Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 405
Filter
1.
Gac. méd. espirit ; 23(2): 123-139, 2021.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339941

ABSTRACT

RESUMEN Fundamento: La hidrocefalia es un desorden pediátrico frecuente y la colocación de una derivación ventriculoperitoneal es la técnica quirúrgica más usada para su tratamiento. La incidencia de las complicaciones en pacientes pediátricos es un problema frecuente que aumenta la morbilidad y mortalidad. Objetivo: Sistematizar y actualizar los conocimientos relacionados con las complicaciones ventriculoperitoneal es en edad pediátrica. Desarrollo: Las complicaciones asociadas a la derivación ventriculoperitoneal son frecuentes y se pueden dividir en tres grupos: mecánicas, infecciosas y funcionales relacionadas con el drenaje anómalo del líquido cefalorraquídeo, bien por defecto o por exceso. Dentro de las mecánicas, la obstrucción tiene la mayor incidencia seguida de las desconexiones y roturas por adherencias y por las calcificaciones que se forman en el trayecto subcutáneo a lo largo del tiempo. Las obstrucciones tardías predominan en el extremo distal y son motivo frecuente de reintervenciones. Las infecciones del sistema resultan las complicaciones más graves y complejas de tratar acompañándose de una alta mortalidad. Se pueden presentar de forma aguda, subaguda y de manera tardía. Se han identificado diferentes factores que pueden aumentar la incidencia de complicaciones, algunos relacionados con el tipo de válvula y la causa de la hidrocefalia. Conclusiones: Las derivaciones del líquido cefalorraquídeo han sido durante mucho tiempo el tratamiento clásico de la hidrocefalia pediátrica, al poder resolver casi todas sus formas independientemente de la causa. La clave del éxito para evitar las complicaciones está en una adecuada valoración preoperatoria y una rigurosa técnica quirúrgica y garantizar las medidas para la prevención de las infecciones.


ABSTRACT Background: Hydrocephalus is a common pediatric disorder and ventriculoperitoneal shunting is the most commonly surgical technique used for its treatment. The prevalence of pediatric complications is a frequent problem that increases morbidity and mortality. Objective: To systematize and update knowledge on pediatric ventriculoperitoneal complications. Development: Complications associated to ventriculoperitoneal shunting are frequent and can be divided into three groups: mechanical, infectious and functional related to inconsistent drainage of cerebrospinal fluid, either by defect or excess. Within mechanical complications, obstruction has the highest incidence followed by disconnections and ruptures due to adhesions and calcifications formed in the subcutaneous tract over time. Late obstructions predominate in the distal end being a frequent cause of reinterventions. Infections of the system are the most serious and complex complications to treat and are accompanied by high mortality. They can be acute, subacute and late. Unlike identified factors may increase the incidence of complications, some related to the type of valve and the cause of hydrocephalus. Conclusions: Cerebrospinal fluid shunts have been long the classic treatment for pediatric hydrocephalus, able to solve almost all of its different forms regardless of the cause. The key to success in avoiding complications lies in an adequate preoperative assessment and a rigorous surgical technique also endorsing infection prevention measures.


Subject(s)
Ventriculoperitoneal Shunt , Hydrocephalus , Patients
2.
Biomédica (Bogotá) ; 41(1): 17-28, ene.-mar. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1249055

ABSTRACT

Resumen | Las alteraciones visuales de origen neurológico en los niños tienen diversas causas, algunas reversibles y otras no. La hidrocefalia es una de las más comunes e importantes, ya que puede producir deficiencias permanentes. Las causas de la hidrocefalia son variadas; entre las principales está la hemorragia intraventricular, generalmente debida al sangrado de la matriz germinal, el cual es muy común en recién nacidos prematuros. Se presenta el caso clínico de una paciente prematura con parálisis cerebral infantil, hemorragia intraventricular e hidrocefalia, producto de un embarazo múltiple, que presentó atrofia óptica en la infancia secundaria a la disfunción del sistema de derivación ventrículo-peritoneal. Durante su rehabilitación y tratamiento, ha recibido sesiones de neurorrehabilitación que le han permitido mejorar su agudeza y capacidad visual. Se comparó el caso de la paciente con algunos similares para establecer las semejanzas y las diferencias entre los cuadros clínicos presentados y la importancia del tipo de tratamiento médico utilizado en el curso de recuperación de la capacidad visual.


Abstract | Neurological visual impairments in children have multiple causes, some of them reversible while others are not. Hydrocephalus is one of the most important and common ones as it can result in permanent impairment. There are multiple causes of hydrocephalus, intraventricular hemorrhage being the main one. This generally occurs when the germinal matrix bleeds and is very common in preterm newborns. We present the clinical case of a patient with cerebral palsy, intraventricular hemorrhage, and hydrocephalus as a result of a preterm multiple pregnancy who developed optic atrophy during childhood secondary to ventricle-peritoneal shunt dysfunction. During the rehabilitation and treatment period, she received neurorehabilitation sessions, which improved her visual acuity and capacity. We found similarities and differences with other cases and we confirmed the importance of the treatment chosen for the recovery of visual capacity.


Subject(s)
Cerebral Palsy , Ventriculoperitoneal Shunt , Cerebral Hemorrhage , Optic Atrophy , Vision, Low , Neurological Rehabilitation , Hydrocephalus
3.
Article in English | WPRIM | ID: wpr-922607

ABSTRACT

OBJECTIVES@#Idiopathic intracranial hypertension (IIH) is a syndrome that excludes secondary causes such as intracranial space-occupying lesion, hydrocephalus, cerebrovascular disease, and hypoxic ischemic encephalopathy. If not be treated promptly and effectively, IIH can cause severe, permanent vision disability and intractable, disabling headache. This study aims to explore the clinical and image features for IIH, to help clinicians to understand this disease, increase the diagnose rate, and improve the outcomes of patients.@*METHODS@#We retrospectively analyzed 15 cases of IIH that were admitted to Xiangya Hospital, Central South University, during January 2015 to September 2020. The diagnosis of IIH was based on the updated modified Dandy criteria. We analyzed clinical data of patients and did statistical analysis, including age, gender, height, weight, medical history, physical examination, auxiliary examination, treatment and outcome.@*RESULTS@#There were 10 females and 5 males. Female patients were 22 to 42 years old with median age of 39.5. Male patients were 27 to 52 years old with the median age of 44.0. The BMI was 24.14-34.17 (28.71±2.97) kg/m@*CONCLUSIONS@#IIH primarily affects women of childbearing age who are overweight. The major hazard of IIH is the severe and permanent visual loss. Typical image signs have high specificity in IIH diagnosis. Prompt diagnosis and effective treatment are significantly important to improve the outcomes of patients.


Subject(s)
Adult , Anemia, Iron-Deficiency , Female , Humans , Intracranial Hypertension , Male , Middle Aged , Pseudotumor Cerebri/diagnostic imaging , Retrospective Studies , Ventriculoperitoneal Shunt , Young Adult
6.
Arq. neuropsiquiatr ; 78(1): 9-12, Jan. 2020. graf
Article in English | LILACS | ID: biblio-1088986

ABSTRACT

Abstract Introduction: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. Methods: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. Results: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. Discussion: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. Conclusion: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.


Resumo Introdução: As complicações da hidrodinâmica cerebral em pacientes com derivação ventriculoperitoneal são frequentemente relacionadas ao malfuncionamento do sistema. O objetivo deste estudo retrospectivo de coorte de centro único é avaliar a segurança e performance clínica do Sistema Sphera® Duo quando utilizado em adultos com hidrocefalia, pseudotumor cerebral ou cistos aracnoides. Métodos: Avaliamos os prontuários de 112 pacientes adultos submetidos a cirurgia de derivação ventriculoperitoneal e acompanhados por 1 ano após a cirurgia. Resultados: O resultado mostra que 76% dos pacientes melhoraram dos sintomas neurológicos e a taxa de reoperação foi de 15% no primeiro ano após a cirurgia. Discussão: O sistema de derivação Sphera Duo® é uma opção de shunt adequada a ser usada no tratamento neurocirúrgico da hidrocefalia por causas diversas. Ele demonstrou bons resultados clínicos enquanto reduziu riscos de hiperdrenagem. A hiperdrenagem é especialmente preocupante e mórbida em pacientes adultos com hidrocefalia não hipertensiva e pode levar a prejuízo clínico e disfunção da válvula, com sintomas de hipotensão craniana, como cefaléia ortostática e náuseas. Conclusão: O sistema de derivação Sphera Duo® é seguro para tratamento da hidrocefalia, pseudotumor cerebri ou cistos aracnóides em adultos.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pseudotumor Cerebri/surgery , Arachnoid Cysts/surgery , Ventriculoperitoneal Shunt/instrumentation , Hydrocephalus/surgery , Reoperation , Time Factors , Pseudotumor Cerebri/physiopathology , Intracranial Pressure/physiology , Reproducibility of Results , Retrospective Studies , Follow-Up Studies , Arachnoid Cysts/physiopathology , Treatment Outcome , Ventriculoperitoneal Shunt/methods , Equipment Design , Hydrodynamics , Hydrocephalus/physiopathology
7.
Arq. neuropsiquiatr ; 77(12): 860-870, Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1055206

ABSTRACT

ABSTRACT Objective: To present a program of home physical exercises for patients with normal pressure hydrocephalus (NPH) and to evaluate adherence, acceptance and applicability; to verify possible changes in patients with NPH in the home physical exercise program, comparing patients with, and without, a ventriculoperitoneal shunt, regarding gait, quality of life, activities of daily living, static and dynamic balance and its impact on the risks of falling. Methods: This was a controlled clinical trial, with assessments in three moments (0, 10 and 18 weeks) at the home, from October 2015 to November 2017. Fifty-two patients (30 women and 22 men) participated in the study. Results: There was a statistically significant improvement with 10 weeks of home physical exercises for the groups with and without ventriculoperitoneal shunt, respectively, in the sub-items: activities of daily living p = 0.032*, p = 0.003*; static balance p < 0.001*, p < 0.001*; functional capacity p < 0.001*, p = 0.027*; and dynamic balance and gait p = 0.009*, p < 0.001*. There was no statistically significant difference for the subitems: quality of life p = 0.695, p = 1.000; and NPH grading scale p = 0.695, p = 1.000, respectively. Conclusion: The developed program of home physical exercise was easily applied and there was good acceptance by most patients with NPH included in the research. There was a statistically significant improvement with the 10 weeks of home physical exercises in the sub-items: activities of daily living, static balance and functional capacity, for both groups. In the sub-item dynamic balance and gait, there was a statistically significant improvement for both groups, but with a higher score for the group with a ventriculoperitoneal shunt. There was no statistically significant difference for the sub-items: quality of life, NPH grading scale and risk of falls, based on the Berg scale.


RESUMO Objetivo: Apresentar um programa de exercícios físicos domiciliares para pacientes com hidrocefalia de pressão normal e avaliar a adesão, aceitação e sua aplicabilidade; verificar possíveis alterações nos pacientes com HPN com o programa de exercícios físicos domiciliares, comparando os pacientes com e sem derivação ventriculoperitoneal, no que diz respeito à marcha, qualidade de vida, atividades de vida diária, equilíbrio estático e dinâmico e sua repercussão nos riscos de queda. Métodos: Trata-se de um Ensaio clínico controlado, com avaliações em três momentos (0.10 e 18 semanas) em nível domiciliar, no período de outubro/2015 a novembro/2017 Participaram do estudo 52 pacientes (30 mulheres e 22 homens). Resultados: Houve melhora estatisticamente significante com as dez semanas de exercícios físicos domiciliares para os grupos sem e com derivação ventriculoperitoneal respectivamente, nos subitens: atividades de vida diária p = 0,032* p = 0.003*, equilíbrio estático p < 0.001*, p < 0.001*; capacidade funcional p < 0.001*, p = 0,027*; equilíbrio dinâmico e marcha p = 0.009*, p < 0.001*. Não houve diferença estatística significante para os subitens: qualidade de vida p = 0,695, p = 1,000 e escala de graduação de HPN p = 0,695, p = 1,000. Conclusão: O programa de exercícios físicos domiciliares desenvolvido mostrou-se de fácil aplicabilidade e houve boa aceitação para a maioria dos pacientes com Hidrocefalia de Pressão Normal inseridos na pesquisa. Houve melhora estatisticamente significante com as dez semanas de exercícios físicos domiciliares nos subitens: atividades de vida diária, equilíbrio estático e capacidade funcional para ambos os grupos. No subitem equilíbrio dinâmico e marcha houve melhora estatisticamente significante para ambos os grupos, mas com escore maior para o grupo com derivação ventriculoperitoneal. Não houve diferença estatisticamente significante para os subitens: qualidade de vida, escala de graduação de Hidrocefalia de Pressão Normal e risco de quedas baseado na escala de Berg.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Exercise/physiology , Exercise Therapy/methods , Hydrocephalus, Normal Pressure/physiopathology , Hydrocephalus, Normal Pressure/rehabilitation , Quality of Life , Reference Values , Time Factors , Activities of Daily Living , Reproducibility of Results , Treatment Outcome , Ventriculoperitoneal Shunt/rehabilitation , Statistics, Nonparametric , Postural Balance/physiology , Exercise Test , Mental Status and Dementia Tests , Gait/physiology , Hydrocephalus, Normal Pressure/surgery
8.
Arq. neuropsiquiatr ; 77(10): 746-748, Oct. 2019. graf
Article in English | LILACS | ID: biblio-1038727

ABSTRACT

ABSTRACT The illustrious Colombian Professor Salomón Hakim provided the annals of neurology with one of the most brilliant and original bodies of research on record, developing the concept of normal pressure hydrocephalus, as well as proving that ventricular shunting is an effective treatment. Thus, Professor Hakim proved that some of the dementias, at that time considered senile, could be successfully treated. Here the authors present an historical review of his main contributions, which continue to influence the study of dementia to this day.


RESUMO O ilustre professor colombiano Salomón Hakim deixou como legado nos anais da neurologia uma das mais brilhantes e originais séries de pesquisa da história, desenvolvendo o conceito de hidrocefalia de pressão normal, bem como introduzindo a derivação ventricular como tratamento efetivo. Assim, Hakim provou que algumas das demências até então consideradas senis tinham possibilidade de tratamento bem-sucedido. Aqui os autores apresentarão uma revisão histórica de suas maiores contribuições, que continuam a influenciar o estudo de demências até os nossos dias.


Subject(s)
History, 20th Century , History, 21st Century , Hydrocephalus, Normal Pressure/history , Neurology/history , Ventriculoperitoneal Shunt/history , Colombia
10.
Iatreia ; 32(3): 236-242, Jul-Set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1040003

ABSTRACT

RESUMEN La infección de la derivación ventriculoperitoneal es una de las complicaciones más frecuentes en este procedimiento. Vibrio cholerae O1 y O139 es una bacteria gram negativa conocida principalmente por ser la responsable del cólera epidémico. No obstante, existen serotipos no O1/ no O139 capaces de causar afecciones extraintestinales, entre ellas se han reportado casos de neuroinfección. Presentamos el caso de una paciente con 9 meses de edad que posterior a la colocación de una derivación ventriculoperitoneal como tratamiento de hidrocefalia obstructiva congénita, presentó un cuadro de neuroinfección y el síndrome de malfunción valvular; se pudo aislar la Vibrio cholerae no O1/ no O139 en el líquido cefalorraquídeo y en la punta del catéter. Es el primer reporte en la literatura en la que se aísla la Vibrio cholerae no O1/ no O139 en líquido cefalorraquídeo secundario a infección de una derivación ventriculoperitoneal.


SUMMARY The infection of the ventriculoperitoneal shunt is one of most frequent complications for this procedure. Vibrio cholera O1 and O139 is a Gram negative bacteria known mainly for being responsible of the epidemic cholera, however, there are serotypes no O1/ no O139 capable of causing extraintestinal conditions, among them neuroinfection cases have been reported. We present the case of a 9 months old patient who after the placement of a ventriculoperitoneal shunt as treatment for connate obstructive hydrocephalus, presents a neuroinfection condition and valve malfunction syndrome, being able to isolate the Vibrio cholerae no O1/ no O139 in the cerebrospinal fluid and the tip of the catheter. It is the first report in the literature in which the Vibrio cholerae no O1/ no O139 is isolated in the cerebrospinal liquid secondary to an infection from a ventriculoperitoneal shunt.


Subject(s)
Humans , Vibrio cholerae non-O1 , Ventriculoperitoneal Shunt
11.
Rev. chil. infectol ; 36(3): 378-383, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013796

ABSTRACT

Resumen Introducción: La derivación ventrículo-peritoneal (DVP) es el tratamiento para la hidrocefalia. El líquido cefalorraquídeo (LCR) se evalúa para el manejo de sus complicaciones; sin embargo, la información de los valores del citoquímico en esta población es insuficiente. Objetivo: Describir las características del citoquímico del LCR de niños en manejo con DVP. Materiales y Métodos: Estudio de tipo observacional descriptivo, desarrollado en Bogotá (Colombia), entre el año 2008 y 2016. Se revisaron los registros de procedimientos de DVP y relacionados. Se incluyeron pacientes entre 6 meses y 18 años de edad. Resultados: Se revisaron 285 registros e ingresaron 31 muestras. Los valores de LCR fueron, respectivamente, para la mediana y al percentil 90%: leucocitos totales: 0 y 7 céls/mm3, neutrófilos: 0 y 6,8 céls/mm3, linfocitos: 0 y 2 céls/mm3, proteínas: 13,4 y 67,2 mg/dL, glucosa: 59 y 27,4 mg/dL. Discusión: Los valores de glucosa presentan un rango normal hacia el extremo inferior más amplio, con valores de proteínas mayores a los valores esperados. El rango de celularidad es la variable que presenta menor variación. Conclusiones: Los valores del citoquímico de LCR en paciente con DVP no son equiparables a los de la población sana y deben interpretarse según las características propias de esta población.


Background: The ventriculo-peritoneal shunt (VPS) is the treatment for hydrocephalus, the cerebrospinal fluid (CSF) is evaluated for the management of its complications; however, information on the values of the cytochemistry in this population is insufficient. Aim: To describe the characteristics of the CSF cytochemistry of children in VPS management. Methods: Descriptive observational study, developed in Bogotá (Colombia), from 2008 to 2016. VPS and related procedures records were reviewed. Patients between 6 months and 18 years were included. Results: A total of 285 records were reviewed, 31 samples were entered. The CSF values were, respectively, for the median and 90% percentile: total leukocytes: 0 and 7 cells/mm3, neutrophils: 0 and 6.8 cells/mm3, lymphocytes: 0 and 2 cells/mm3, proteins: 13.4 and 67.2 mg/dL, glucose: 59 and 27.4 mg/dL. Discussion: Glucose values evinced a normal rank towards the widest inferior limit with protein values exceeding the values expected. Cellularity is the variable with the lowest variation. Conclusions: The values of the CSF cytochemistry in patients with VPS are not comparable to those of the healthy population and should be interpreted according to the characteristics of this population.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Cerebrospinal Fluid/chemistry , Cerebrospinal Fluid Proteins/analysis , Ventriculoperitoneal Shunt , Histocytochemistry/standards , Cerebrospinal Fluid/cytology , Prospective Studies , Retrospective Studies , Glucose/cerebrospinal fluid , Leukocytes
12.
Article in Chinese | WPRIM | ID: wpr-813025

ABSTRACT

To investigate the effects of ventricular shunt placement in children with post-infective hydrocephalus.
 Methods: A total of 24 cases of post-infectious hydrocephalus, who received ventricular shunt, were enrolled. Age, gender, disease progression, clinical manifestation, laboratory data, treatment, prognosis, complication, and sequela for each patient were retrospectively reviewed.
 Results: Of the 24 cases, 8 had a full recovery, 11 had slight sequela, 2 had severe sequela, 1 was in vegetative state, and 2 died because of bacterial meningitis and tubercular meningitis. Epilepsy, mental impairment, visual and hearing damage were the main sequelae.
 Conclusion: Ventricular shunt is the preferred treatment in children with post-infective hydrocephalus, which shows positive clinical efficacy and can improve the long-term prognosis of such patients.


Subject(s)
Child , Humans , Hydrocephalus , Retrospective Studies , Treatment Outcome , Tuberculosis, Meningeal , Ventriculoperitoneal Shunt
13.
Article in English | WPRIM | ID: wpr-788822

ABSTRACT

OBJECTIVE: Shunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration.METHODS: We reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge.RESULTS: In the multivariate analysis, acute HCP (bicaudate index of ≥0.2) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843–16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044–16.169; p=0.043), and an age of ≥50 years (OR, 3.938; 95% CI, 1.375–11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0–3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750–0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847–0.943).CONCLUSION: Our results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.


Subject(s)
Aneurysm , Cerebral Infarction , Cerebrospinal Fluid Leak , Diabetes Mellitus , Hemorrhage , Hospital Mortality , Humans , Hydrocephalus , Hypertension , Multivariate Analysis , Prospective Studies , Risk Factors , ROC Curve , Septum Pellucidum , Subarachnoid Hemorrhage , Ventriculoperitoneal Shunt
14.
Article in English | WPRIM | ID: wpr-788741

ABSTRACT

OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision.METHODS: The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the ‘double incision’ whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision.RESULTS: Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection.CONCLUSION: The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.


Subject(s)
2-Propanol , Cerebrospinal Fluid , Humans , Hydrocephalus , Methods , Microbiota , Mortality , Povidone-Iodine , Skin , Surgical Wound Infection , Ventriculoperitoneal Shunt
15.
Article in Korean | WPRIM | ID: wpr-766779

ABSTRACT

Intracranial hypotension usually arises in the context of known or suspected leak of cerebrospinal fluid (CSF). This leakage leads to a fall in intracranial CSF pressure and CSF volume. The most common clinical manifestation of intracranial hypotension is orthostatic headache. Post-dural puncture headache and CSF fistula headache are classified along with headache attributed to spontaneous intracranial hypotension as headache attributed to low CSF pressure by the International Classification of Headache Disorders. Headache attributed to low CSF pressure is usually but not always orthostatic. The orthostatic features at its onset can become less prominent over time. Other manifestations of intracranial hypotension are nausea, spine pain, neck stiffness, photophobia, hearing abnormalities, tinnitus, dizziness, gait unsteadiness, cognitive and mental status changes, movement disorders and upper extremity radicular symptoms. There are two presumed pathophysiologic mechanisms behind the development of various manifestations of intracranial hypotension. Firstly, CSF loss leads to downward shift of the brain causing traction on the anchoring and supporting structures of the brain. Secondly, CSF loss results in compensatory meningeal venodilation. Headaches presenting acutely after an intervention or trauma that is known to cause CSF leakage are easy to diagnose. However, a high degree of suspicion is required to make the diagnosis of spontaneous intracranial hypotension and understanding various neurological symptoms of intracranial hypotension may help clinicians.


Subject(s)
Brain , Cerebrospinal Fluid , Cerebrospinal Fluid Leak , Classification , Diagnosis , Dizziness , Fistula , Gait , Headache , Headache Disorders , Hearing , Intracranial Hypotension , Movement Disorders , Nausea , Neck Pain , Photophobia , Post-Dural Puncture Headache , Spine , Tinnitus , Traction , Upper Extremity , Ventriculoperitoneal Shunt
16.
Article in English | WPRIM | ID: wpr-765396

ABSTRACT

OBJECTIVE: Shunt-dependent hydrocephalus (SdHCP) is a well-known complication of aneurysmal subarachnoid hemorrhage (SAH). The risk factors for SdHCP have been widely investigated, but few risk scoring systems have been established to predict SdHCP. This study was performed to investigate the risk factors for SdHCP and devise a risk scoring system for use before aneurysm obliteration. METHODS: We reviewed the data of 301 consecutive patients who underwent aneurysm obliteration following SAH from September 2007 to December 2016. The exclusion criteria for this study were previous aneurysm obliteration, previous major cerebral infarction, the presence of a cavum septum pellucidum, a midline shift of >10 mm on initial computed tomography (CT), and in-hospital mortality. We finally recruited 254 patients and analyzed the following data according to the presence or absence of SdHCP : age, sex, history of hypertension and diabetes mellitus, Hunt-Hess grade, Fisher grade, aneurysm size and location, type of treatment, bicaudate index on initial CT, intraventricular hemorrhage, cerebrospinal fluid drainage, vasospasm, and modified Rankin scale score at discharge. RESULTS: In the multivariate analysis, acute HCP (bicaudate index of ≥0.2) (odds ratio [OR], 6.749; 95% confidence interval [CI], 2.843–16.021; p=0.000), Fisher grade of 4 (OR, 4.108; 95% CI, 1.044–16.169; p=0.043), and an age of ≥50 years (OR, 3.938; 95% CI, 1.375–11.275; p=0.011) were significantly associated with the occurrence of SdHCP. The risk scoring system using above parameters of acute HCP, Fisher grade, and age (AFA score) assigned 1 point to each (total score of 0–3 points). SdHCP occurred in 4.3% of patients with a score of 0, 8.5% with a score of 1, 25.5% with a score of 2, and 61.7% with a score of 3 (p=0.000). In the receiver operating characteristic curve analysis, the area under the curve (AUC) for the risk scoring system was 0.820 (p=0.080; 95% CI, 0.750–0.890). In the internal validation of the risk scoring system, the score reliably predicted SdHCP (AUC, 0.895; p=0.000; 95% CI, 0.847–0.943). CONCLUSION: Our results suggest that the herein-described AFA score is a useful tool for predicting SdHCP before aneurysm obliteration. Prospective validation is needed.


Subject(s)
Aneurysm , Cerebral Infarction , Cerebrospinal Fluid Leak , Diabetes Mellitus , Hemorrhage , Hospital Mortality , Humans , Hydrocephalus , Hypertension , Multivariate Analysis , Prospective Studies , Risk Factors , ROC Curve , Septum Pellucidum , Subarachnoid Hemorrhage , Ventriculoperitoneal Shunt
17.
Article in English | WPRIM | ID: wpr-765312

ABSTRACT

OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision. METHODS: The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the ‘double incision’ whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision. RESULTS: Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection. CONCLUSION: The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.


Subject(s)
2-Propanol , Cerebrospinal Fluid , Humans , Hydrocephalus , Methods , Microbiota , Mortality , Povidone-Iodine , Skin , Surgical Wound Infection , Ventriculoperitoneal Shunt
18.
Article in English | WPRIM | ID: wpr-759990

ABSTRACT

Presyrinx consists of reversible spinal cord swelling without frank cavitation, as observed on T2 weighted magnetic resonance imaging (MRI). The condition may evolve into syringomyelia, but timely surgical interventions have achieved meaningful results. Here, we report the case of a 27-year-old woman who presented with headache, dizziness, and diplopia 2 months after suffering a mild head trauma. On MRI, hydrocephalus, downward herniation of the cerebellar tonsil, and a diffuse high signal change in the cervical spinal cord were detected. After insertion of a ventriculoperitoneal shunt, her neurological symptoms resolved, and she has had no signs of presyrinx recurrence for >4 years.


Subject(s)
Adult , Arnold-Chiari Malformation , Cervical Cord , Craniocerebral Trauma , Diplopia , Dizziness , Female , Headache , Humans , Hydrocephalus , Magnetic Resonance Imaging , Palatine Tonsil , Recurrence , Spinal Cord , Syringomyelia , Ventriculoperitoneal Shunt
19.
Korean Journal of Medicine ; : 383-386, 2019.
Article in Korean | WPRIM | ID: wpr-759942

ABSTRACT

Ventriculoperitoneal (VP) shunt insertion is the standard treatment for hydrocephalus; shunt-associated infection is the most common complication after surgery. However, fungal infections are unusual. We present a case of cryptococcal meningitis complicated by a brain abscess and an infected intra-abdominal pseudocyst that developed 14 weeks after VP shunt insertion to treat hydrocephalus in a 74-year-old patient. Cryptococcal central nervous system (CNS) infection has a high mortality rate; however, diagnosis is challenging. Therefore, prompt diagnosis and treatment are required when a cryptococcal CNS infection is suspected in patients with VP shunts.


Subject(s)
Aged , Brain Abscess , Brain , Central Nervous System , Cryptococcus , Diagnosis , Humans , Hydrocephalus , Meningitis, Cryptococcal , Mortality , Ventriculoperitoneal Shunt
20.
Article in English | WPRIM | ID: wpr-761743

ABSTRACT

The prevalence of human taeniasis has decreased in Korea. The stool egg positive proportion decreased from 1.9% in 1971 to 0% in 2004 in nationwide surveys. The neurocysticercosis (NCC) is also presumed to decrease. However, detailed information regarding the recent status of NCC in Korea is lacking. We retrospectively reviewed NCC cases from 1990 to 2016 at Asan Medical Center, a 2700-bed tertiary referral hospital in Korea. We identified patients based on clinical symptoms, brain imaging, pathology and serological assay. The cases were classified as parenchymal, extraparenchymal, and mixed NCC. Eighty-one patients were included in the analysis. The mean age was 54.5 years, and 79.0% were male. The number of NCC cases was highest from 1995 to 1999, and continuously decreased thereafter. Forty (49.4%) patients had parenchymal NCC, while 25 (30.9%) patients had extraparenchymal NCC, and 16 (19.8%) patients had mixed NCC. The seizure and headache were most common symptom of parenchymal NCC and extraparenchymal NCC respectively. Hydrocephalus was more common in extraparenchymal NCC, and patients with extraparenchymal NCC were more likely to require a ventriculoperitoneal shunt. Cases of NCC are decreasing accordingly with human taeniasis and lesion location was the most important determinant of clinical presentation and outcome of NCC in Korea.


Subject(s)
Headache , Humans , Hydrocephalus , Korea , Male , Neurocysticercosis , Neuroimaging , Ovum , Pathology , Prevalence , Retrospective Studies , Seizures , Taenia solium , Taeniasis , Tertiary Care Centers , Ventriculoperitoneal Shunt
SELECTION OF CITATIONS
SEARCH DETAIL