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.
Subject(s)
Hydrocephalus, Normal Pressure/history , Neurology/history , Colombia , History, 20th Century , History, 21st Century , Humans , Ventriculoperitoneal Shunt/historyABSTRACT
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 , ColombiaABSTRACT
A hidrocefalia de pressão normal (HPN), descrita em 1964 por Salomón Hakim, é uma doença insidiosa que acomete, sobretudo, idosos entre 60 e 80 anos e manifesta-se por meio da tríade clínica de distúrbios da marcha, demência e incontinência urinária, associada a achados radiológicos de ventriculomegalia e achados laboratoriais de pressão liquórica normal. Apesar de representar cerca de 5% das causas de demência, ficando atrás da doença de Alzheimer e demência vascular, ao contrário dessas causas a HPN é uma das poucas causas reversíveis de demência, e é por essa reversibilidade que torna fundamental o conhecimento da doença por parte de todos os médicos que cuidam dos pacientes dessa faixa etária. O artigo foi realizado a fim de apresentar as principais hipóteses relacionadas a fisiopatologia, diagnóstico e tratamento da HPN empregadas atualmente. A revisão da literatura foi realizada por meio das bases de dados Medline e PubMed, sendo utilizado o recurso MeSH (Medical Subject Headings) para a combinação dos descritores (hidrocefalia de pressão normal, história, epidemiologia, etiologia, fisiopatologia, diagnóstico e terapia) e seleção de artigos dos últimos seis anos. Tanto as bases fisiopatológicas quanto os critérios diagnósticos da HPN ainda não estão totalmente estabelecidos, porém as principais hipóteses envolvem distúrbios da hemodinâmica e complacência cerebral. O principal tratamento consiste na derivação liquórica, mediante a derivação ventriculoperitoneal e da terceira ventriculostomia endoscópica, sendo fundamental que o diagnóstico da HPN seja realizado precocemente e que os pacientes com maiores chances de responder à derivação liquórica sejam identificados.
The normal pressure hydrocephalus (NPH), described in 1964 by Salomón Hakim, is an insidious disease that affects mainly elderly people between 60 and 80 years and is manifested by the clinical triad of gait disturbances, dementia and urinary incontinence associated the radiological findings of ventriculomegaly and laboratory findings of normal cerebrospinal fluid pressure. Despite representing about 5% of the causes of dementia, behind Alzheimer?s disease and vascular dementia, unlike these causes NPH is one of the few reversible causes of dementia, and it is this reversibility that makes crucial the knowledge of the disease by of all physicians who care of patients in this age group. The paper was developed in order to present the main hypotheses related to the pathophysiology, diagnosis and treatment of NPH in practice today. The literature review was conducted through Medline and PubMed, where was used the MeSH resource (Medical Subject Headings) for the combination of keywords (normal pressure hydrocephalus, history, epidemiology, etiology, pathophysiology, diagnosis and therapy and selection of articles from the last six years. Both the pathophysiology and diagnostic criteria of NPH has not been fully established, but the main hypotheses involve disturbances of cerebral hemodynamics and complacency. The main treatment consists of CSF shunt through the ventriculoperitoneal shunt and endoscopic third ventriculostomy and it?s essential that the diagnosis of NPH be realized early and that patients with higher chance to improve after CSF shunt are identified.
Subject(s)
Humans , Aged , Hydrocephalus, Normal Pressure/diagnosis , Hydrocephalus, Normal Pressure/epidemiology , Hydrocephalus, Normal Pressure/physiopathology , Hydrocephalus, Normal Pressure/history , Hydrocephalus, Normal Pressure/therapy , Ventriculoperitoneal ShuntABSTRACT
INTRODUCTION: Normal-pressure hydrocephalus (NPH) is a chronic neurological disorder characterized by enlarged ventricles and a triad of clinical symptoms affecting gait, cognition, and urinary continence. Salomón Hakim first identified the syndrome in 1957 at the Hospital San Juan de Dios in Bogotá, Colombia. Even after decades of international focus and thousands of publications on his disorder, Hakim's story remains largely untold. METHODS: In this historical review, we explore the discovery of NPH through a series of personal interviews with Professor Hakim and his family, discussions with former colleagues, and review of the relevant medical literature. RESULTS: Professor Hakim first published his thesis in 1964 and 6 case reports of NPH in The New England Journal of Medicine and the Journal of the Neurological Sciences in 1965. Hakim rose to the forefront of academic medicine as he described a newfound ability to reverse symptoms of "neurodegeneration" that had long been considered irreversible. CONCLUSIONS: As we learn more about NPH, the fascinating story of Professor Hakim, the father of NPH, is of both historical relevance and current interest.
Subject(s)
Hydrocephalus, Normal Pressure/history , Neurosurgery/history , Cerebrospinal Fluid Shunts/history , History, 20th Century , Humans , Neurodegenerative Diseases/historyABSTRACT
Normal Pressure Hydrocephalus first became recognized as a treatable, reversible disorder in the 1960s. The classic triad of magnetic apraxia, urinary incontinence, and dementia remain relevant into the 21(st) century as being the basis for symptomatic diagnosis and predicting potential benefit from ventriculoperitoneal shunting, though they have been greatly augmented by the addition of modern neuroimaging, particularly MRI. Modern criteria recognize a wider range of diagnostic criteria, and new positive and negative prognostic indicators for treatment benefit have been discovered, though the mainstay remains initial drainage of a large volume of cerebrospinal fluid and monitoring for clinical improvement. Even with our advances in understanding both primary and secondary normal pressure hydrocephalus, diagnosis, management, and counseling remain challenging in this disorder.
Subject(s)
Hydrocephalus, Normal Pressure , Cerebrospinal Fluid Shunts/methods , Diagnostic Imaging/methods , History, 20th Century , History, 21st Century , Humans , Hydrocephalus, Normal Pressure/diagnosis , Hydrocephalus, Normal Pressure/history , Hydrocephalus, Normal Pressure/therapyABSTRACT
Se realiza un estudio descriptivo retrospectivo del cuadro histopatológico de 23 ojos pertenecientes a 21 hidrocefálicos, del Laboratorio de Patología Ocular del Instituto de Oftalmología del Ministerio de Salud. Los hallazgos del cristalino, clivaje jincompleto del ángulo, sinequias, bridas angulares, coloboma de coroides y retina, disminución acentuada de células ganglionares y fibras nerviosas en la retina, hipoplasia del nervio óptico, y un caso de retina ectópica en el cuerpo ciliar.
