Clinical picture of hydrocephalus due to extraventricular cisternal CSF pathways obstruction

Abstract

Introduction. The variety of clinical symptoms of hydrocephalus due to obstruction at the level of the posterior cranial fossa cisterns, or extraventricular obstructive hydrocephalus (EVOH), frequently goes against radiological semiotics and causes difficulties in developing patient management tactics.Materials and methods. Analysis of 65 patients treated for idiopathic hydrocephalus due to cisternal CSF pathways obstruction at the FSAI N. N. Burdenko National Medical Research Center of Neurosurgery of the Ministry of Health of Russia. All symptoms the patients complained of, which could be caused by hydrocephalus, were evaluated. Results. Extraventricular obstructive hydrocephalus has a longer history of illness compared to other forms of hydrocephalus and averages almost 4 years. The most common symptoms of the onset of the disease are headaches (41.5 %) and gait disturbances (29.2 %). When diagnosing, the main symptoms of the disease are gait disturbances (76.9 %), memory loss in relation to current events (76.9 %), headache (63 %), and pelvic disorders in the form of incontinence (46.1 %). Dizziness, nausea, arm tremor, amenorrhea, vomiting, pyramidal symptoms, and syncope are significantly less common. The clinical picture of patients under 60 years is characterized by common cerebral symptoms and mild signs of the Hakim-Adams syndrome. However, there is a different dependence for elderly patients. Endoscopic or shunt surgery can help to achieve complete or partial recovery. Conclusion. Thus, the EVOH clinical picture is diverse and often has completely non-specific manifestations, which match the anatomical changes in different brain structures according to MRI, but the sequence of occurrence of some symptoms is not explained. Each of the EVOH clinical manifestations, individual or in combination with other symptoms, should be considered as an indication for surgical treatment.