. METHODS: We retrospectively reviewed on the clinical data of 26 patients and they were analyzed in terms of age, sex, clinical features, radiologic findings, treatment and prognosis. RESULTS: The male to female ratio was 1:1.6 and the mean age was 9.3 years(male 6.1 years and female 10.9 years). There was a higher occurrence rate in 11-15 year-old group, compared to the previous studies. The most common symptoms at onset were hemiparesis and hemiplegia. Brain infarction, hemorrhage and seizure were found in five, three and two patients on brain imaging respectively. Eight patients(44%) showed reduced perfusion without structural abnormalities on brain perfusion CT. The internal carotid artery was the most common site of occlusion on conventional angiography. Indirect encephalo-duro-arterio-synangiosis was performed in 76.9% of the patients. One patient(3.85%) died and twelve patients(46.15%) showed neurologic sequelae at the time of discharge. Sequelae included hemiplegia, gaze disturbance, facial palsy, and seizures. CONCLUSION: Compared with previous studies, the age at onset was higher in our patients, with a peak incidence after the age of 10. Lower rate of severe neurologic sequelae, such as hemiparesis and hemiplegia was observed in this study. Because this study was limited by the small number of patients included, further investigations such as multi-center prospective analysis is needed.

Analysis of the Pharmacokinetics of Recombinant Human TSH in Patients with Thyroid Papillary Carcinoma / 대한내분비학회지

BACKGROUND: Individual variations of the pharmacokinetics of recombinant human TSH (rhTSH) might influence the efficacy of the radioactive iodine (RAI) uptake. We studied to investigate the individual pharmacokinetics of rhTSH and the effect of the anthropometric parameters on the serum TSH levels in patients with thyroid papillary carcinoma. METHODS: We selected 16 patients with conventional rhTSH administration for the preparation of RAI administration between June 2004 and May 2005. We measured serum TSH levels at 24-hour (prior to second rhTSH injection), 48-hour (peak level, prior to RAI administration) and 96-hour (prior to scanning) after the first rhTSH injection. We analyzed the correlation of each TSH levels with age, height, weight, creatinine clearance, body mass index (BMI), and body surface area (BSA). RESULTS: Peak TSH levels were negatively correlated with weight, BMI, and BSA. Among them, weight was an independent parameter by multivariate analysis. Decrement of serum TSH levels from the peak to the level at 96-hour was negatively correlated with weight, BMI, and BSA. It was positively correlated with increment of serum TSH levels from the level at 24-hour to the peak level. Serum TSH level at 96-hour was lower than 25 mU/L in nine of 16 patients. CONCLUSION: Body weight was inversely correlated with peak TSH level after rhTSH administration. rhTSH-stimulated TSH levels might be exaggerated to unwanted levels, and very rapidly degraded in lower-weighted patients. We should make up for the rhTSH regimen considering the individual variations of its pharmacokinetics.

The Therapeutic Effect of Lactobacillus reuteri in Acute Diarrhea in Infants and Toddlers / 소아과

PURPOSE: Certain strains of lactobacilli are known to accelerate recovery from acute diarrhea. Lactobacillus reuteri is isolated from human breast milk and a commonly occurring Lactobacillus species with therapeutic potential in acute diarrhea. The purpose of the present study was to investigate the therapeutic effect of L. reuteri in acute diarrhea in young children. METHODS: Fifty patients between 6 and 36 months of age hospitalized with acute diarrhea (rotavirus in 40 percent) were randomized into two groups to receive either 10 (8) colony-forming units of L. reuteri or a matching placebo, twice a day for their length of hospitalization, or for up to 5 days. Antidiarrheal drugs were not prescribed to either group. The clinical outcome of diarrhea was evaluated. RESULTS: The mean duration of watery diarrhea after initiation of treatment was 2.3 days for the L. leuteri group (n=25) vs. 2.9 days for the placebo group (n=25) (P=0.072). By the second day of treatment, watery diarrhea persisted in 64 percent of patients receiving L. reuteri, compared to 84 percent of those receiving placebo (P=0.006). On the second day, the mean frequency of watery diarrhea was 1.9 in the L. leuteri group and 3.4 in the placebo (P=0.046). Also, vomiting continued to the second day in 16 percent of patients receiving L. reuteri and 40 percent of those recieving placebo (P= 0.031). CONCLUSION: L. reuteri is effective as a therapeutic agent in acute diarrhea in children.

Treatment for Enuresis

Monosymptomatic enuresis(bed-wetting without other symptoms) is a common problem in children, affecting 15% of five-year-olds and occurring more frequently in boys than in girls. Because it is usually caused by a physiologic maturational delay, the prevalence decreases with age. Children with enuresis have a small bladder capacity. Failure to awake to the micturition urge is not necessarily related to being a "deep sleeper", and children with enuresis may pass urine involuntarily because of the immature central nervous pathways. As the CNS pathways matures with age, most children are more easily aroused from sleep. There is strong evidence of a genetic predisposition for enuresis. Children with enuresis must be evaluated to reveal any underlying physiologic conditions or disease states, such as urinary tract infection or structural abnormality. Once these are ruled out, the goal is to stop the bed-wetting while preserving the child's self-esteem. However, before treatment of enuresis, concurrent problems, such as daytime enuresis and urgency or chronic constipation, should be managed. For the treatment of enuresis, the child wears a moisture alarm-a small, portable, transistorized device-to bed. The alarm sounds or vibrates when wet, awakening the child. Drug therapy for enuresis includes desmopressin, which decreases the urine volume, and imipramine and oxybutynin, which inhibit bladder contraction. Both delayed urinary control and current enuresis are associated with a markedly increased risk of behavioral, emotional, and academic problems.

An Assessment of Adolescent Internet Addiction Problems Related to Depression, Social Anxiety and Peer Relationship / 신경정신의학

OBJECTIVE: The purpose of this study was to survey the present conditions of adolescents' Internet use and to investigate the relations of Internet addiction to depression, social anxiety and problems in peer relationship. METHOD: Eight hundred and sixty-nine high-school students(male/female=371/498) were included in the study, each of whom completed a standard questionnaire related to Internet use determined. We assessed internet addiction and depressive symptoms of adolescents using Youngs Internet Addiction Scale and the Beck Depression Inventory(BDI), respectively. Social Avoidance and Distress Scale were employed to measure social anxiety and avoidance. Fear of Negative Evaluation-Brief Scale was for fear of negative evaluation by other people. An Index of Peer relation was devoted to problems in peer relationships. Chi-square test and ANOVA were used to identify the present conditions of Internet addiction and to analyze the relations of Internet addiction with depression, social anxiety and problems in peer relationship. RESULTS: 1) Of these 869 subjects, 371(42.7%) were male students and 498(57.3%) were female. The mean age was 16.27 years(SD=0.82) and there was no significant difference between two sex groups. 2) Of these 869 subjects, 291(33.4%) showed addictive tendency and among them 18 subjects(2.07%) were classified into obvious addiction group. In this study, we defined upper 30% of Internet addiction scores as 'addiction group' and lower 30% as 'normal control group'. 3) Male students had significantly higher mean scores of Internet addiction scale than females and there was significantly higher rates of male students in addiction group. 4) Comparing two groups, there was no statistically significant difference in terms of the preferred types of Internet media, although addiction groups tended to use chatting and E-mail more, normal control group tended to use information search more. And there was no significant difference regarding games on the Internet. 5) There was more depressive tendency in line with more sensitive response against negative-evaluation and more problems of peer relationship in addiction group. However, there was no significant difference regarding anxiety on social situation. CONCLUSION: Compared to previous studies, findings from this study showed that the rates classified as the group of obvious Internet addiction were relatively lower. However, including those who had tendency of Internet addiction, about 30% of all subjects had problems related to Internet use. In addition, depression or relationship problems were triggered more severely in Internet addiction group. With these findings in mind we finally suggest that therapeutic approach to comorbid psychopathology as well as Internet addiction itself should be required.

Routine Measurement of Serum Calcitonin Concentration is Useful in Early Detection of Medullary Thyroid Carcinoma Among Patients with Nodular Thyroid Disease / 대한내분비학회지

BACKGROUND: Serum calcitonin is a sensitive and specific marker for diagnosis of medullary thyroid carcinoma (MTC) and its determination leads to accurate preoperative diagnosis and gives chances of definite cure. However, since many non-MTC diseases are also associated with calcitonin elevation, its significance in patients with mild or moderately elevated basal serum calcitonin levels is not clear. Furthermore, the normal value of calcitonin using immunoradiometric assay (IRMA) kit has not so far been definitely ascertained. This study is aimed at assessing the clinical significance of routine measurement of serum basal calcitonin concentration in nodular thyroid disease patients and evaluating the pentagastrin stimulation test in case of mild or moderate elevation of basal calcitonin level. We also measured serum calcitonin value in 408 normal individuals. METHODS: The basal serum calcitonin concentrations using a commercial IRMA kit (Medgenix CT-U.S.-IRMA) were measured in 818 patients with nodular thyroid disease (average age 45 years with a range from 13 to 82 years; 125 males and 693 females) who visited thyroid clinics in Samsung Medical Center between June 1997 and December 1998. Serum concentrations of T3, T4, TSH and thyroid autoantibodies were measured and ultrasonography of thyroid and thyroid scan using 131I or 99mTc-pertechnetate were performed in all patients. We also studied 408 healthy subjects without any thyroid disease (average age 48 years with a range from 20 to 86 years; 224 females). RESULTS: The calcitonin value in normal subjects was found to range from 0 to 13 pg/mL, and it was shown that men had higher calcitonin level than women (p 10pg/mL) in nodular thyroid disease was 1.71% (14/818), and the incidence of MTC was 0.73% (6/818) in this study. MTC was found in all patients with basal serum calcitonin levels more than 100 pg/mL. Pentagastrin stimulation test was also required to diagnose MTC in patients with basal serum calcitonin levels between 30 and 100pg/mL. The calcitonin concentration stimulated by pentagastrin increased more than 400pg/mL or more than 3.8 times of basal concentration. It was possible to diagnose MTC with fine needle aspiration and cytology in only one case out of six patients with MTC. CONCLUSION: Fine needle aspiration and cytology in diagnosing MTC was not sensitive and not devoid of false positive results. We confirmed that serum calcitonin measurement was very useful means for the preoperative diagnosis of unsuspected MTC. Pentagastrin stimulation test may be a reliable means of evaluation in nodular thyroid disease patients with mild or moderate elevation of basal calcitonin level. We recommend routine measurement of serum calcitonin concentration in patients with nodular thyroid disease.

An Association of ADHD and Their Risk Factors in Pregnancy, Delivery, Perinatal Stage / 신경정신의학

OBJECTIVE: Many researchers reported that obstetrical complications during late pregnancy or delivery may be related to major psychiatric illnesses, especially schizophrenia. We hypothesized that obstetrical complications are among the most important factors which precipitate onset of attentiondeficit hyperactivity disorder. We studied retrospectively obstetrical complications of the Attention deficit-hyperactivity disorder(ADHD) patients who were diagnosed and treated at the outpatient and inpatient clinics of Ajou University Hospital. METHOD: The subjects were composed of 94 ADHD patients who were diagnosed by DSM-IV and 65 normal subjects. ADHD patients were divided into two groups; the familial group (n=27) consisted of those who have a family history of ADHD, and the non-familial group(n=65) consisted of those without a family history of ADHD. The authors examined gestational age, birth weight, type of delivery, and type of obstetrical complications. Obstetrical complications were divided into maternal, intrapartal and neonatal factors. RESULTS: 1) Non-familial ADHD patients have significantly higher NSVD(normal spont-aneous vaginal delivery) than normal controls. 2) Familial ADHD patients have significantly higher intrapartal obstetrical complications than normal controls. 3) ADHD patients have no significantly higher maternal and neonatal complications than normal controls. CONCLUSION: This study suggests that obstetrical complications are related to the onset of ADHD, possibly when combined with genetic predispositions.

Comparison of Therapeutic Efficacy between Haloperidol and Risperidone in Tic Disorders / 대한정신약물학회지

Tourette's syndrome is a heritable neuropsychiatric disorder that begins in childhood. No known medication suppresses tics completely, and the dopamine receptor antagonists-haloperidol and pimozide-for Tourette's syndrome often either produce or risk intolerable side effects that preclude their use. Clinical trials of risperidone, a benzisoxazole derivative with potent 5-HT 2 and D 2 receptor binding properties, have indicated that it is a safe and effective alternative to haloperidol in the treatment of schizophrenia. Fifty-four patients with Tourette's syndrome (n=20) and chronic motor or vocal tic disorder (n=34) were recurited from the outpatient clinic of the psychiatry of university. The research was started with 0.5 mg/d risperidone, haloperidol which was increased based on the severity of symptoms. Severity of clinical symptoms were assessed at baseline, 4, 8 and 16 weeks evaluation symptom using the Yale Global Tic Severity scale. In conclusion, YGTSS scores of the two groups were significantly improved at the end when compared with baseline. We did not find significant difference in side effects between haloperidol and risperidone group. But, easy fatigue, acute dystonia, constipation were less reported in risperidone group. As a result, the treatment of both groups demonstrated significant improvement on the severity of tic symptoms 8, 16 weeks later.

Unolateral Aldosterone-producing Adenoma with a Contralateral Black Adenoma / 대한내분비학회지

Primary aldosteronism due to unilateral adenoma is a rare cause of surgically curable hypertension. Bilateral adrenal mass has occasionally been reported in this syndrome, and bilateral aldosterone-producing adenoma (APA), or bilateral adrenal nodular hyperplasia have been demonstrated in some cases. However, another possibility is the coexistence of a unilateral APA with a contralateral benign or metastatic nonfunctioning mass, because adrenal tumors are frequently found at autopsy or incidentally detected during abdominal morphological evaluation in patients without adrenal dysfunction. A 39 year-old woman presented with hyperaldosteronism, suppressed renin levels, and bilateral adrenal mass on adrenal CT scanning. Selective adrenal venous sampling was unsuccessful in demonstrating concentration gradient of aldosterone. Postoperative measurement of hormone content in the tumor extract revealed unilateral aldosteron-producing adenoma with contralateral nonfunctioning black adenoma, Determination of hormone content in the tumor extract could be useful for the discrimination of functioning and nonfunctioning endocrine tumors, particularly in case of multiple tumors.

Imaging of the Ventriculoperitoneal Shunt-Related Complications in Infants and Children With Hydrocephalus

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.

Imaging of the Ventriculoperitoneal Shunt-Related Complications in Infants and Children With Hydrocephalus

PURPOSE: To evaluate the frequency and imaging findings of various ventriculo-peritoneal shunt-relatedcomplications in pediatric patients with hydrocephalus. MATERIALS AND METHODS: We retrospectively reviewed 246plain radiographs, three shuntograms, 53 ultrasounds, 133 CT scans, and 24 MR images obtained before and after theventriculo-peritoneal shunt procedure in 33 pediatric patients with hydrocephalus. Using preoperative images, theetiology of the hydrocephalus was assessed. Changes in the size and shape of the ventricles, the location andcontinuity of shunt apparatus, and the presence of any abnormal enhancement, hemorrhage, edema or tissue loss, orother findings of complications, were analyzed on postoperative images; the frequency and imaging findings ofshunt-related complications such as shunt malfunction, infection, hemorrhage or isolated ventricle, andcomplications caused by overdrainage, were thus evaluated. The frequency of such complications was analyzedaccording to the etiology of the hydrocephalus, and in addition, medical records were reviewed and correlated withimaging findings. RESULTS: In 18 of the 33 patients(54%), a total of 31 complications was detected. These werepresent in four of five cases (80%) of hydrocephalus caused by meningitis and ventriculitis, seven of twelve (58%)intraventricular hemorrhage, two of four (50%) unknown cases, three of nine (33%) congenital malformations, one oftwo (50%) tumors, and one (100%) congenital infection. Shunt malfunction was most common(n=15), and wasaccompanied by findings of enlarged ventricles, periventricular and peritubal edema, and abnormal location of theshunt tube. Symptoms and signs of increased intracranial pressure were also noted. Subdural hemorrhage andinfection were present infour cases each;findings of infection were enhancement of the ventricular wall, meninges,and parenchyma, as well as sonographically noted intraventricular septation and increased ventricular wall echo.Isolated lateral ventricle (n=4) or 4th ventricle (n=1) was persistently distended in spite of the presence of ashunt tube within the other ventricle. Collapsed ventricles, thick calvarium, and symptoms of increasedintracranial pressure were helpful in the diagnosis of slit ventricle syndrome(n=1). Immediate postoperativeintraventricular and parenchymal hemorrhage were noted in one case each. CONCLUSION: Shunt-related complicationswere found on postoperative images in 54% of pediatric patients with hydrocephalus; the frequency was highest incases of hydrocephalus caused by infection. Shunt malfunction occurred most frequently and each complication hadvarious imaging findings. For the diagnosis of post-operative shunt-related complication, continuous follow-upstudies are therefore necessary.