Current research of idiopathic normal pressure hydrocephalus:Pathogenesis,diagnosis and treatment

Idiopathic normal pressure hydrocephalus(iNPH)is caused by impaired cerebrospinal fluid absorption in the elderly;it is a surgically treatable form of dementia.Gait disturbance,dementia,and urinary incontinence are the triad of signs for iNPH.In addition to these clinical findings,imaging studies show characteristic ventricular enlargement.High Evans Index and‘disproportionately enlarged subarachnoid hydrocephalus’are other well-known imaging findings of iNPH.If the tap test shows improved symptoms,shunt surgery is performed.The disease was first described by Hakim and Adams in 1965,followed by the publication of the first,second,and third editions of the guidelines in 2004,2012,and 2020,respectively.Recent studies signal the glymphatic system and classical cerebrospinal fluid(CSF)absorption from the dural lymphatics as aetiological mechanisms of CSF retention.Research is also underway on imaging test and biomarker developments for more precise diagnosis,shunting technique options with fewer sequelae and complications,and the influence of genetics.Particularly,the newly introduced‘suspected iNPH’in the third edition of the guidelines may be useful for earlier diagnosis.However,less well-studied areas remain,such as pharmacotherapy in non-operative indications and neurological findings other than the triadic signs.This review briefly presents previous research on these and future issues.

CT Profile of Hydrocephalus in Children at the Charles de Gaulle Pediatric Teaching Hospital in Ouagadougou

Aim of the Study: The aim is to analyse the epidemiological, clinical and CT aspects of hydrocephalus in children. Method: This was a cross-sectional descriptive study with retrospective collection from 1 June 2021 to 31 December 2022 within the radiology department of Charles De Gaulle Pediatric Teaching Hospital in Ouagadougou, Burkina Faso. The study included the records of patients with hydrocephalus who underwent cerebral computed tomography within this radiology department. Results: Hydrocephalus is due to a disorder of the hydrodynamics of the cerebrospinal fluid causing an increase in the volume allocated to this fluid in the brain and being accompanied by an increase in the pressure of this fluid. Its diagnosis is established by Doppler ultrasound or MRI prenatally, transfontanellar ultrasound in newborns and young children whose fontanel is permeable and by CT or MRI in older children, who can also determine the etiology. MRI remains an imaging technique that is less available and less accessible than CT in developing countries like ours. In Burkina Faso, MRI is only available in two private health facilities. The objective of this study was to describe the epidemiological, clinical and computed tomography aspects of hydrocephalus in children at the Charles de Gaulle pediatric teaching hospital in order to contribute to the diagnostic assessment and better management of this pathology. Over 19 months, 105 cases of hydrocephalus were recorded out of a total population of 115 children, or an average of 6 cases per month. The mean age was 17.52 months, with extremes of 03 days and 13 years, and the sex ratio was 1.38. Macrocrania, convulsions and psychomotor retardation were the main clinical signs, with rates of 49%, 34% and 30% respectively. On cerebral CT scan, hydrocephalus was triventricular (41.90%), tetraventricular (40%), and predominantly non-communicating (60%), with a mean Evans score of 0.53. The aetiologies were malformations in 34.28% of cases, tumours in 10.47% and infections in 5.71%. Among the malformations, Arnold Chiari II syndrome associated with spina bifida and Dandy Walker syndrome were the most common, accounting for 25% each. Tumour causes were dominated by craniopharyngioma and astrocytoma, each accounting for 27.30% of cases. Conclusion: The incidence of hydrocephalus was high in our study. In the absence of MRI (due to its unavailability and inaccessibility), CT revealed hydrocephalus that was predominantly tri- and tetraventricular, and predominantly non-communicating.

Accumulation and exploration enlightenment of shallow normal-pressure shale gas in southeastern Sichuan Basin, SW China

Based on the drilling, logging, experimental and testing data of Well PD1, a shallow normal-pressure shale gas well in the Laochangping anticline in southeastern Sichuan Basin, the shallow shale gas reservoirs of the Ordovician Wufeng Formation to Silurian Longmaxi Formation (Wufeng-Longmaxi) were investigated in terms of geological characteristics, occurrence mechanism, and adsorption-desorption characteristics, to reveal the enrichment laws and high-yield mechanism of shallow normal-pressure shale gas in complex structure areas. First, the shallow shale gas reservoirs are similar to the medium-deep shale gas reservoirs in static indicators such as high-quality shale thickness, geochemistry, physical properties and mineral composition, but the former is geologically characterized by low formation pressure coefficient, low gas content, high proportion of adsorbed gas, low in-situ stress, and big difference between principal stresses. Second, shallow shales in the complex structure areas have the gas occurrence characteristics including low total gas content (1.1-4.8 m3/t), high adsorbed gas content (2.5-2.8 m3/t), low sensitive desorption pressure (1.7-2.5 MPa), and good self-sealing. Third, the adsorbed gas enrichment of shales is mainly controlled by organic matter abundance, formation temperature and formation pressure: the higher the organic matter abundance and formation pressure, the lower the formation temperature and the higher the adsorption capacity, which is more beneficial for the adsorbed gas occurrence. Fourth, the shallow normal-pressure shale gas corresponds to low sensitive desorption pressure. The adsorbed gas can be rapidly desorbed and recovered when the flowing pressure is reduced below the sensitive desorption pressure. Fifth, the exploration breakthrough of Well PD1 demonstrates that the shallow complex structure areas with adsorbed gas in dominance can form large-scale shale reservoirs, and confirms the good exploration potential of shallow normal-pressure shale gas in the margin of the Sichuan Basin.

Rhombencephalitis caused by Listeria monocytogenes with hydrocephalus and intracranial hemorrhage:A case report and review of the literature

BACKGROUND Listeria monocytogenes(L. monocytogenes), a Gram-positive facultatively intracellular bacterium, is the causative agent of human listeriosis. Listeria infection is usually found in immunocompromised patients, including elderly people, pregnant women, and newborns, whereas it is rare in healthy people. L.monocytogenes may cause meningitis, meningoencephalitis, and some very rare and severe complications, such as hydrocephalus and intracranial hemorrhage,which cause high mortality and morbidity worldwide. Up to now, reports on hydrocephalus and intracranial hemorrhage due to L. monocytogenes are few.CASE SUMMARY We herein report a case of rhombencephalitis caused by L. monocytogenes in a 29-year-old man. He was admitted to the hospital with a 2-d history of headache and fever. He consumed unpasteurized cooked beef two days before appearance.His medical history included type 2 diabetes mellitus, and contaminated beef intake 2 d before onset. Cerebrospinal fluid analysis revealed Gram-positive rod infection, and blood culture was positive for L. monocytogenes. Magnetic resonance imaging findings suggested rhombencephalitis and hydrocephalus.Treatment was started empirically and then modified according to the blood culture results. Repeated CT images were suggestive of intracranial hemorrhage.Although the patient underwent aggressive external ventricular drainage, he died of a continuing deterioration of intracranial conditions.CONCLUSION Hydrocephalus, intracranial hemorrhage, and inappropriate antimicrobial treatment are the determinations of unfavorable outcomes.

Lumboperitoneal shunts for the treatment of post-traumatic hydrocephalus

Objective: To assess the effectiveness and safety of lumboperitoneal shunt for treatment of post-traumatic hydrocephalus(PTH).Methods: A retrospective analysis of medical records of patients with lumboperitoneal shunts admitted in Shanghai Tenth People's Hospital from January 2014 to March 2017 was done.Experience with lumboperitoneal shunt placement for PTH was reviewed.The diagnosis of PTH was based on ventricular enlargement with the Evans' index(EI>0.3) before shunt implantation.Patients were evaluated for improvements in Glasgow Coma Scale(GCS), Glasgow Outcome Scale(GOS), and EI after shunt placement.Results: Totally, the study included 34 PTH patients with the average age of 49.32 years(range: 9–67 years).The average follow-up period was(3.9±3.5) months.Before lumboperitoneal shunt, the GOS score was(4±1), the GCS score was(8.53±3.38), and the EI score was(0.40±0.08).After shunt implantation, the GOS score was(3±1), the GCS score was(10.29±3.15), and the EI score was(0.34±0.13), respectively(P<0.05).Before lumboperitoneal shunt, 24(70.58%) patients had a GOS score of 4(vegetative state), and 10(29.42%) patients had a GOS score of 3(severe disabled).After lumboperitoneal shunt, 18(52.94%) patients had improvement in GOS(11 patients improve from GOS 4 to GOS 3, 5 patients from GOS 3 to GOS 2 and 2 patients from GOS 3 to GOS 1), 22(64.71%) patients achieved improvement in their GCS(14 patients GCS improvements ≥2 and 8 patients GCS improvement=1), 21(61.76%) patients had EI improvement(18 patients with EI<0.3).There was no complication in this study.Conclusion: Lumboperitoneal shunt placement is safe and effective for PTH, and serious complications are not observed.

Brucella meningoencephalitis with hydrocephalus masquerading as tuberculosis

Neurobrucellosis is a rare form of localized brucellosis usually with no systemic manifestations. We report a rare case of brucellosis presenting as meningoencephalitis associated with hydrocephalus.This patient had a lymphocytic predominant CSF and was initially treated with empirical anti tubercular therapy and steroids.A week later,when his CSF culture grew Brucella species,the treatment was changed to a combination of streptomycin,doxycycline and rifampicin and the patient improved with this therapy.This case illustrates the need to consider neurobrucellosis as a close differential diagnosis of neurotuberculosis in endemic areas when the patient presents with meningo encephalitis with lymphocytic CSF.

Hydrocephalus after subarachnoid hemorrhage:A metaanalytic comparison of aneurysm treatments

AIM: To compare two treatments for ruptured cerebral aneurysm with reference to the relative risk of developing hydrocephalus.METHODS: We reviewed the English language literature on the risk of developing hydrocephalus after aneurysm treatment.Data were divided by type of study(randomized controlled trial,cohort trial,nonrandomized comparison,prospectively- and retrospectively-collected observational study).They were also divided by type of aneurysm treatment(microvascular- clipping,or endovascular- coiling).Additional predictive variables collected for each publication were average age,gender distribution,measures of hemorrhage volume and subarachnoid hemorrhage severity,aneurysm locations,time to treatment,duration of follow-up and date of publication.We employed meta-analysis to calculate pooled risk ratios of developing hydrocephalus in cases receiving aneurysm clipping vs those receiving coiling.Meta-regression was used to correct pooled results for covariates.RESULTS: Because indications for the two treatments are different,there is little clinical equipoise for treating most cases.The single randomized,controlled trial dealt with a small subset of ruptured aneurysms.Neither this nor pooled values from other studies which compared the two treatments had the power to demonstrate significant differences between the two treatments.Nor was there an apparent difference when observational data were meta-analytically pooled.However,when meta-regression was used to correct for predictive variables known to differ between the two treatment groups,a highly-significant difference appeared.Coiling is used more commonly in older,sicker patients with aneurysms in certain locations.These cases are more likely to develop hydrocephalus.When corrected for these covariates,the risk of hydrocephalus was found to be significantly lower in coiled vs clipped cases(P = 0.014).CONCLUSION: Pooled observational data were necessary to demonstrate that coiling ruptured cerebral aneurysms is associated with a lower risk of developing hydrocephalus than is clipping.

Adrenal Hemorrhage as a Rare Cause of Neonatal Anemia Associated with Hydrocephalus Secondary to Intraventricular Hemorrhage—A Case Report

Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, intrauterine infection, coagulation defects and thromboembolism. It has varied clinical presentation depending on degree of hemorrhage and amount of adrenal cortex compromised by hemorrhage. The most common clinical presentations are persistent jaundice and flank mass. We report a case of left sided adrenal hemorrhage in a breech delivered male neonate with perinatal asphyxia presented with anemia and fever. On further evaluation, he was also having moderate communicating hydrocephalus secondary to intraventricular hemorrhage. The adrenal hemorrhage was managed conservatively. Subsequent abdominal ultrasound showed resolving adrenal hemorrhage. Right ventriculoperitoneal shunt was done for hydrocephalus. Postoperative course was uneventful. The patient is asymptomatic at follow-up.

MODIFIED GRAEB CRITERIA FOR PREDICTING THE POST-HEMORRHAGIC HYDROCEPHALUS IN INTRAVENTRICULAR HEMORRHAGE

Objective To set up a new grading system of intraventricular hemorrhage (IVH) and determine the value of predicting the probability of post-hemorrhagic hydrocephalus (PHH) in IVH. Methods We first modified the Graeb criteria, then compared the value of prediction for PHH assessed by the Graeb criteria with the modified Graeb criteria. One hundred and thirty one IVH patients were divided into two groups: the upper group (n=67) and the lower group (n=64). Gold standard of PHH was assessed by CT scan or by out-drainage. The diagno-stic parameters such as sensitivity (SE), specificity (SP) were analyzed. In the cutoff point of SE and SP curves, diagnostic efficiency (DE), and Kappa value (K) were analyzed. The probability of PHH was estimated by binary logistic regressions. Results In all ventricular group, to Graeb criteria in the cutoff point, SE, SP, and K was 0.78, 0.84, and 0.60; and to modified Graeb criteria SE, SP, and K was 0.90, 0.84, and 0.74 respectively. The probability of PHH from point of 3-12 was 0.011, 0.032, 0.085, 0.212, 0.435, 0.689, 0.865, 0.949, 0.981, and 0.994 respectively according to modified Graeb criteria. Conclusion The modified Graeb criteria combined with logistic regression were useful methods to assess the severity of IVH and to predict the probability of PHH in IVH.

Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus

Introduction: Patients with hydrocephalus, which is the most pediatric neurological disorder, undergo Cerebrospinal fluid (CSF) diversion through third ventriculostomy or ventriculo-peritoneal shunt. Up to date, the optimal hydrocephalus treatment modality is not clear. Aim: We compared the outcome of endoscopic third ventriculostomy (ETV) versus ventriculo-peritoneal shunt (VP shunt) as a second surgical intervention in management of Infant hydrocephalus concerning success rate and complications. Patients and Methods: We conducted an observational study of 52 children with hydrocephalus (congenital or acquired) in whom CSF diversion was performed using either ETV or VP shunt in randomized control trial. Results: During the period examined, 52 children, 26 underwent ETV and 26 underwent VP shunt. The mean age was 11.0 ± 4.3 months in ETV and 11.3 ± 4.7 months in VP shunt. Postoperative infection in the ETV group was lower than in the VP shunt group (23.1% vs. 53.8% P = 0.045). Regarding operating time, In ETV group operation duration was 46.9 min and 64.3 min in the V-P shunt group (P = 0.13). There was no statistically significant difference between the two study groups regarding the rate of obstruction, change in occipital frontal circumference (OFC) or the need of revision surgery. One year survival for VP shunt group vs. ETV group was 46.2% vs. 65.4% respectively. Conclusion: ETV associated with lower rates of postoperative infection and shorter operation time with no significant difference in rates of obstruction, change in OFC and revision surgery in comparison to VP shunt.

Advanced diffusion-weighted magnetic resonance imaging in the evaluation of white matter axons in patients with idiopathic normal pressure hydrocephalus

With the increasing application of regenerative medicine in vivo,non-invasive and accurate methods for estimating the white matter axons in neuronal tissue have become increasingly important.As a non-invasive method for patients,magnetic resonance（MR）imaging has demonstrated potential as a promising tool for evaluating axons in vivo.In particular,diffusion-weighted MR imaging（d MRI）and its applications,

Prevalence of congenital hydrocephalus in the Hashemite kingdom of Jordan: A hospital-based study

Background: Congenital hydrocephalus, an important cause of neurologic morbidity and mortality in children, is a medical condition characterized by an abnormal accumulation of cerebrospinal fluid in the brain. It can be caused by abnormal brain development, obstruction of the cerebral aqueduct flow, Chiari malformations, and Dandy-Walker malformation. The prevalence of congenital hydrocephalus is 2.2 to 18 per 10,000 live births. Objectives: To determine the prevalence of congenital hydrocephalus among livebirths in the Hashemite Kingdom of Jordan (HKJ). Methods: Clinical data were collected from medical records of all livebirths with congenital hydrocephalus born at Al Bashir Hospital, Amman/The Hashemite Kingdom of Jordan in 2004-2005 and 2008-2011. Descriptive analysis was carried out using the Statistical Package for the Social Science (SPSS 20). Results: The prevalence of hydrocephalus was 0.092% with a relative predominance among males. Conclusion: The study concluded that the prevalence of congenital hydrocephalus is comparable to that of developed countries. The efforts made by the Ministry of Health seem to have paid off. More research on stillbirths is recommended.

Early fault prediction and detection of hydrocephalus shunting system

Trends of various intracranial pressure (ICP) parameters for high pressure hydrocephalus patients are utilized to detect various shunt faults in their early stages, as well as, to monitor the effect of such faults on shunt performance. A method was proposed to predict the time required for ICP to be abnormal and for the valve to reach full blockage condition. Furthermore, an auto valve schedule updating method is proposed and used to temporarily deal with detected faults until the patient is checked up by his/her physician. The proposed algorithms were evaluated using numerical simulation.

Visual acuity evaluation in children with hydrocephalus:An electrophysiological study with sweep visual evoked potential

The objective was to measure the visual acuity (VA) of children with the diagnosis of hydrocephalus with or without peritoneal-ventricular shunt (PVS). A total of 55 children were included in the study (34 Female), with an age range of 0 to 291 weeks. The VA was measured by the sweep visual evoked potential technique. Of those with a PVS, in 31 the ventricular valve was inserted before 15 days after the diagnosis whereas in 14 the ventricular valve was inserted after 15 days. The sweep VEP was performed in all children, 95 exams (94%) were abnormal and only 6 were normal. There was a statistical difference in the VA between children with a PVS inserted before 15 days of the diagnosis and children with a PVS after 15 days (p = 0.038) or those without a shunt (p = 0.031). Children with no complications of the PVS had a better VA as compared to those with shunt complications (p < 0.001). In the group of children with complications, again those who had a shunt inserted be-fore 15 days had better VA results in com- parison to those in whom the shunt was inserted after 15 days (p = 0.029). No statistical difference in the VA was found between children without the PVS and with those in which the shunt was inserted after 15 days of the di-agnosis of hydrocephalus (p = 0.699). We conclude that the delayed insertion of the PVS may compromise the visual development of these children.

Tumor Obstructive Hydrocephalus Treated with Endoscopic Third Ventriculostomy in Cameroon

The goal of this work was to report on a series of preoperative endoscopic third ventriculostomy (ETV) performed for obstructive hydrocephalus due to posterior fossa tumors. Eight patients underwent preoperative ETV prior to tumor biopsy or removal for obstructive hydrocephalus related to posterior fossa tumors. All patients underwent surgery in two steps;ETV followed a week later by tumor resection. Clinical, radiological and outcome data were retrospectively reviewed. Eight patients (6 males, 2 females) aged between 8 and 45 years (mean age 24.62 years) suffering from obstructive hydrocephalus due to posterior fossa tumors had ETV prior to tumor removal or biopsy. Five patients were adults while 3 were under 18 years. All patients complained of headaches, seven presented with symptoms of raised intracranial pressure or visual disturbances and four had vomiting or cerebellar disturbance. Computed tomography scan was done in all patients and magnetic resonance imaging in five. Complete tumor removal was achieved in 4 cases and partial removal or biopsy in the remaining 4. ETV was successful in 7 (87.50%) cases but failed in one. Two patients experienced intraoperative transitory bradycardia. Two postoperative complications occurred (one meningitis and one CSF leak). No death related to procedures occurred. The histological diagnosis were as follows: ependymoma (3), medulloblastoma (3), astrocytoma grade II (1) and pineoblastoma (1). Hospital stay ranged from 9 to 21 days (mean, 12.71 days). Follow up range was 4 months to 78.4 months (0.33 to 6.53 years;mean, 46.11 months (3.84 years);median, 41.2 months (3.43 years).

One-Month-Old Female Baby with Symmetrical Hydrocephalus: Treatment Option

A female infant, named Anum 1.8 kg was born on 9th August 2007 at Jinnah Postgraduate Medical Centre (JPMC) with a big head, Occipitofrontal Circumference (OFC) 36 cm. She was admitted on 29th August 2007 and was discharged on 5th September 2007 from Jinnah Postgraduate Medical Centre after the management of moderate birth asphyxia. Cranial ultrasound revealed moderate Hydrocephalus (symmetrical) with prominent third ventricle. Treatment and its effectiveness have been discussed.

Neuropathological Changes in Hydrocephalus—A Comprehensive Review

Hydrocephalus is a heterogeneous, neurological condition characterized by altered flow of cerebrospinal fluid (CSF) that can occur at any age. Neuropathological changes associated with hydrocephalus are dependent on the age of onset, rate of ventricular enlargement, and the etiology. Hydrocephalic brain damage is also influenced by contributions from both mechanical forces and metabolic changes, which increases the heterogeneity of the condition. However, as ventriculomegaly progresses, the surrounding brain tissue is compressed within the cranial vault, elevating intracranial pressure and eventually leading to severe brain damage. From this perspective, it makes sense that periventricular brain regions are the initial sites of damage as ventricular dilatation occurs. The following review of neuropathological changes in hydrocephalus will first discuss cellular and region specific damage from the ventricles and outward towards the cortex and brainstem. This will be followed by vascular and hypoxic changes associated with the condition. Both types of brain impairments are dependent on the severity of the condition, and they will be described accordingly.

Resection of Multiple Neurinomas of the Cauda Equina Improves Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a treatable neurological condition characterized by dementia, gait disturbances, and urinary incontinence. This case study aimed to evaluate the effectiveness of surgical intervention in treating NPH associated with spinal cord tumors. A patient suffering with NPH underwent a spinal tap procedure and surgical resectioning of three neurinomas on the cauda equina. The patient exhibited marked improvement in neurological and motor symptoms related to NPH following surgical intervention. These findings suggest that surgical resectioning of neurinomas is an effective intervention for treating NPH associated with spinal cord tumors.

Animal Models of Hydrocephalus

Hydrocephalus is a neurological condition characterized by altered cerebrospinal fluid (CSF) flow leading to an accumulation of CSF inside the cranial vault. Neuropathogenesis associated with hydrocephalus has been elucidated by pathological studies of human brains and through experimental and genetic animal models. Experimental animal models have been developed in numerous species using a variety of methods and agents to induce hydrocephalus or through genetic mutations in rodents. Each of these animal models has been described briefly in this review, along with the basic strengths and weaknesses of each model. Although none of these models can fully mimic the human condition, they each provide fundamental knowledge contributing to understanding more about the pathogenesis of hydrocephalus and its underlying causes.

Surgical Treatment for Neonatal Hydrocephalus: Catheter-Based Cerebrospinal Fluid Diversion or Endoscopic Intervention?

Neonatal hydrocephalus can arise from a multitude of disturbances, among them congenital aqueductal stenosis, myelomeningocele or posthemorrhagic complications in preterm infants. Diagnostic work-up comprises transfontanellar ultrasonography, T2 weighted MRI and clinical assessment for rare inherited syndromes. Classification of hydrocephalus and treatment guidelines is based on detailed consensus statements. The recent evidence favors catheter-based cerebrospinal fluid diversion in children below 6 months, but emerging techniques such as neuroendoscopic lavage carry the potential to lower shunt insertion rates. More long-term study results will be needed to allow for individualized, multidisciplinary decision making. This article gives an overview regarding contemporary pathophysiological concepts, the latest consensus statements and most recent technical developments.