Factors Affecting the Response to First-Line Treatments in Patients with Anti-N-Methyl-D-Aspartate Receptor Encephalitis

BACKGROUND AND PURPOSE: Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common type of autoimmune encephalitis. This study aimed to explore the possible factors affecting the response to first-line treatments in patients with anti-NMDAR encephalitis. METHODS: We enrolled 29 patients who were diagnosed as anti-NMDAR encephalitis between January 1, 2015, and June 30, 2018. They were divided into the remission and nonremission groups according to their response to first-line treatments. The demographics, clinical manifestations, main ancillary examinations, follow-up treatments, and prognosis of patients were recorded. The symptoms reported on in this study occurred before treatments or during the course of first-line treatments. RESULTS: There were 18 patients (62.07%) in the remission group and 11 patients (37.93%) in the nonremission group. Compared to the remission group, a higher proportion of the patients in the nonremission group exhibited involuntary movements, decreased consciousness, central hypoventilation, lung infection, and hypoalbuminemia. The nonremission group had a high incidence of increased intracranial pressure and significant elevations of the neutrophil-to-lymphocyte ratio in peripheral blood (NLR), aspartate aminotransferase, and fibrinogen. Six patients (54.55%) in the nonremission group received second-line immunotherapy. Only one patient (3.45%) died, which was due to multiple-organ failure. CONCLUSIONS: Anti-NMDAR-encephalitis patients with more symptoms—especially involuntary movements, disturbance of consciousness, central hypoventilation, and accompanying hypoalbuminemia and pulmonary infection—may respond poorly to first-line treatments. Positive second-line immunotherapy therefore needs to be considered. Admission to an intensive-care unit, increased cerebrospinal fluid pressure, and increased NLR might be the significant factors affecting the response to first-line treatments.

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test / Marcha na hidrocefalia de pressão normal: características e efeitos do tap-test

ABSTRACT Normal pressure hydrocephalus (NPH), described by Hakim and Adams in 1965, is characterized by gait apraxia, urinary incontinence, and dementia. It is associated with normal cerebrospinal fluid (CSF) pressure and ventricular dilation that cannot be attributed to cerebral atrophy. Objectives: To evaluate gait characteristics in patients with idiopathic NPH and investigate the effect of the CSF tap test (CSF-TT) on gait. Methods: Twenty-five patients diagnosed with probable idiopathic NPH were submitted to the CSF-TT. The procedure aimed to achieve changes in gait parameters. Results: Fifteen gait parameters were assessed before and after the CSF-TT. Five showed a statistically significant improvement (p < 0.05): walking speed (p < 0.001), cadence (p < 0.001), step length (p < 0.001), en bloc turning (p = 0.001), and step height (p = 0.004). Conclusion: This study demonstrated that gait speed was the most responsive parameter to the CSF-TT, followed by cadence, step length, en bloc turning, and step height.

RESUMO A hidrocefalia de pressão normal (HPN), descrita por Hakim-Adams em 1965, caracteriza-se por apraxia de marcha, incontinência urinária e demência e está associada com pressão normal do líquido cefalorraquidiano e dilatação ventricular não atribuída a atrofia cerebral. Objetivos: Avaliar as características da marcha em pacientes com HPN idiopática e o efeito do "tap-test" (TT) na marcha. Métodos: Vinte e cinco pacientes com o diagnóstico HPN idiopática provável, foram avaliados com o TT. O procedimento tem como objetivo causar mudanças nas características da marcha. Resultados: Quinze parâmetros da marcha foram avaliados com o TT. Cinco mostraram melhora estatisticamente significativa (p < 0,05): velocidade da marcha (p < 0,001), cadência (p < 0,001), comprimento do passo (p < 0,001), giro em "bloco" (p = 0,001) e altura do passo (p = 0,004). Conclusão: Este estudo demonstrou que a velocidade da marcha foi o parâmetro que mais respondeu ao efeito do TT, seguido da cadência, comprimento do passo, giro em "bloco" e altura do passo.

Cerebrospinal Fluid Pressure and Trans-lamina Cribrosa Pressure Difference in Open-angle Glaucoma: KNHANES V

PURPOSE: To investigate the relationships between estimated cerebrospinal fluid pressure (CSFP) and trans-lamina cribrosa pressure difference (TLCPD) in open-angle glaucoma (OAG) in Korean population. METHODS: A total of 10,801 eyes were included from the Korean National Health and Nutrition Examination Survey V. All participants (aged 19 years or older) were classified as non-glaucomatous group, OAG suspect group and OAG group. CSFP was calculated as CSFP (mm Hg) = 0.44 body mass index (kg/m²) + 0.16 diastolic blood pressure (mm Hg) - 0.18 age (years) - 1.91. TLCPD was calculated by subtracting CSFP from intraocular pressure. RESULTS: The mean estimated CSFP was (8.7 ± 3.3 mm Hg vs. 11.6 ± 3.7 mm Hg, 11.2 ± 3.8 mm Hg vs. 11.6 ± 3.7 mm Hg) was lower, and the mean TLCPD (5.7 ± 4.4 mm Hg vs. 2.2 ± 4.4 mm Hg, 3 ± 4.7 mm Hg vs. 2.2 ± 4.4 mm Hg) was higher in the OAG group and in the OAG suspect group than in the non-glaucomatous control group, respectively (p < 0.001). After adjusting relating factor with CSFP and TLCPD using simple linear regression and multivariate analyses, the mean estimated CSFP was distributed lower (p < 0.001; beta: -0.12; B: -2.306; 95% confidence interval [CI]: -2.717, -1.895) in OAG group than in non-glaucomatous group and the mean TLCPD was distributed higher (p < 0.001; beta: 0.099; B: 1.349; 95% CI: 0.977, 1.72; p < 0.001; beta: 0.118; B: 2.776; 95% CI: 2.264, 3.289) in OAG suspect group and in OAG group than in non-glaucomatous group, respectively. CONCLUSIONS: Estimated CSFP and calculated TLCPD showed essential association with OAG presence. It supports the potential role of low CSFP in the pathogenesis of OAG.

Correlation between Trans-lamina Cribrosa Pressure Difference and Morphologic Parameters of Optic Disc in Normal Tension Glaucoma Patients

PURPOSE: To investigate the relationship between trans-lamina cribrosa pressure difference (TLCPD) and morphologic parameters of optic disc (OD) in normal tension glaucoma (NTG) patients. METHODS: Data from 31 NTG patients (31 eyes) and 29 controls (29 eyes) were analyzed retrospectively. Their cerebrospinal fluid pressure was estimated using diastolic pressure (DBP), body mass index (BMI) and age. TLCPD was defined as the difference of intraocular pressure (IOP) and the estimated cerebrospinal fluid pressure (ECSFP). Measurements of the rim area (RA), disc area (DA), average and vertical cup/disc (C/D) ratio, retinal nerve fiber layer thickness (RNFLT) and cup volume (CV) were taken for all patients using optical coherence tomography. The correlation between TLCPD and morphologic parameters of OD were assessed. RESULTS: There were no significant differences between the two groups in terms of age, DBP, IOP and spherical equivalent (SE) and BMI. The mean ECSFP was significantly higher in the controls (10.7 ± 2.8 vs. 12.2 ± 2.2 mm Hg, p = 0.031) and TLCPD was significantly higher in patients (2.4 ± 2.1 vs. 4.9 ± 3.7 mm Hg, p = 0.002). In the NTG group, there was a negative correlation between TLCPD and RA (r = -0.595) and positive correlations between TLCPD and the average C/D ratio (r = 0.504), vertical C/D ratio (r = 0.434) and CV (r = 0.420). Average RNLFT was also significantly correlated with TLCPD (r = -0.500) and RNFLT for four quadrants, except the nasal quadrant, in NTG patients. CONCLUSIONS: NTG patients had higher TLCPD. A higher TLCPD was associated with a narrower RA, larger C/D ratio, and thinner RNFLT.

Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis / Potenciais evocados visuais mostram correlação positiva forte com a pressão intracraniana em pacientes com meningite criptocócica

Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis. .

Objetivo : Verificar a relação entre pressão intracraniana e potencial evocado visual por flash (PEV-F) em pacientes com meningite criptocócica. Método A amostra incluiu pacientes admitidos em um hospital de referência para doenças infecciosas. Realizou-se PEV-F antes de cada punção lombar. Calculou-se o coeficiente de correlação de Pearson e a equação de regressão linear entre as variáveis latência N2 e pressão intracraniana inferida através de raquimanometria. Resultados Dezoito pacientes foram submetidos a um total de 69 punções lombares. A latência N2 mostrou correlação positiva forte com a pressão de abertura verificada na primeira punção lombar a que cada paciente foi submetido (r = 0,83; IC = 0,60 – 0,94; p < 0,0001). A positividade da correlação foi mantida nas aferições subsequentes. Conclusão Houve associação positiva forte entre a latência N2 do PEV-F e pressão intracraniana em pacientes com meningite criptocócica. .

Dynamic observation of clinical course in patients with subacute 1, 2-dichloroethane poisoning / 中华劳动卫生职业病杂志

<p><b>OBJECTIVE</b>To observe the clinical characteristics and regular patterns of subacute 1, 2-dichloroethane poisoning patients for providing evidences to it's diagnosis, treatment and prognosis.</p><p><b>METHODS</b>51 cases of subacute 1, 2-dichloroethane poisoning analyzed. They were divided into 3 groups according to their main clinical manifestation: group A mainly with intracranial hypertension (n = 25), group B with limbs tremor (n = 18), group C with mental and behavior disorder (n = 8). All cases' clinical symptoms, cranial computer tomography, cerebrospinal pressure (Group A) were observed, the durations of the onset, deterioration, improvement, recovery and whole course of the disease were compared between groups and in each group.</p><p><b>RESULTS</b>In all of 51 cases, only the differences between the deterioration duration of cranial CT and symptom was significantly (t = 2.555, P<0.05), which indicate the deterioration of symptom was earlier than radiological change. The symptom deterioration of group C was the fastest than group A and group B (P<0.00). As to the change of symptom duration, group B's improvement, recovery and whole course was the longest comparing with group A and group C (P<0.05). As to the change of cranial CT duration, group B's recovery duration was the shortest and group A's recovery duration was the longest (P<0.01); group B's whole course was also the shortest and group A's whole course was the longest (P<0.05). The clinical course of symptoms, cranial computer tomography, cerebrospinal pressure (Group A) was compared in each group, in group A, the duration of improvement and whole course of the cranial CT and cerebrospinal pressure change was longer than that of the symptom change (P<0.01), this indicated that group A has longer asymptomatic intracranial hypertension and their cranial radiography recover slowly. In group B, their symptoms (3.94 ± 4.31 days) deteriorated is earlier than cranial CT changes (P<0.05), the recovery (92.39 ± 55.04 days) and whole course of symptom was longer than cranial CT change (all P<0.01). In group C, symptom deterioration was earlier than CT deterioration (P< 0.05).</p><p><b>CONCLUSION</b>The clinical characteristic of subacute 1, 2- dichloroethane poisoning is central nervous system damage, it differs according to the different stage of course, the regions and severity of pathology lesions.</p>

Isolated and bilateral simultaneous facial palsy disclosing early human immunodeficiency virus infection

Bilateral lower motor neuron type facial palsy is an unusual neurological disorder. There are few reports that associate it with the human immunodeficiency virus (HIV) infection on initial presentation. A 51-year-old married woman, who was previously healthy and had no risk of HIV infection, presented solely with bilateral simultaneous facial palsy. A positive HIV serology test was confirmed by an enzyme-linked immunosorbent assay test. Following a short course of oral prednisolone, the patient recovered completely from facial palsy in three months, even though an antiretroviral treatment was suspended. Exclusion of HIV infection in patients with bilateral facial palsy is essential for early diagnosis and management of HIV.

Punção liquórica cervical lateral em C1-C2: um procedimento de grande utilidade em pacientes vítimas de trauma ­ Relato de série de casos / Lateral Cervical Spinal Puncture at c1-c2: A Useful Procedure in Trauma Patients - Report of a Series of Cases

A punção liquórica cervical lateral no espaço C1-C2 foi descrita a partir de uma modificação da técnica utilizada para cordotomia percutânea anterolateral. Neste artigo, é descrita uma série de 14 pacientes vítimas de trauma, submetidos à punção liquórica cervical lateral. Todos os procedimentos foram realizados para pesquisa de meningite bacteriana. Presença de escara lombar e occipital, fratura instável de coluna vertebral, tração ou imobilização ortopédica e ventilação mecânica controlada foram os principais motivos para se optar pela punção liquórica cervical lateral. A taxa de sucesso foi de 93%. Não foram evidenciadas maiores complicações per ou pósprocedimento. A punção liquórica cervical lateral se mostrou um método eficaz para obtenção de líquor em pacientes vítimas de trauma, pois não requer mudança de decúbito ou angulação da cabeceira, o que evita complicações em pacientes entubados e com fratura instável de coluna vertebral. Estudos prévios sugerem que a punção liquórica cervical lateral deve ser o método de escolha em pacientes vítimas de trauma com restrição de mobilização.

The lateral cervical spinal puncture at C1-C2 was described from a modification of the technique used for percutaneous anterolateral cordotomy. In this article, we describe a series of 14 patients of multiple trauma victims who underwent lateral cervical spinalpuncture. All procedures were performed as a screening for bacterial meningitis. Low back and occipital ulcer, unstable spinal fractures, orthopedic traction or immobilization and ventilated patients were the main reasons to opt for the lateral cervical spinal puncture over standard techniques of liquor puncture. The success rate was 93%. There was not major complication per or post procedural. The lateral cervical spinal puncture proved to be an effective method of obtaining liquor in victims of trauma because it does not requires changing position or rotation of the head, preventing complications in patients with orotraqueal tube and unstable spinal fractures. Previous studies suggest that the lateral cervical spinal puncture should be the method of choice in trauma patients with restriction of mobilization.

Hipertensión intracraneal idiopática en pediatría / Idiopathic intracranial hypertension in pediatrics

La Hipertensión Intracraneal Idiopática es un trastorno que afecta típicamente a mujeres jóvenes y obesas, produciendo aumento de la presión intracraneal sin causa identificable. Se deben descartar los trastornos intracraneales como un proceso meníngeo o trombosis venosa cerebral, para hacer un diagnóstico de Hipertensión Intracraneal Idiopática. Los estudios de tratamiento muestran que la punción lumbar es una intervención valiosa más allá de su importancia diagnóstica, el pronóstico es variable, pero la pérdida visual grave se produce en 10 a 25% de los pacientes. La incidencia de la hipertensión intracraneal idiopática va en aumento entre los niños y adolescentes; su cuadro clínico es similar al adulto. Entre los niños se ha asociado con varias etiologías nuevas, incluyendo la hormona de crecimiento recombinante y el ácido todo trans-retinoico. Para la revisión bibliográfica se utilizaron datos más recientes del tema por parte de la revista continuum y bases de datos en Journal of Neurological Science. Caso clínico: paciente femenina de 11 años de edad, con cefalea holocraneana de 3 meses de evolución y visión borrosa concomitante; al examen físico se encontró papiledema bilateral grado IV. Los estudios de imágenes descartaron lesión ocupativa o trombosis cerebral, que provocaron el aumento de la presión intracraneana. La punción lumbar terapéutica y diagnóstica reveló presión de apertura 40cmH2O y citoquímica normal. Conclusión: los pacientes diagnosticados con hipertensión intracraneal...(AU)

Quantitative Measurement of the Sella Turcica in Pseudotumor Cerebri

PURPOSE: In this study we evaluated the hypothesis that sella turcica enlarged in size due to increased intracranial hypertension by measuring the sella turcica area using magnetic resonance imaging (MRI) in patients with increased intracranial hypertension and compared to normal controls. METHODS: Brain magnetic resonance (MR) midsagittal images of patients diagnosed with pseudotumor cerebri from 2005 to 2012 at Dankook University Hospital and 10 normal controls who had no overt signs or symptoms of neurological disease and had normal gadolinium-enhanced MR examination of brain were compared. The area of the sella turcica was measured by the double-blind method using Dicomworks v 1.3.5b (Philippe Puech and Loic Boussel, Freeware, France). Statistical analysis was conducted using GraphPad Prism (GraphPad Software, Inc., USA) and Mann-Whitney U-test. RESULTS: The sella turcica areas of 2 pseudotumor cerebri patients were 93 mm2 and 123 mm2 and were significantly larger than in the controls (p = 0.03). CONCLUSIONS: Empty sella which commonly occurs in pseudotumor cerebri can be caused by pituitary gland atrophy but, conversely, can result from the enlargement of the bony sella in response to an abnormal cerebrospinal fluid pressure gradient.

The correlation of cerebrospinal fluid pressure according to the degree of flexion and spinal block level in spinal anesthesia for Cesarean section

BACKGROUND: The use of neuraxial anesthesia for Cesarean section has dramatically increased. There was little information about the relationship of cerebrospinal fluid (CSF) pressure according to the position and spinal block level in pregnant women. The aims of this study are to investigate the cerebrospinal fluid pressure according to the degree of flexion in the lateral position and block height after spinal anesthesia in pregnant women undergoing Cesarean section. METHODS: We enrolled 40 patients, American Society of Anesthesiologists physical status I-II, aged 22-40 years, undergoing Caesarean section under spinal anesthesia. Patients were randomly divided into two groups. In group I, patients were placed in a full flexed position, and 10 mg of 0.5% hyperbaric bupivacaine was injected. In group II, the same dose of bupivacaine was injected when the hip and neck was straightened slowly. Following injection, the patients were immediately placed in supine position. The level of spinal anesthesia was checked by pinprick at 5, 10, 15, and 30 min after the subarachnoid injection. RESULTS: There was significant difference in the cerebrospinal fluid pressure between full-flexed position and non-full-flexed position. The spinal block height level was T3-T5 in both groups, and there was no significant difference in the spinal block height level in both groups. CONCLUSIONS: CSF pressures according to the degree of flexion in the lateral position during the subarachnoid injection have no significant correlation with the block level in spinal anesthesia for Cesarean section.

Changes of cerebrospinal fluid pressure after thoracic endovascular aortic repair / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Decreasing the intracranial pressure has been advocated as one of the major protective strategies to prevent spinal cord ischemia after endovascular aortic repair. However, the actual changes of cerebrospinal fluid (CSF) pressure and its relation with spinal cord ischemia have been poorly understood. We performed CSF pressure measurements and provisional CSF withdrawal after thoracic endovascular aortic repair, and compared the changes of CSF pressure in high risk patients and in patients with new onset paraplegia and paraparesis.</p><p><b>METHODS</b>Four hundred and nineteen patients were evaluated for the risk of spinal cord ischemia after thoracic endovascular aortic repair. Patients with identified risk factors before the procedure constituted group H and received prophylactic sequential CSF pressure measurement and CSF withdrawal. Patients who actually developed spinal cord ischemia constituted group P and received rescue CSF pressure measurements and CSF withdrawal.</p><p><b>RESULTS</b>Among the 419 patients evaluated, 17 were graded as high risk. Four patients actually developed spinal cord ischemia after endovascular repair. The incidence of spinal cord ischemia in this investigation was 0.9%. The patients who actually developed spinal cord ischemia had no identified risk factors and had elevated CSF pressure, ranging from 15.4 to 30.0 mmHg. Six of the 17 patients graded as high risk had elevated CSF pressure: >20 mmHg in two patients and >15 mmHg in four patients. Sequential CSF pressure measurements and provisional withdrawal successfully decrease CSF pressure and prevented symptomatic spinal cord ischemia in high-risk patients. However, these measurements could only successfully reverse the neurologic deficit in two of the patients who actually developed spinal cord ischemia.</p><p><b>CONCLUSIONS</b>Cerebrospinal fluid pressure was elevated in patients with spinal cord ischemia after thoracic endovascular aortic repair. Sequential measurements of CSF pressure and provisional withdrawal of CSF decreased CSF pressure effectively in high risk patients and provided effective prevention of spinal cord ischemia. Risk factor identification and prophylactic measurements play the key role in prevention of spinal cord ischemia after thoracic endovascular aortic repair.</p>

Slowly Recovering Isolated Bilateral Abducens Nerve Palsy after Embolization of Ruptured Anterior Communicating Artery Aneurysm

Bilateral abducens nerve palsy related to ruptured aneurysm of the anterior communicating artery (ACoA) has only been reported in four patients. Three cases were treated by surgical clipping. No report has described the clinical course of the isolated bilateral abducens nerve palsy following ruptured ACoA aneurysm obliterated with coil. A 32-year-old man was transferred to our institution after three days of diplopia, dizziness and headache after the onset of a 5-minute generalized tonic-clonic seizure. Computed tomographic angiography revealed an aneurysm of the ACoA. Magnetic resonance imaging showed focal intraventricular hemorrhage without brain stem abnormalities including infarction or space-occupying lesion. Endovascular coil embolization was conducted to obliterate an aneurysmal sac followed by lumbar cerebrospinal fluid (CSF) drainage. Bilateral paresis of abducens nerve completely recovered 9 weeks after ictus. In conclusion, isolated bilateral abducens nerve palsy associated with ruptured ACoA aneurysm may be resolved successfully by coil embolization and lumbar CSF drainage without directly relieving cerebrospinal fluid pressure by opening Lillequist's membrane and prepontine cistern.

role of cerebrospinal fluid pressure in glaucoma and other ophthalmic diseases: a review

Glaucoma is one of the most common causes of blindness in the world. Well-known risk factors include age, race, a positive family history and elevated intraocular pressures. A newly proposed risk factor is decreased cerebrospinal fluid pressure [CSFP]. This concept is based on the notion that a pressure differential exists across the lamina cribrosa, which separates the intraocular space from the subarachnoid fluid space. In this construct, an increased translaminar pressure difference will occur with a relative increase in elevated intraocular pressure or a reduction in CSFP. This net change in pressure is proposed to act on the tissues within the optic nerve head, potentially contributing to glaucomatous optic neuropathy. Similarly, patients with ocular hypertension who have elevated CSFPs, would enjoy a relatively protective effect from glaucomatous damage. This review will focus on the current literature pertaining to the role of CSFP in glaucoma. Additionally, the authors examine the relationship between glaucoma and other known CSFP-related ophthalmic disorders

Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention / Desempenho da válvula de pressão fixa com antissifão SPHERA® no tratamento da hidrocefalia e na prevenção da ocorrência de hiperdrenagem

Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure <5 cm H2O after tap test (40 mL), 6 had pseudotumor cerebri, and 7 had hydrocephalus due to other causes. Clinical improvement was observed and sustained in 94.3% of the patients during the two-year period with no computed tomography (CT) evidence of hypo or overdrainage, and no immediate early or late significant complications.

Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS) com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifão SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%); 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final <5 cm H2O após tap test (40 mL); 6 apresentavam pseudotumor cerebral; e 7, devido a outras causas. A melhoria clínica foi detectada e sustentada em 94,3% dos pacientes no período de dois anos, sem indícios tomográficos de hipo ou hiperdrenagem e sem complicações significativas imediatas, precoces ou tardias.

Continuous ventricular cerebrospinal fluid drainage with intracranial pressure monitoring for management of posttraumatic diffuse brain swelling / Drenagem contínua de líquido cefalorraquidiano com monitoração intermitente de pressão intracraniana em pacientes com tumefação cerebral difusa pós-traumática

BACKGROUND: Ventricular drainage has played an important role in the management of traumatic brain-injured patients. The aim of the present study was describe outcomes in a series of 57 patients with diffuse brain swelling underwent to intracranial pressure (ICP) monitoring. METHOD: Fifty-eight patients with diffuse posttraumatic brain swelling, were evaluated prospectively. The Glasgow Coma Scale (GCS) scores of patients varied from 4 to 12. Patients groups divided according to GCS and age. Patient neurological assessment was classified as favorable, unfavorable, and death. RESULTS: Mechanisms of injury were vehicle accidents in 72.4 percent and falls in 15.6 percent. 54 percent of patients had GCS scores between 6 and 8. There were no statistical differences, regarding outcome, between groups separated by age. In the adults group (n=47), 44.7 percent evolved favorably. CONCLUSION: Our results indicate a poor prognosis in patients with brain swelling. We believe that continuous ventricular CSF drainage with ICP monitoring is a simple method as an adjunct in the management of these patients.

INTRODUÇÃO: Monitoração da pressão intracraniana (PIC) tem desempenhado um papel importante nos pacientes com lesão cerebral difusa traumática. O objetivo do presente estudo foi descrever os resultados de uma série de 57 pacientes com tumefação cerebral difusa submetidos à monitoração da PIC. MÉTODO: Cinquenta e oito pacientes com lesão axonal difusa foram avaliados prospectivamente. Na Escala de Coma de Glasgow (GCS) os escores variaram de 4 a 12. Os grupos de pacientes, foram divididos de acordo com a GCS e a idade. Avaliação neurológica tardia foi classificada como favorável, desfavorável, e da morte. RESULTADOS: Mecanismos de lesão predominantes foram os acidentes de veículos em 72,4 por cento e quedas em 15,6 por cento; 54 por cento dos pacientes tiveram escores GCS entre 6 e 8. Não houve diferença estatística entre os grupos separados por idade. No grupo de adultos (n=47), 44,7 por cento evoluíram favoravelmente. CONCLUSÃO: As lesões difusas tipo III apresentam resultados funcionais desfavoráveis. Acreditamos que a monitoração intermitente de PIC com drenagem de líquido cefalorraquidiano seja um método simples e aplicável no apoio ao tratamento destes pacientes.

A Case of Bilateral Hearing Loss Following External Ventricular Drainage / 대한이비인후과학회지

The sensorineural hearing loss following extraventricular drainage (EVD) is perhaps an underestimated complication rather than an uncommon event. Changes in the cerebrospinal fluid (CSF) pressure may lead to endolymphatic hydrops through the patent cochlear aqueduct resulting in sensorineural hearing loss. We describe the case of a 9-year-old child suffering from meduloblastoma. Bilateral hearing loss, especially at low frequency was found after emergent extraventricular drainage. At 2 months of treatment, hearing loss improved a little, but not restored to a serviceable hearing. Our experience and a review of articles indicate that early detection and awareness of hearing loss after EVD are important for treatment strategy.

Cerebellar hemorrhage after spine fixation misdiagnosed as a complication of narcotics use: A case report / 대한마취과학회지

Cerebellar hemorrhage occurs mainly due to hypertension. Postoperative cerebellar hemorrhage is known to be associated frequently with frontotemporal craniotomy, but quite rare with spine operation. A 56-year-old female received spinal fixation due to continuous leg tingling sensation for since two years ago. Twenty-one hours after operation, she was disoriented and unresponsive to voice. Performed computed tomography showed both cerebellar hemorrhage. An emergency decompressive craniotomy was carried out to remove the hematoma. On the basis of this case, we reported this complications and reviewed related literature.