Acute Hydrocephaly Research Articles

Subarachnoid hemorrhage caused by intracranial aneurysms, experience in 82 patients

One third of patients with subarachnoid hemorrhage caused by intracranial aneurysms, die. Review of medical records of patients with subarachnoid hemorrhage treated at a clinical hospital. Review of medical records of patients discharged from the hospital between 2006 and 2011 with the diagnosis of subarachnoid hemorrhage. Patients initially or subsequently treated elsewhere were not analyzed. The medical records of 82 patients aged 24 to 100 years (77% females), were analyzed. The clinical diagnosis at the onset of the condition was correct in 82% of cases. In 95% of patients, an angiographic study and subsequent surgical intervention of the aneurysm were carried out within 24 hours of diagnosis. Global mortality was 23%. Twelve patients died prior to any possible treatment, due to the severity of the disease. Seventy six aneurysms in 70 patients were treated with clips or coils in 37 and 39 cases, respectively. Seven patients died. Forty seven patients had a Rankin disability score of two or less. The presence of an intracranial hematoma or acute hydrocephaly on admission and clinical vasospasm during evolution were associated with a bad prognosis.

Colloid cyst of third ventricle

1878-7649/$ – see front matter 2010 Elsevier Masson SAS and European Union Ger doi:10.1016/j.eurger.2010.07.014 Computed tomography (CT) without contrast product showed a 23 mmhyperdense spheric tumor of the third ventricle (Fig. 1). The cerebral Magnetic Resonance Imaging (MRI) described a ponto cerebellar ischemic stroke and a lesion hanging on the roof of third ventricle and hyperintense on T1 weighted sequence (Fig. 2). A voluminous colloid cyst was diagnosed. The patient progressively recovered of ataxia and dysarthria. An atrial fibrillation was diagnosed on electrocardiogram and treated with warfarin and a beta-blocker. She did not have previous symptoms suggesting colloid cyst as headaches. In agreementwith the neurosurgeon, the colloid cyst was not removed and a follow-up by CT scan was proposed. A colloid cyst is a quite unusual benign tumor that occurs within the third ventricle and can obstruct the cerebrospinal fluid flow [1]. The cyst size range from 2–50 mm and contains colloid material including cholesterol fats responsible of the MRI aspects. Associated signs and symptoms cover a wide range of features, from asymptomatic to intermittent headaches or less commonly nausea, gait disturbance or short-term memory loss. Some colloid cysts can lead to acute hydrocephaly and sudden death [1]. On CT the mass is usually hyper or isodense to grey matter while on MR

P0524 A REVIEW OF THE DIAGNOSIS AND MANAGEMENT OF HYPOKALEMIA

in upper left limb (4/5). She was transferred to Neurosurgery Department to stereotaxic biopsy and five days after had deteoration of conscience level (Glasgow Coma Scale 11, E3 V3 M5), with acute hydrocephaly in CT and emergency surgery for ventriculoperitoneal shunt and in a second time cerebral biopsy. The patient died four days after. Discussion/conclusion: This case-study shows the importance of medicine semiology, which conduce to an immediately diagnosis, avoiding all the complementary exams. It enhance the internist as the manager of any health unity, capable of creating more economical and suitable alternatives. This quick and fatal evolution in a disease of indolent natural history announce the importance of familiar screening and genetic counselling. Many patients in Psychiatric Institutions have organic disease which should be always excluded.

Cerebral edema and its treatment

Cerebral edema is a life-threatening condition that develops as a result of an inflammatory reaction. Most frequently, this is the consequence of cerebral trauma, massive cerebral infarction, hemorrhages, abscess, tumor, allergy, sepsis, hypoxia, and other toxic or metabolic factors. At present, the following types of cerebral edema are differentiated: the vasogenic cerebral edema resulting from an increased permeability of the endothelium of cerebral capillaries to albumin and other plasma proteins; the cytotoxic cerebral edema resulting from the exhaustion of the energy potential of cell membranes without damage to the barrier; the hydrostatic cerebral edema resulting from disturbance of the autoregulation of cerebral blood circulation; the osmotic cerebral edema resulting from dilution of blood; and the interstitial cerebral edema resulting from acute hydrocephaly. Some authors also differentiate ischemic cerebral edema. At present, when various traumas and traumatic cerebral injuries are frequent causes of death in young people, treatment strategy for cerebral edema is of utmost importance. Monitoring of the patient's condition in the intensive care unit is a necessity. It is important to ensure proper positioning of the patient--the head should be tilted at 30 degrees in order to optimize the cerebral perfusion pressure and control of the increase in intracranial pressure. Hyperventilation should be applied. Controlled hypothermia decreases the rate of metabolism in the brain. Slightly positive fluid balance should be maintained using crystalloid or colloid (hypertonic-hyperoncotic) solutions, at the same time maintaining cerebral perfusion pressure exceeding 70 mmHg. The treatment includes administration of antihypertensive medications, nonsteroidal antiinflammatory drugs, and barbiturates. Steroids decrease the permeability of capillaries and the hemato-encephalic barrier, promoting the movement of Na(+)/K(+) ions and water through the main endothelial membrane, and therefore they are used in the treatment of vasogenic cerebral edema as well as edema caused by a cerebral tumor. Glutamate and N-methyl-D-aspartate receptor antagonists improve cerebral microcirculation and metabolism. Trometamol corrects cerebral acidosis. Extended cerebral edema is treated surgically via a bilateral decompressive craniotomy, sometimes including craniotomy of lateral and posterior fossae. The treatment of cerebral edema is complex, and positive results may be expected only if the diagnosis and the provision of assistance are timely.

Cranioplastie par lambeau libre ostéomusculaire temporo-pariétal

Advances in composite materials for craniofacial reconstruction surgery has tended to limit indications for osteomuscular free flaps which nevertheless must be used for certain septic patients. The purpose of this report was to illustrate the usefulness of the free temoroparietal osteomuscular flap in this particular situation. A 47-year-old man underwent surgical repair of an aneurysm of the anterior communicating artery complicated by acute hydrocephaly treated by external then ventriculoperitoneal bypass. The fronto-pteryonal approach was used. The early postoperative period was complicated by osteitis of the cranial piece requiring revision. The revision procedure, performed at the end of the septic period, involved cranioplasty with acrylic cement. Recurrent infection contraindicated any new attempt for prosthetic repair. The patient was treated with a controlateral free temporoparietal osteomuscular flap to achieve cranioplasty. The postoperative period was uneventful with no infection and satisfactory healing. Flap vitality was very satisfactory. The patient's neurological status improved and no further complication developed. In certain therapeutic situations, several diffent techniques may be required to overcome postoperative complications or manage particularly difficult cases. A free osteomuscular flap can be a useful alternative for cranioplasty. This technique is rarely used but can offer an optimal solution in selected patients, particularly for second intention revision after failure of prosthetic repair.

Colloid cyst of the third ventricle — a neurological emergency

Colloid cyst of the third ventricle, although a benign lesion, carries with it high mortality and morbidity if not diagnosed in time. The most common presenting symptom is headache. A 31-year-old man with a history of intermittent, throbbing, unilateral headache and nausea was admitted because of exacerbation of his headache, which responded poorly to medication. A few hours after admission he became comatose. A colloid cyst of the third ventricle causing acute hydrocephaly was diagnosed by computed tomographic scan and removed in toto. Despite an uneventful postoperative course the patient was left with permanent bilateral cerebral damage. In patients with headache not responding to conventional medication, colloid cyst of the third ventricle perhaps should be ruled out, even if the symptoms are suggestive of vascular headache, such as migraine headache.