Internal Hydrocephalus Research Articles

Aflatoxin B1 induces infertility, fetal deformities, and potential therapies.

Aflatoxin B1 (AFB1) is a subsidiary poisonous metabolite, archetypally spawned by Aspergillus flavus and A. parasiticus, which are often isolated in warm or tropical countries across the world. AFB1 is capable of disrupting the functioning of several reproductive endocrine glands by interrupting the enzymes and their substrates that are liable for the synthesis of various hormones in both males and females. In men, AFB1 is capable of hindering testicular development, testicular degeneration, and reduces reproductive capabilities. In women, a direct antagonistic interaction of AFB1 with steroid hormone receptors influencing gonadal hormone production of estrogen and progesterone was responsible for AFB1-associated infertility. AFB1 is potentially teratogenic and is responsible for the development of malformation in humans and animals. Soft-tissue anomalies such as internal hydrocephalus, microphthalmia, cardiac defects, augmented liver lobes, reproductive changes, immune modifications, behavioral changes and predisposition of animals and humans to neoplasm development are AFB1-associated anomalies. Substances such as esculin, selenium, gynandra extract, vitamins C and E, oltipraz, and CDDO-Im are potential therapies for AFB1. Thus, this review elucidates the pivotal pathogenic roles of AFB1 in infertility, fetal deformities, and potential therapies because AFB1 toxicity is a key problem globally.

Non-occlusive hydrocephalus after radiosurgery for vestibular schwannomas

Stereotactic radiosurgery has firmly entered the arsenal of methods for treating vestibular schwannomas along with traditional surgical removal, providing high control of tumor growth and a low level of functional complications. Meanwhile, there is evidence of a possible relationship between the irradiation performed and the subsequent development of non-occlusive hydrocephalus. Purpose: to retrospectively assess the current level of development of hydrocephalus after stereotactic radiosurgery for vestibular schwannomas. Materials and methods: of 541 patients who received treatment with the Gamma Knife for unilateral vestibular schwannoma, 456 (84.3%) patients initially had no signs of non-occlusive hydrocephalus (group 1), while in 85 (15.7%) patients, MRI signs of internal non-occlusive hydrocephalus were revealed at the time of radiosurgery (group 2), of whom in 1 case VP shunting had previously been performed. In all cases, non-occlusive hydrocephalus at the time of SRS had a compensated course without clinical manifestations. Results: after radiosurgery, the development of de novo non-occlusive hydrocephalus in 7 (1.5%) patients from group 1 and its progression in 11 (12.9%) patients from group 2 were noted. The overall incidence of non-occlusive hydrocephalus after radiosurgery was 3.3%. Ventriculoperitoneal shunting was required in 3 cases in group 1 and 7 cases in group 2 due to the occurrence of neurological symptoms (1.8%). Conclusion: In some cases, radiosurgery can lead to decompensation of existing non-occlusive hydrocephalus, but it rarely occurs de novo. The asymptomatic course of non-occlusive hydrocephalus allows for SRS, as the risk of decompensation with subsequent need for VP shunting is low. Patients with non-occlusive hydrocephalus before SRS require more careful monitoring with assessment of neurological status and control MRI.

Surgical management of primary and idiopathic internal hydrocephalus in dogs and cats.

Ventriculoperitoneal shunt placement is an effective method to treat internal hydrocephalus in dogs and cats. Although it has a long history in veterinary medicine, the technique continues to evolve. Despite continuing attempts to reduce the incidence of associated complications, shunt failure remains a major problem, and often leads to multiple hospital admissions. This review gives an overview about current knowledge of ventriculoperitoneal shunting techniques in animals, applicable shunt hardware as well as shunt-associated complications and their prevention and treatment.

Risk factors, treatment, and outcome in dogs and cats with subdural hematoma and hemispheric collapse after ventriculoperitoneal shunting of congenital internal hydrocephalus.

Overshunting and hemispheric collapse are well-known complications after ventriculoperitoneal shunt (VPS) implantation. Risk factors that predispose to overshunting, treatment options, and prognosis after therapeutic intervention have not been described. To identify preoperative risk factors for overshunting, the effect of surgical decompression, and their outcomes. Seventy-five dogs and 7 cats. Retrospective case cohort study. Age, breed, sex, body weight, number of dilated ventricles, ventricle brain ratio, intraventricular pressure, and implanted pressure valve systems were evaluated as possible risk factors. Overshunting had a prevalence of 18% (Cl 95% 9.9-26.66). An increase of 0.05 in VBR increased the risk of overshunting by OR 2.23 (Cl 95% 1.4-3.5; P = .001). Biventricular hydrocephalus had the highest risk for overshunting compared to a tri- (OR 2.48 with Cl 95% 0.5-11.1) or tetraventricular hydrocephalus (OR 11.6 with Cl 95% 1.7-81.1; P = .05). There was no influence regarding the use of gravitational vs differential pressure valves (P > .78). Overshunting resulted in hemispheric collapse, subdural hemorrhage, and peracute deterioration of neurological status in 15 animals. Subdural hematoma was removed in 8 dogs and 2 cats with prompt postoperative improvement of clinical signs. Biventricular hydrocephalus and increased VBR indicate a higher risk for overshunting. The use of differential valves with gravitational units has no influence on occurrence of overshunting related complications and outcomes. Decompressive surgery provides a favorable treatment option for hemispheric collapse and has a good outcome.

PECULIARITIES OF STRUCTURAL CHANGES IN THE BRAIN SUBSTANCE IN PATIENTS WITH ARRHYTHMIAS DEPENDING ON THE SEVERITY OF COGNITIVE DISORDERS.

The aim: To evaluate the structural changes of the brain in relation to the formation of cognitive disorders (CD) in patients with arrhythmias. Materials and methods: 147 patients with different clinical forms arrhythmias against the background of ischemic heart disease were examine. At the first stage, all patients with arrhythmias assessed cognitive functions. At the second stage, patients were distributed divided into two groups: the main group patients with CD, control - patients without CD. These groups underwent computed tomography examination of the brain. Results: CD were established in 83% patients with arrhythmias. Mild CD were more often diagnosed in patients with persistent form of atrial fibrillation (AF), severe CD - in patients with permanent form of AF and atrioventricular blockade ІI-III degrees. Neuroimaging changes were found in 73.8% patients with CD and in 36% patients without CD. They were manifested by atrophic changes of the cortex, internal hydrocephalus, a decrease in the density of the brain sub¬stance of the periventricular area. In patients with CD, compared to patients without CD, showed lacunar foci with predominant localization in the parietal and frontal lobes of the brain, periventricular and subcortical leukoaraiosis. Multiple correlations were established between CD and structural changes of the brain. Conclusions: The increase in the severity of CD in patients with arrhythmias is associated with atrophic changes at the cortical-subcortical level, accompanied by the phenomena of internal hydrocephalus, periventricular and subcortical LA, lacunar foci, with a predominant localization in the frontal-temporal-occipital lobes, in the visual hump and basal ganglia of both cerebral hemispheres.

Peculiarities of brain structural changes in young patients with arterial hypertension

Actuality: Arterial hypertension (AH) is one of the most common diseases among diseases of the circulatory system and, together with other cardiovascular diseases, ranks first in the world and in Ukraine in terms of mortality rates. About 45% of patients do not know that they have hypertension. The scale of this problem in the world is evidenced by the fact that hypertension is found in every third adult. This disease occurs more often in the elderly, but its development often begins at a young age, and sometimes even in childhood. The intensive development of neuroimaging methods (CT and MRI) in recent decades makes it possible to detect various changes in the brain at early preclinical stages, which is of great importance for the implementation of adequate differentiated primary prevention of the development and progression of cerebrovascular disease and such unpleasant manifestations as cognitive deficits, dementia and ischemic stroke. The purpose of the study: to reveal the nature of structural changes in the brain in young patients with clinically confirmed hypertension. Material and methods: a study of structural changes in the brain was conducted based on the MRI examination data (1.5 T) of 54 young patients (18-44 years old) with hypertension of various degrees. Statistical analysis was carried out by the IBM SPSS Statistics 20 license program using the criterion of agreement with the test of static significance (Fisher's exact test -F). Results: Differences in brain structural changes were obtained in patients depending on the degree of hypertension. A significant difference according to the χ² criterion (р<0.05) was found in the frequency of occurrence of mixed, external and internal hydrocephalus in patients with hypertension of the first and second century. Differences in the incidence of external and internal hydrocephalus in patients with AH I and AH III, AH II and AH III not detected by the χ² criterion (p< 0.05). There are differences in the frequency of leukoaraiosis of the 0th, 1st, 2nd, and 3rd stages. according to the Fazekas scale between groups of patients with 1st stage hypertension, 2nd stage hypertension, and 3rd stage hypertension reliable according to the χ² criterion (р< 0.05). Differences in the frequency of lacunar foci at different degrees of hypertension were not reliably detected. The analysis of the results of the assessment of structural changes of the brain by age showed that the main differences in the occurrence of mixed and external hydrocephalus are characteristic of all age groups. There is no difference in the frequency of internal hydrocephalus, mild and moderate leukoaraiosis in the groups of men and women. The frequency of occurrence of mixed, external hydrocephalus, the absence of leukoaraiosis and the presence of severe draining leukoaraiosis (in men, the severity of these changes prevails) is significantly different. No difference in the frequency of lacunar foci was found in the groups of men and women. Conclusions: Thus, hypertension is an age-dependent disease. No differences were found in the frequency of complaints of noise in the head, decreased attention and cognitive activity, sleep disturbances, and gender differences in the examined patients with hypertension of various degrees of severity. The main structural changes of the brain in the examined patients are various types of hydrocephalic manifestations, signs of leukoaraiosis (characteristic for the older age of 36-44 years) of one degree or another. Some gender specific features of brain structural changes in the examined patients were revealed (increased manifestations of hydrocephalus syndrome in men and absence of leukoaraiosis in them compared to women).

Challenges in the pre- and post-natal diagnosis of posterior fossa cysts: A case report and review of historical evolution of descriptive terminologies.

Radiological diagnoses of posterior fossa cystic abnormalities during antenatal and postnatal periods pose significant challenges as they may have similar early imaging features. Some of the frequently described entities are arachnoid cysts and Dandy-Walker malformations. Blake's pouch cyst is relatively underdiagnosed. The main aim of the study was to explore these diagnostic challenges in the context of various descriptive terminologies and their prognostic implications. We illustrate this through our case, where fetal magnetic resonance imaging (MRI) at 36 weeks gestation showed small right cerebellum without hydrocephalus or hemorrhage. Possible differential diagnoses included Dandy-Walker malformation or posterior fossa malformations, facial hemangiomas, arterial anomalies, cardiac and eye anomalies, sternal clefting, and supraumbilical raphe. Postnatal sonography noted posterior fossa cyst without hydrocephalus in a normal term infant, who went on to develop symptomatic hydrocephalus by 15 weeks. Computed tomography brain scan confirmed large subtentorial posterior fossa cyst and extensive internal hydrocephalus. Despite emergent ventriculoperitoneal shunt insertion, head circumference continued to rise. MRI scan showed persistent cyst. Subsequently, infant underwent endoscopic fenestration of the cyst with balloon septostomy and now has an age appropriate developmental profile. There is considerable discordance between antenatal and postnatal neuroimaging findings as highlighted in our case. Diagnostic conundrum here was whether this was an arachnoid or Blake's pouch cyst. Differentiating between posterior fossa fluid collections is crucial for management, prognosis, and parental counseling. Close postnatal follow-up is essential to avert complications due to acute hydrocephalus.

Short Falls in Childhood Occasionally Cause Major Brain Injuries Because of Unusual Circumstances.

Records and imaging were reviewed for children younger than 6 years, hospitalized between 2015 and 2020 for major closed head injuries following less than 4-ft falls. Major injury was defined as intensive care admission more than 2 days, neurosurgical intervention, death, or disability at hospital discharge. Subjects were identified through Seattle and Spokane, Washington abuse consultations. Harborview Medical Center's trauma registry and Seattle Children's Hospital's Hemophilia Treatment Program and Radiology were searched for subjects. We identified 12 young children who sustained major closed head injury due to short falls. Seven developed major space-occupying epidural hemorrhages. One child developed internal hydrocephalus after intraventricular hemorrhage. One child with prior meningomyelocele, Chiari 2 malformation, and ventriculoperitoneal shunt developed shunt decompensation after an acute-on-chronic subdural hemorrhage. One child developed an internal capsule stroke because of a previously undiagnosed calcifying angiopathy. Another child developed space-occupying subdural hemorrhage associated with previously unrecognized platelet pool disorder. Only this child had abuse concerns, which were resolved with his coagulopathy diagnosis. One child had a diastatic skull fracture leading to pseudomeningocele.At Harborview Medical Center, 140 children were seen for short falls in the emergency department or inpatient service. Among the 40 needing intensive care, 4 (12.5%) had major injuries after short falls. Our hemophilia treatment program did not see any children who had sustained major injury following a short fall in a 5½ year period. Although young children rarely sustain major head injury following short falls, serious head injuries do occasionally occur because of unusual injury mechanisms or preexisting conditions. It is important to fully evaluate these patients to differentiate these unintentional falls from abusive head injury.

Clinical, psychological and neuroimaging characteristics of chronic tension headache in elderly persons

The aim of the study. To study clinical, psychological and neuroimaging characteristics of chronic tension headache (CTH) in the elderly.Materials and methods. 92 patients with CHTHN (37 men and 55 women aged 55–74 years) were examined. The control group consisted of 53 people (22 men and 31 women of the same age) who did not have neurological complaints, including headache. Pain intensity was assessed on a 10-point visual analogue scale. The severity of neurological symptoms was determined using the NIH-NINDS scale. For the study of cognitive functions, a short scale for assessing mental status was used Mini Mental State Examination (MMSE) and a frontal assessment battery (FAB). Memory was assessed according to the results of the memory subtest MMSE and the 10 words test. The level of attention was studied using the Schulte table, speech fluency – in the «fluency of speech» subtest of the FAB and in the test of verbal associations, visuospatial functions were assessed using the clock drawing test. Memory was assessed by the results of the subtest of memory MMSE and the 10-words test. The level of attention was studied using the Schulte table, the fluency of speech – in the subtest ‘fluency of speech’ FAB and in the verbal association test, visuospatial functions were assessed using the clock drawing test. Magnetic resonance imaging of the head was performed on a Magnetom Impact Expert (Siemens, Germany) tomograph with a magnetic field strength of 1.5 Tesla in T1 and T2 modes. The localization and severity of leukoaraiosis, signs of external and internal atrophy of the brain were determined, the linear dimensions of the anterior horns and central sections of the bodies of the lateral ventricles were measured, and the indices of the anterior horns and bodies of the lateral ventricles were calculated.Results. Patients with chronic tension headache were characterized by clinical and cognitive heterogeneity: frequent «non-standard» characteristics of headache, severe polymorphism of algic manifestations, high frequency of comorbid disorders, cognitive dysfunction and somatic burden, high representation of leukoaraiosis, external and internal hydrocephalus according to MRI study.

ОДНОМОМЕНТНОЕ ВЫПОЛНЕНИЕ ЭНДОСКОПИЧЕСКОЙ ВЕНТРИКУЛОЦИСТЕРНОСТОМИИ ДНА III ЖЕЛУДОЧКА, АКВЕДУКТОПЛАСТИКИ, ФЕНЕСТРАЦИИ СУПРАЦЕРЕБЕЛЛЯРНОЙ КИСТЫ ПРИ ОККЛЮЗИОННОЙ ГИДРОЦЕФАЛИИ У РЕБЕНКА ПЕРВОГО МЕСЯЦА ЖИЗНИ

The article presents a clinical case of the simultaneous execution of endoscopic ventriculocisternostomy of the third ventricle floor (ETV), aqueductoplasty, fenestration of the supracerebellar cyst in occlusive hydrocephalus using a semi-rigid needle neuroendoscope. The authors describe a child who, at the age of 1 month, was admitted to Neurosurgical Department No. 1 of the Federal Center for Neurosurgery of the Ministry of Health of the Russian Federation in Tyumen with a diagnosis of congenital internal occlusive hydrocephalus, subcompensated course. MRI scan of the brain: triventricular occlusive asymmetric hydrocephalus is visualized, adhesions in the upper parts of the aqueduct, supracerebellar arachnoid cyst were visualised. ETV, aqueductoplasty, fenestration of the supracerebellar cyst were performed. There were no postoperative neurological, endocrine and infectious complications. The observation period after surgery is 7 years from today. Conclusion: preoperative MRI analysis of the structures of the third ventricular floor, interventricular and prepontine cisterns is important for understanding endoscopic, microsurgical anatomy and surgical planning. The use of modern improved endoscopic instruments, low-traumatic performance of all stages of the operation allow to restore cerebrospinal fluid circulation and achieve high efficiency in the treatment of occlusive hydrocephalus in the long-term period. This, in turn, relieves patients of the shunt-dependent state, constant correction of the dysfunctions of the shunt system and long-term, and often ineffective, treatment performed by neurologists and pediatricians.

Venom Induced Toxic Ventriculitis Resulting in Acute Reversible Communicating Internal Hydrocephalus, Acute Pituitary Haemorrhage, Acute Hypopituitarism, Acute Kidney Injury, Septicaemia, Cellulitis and DIC Due to Viper Bite in a Young Farmer: A Case Report

A young farmer, tenth standard student, helping his grandfather during holiday, developed anuria after viper bite. Because of headache, non-enhanced CT scan head was done on admission which showed a small pituitary haemorrhage with normal ventricles. Later, he had generalized fits and second non-enhanced CT scan head was repeated which revealed a small pituitary haemorrhage with dilated ventricles. He also had acute kidney injury, septicaemia, cellulitis and DIC. The serum level of TSH, free T3 & free T4 were low; thus, replacement was done. Cerebrospinal fluid study (protein, sugar, cells) including culture was normal. Renal replacement therapy (haemodialysis), platelets transfusion and antibiotics were given. He had torrential polyuria (urine output 12 liter per day) when he recovered from renal failure and it improved dramatically with desmopressin replacement. There was improvement in third non-enhanced CT scan head and fourth one was consistent with normal ventricle and reduction in size of pituitary haemorrhage.

Роль внутричерепной гипертензии в патогенезе центральной серозной хориоретинопатии

Central serous chorioretinopathy (CSCR) is a pachychoroid condition, but the causes of pachychoroid development remain unknown. Taking into account the anatomical features of the blood supply to the eyeball, it was suggested that the phenomena of pachychoroid can be caused by intracranial hypertension. Purpose. Evaluate blood supply disorders at the level of eyeball vessels, intracranial vessels and vertebrobasilar basin in patients with CSCR. Material and methods. 10 patients with CSCR were examined, 4 of them additionally underwent magnetic resonance imaging (МРТ) of the brain and cervical spine, intra-and extracranial arterio-and venography, and ultrasound of extra-and intracranial vessels. Results. By OCT data, all patients had significant increase in the choroidal thickness both in eyes with CSCR, and in fellow eyes. OCT of the optic disc revealed subarachnoid space expansion - a marker of intracranial hypertension. By ultrasound B-scan data, 8 patients with CSCR showed moderate expansion of the perineural space of the optic nerve and significant expansion of orbital vessels, which also indicates intracranial hypertension. By MRI data, all patients showed signs of internal hydrocephalus, which may indicate intracranial hypertension. In addition, the presence of signs of cervical osteochondrosis and asymmetry in the vertebral arteries was established. In 50% of cases, there was a decrease in intravascular blood flow along the orbital vein on the side of the affected eye, and an asymmetry of venous blood flow along the transverse and cavernous sinuses. By ultrasound dopplerography signs of intracranial venous hypertension of extra-and intracranial vessels were revealed. Conclusion. The role of pathological changes of central genesis in the development of CSСR has been established, requiring interdisciplinary research and expansion of therapeutic measures aimed at limiting the identified disorders. Key words: central serous chorioretinopathy, pachychoroid condition, intracranial hypertension.

<i>Spina bifida</i>: a multidisciplinary problem (a literature review)

BACKGROUND: Congenital malformations of the spine and spinal cord can be combined with various clinical manifestations of the spine, spinal cord, and lower extremities. Children with these neurological disorders often lack sensitivity and motor activity of their lower extremities and, in most cases, have bladder infections and incontinence (lack of bladder and bowel control).
 AIM: This study aims to analyze publications with the diagnostic and treatment results of patients with neurological, orthopedic, neurological, and ophthalmological problems with spina bifida.
 MATERIALS AND METHODS: We searched PubMed, Web of Science, Scopus, MEDLINE, eLibrary, and RSCI databases and found about 2000 references and 374 articles. We selected 60 articles for review in orthopedics, neurosurgery, urology, and ophthalmology.
 RESULTS: Neural tube defects are a wide range of congenital malformations, including skull defects and open or closed spinal dysraphism. The incidence of spine and spinal cord malformations in different countries is quite broad and amounts to 0.3199.4 cases per 10,000 births worldwide. Spinal cord malformations often occur in combination with bladder infections and incontinence, limb deformities, and other central nervous system developmental anomalies. Among the orthopedic problems leading to impaired support function, the most common are foot deformities and hip joint instability. Orthopedic monitoring of a patient with spina bifida consists of mainly preventing or correcting deformities according to the rehabilitation potential of the child. The timely completion of treatment allows the child to maintain mobility and independence of movement daily activities. At the same time, such treatment must pursue realistic goals according to the potential motor level of the child. In addition to neurosurgical and orthopedic problems, most children with spina bifida (88%94%) suffer from pelvic disorders. A urologist should observe a patient with spina bifida to perform ultrasound and laboratory monitoring of both the lower and upper urinary tract conditions from an early age. Timely procedures to eliminate urinary retention and sanitation can maintain normal kidney function and contribute to the adequate conduct of motor and neurological rehabilitation of the child. The most common complication of spina bifida is the Chiari II malformation, which is manifested by damage to brain stem structures and internal occlusal hydrocephalus with various symptoms, including neuroophthalmological signs.
 CONCLUSIONS: A multidisciplinary team of specialists comprising a neurologist, neurosurgeon, urologist, orthopedic surgeon, ophthalmologist, orthosis specialist, and psychologist should be involved in treating the children with the above presented problems. The use of an integrated approach to treat this group is absolutely justified and enabled the maximum rehabilitation potential of the child to be achieved.

Клинический случай выраженной внутренней гидроцефалии при мальформации Денди-Уокера

Dandy-Walker syndrome is a complex of symptoms presented by a congenital malformation involving essential structures of the brain: cerebellum, ventricles, medulla oblongata, cranial nerves and large vascular trunks, and characterized by especially severe course. In the article, a clinical case of pronounced internal hydrocephalus in Dandy-Walker malformation is described. Peculiarities of the given case are young age of the patient and diagnosis at the advanced stage when a stable neurologic deficit and alteration of the personality of organic type have already been formed. Thus, the performed neurosurgical intervention (endoscopic triventriculocisternostomy) appeared of low effectiveness and caused aggravation of the patient’s condition in the late postoperative period in the form of subdural hematoma which required a repeated operation for its removal. Conclusion. Issue of the internal hydrocephalus in Dandy-Walker syndrome is of much practical interest for both neurosurgeons, and neurologists and radiologists, since the modern diagnosis and effectiveness of treatment directly depend on the coordinated work of these specialists.

Boundary conditions investigation to improve computer simulation of cerebrospinal fluid dynamics in hydrocephalus patients

Three-D head geometrical models of eight healthy subjects and 11 hydrocephalus patients were built using their CINE phase-contrast MRI data and used for computer simulations under three different inlet/outlet boundary conditions (BCs). The maximum cerebrospinal fluid (CSF) pressure and the ventricular system volume were more effective and accurate than the other parameters in evaluating the patients’ conditions. In constant CSF pressure, the computational patient models were 18.5% more sensitive to CSF volume changes in the ventricular system under BC “C”. Pulsatile CSF flow rate diagrams were used for inlet and outlet BCs of BC “C”. BC “C” was suggested to evaluate the intracranial compliance of the hydrocephalus patients. The results suggested using the computational fluid dynamic (CFD) method and the fully coupled fluid-structure interaction (FSI) method for the CSF dynamic analysis in patients with external and internal hydrocephalus, respectively.

Studying of dynamics of Alzheimer's disease symptoms manifestation against the background of COVID-19 in department № 5 for treatment of COVID-19, city clinical hospital № 2 named after F.H. Gral

A clinical case was analyzed, the regularity and dynamics of psychoneurological symptoms was studied in a patient with a moderately severe form of the course of a new coronavirus infection with concomitant neurodegenerative disease Alzheimer's disease. 
 The patient aged 73 was admitted to the City Clinical Hospital №2 named after F.H. Gral by the team of emergency care with identified COVID-19. When admitted to the hospital, she had disability group 2 regarding neurodegenerative disease Alzheimer's disease. A multispiral computed tomography of the head revealed the following: internal open substitutional hydrocephalus, moderately expressed bilateral leukoaraiosis, cerebral atrophy, predominantly in temporoparietal region, that is typical for Alzheimer's disease.
 The results of tests indicated a decrease in cognitive status. In the test with figures, the patient could not find the required figure for the desired time. When conducting clock-drawing test in dynamics, at the second attempt the patient needed about 7 minutes; a worse capability for drawing was noted; apraxia was observed. The result of the test 6CIT at the second attempt, carried out before discharge from the hospital became worse she could answer only one of four questions, whereas at the first attempt, when admitted, she could answer two questions of four. By the time of discharge from the hospital, the patient was noted to have more pronounced cognitive disorders than at admission. Emotional lability, nervousness and anxiety also remain.

"Eppur si muove" - Clinical case: evolutionary "saga" during the last 6 years: posttraumatic subdural hematoma, decompressive craniectomy, right hemiplegia and aphasia, cranioplasty, hydrocephalus and porencephaly, post-traumatic encephalopathy - in remission

The case reports a 59-year-old male patient who suffered a severe head injury (affirmative by accidental fall from 3 m) with multiple hemorrhagic lesions (bifrontal, bioccipital, biparieto-temporal) and left cerebral subdural hematoma, requiring a large fronto- temporo-parietal decompressive craniotomy for the mass lesion evacuation. Cranioplasty was performed after 6 months. The paper synthesizes the evolution over six years of follow-up (12 in-patient admissions and 4 out-patient evaluations), like in a neurorehabilitation cinematographic “saga”. The posttraumatic encephalopathy had a peculiar evolution, sugestively compared with the humps of a camel: the brain injury (determined coma, right hemiplegia and mixed aphasia, intense psycho-motor agitation, severe dysphagia for solids and liquids, neurogenic bladder, anemia), was followed by a slowly progressive favorable neuro-psychological evolution (after the decompressive craniectomy). A brutal neurological fall-down was noticed after the cranioplasty, and finally a gradually favorable ascending trend, towards a global neuro-psichological stabilization (with an almost imperceptible sequelary ataxic hemiparesis). The paper discusses the pathophisiological aspects focused on the decompressive craniectomy and cranioplasty, correlated to the patient’s evolution. Complications of each neurosurgical procedures are succinctly depicted. The traumatic encephalopathy was complicated with post-traumatic seizures (therapeutically controlled) and active internal hydrocephalus with interstitial edema and an ischemic lesion. Finally it was a "happyend", with favorable clinical evolution, towards a stable and stationary normotensive asymmetric hydrocephalus, with a gigantic and deforming porencephaly. The paper advocates for a carefully follow-up and prompt intervention in order to prevent recurrences and/ or complications (secondary and tertiary prophylaxis). Keywords: traumatic brain injury, subdural hematoma, decompressive craniectomy; cranioplasty; internal hydrocephalus; post-traumatic encephalopathy; seizures; neurorehabilitation,

Characteristics of cerebral hemodynamics in patients with chronic brain ischemia

Background. Literature sources report conflicting results regarding the severity of clinical symptoms of hydrocephalus (HC) and their association with cerebral arterial blood flow (CABF); most studies do not show a direct relationship, while some suggest a link between clinical severity and progressive decrease in CABF. The study of hemodynamic changes in the brain of patients with chronic brain ischemia (CBI), elucidation of their relationship with cognitive impairments helps to improve diagnostic approaches and optimize the prognosis of the disease. The purpose of this study is to investigate the state of cerebral hemodynamics and to establish its relationship with changes in cognitive functions in patients with CBI and HC. Materials and Methods. A comprehensive examination of 110 patients with CBI and HC was performed. The localization of the HC and results of Montreal Cognitive Test (MoCA scale) were taken into account. Computed tomography of the brain was performed with subsequent determination of morphometric parameters and indices. The state of cerebral blood flow and structural changes of blood vessels were studied using transcranial color-coded duplex ultrasonography (TCCS) of intracranial vessels and extracranial divisions. Microsoft Excel 2011 and Statistica were used for statistical processing of the results. Results. It was found that there was a significantly larger diameter of both common carotid arteries (CCA), thickness of complex intima\media (CIM), maximum systolic velocity (Vs), velocity at the end of the diastolic cycle (Vd), as well as peripheral resistance (IR) in left CCA (p <0,05) in patients with CBI and HC compared with patients with CBI without HC. Significantly larger diameter of left internal carotid artery (ICA), Vs, Vd and IR was revealed; Vs and Vd in the right ICA; Vd in the extracranial devision of vertebral artery (VA) in patients with HC. A significant relationship was found between the following blood flow parameters and the values of the MoCA scale: Vs MCA/MoCA (r = 0,45, p <0,05), Vs ACA/MoCA (r = 0,38, p <0.05), ICA diameter/MoCA (r = -0,51, p <0,05). It was found that the diameter of CCA and the thickness of CIM were significantly larger in patients with CBI with internal HC in comparison with patients with CBI with external HC (p <0,01). Vs and Vd in patients with internal hydrocephalus were significantly lower, and IR was significantly higher compared with patients with external hydrocephalus (p <0,01). The diameter of ICA and IR in patients with CBI with internal HC was significantly higher, and Vs was significantly lower compared with patients with CBI and external HC (p <0,01). Significantly different values were found in Vs and IR meanings in middle cerebral artery (MCA) and Vs in anterior cerebral artery (ACA) in patients with CBI with internal HC compared with patients with CBI with external HC.Conclusions. Functional parameters of blood flow and structural changes of cerebral arteries in patients with CBI with concomitant hydrocephalus differed significantly from those in patients without hydrocephalus and depended on the type and severity of hydrocephalus. ICA occlusion, ICA stenosis >50%, and intracranial venous stasis were significantly more common in patients with severe and moderate HC compared with those with mild HC. A weak relationship was found between the structure of carotid arteries and blood flow in intracranial arteries in patients with CBI and HC. There was a significant relationship between blood flow indices and the values of the MoCA scale, which indicated the effect of changes in the vessels of the anterior circular basin on the cognitive functions and the lack of such connection with blood flow indices in vertebrobasilar basin.

Severe Encephalitis in Infant with COVID-19: A Case Report

BACKGROUND: Encephalitis is a serious condition that contains neurological dysfunction cause by inflammation of the brain tissue. Etiological factors for the occurrence of this condition include infectious and non-infectious causes.
 CASE REPORT: We are presented 9-month-old infant referred to our clinic in convulsive status, fever, and disturbed consciousness. From anamnestic information, the infant has been febrile for 2 days with profuse vomiting initiating just before admission at the clinic. At the moment of admission in the clinic, the infant looked intoxicated with generalized tonic-clonic seizures, with shortness of breath and fever with a weakened reaction to painful stimuli. It was admitted in the Isolation Unit by the protocol of the clinic. Laboratory investigations were done. Due to the persistence of convulsive status, a computed tomography scan of the brain was performed with the finding of enlargement of the lateral ventricles, with intraventricular masses and pronounced internal hydrocephalus. The results of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) from the infant were positive as well as the grandmother. The infant was intubated immediately and put on mechanical ventilation SIPPV.
 CONCLUSION: Our case report could suggest that SARS-CoV-2 infection may cause severe clinical symptoms, neurological manifestations, and encephalitis in infants.

Prevalence of seizures in dogs and cats with idiopathic internal hydrocephalus and seizure prevalence after implantation of a ventriculo-peritoneal shunt.

BackgroundSeizures are considered a clinical sign in dogs with internal hydrocephalus but are not found in recent studies. Seizure prevalence due to ventricular enlargement and the prevalence of postoperative seizures in animals is not known.ObjectivesTo determine seizure prevalence in dogs and cats with idiopathic internal hydrocephalus, to identify risk factors for seizure development, and to determine seizure prevalence in a 2‐year period after ventriculo‐peritoneal shunting (VPS).AnimalsRecords and MRIs of 197 animals from 2001 to December 2019 were investigated. A total of 121 animals (98 dogs and 23 cats) were included in the study.MethodsA retrospective multicenter case cohort study was conducted. Databases were searched for dogs and cats with internal hydrocephalus. MRI and CSF examinations were evaluated for signs of additional underlying disorders. Prevalence of seizures was estimated for animals showing only hydrocephalus internus. Risk factors were evaluated according to age, morphometric and morphological findings in the brain. All animals that underwent surgery were reexamined 2 years after surgery.ResultsOne hundred twenty‐one animals (98 dogs and 23 cats) with internal hydrocephalus met the inclusion criteria. Seizure prevalence in dogs and cats with internal hydrocephalus was low (1.7%; <5.8% CI 95%). Seizures were not observed in the 2‐year period after surgery.Conclusion and Clinical ImportanceSeizure prevalence in dogs and cats diagnosed with hydrocephalus internus is low. Seizures in association with VPS do not seem to be a complication of the procedure.