Hydrocephalic Syndrome Research Articles

Anxiety, depression and stress of mothers of premature infants with intraventricular cerebral hemorrhages in the first year of their life

The study is focused on the emotional state and stress of mothers of prematurely born infants with structural intracranial changes during the first year of their life. Study participants were 77 mothers of infants born at 28.3 ± 3.1 weeks of gestation with intraventricular cerebral hemorrhage, divided in 3 groups: those who received surgical neurosurgical treatment of posthemorrhagic hydrocephalus (N = 33), conservative treatment for hydrocephalic syndrome (N = 26), and in the intraventricular cerebral hemorrhage group of 1st degree without hydrocephalic syndrome (intraventricular cerebral hemorrhage comparison group, N = 18). The study used measures of depression (BDI-II, 1996) and anxiety (1983), and the Heidelberg Family Stress Scale (2007). The examination of mothers was carried out longitudinally at three age stages: 1) during the neonatal period while in the intensive care unit; 2) at the age of 3 corrected months at the department of pathology of newborns and the department of pathology of young children; 3) at the age of 12 corrected months at home. Results indicate that in the group of mothers of prematurely born infants with intraventricular cerebral hemorrhage, regardless of group membership, the values of depressive experiences and reactive anxiety are higher at the 1st stage of the examination, compared to 2 and 3. In the group of families with infants with posthemorrhagic hydrocephalus there were no significant changes observed in stress indicators during the first years of life of children, while the values of certain individual indicators are higher compared to the indicators in groups of families of children with hydrocephalic syndrome and intraventricular cerebral hemorrhage. The results are discussed from the perspective of possible mental health disorders among mothers of infants with intraventricular cerebral hemorrhage, its additional negative impact on the development of children, and the need of families for early, during the first trimester of the child’s life, beginning of family-centered intervention program and psychological support for mothers. Keywords: preterm infants, intraventricular hemorrhages, caregivers, emotional state, depression, anxiety, stress, early intervention.

Clinical and evolutionary aspects of classification and treatment for pediatric hydrocephalic syndrome: a bibliographic review

Introduction: The term hydrocephalus comes from the Greek and means “water in the head”. It is characterized by an increase in the amount and pressure of cerebrospinal fluid or cerebrospinal fluid, leading to dilatation of the ventricles and compression of nervous tissue. Hydrocephalus is not a specific disease. Rather, it represents a diverse group of disorders, which result from impaired circulation and absorption of cerebrospinal fluid (CSF) or, in rare circumstances, increased production by a choroid plexus papilloma. Objective: to review clinical and evolutionary aspects of the classification and treatment for pediatric hydrocephalus syndrome, its clinical presentations and procedures that provide a better resolution of this neurosurgical emergency. Method: a computerized bibliographic search was carried out, using the keywords (Endoscopic third ventriculostomy (ETV); ventriculoperitoneal shunt for hydrocephalus (VP ​​shunt); Treatment and Diagnosis.), in the following databases (SciELO, Google Scholar, Brazilian Journal of Neurosurgery, Arquivos Ciência Saúde, American Journal of Neurosurgery and Publab). Conclusion: there are few references in the Brazilian literature that address the topic on clinical and evolutionary aspects of classification and treatment for pediatric hydrocephalus syndrome. Thus, it is important to encourage research on the subject, enabling the strengthening and expansion of their professional practice in this area, as critical training and the development of skills to assist children with neurological disorders are fundamental.

Нейровизуализационный мониторинг острой транзиторной формы гидроцефалии травматического генеза

The paper shows the possibility of non-invasive computed tomographic monitoring (CT) of intracranial pressure (ICP) as a classifier of intracranial hypertension (ICH). To determine the prevalence of parenchymal or hydrocephalic hypertension syndrome, we calculated the correlation coefficient of the optic nerve width (dON) and the size of the 3rd ventricle, using their CT imaging. 312 patients with isolated crania-cerebral injury (CCI) were examined. In 170 (54.5%) cases, hypertension syndrome was detected without signs of acute hydrocephalus. In 142 (45.5%) patients, the correlation of the width of the dON and the size of the 3rd ventricle revealed mainly hydrocephalic syndrome against the background of the development of acute transient hydrocephalus (ATHC). CT monitoring and the determination of the correlation between the width of the retroorbital part of the optic nerve and the size of the 3rd ventricle allowed determining the development of an acute form of transient hydrocephalus, which in turn led to the further implementation of invasive methods for measuring, monitoring and correcting the traumatic ICH.

NEUROSONOGRAPHIC STUDY OF CHILDREN WITH HYPOXIC-ISCHEMIC BRAIN IJURY

The study is aimed at neurosonographic characteristics of brain injury in newborn patients with perinatal hypoxic-ischemic injury of central nervous system, complicated with inflectional process (meningitis, ventriculitis). It is settled that brain immaturity, hydrocephalic syndrome, ischemia of the brain tissue and intraventricular hemorrhages are found 2 times more often in infants with perinatal hypoxic-ischemic injury of central nervous system, complicated with inflectional process. This fact generally characterizes disorders of the hemato-encephalic barrier and the development of destructive processes in the tissue of the brain.

FEATURES OF CENTRAL NERVOUS SYSTEM DEFEAT IN NEWBORNS WITH INTRAUTERINE VIRAL INFECTIONS

Introduction. Intrauterine infections with central nervous system lesions remain an urgent problem of modern perinatology, neonatology and pediatrics and belong to a group of diseases whose diagnosis is associated with certain difficulties. The number of pathogens of intrauterine infections with an ante, intra- and perinatal infection is practically unlimited. However, one of the first places belongs to the causative agents of viral infections, the prevalence of which is not specified in connection with the difficulties of diagnosis. The purpose of the study was to determine the features of central nervous system damage in newborns with intrauterine infections based on the results of the verification of etiologic pathogens, the evaluation of risk factors for perinatal history and the specific features of the clinical course of intrauterine infections. Materials and methods. Clinico-laboratory examination of 834 mothers and their sick newborns with suspicion of intrauterine infections in the first 3 days of life was performed. The subject of the study was a group of 224 patients with newborns with congenital viral infections. The control group consisted of 30 conditionally healthy newborns. The methods were general clinical and special studies (luminescence microscopy, culture method, polymerase chain reaction, serodiagnostics). Materials for examination in children and mothers were blood from the umbilical and peripheral veins, feces. Statistical processing was carried out with the calculation of parametric and nonparametric criteria. Results of the research. Among the total number of examined newborns with suspected congenital infection, congenital viral infections were verified in 224 (31.6%). Among them, term infants - 132 (58.9%), premature babies - 92 (41.1%). Among 224 children, 77 (34.4%) mixed virus infections, 62 (27.7%) viral and bacterial infections, 53 (23.6%) mixed-virus-TORCH infections and monoviral infections - in 32 (14.3%). It was proved that all children had different clinical variants of neurological disorders. Among the factors of perinatal risk are acute respiratory infections in pregnant women, the threat of abortion, anemia of pregnant women, early delivery, placental dysfunction, preeclampsia, birth asphyxia. When the etiologic pathogen was verified, the influenza A virus was defined in 15.6%, parainfluenza in 20.5%, adenovirus in 40.6%, the PC virus in 27.2% and enterovirus in 48.2%, cytomegalovirus - in 56.6%, the herpes simplex virus - in 22.6%. It is proved that along with severe lesions of the central nervous system in the form of cerebral edema, intracranial hemorrhages, meningoencephalitis, hypoxic-ischemic lesions with oppression syndrome, hypertensive hydrocephalic syndrome or indistinct neurologic symptoms at birth and in the first day of life in the form of moderate muscular dystonia and tremors. Characteristic signs on the neurosonogram in monovirus infections were predominantly hypoxic-ischemic structural changes, with mixed forms of viral infections, signs of intraventricular hemorrhages of I or II degree, subependimal cysts and signs of ventriculitis predominated. Conclusions. High frequency (31.6%) of virus isolation in patients with newborns at risk for intrauterine infection and their mothers, features of the clinical course of intrauterine viral infections with central nervous system damage motivate early clinical and laboratory diagnosis.

Клинико-эпидемиологические особенности и резидуальные проявления серозных менингитов энтеровирусной этиологии у детей в РСО -Алания

The article presents the analysis of the epidemiological, clinical and laboratory features of serous meningitis enteroviral etiology in children hospitalized at the RCCH of Vladikavkaz in 2008–2012. We have also studied the residual manifestations of enteroviral meningitis in 44 patients in the early period of convalescence. The study showed that of RNO-Alania typical summer – autumn seasonality of serous meningitis enteroviral etiology in children. The central nervous system caused by enteroviruses more often develops in children of preschool and school age. The clinical picture of enteroviral meningitis remains a leading hypertension – hydrocephalic syndrome. In the early period of convalescence enteroviral meningitis in children often formed cerebro-asthenic, hypertension, neurosis-like syndromes and syndrome immune dysfunction.

Efficiency of Osteopathic Treatment of Hypertensive-Hydrocephalic Syndrome in Young Children

This article contains the results of medical examination and osteopathic treatment of hypertensive- hydrocephalic syndrome in young children. During the study neurological and osteopathic statuses of these patients were characterized. The study showed the efficiency of osteopathic treatment during out-patient medical rehabilitation course.

P12.07 * EPIDERMOID AND DERMOID CYSTS OF THE CENTRAL NERVOUS SYSTEM: SURGICAL RESULTS

INTRODUCTION: Epidermoid and dermoid cysts of the central nervous system are usually developmental, benign tumors that arise when retained ectodermal implants are trapped by two fusing ectodermal surfaces. Together they compromise 1 - 1.5% of all brain tumors. Epidermoid cysts consist solely of layers of stratified squamous epithelium and localize more laterally (lateral sulcus, cerebellopontine angle (CP-angle)). Dermoid cysts also include dermal appendage organs (hair follicles and sebaceous glands). Unlike epidermoids, they are placed in the midline (suprasellary, IV ventricle). The aim of the current study was to define the clinical course and results of surgical treatment of dermoid and epidermoid cysts, depending on their location and tumor type. MATERIALS AND METHODS: A retrospective analysis of 16 consecutive surgical interventions on brain epidermoids and dermoids (4 dermoid cyst, 12 - epidermoid cysts), that were treated at the Uzhhorod Regional Clinical Center of Neurosurgery and Neurology in the period from January 2009 to February 2013. The distribution of patients by gender and age: men - 9, women - 7; mean age of patients - 30.1 years. Localization of the tumours was as follows: epidermoids (cerebellopontine angle - 6 patients, lateral sulcus - 4 patients, parietal lobe and spinal cord - 1 patient each); dermoid cysts (suprasellary - 3 patients, IV ventricle - 1 patient). RESULTS AND DISCUSSION: In the clinical picture of 7 patients the dominant symptom was focal neurological deficit (paresis of the extremities, dysfunction of cranial nerves), 6 patients presented with seizures and 3 patients with occlusive hydrocephalic syndrome. Hydrocephalic-occlusive syndrome dominated the clinical picture in 2 patients with CP-angle epidermoid and in patients with dermoid cyst of the IV ventricle. 13 patients underwent total removal of dermoid and epidermoid cysts, which was confirmed by control MRI, in 3 - a small part of the tumor capsule, closely linked with one of the large vessels of the brain (middle cerebral artery, basilar artery, posterior cerebral artery), was left. 14 of 16 patients (88%) noted improvement immediately after surgery. In 1 patient with epidermoid cyst of CP-angle there was new neurological deficit after surgery, that totally resolved after ventriculoperitoneal shunting. The median follow-up of the study was 3.1 years. The results of the treatment were assessed according to Karnofsky scale: more then 60 points - 16 patients. CONCLUSIONS: The only effective treatment for epidermoid and dermoid tumors is surgical removal. Careful microsurgical removal of these tumors can achieve satisfactory results and long-term remission. There is no influence of tumor localization on surgical results of the treatment.

Doppler inspection results of first year infants with hydrocephalic syndrome of hypoxic-ischemic genesis

Case monitoring of 105 infants from 1 to 12 months with 1, 2 degrees cerebral ischemia was realized. Clinical, clinical-neurovisual signs of hydrocephalic syndrome were observed in 57 patients of the first group. For 48 infants of the second group there were only neurosonographic signs of cerebrum liquor spaces dilatation. Transcranial Doppler investigation was included into case monitoring. Indices of cerebral hemodynamics determining clinical finding of intracranial hypertension were established. Principal mechanisms of cerebral hemodynamics changing under hydrocephalic syndrome for infants of the first year were found. Stable characteristics pointing to intracranial hypertension regardless of clinical finding are shown.

Evaluation of the vegetative dysfunction by means of the method of heart rate variability analysis during nontraumatic intracranial hemorrhages

Оn the basis of the heart rate variability analysis in 41 patients during acute period of nontraumatic intracranial hemorrhages it was revealed that dynamics of the vegetative dysfunction rise was characterized by transition from reflex to humoral metabolic type of regulation. The reduction of reactivity of vegetative nervous system parasympathetic part during respiratory and active orthostatic test was noted. The method of evaluation of vegetative nervous system reactivity by means of heart rate variability analysis recorded before, during and after lumbar puncture with measure of cerebrospinal fluid pressure was worked out. It allows to evaluate the reactivity of suprasegmental centers (adequate, insufficient, exhaustion), raises accuracy of detection of adaptive organism resources with the detachment of the disease course variant and helps to reveal correlation of exertion extent of suprasegmental centers with hypertensive hydrocephalic syndrome.

The Role of Cross-Modal Perception in the Development of the Attention Process and the Uncovering of Its Deficit in Infants in the First Year of Life (Psychophysiological Study)

This paper is devoted to studying cross-modal perception providing for the performance of object-manipulative activity of the hand, which is the basic component of the attention process in infants during the first year of life. The introduction of multifactorial analysis consisting of eight parameters, five of which revealed the characteristics of the cross-modal reaction and allowed its components to be separately assessed. The activity, all the repertoire of the hand motor acts, the duration of individual episodes, the degree of involvement of the visual component in each of them, and the habituation paradigm were analyzed. Simultaneously, the visual attention phase preceding the cross-modal reaction and the emotional activity accompanying the attention process were studied. The study subjects were healthy term infants and infants with congenital cerebral pathology, including mental retardation (MR), hydrocephalic syndrome, and periventricular myeloleukomalacia (PVL). The study of cross-modal perception revealed a 2.5- to 3-month delay in the time of its maturation in infants with hydrocephalic syndrome and MR as compared with healthy and PVL infants. Specific features of the dynamics of the development of cross-modal reaction that indicated its jump-like increase at seven to eight months and 11 to 12 months were revealed in the latter group. On the whole, in months 5–12, the duration of this reaction increased threefold; the number and complexity of manipulations, as well as the involvement of digital activity and the participation of the visual component in it, increased. In infants with hydrocephalic syndrome and MR, the duration of cross-modal reaction at 12 months was only 18 to 25% of the similar parameter in healthy and PVL infants. The number of manipulations at 12 months was consistent with reactions of healthy infants aged 4.5 to 6 months. These data obtained provide evidence of, firstly, a significant role played by cross-modal perception in the formation of the attention process and, secondly, the hypofunction of this perception and, as a consequence, attention deficit in infants with this brain dysfunction.

Expanding lacunae causing triventricular hydrocephalus

Two patients are reported in whom the presence of triventricular hydrocephalus and aqueductal obstruction or stenosis due to multiple expanding lacunae in the mesencephalothalamic region possibly corresponds to abnormally dilated perivascular spaces. Placement of a ventriculoperitoneal cerebrospinal fluid (CSF) shunt in one patient and the performance of a third ventricle cisternotomy in the other reversed the hydrocephalic syndrome, but did not modify the complex neuroophthalmological disturbance and rubral tremor presumably related to the compressive effects of the lacunae on adjacent parenchyma. In one patient the number and size of the lacunae were increased 4 years after CSF shunt placement. A review of the literature revealed two cases in which magnetic resonance imaging demonstrated a similar, poorly understood pathological condition.

Low-Pressure Hydrocephalic State and Viscoelastic Alterations in the Brain

Most shunt-dependent hydrocephalic patients present with predictable symptoms of headache and mental status changes when their cerebrospinal fluid shunts malfunction. Their intracranial pressure (ICP) is usually high, and they usually respond to routine shunt revision. This report describes 12 shunted patients who were admitted with the full-blown hydrocephalic syndrome but with low to low-normal ICP. All 12 patients had been maintained previously on medium-pressure shunts. Their symptoms included headache, lethargy, obtundation, and cranial neuropathies. At peak symptoms, their ventricular sizes were large (ventricular/biparietal ratio of 0.35 to 0.45) in six and massive (ventricular/biparietal ratio > 0.45) in six and their ICPs ranged from 2.2 to 6.6 mm Hg, with a mean of 4.4 +/- 1.3 mm Hg (+/- standard deviation), i.e., below or well within the pressure range of their shunts. The pressure volume index of three patients at peak symptoms ranged from 39.2 to 48.5 ml, with a mean of 43.9 +/- 4.6 ml, which represents a 190% increase from the predicted normal value. Seven patients failed to improve with multiple shunt revisions, including the use of low-pressure valves. In 11 patients, symptoms and ventriculomegaly were not reversed except with prolonged external ventricular drainage at subzero pressures (mean external ventricular drainage nadir pressure of -5.7 +/- 3.6 mm Hg, for a mean period of 22.2 days). During external ventricular drainage treatment, symptoms correlated only with ventricular size and not with ICP. All 11 were subsequently treated successfully with a new medium- or low-pressure shunt. One patient was treated successfully with prolonged shunt pumping. We postulate that: 1) the development of this low-pressure hydrocephalic state is related to alteration of the viscoelastic modulus of the brain, secondary to expulsion of extracellular water from the brain parenchyma, and to structural changes in brain tissues due to prolonged overstretching; 2) certain patients are susceptible to developing low-pressure hydrocephalic state because of an innate low brain elasticity due to bioatrophic changes; 3) low-pressure hydrocephalic state symptoms are due not to pressure changes but to brain tissue distortion and cortical ischemia secondary to severe ventricular distortion and elevated radial compressive stresses within the brain; and 4) treatment must be directed toward allowing the entry of water into the brain parenchyma and the restoration of baseline brain viscoelasticity.

Cerebral energy metabolism in experimental canine hydrocephalus

Cerebral energy metabolism, its relationship to the stage and extent of hydrocephalus, and the effect of cerebrospinal fluid (CSF) removal on it were studied in experimental canine hydrocephalus produced by intracisternal injection of kaolin by using phosphorus-31 (P-31) magnetic resonance (MR) spectroscopy and MR imaging. P-31 MR spectra were serially obtained before and after CSF removal, maximally on eight occasions over a period of nearly 5 h. There was a decrease in the ratio of creatine phosphate to inorganic phosphate, used as an indicator of the bioenergetic state, in acute and subacute stages of hydrocephalus as compared with the control. An animal in the subacute stage, when periventricular edema was most prominent, exhibited the most predominent decrease in this ratio at 14 days after hydrocephalic insult. The recovery of the ratio toward the control level was seen in the chronically hydrocephalic animal. There was no change in adenosine triphosphate (ATP) levels in any stage of hydrocephalus. Serial spectra obtained after the withdrawal of ventricular CSF showed no change in the bioenergetic state of the brain in any stage of hydrocephalus. There was no relationship between either the extent of hydrocephalus or the ventricular CSF pressure and the change in the bioenergetic state or the levels of any of the phosphorus compounds. These findings may indicate the alteration of the mitochondrial energy metabolism in hydrocephalus, which may explain the mechanism of hydrocephalic syndrome.

Genetic prenatal aqueductal stenosis with hydrocephalus in rat.

A recessive mutation which arose in Wistar albino rats was variably expressed in the homozygous state as prenatal stenosis of the aqueduct with resultant hydrocephalus. The condition was often compatible with survival to adulthood and with successful reproduction. Mildly sparse hair was the constant gene marker. Eye defects and sometimes foot deformities occurred. The first observable ultrastructural alteration was a disruption of the integrity of the neuroepithelial basal lamina in the cephalic neural tube of affected embryos as early as the 11th fetal day (16-24 somite pairs). The hydrocephalic syndrome closely resembled that produced by giving folic acid analogs to, or producing vitamin B12 deficiency in, pregnant rats in the period including the 11th day. Neither vitamin B12 nor folate, nor certain metabolites closely related to their metabolism, prevented the gene's expression. Homozygote mutants mated with homozygote mutants produced 70% hydrocephalic (dome-shaped heads) offspring, but if the mother was heterozygote, there was a "protective" effect and the number of hydrocephalic young was disproportionately smaller.

Hydrocephalus in the adult secondary to the rupture of intracranial arterial aneurysms.

HE interest paid during the last years to the hydrocephalic syndrome in the adult is reflected in the increasing number of publications dealing with this subject. 1,~,s,11,14,1~,1~,~~ The nomenclature is somewhat confusing, for terms such as occult hydrocephalus, non-pressure hydrocephalus, normal-pressure hydrocephalus, low-pressure hydrocephalus, idiopathic hydrocephalus, and nonobstructive adult have been used to refer, within some limitations, to the same clinical entity. Some new etiological aspects have been reported, TM and more active therapy is being carried out in most neurological centers. This report concerns the hydrocephalic picture that may develop in the adult secondary to subarachnoid hemorrhage from the rupture of arterial intracranial aneurysms. A classical study of the reactions caused by blood when injected in the subarachnoid space and the relation of these reactions to the development of hydrocephalus was reported in 1928 by Bagley. 4,~ Although since then both clinical ~,6,12,2~176 and pathological 3,6,2~ reports on short series have been published, there are still no statistics on the incidence of this complication in a large series of adults 3~ and the frequency of hydrocephalus due to basal arachnoiditis following subarachnoid hemorrhage is not known? ~ Statements like these, and the fact that during the treatment of our cases some interesting clinical, radiological, and etiological factors were found, have prompted this study.

Serum enzyme studies of a hydrocephalic syndrome of newborn calves.

SummaryThe serum enzyme levels were studied in 4 calves which exhibited a hydrocephalic syndrome (encephalo-ophthalmomyopathy(10)). More than a 30-fold elevation of serum glutamic oxaloacetic and glutamic pyruvic transaminases, lactic and malic dehydrogenases, and aldolase was found compared with sera from normal calves of similar age. The elevated serum enzymes, not previously reported for calves with the hydrocephalic syndrome, were believed to be due to extensive and progressive muscular dystrophy observed in these calves.