ABSTRACT
Se presenta el caso clínico de una paciente que ingresó en el Hospital Clinicoquirúrgico Hermanos Ameijeiras con antecedentes de etilismo crónico y cuadro clínico progresivo de deterioro cognitivo-conductual, trastornos de la marcha y esfinterianos, a quien se le realizó una cisternografía radioisotópica con el objetivo de comprobar su eficacia en el estudio de la dinámica del líquido cefalorraquídeo para diagnosticar la hidrocefalia oculta normotensa. La resonancia magnética de cráneo evolutiva evidenció hidrocefalia y la cisternografía radioisotópica confirmó el diagnóstico de hidrocefalia oculta normotensa. A la paciente se le realizó una derivación ventrículo peritoneal con la que se obtuvo una respuesta clínica evolutiva favorable. Se concluye que la cisternografía radioisotópica continúa siendo una herramienta útil para confirmar este diagnóstico y predecir la respuesta al tratamiento derivativo(AU)
A female patient who was admitted to Hermanos Ameijeiras Clinical and Surgical Hospital is presented here. She had a history of chronic alcohol abuse and progressive clinical deterioration of cognitive behavioral, abnormal gait and sphincter disorders. This patient had a radioisotope cisternography in order to test its effectiveness in the study of the dynamics of cerebrospinal fluid, and to diagnose normotensive hidden hydrocephalus. This MRI revealed hydrocephalus and skull evolutionary radioisotope cisternography confirmed the diagnosis of normal pressure hidden hydrocephalus. This patient received a shunt with a favorable evolutionary clinical response. It is concluded that cisternography radioisotope remains a useful tool to confirm this diagnosis and predict response to derivative treatment(AU)
Subject(s)
Humans , Female , Middle Aged , Pneumoencephalography/methods , Hydrocephalus, Normal Pressure/diagnostic imaging , Cerebrospinal Fluid/diagnostic imaging , Hydrocephalus, Normal Pressure/diagnosisABSTRACT
Spontaneous intracranial hypotension (SIH) is an uncommon disease which present as a spontaneously occurring postural headache. Diagnosis is supported by a low CSF pressure by lumbar puncture, diffuse dural enhancement on gadolinium-enhanced brain MRI, or by a CSF leakage site on a radioisotope cisternography or by computed tomographic myelography. Usually SIH treatment is conservative but often requires caffeine, steroids, continuous epidural saline infusion and an epidural blood patch. The most important complication of SIH is bilateral subdural hematoma (SDH), because it may require urgent neurosurgical intervention. We experienced two-cases of SIH with SDH treated with an epidural blood patch, but subdural hematoma increased after radioisotope cisternography, so burr hole drainage was performed with another epidural blood patch.
Subject(s)
Blood Patch, Epidural , Brain , Caffeine , Diagnosis , Drainage , Headache , Hematoma, Subdural , Intracranial Hypotension , Magnetic Resonance Imaging , Myelography , Spinal Puncture , SteroidsABSTRACT
The effect of lumboperitoneal(LP) shunt and the prognostic factors of 40 cases of communicating hydrocephalus confirmed by brain computerized tomography(CT) and/or magnetic resonance imaging(MRI) and radioisotope cisternography(RI) were analyzed. Possible prognostic factors such as disease entity, CT or MRI findings, and the type of radioisotope cisternography were compared to improvement of clinical status after LP shunt. The etiology of communicating hydrocephalus in the analyzed 40 cases included trauma in 13 cases(32.5%), subarachnoid hemorrhage(SAH) in 12 cases(30%), intracerebral hemorrhage(ICH) in 10 cases(25%), and idiopathic in 5 cases(12.5%). An overall clinical improvement after LP shunt was seen in 22 cases(55%). However, in 17 cases of SAH and idiopathic group, improvement after LP shunt was seen in 13 cases(75%), indicating that LP shunt is more effective in SAH/idiopathic group than trauma/ICH group(p<0.05). Many findings of brain CT/MRI such as Evan's index, periventricular low density, 3rd ventricular width, obliteration of cerebral sulci, rounding of frontal horn, and cortical atrophy were analyzed as prognostic factors. Except for the absence of cortical atrophy(p<0.05), none of the factors were related to the patient's outcome. The type of abnormal RI cisternography findings(Typ I, II, III) also did not show any relationship with the effectiveness of LP shunt. These findings suggest that SAH/idiopathic group were more favorable candidates for LP shunt than trauma/ICH group, and that there are no reliable brain CT/MRI findings indicating a good prognosis after LP shunt except for the absence of cortical atrophy. RI cisternography findings are also not a reliable diagnostic tool in evaluating the indication of LP shunt in communicating hydrocephalus.