Signs Of Intracranial Hypertension Research Articles

A rare case of arachnoid cyst of the fourth ventricle resulting in an Isolated fourth ventricle: Case report and review of the literature

Introduction: Post-hemorrhagic or post-infectious isolated or trapped fourth ventricles are rare occurrences associated with cystic lesions of the V4. However, the even less frequent arachnoid cyst of the fourth ventricle poses a differential diagnosis challenge and may be easily overlooked during initial medical assessments of V4 cystic lesions. Case Report: An 11-year-old child, previously healthy, presented with symptoms indicative of intracranial hypertension syndrome, including headaches, vomiting, and bilateral Grade II papilledema. Neuroradiological examination revealed a significantly enlarged fourth ventricle (V4) alongside small lateral and third ventricles. Initially suspected as a V4 arachnoid cyst, the patient underwent surgical intervention with a sub-occipital approach for cyst marsupialization, showing positive progress in the first postoperative month. However, one month later, intracranial hypertension symptoms recurred, and imaging indicated cyst recurrence within V4. A second procedure involved a V4-peritoneal shunt, resulting in a favorable postoperative outcome for one month. One month later, headaches and vomiting without papilledema reappeared, and imaging revealed moderate ventricle dilation. The therapeutic approach included ventriculocisternostomy alongside the V4 peritoneal shunt, leading to a favorable outcome with no signs of intracranial hypertension during follow-up consultations and a normal clinical examination. Conclusion: Trapped fourth ventricle is a rare clinico-radiologic entity, with limited cases reported. Treatment options encompass direct microsurgical approaches, fourth ventricle outflow fenestration, and alternative treatments like fourth ventriculoperitoneal shunts. Additionally, the combination of ventriculoperitoneal shunt and endoscopic treatment (VCS) may be considered for comprehensive management.

Seronegative brucella meningitis diagnosed by CSF PCR: report on seven cases

IntroductionNeurobrucellosis (NB) can be associated with meningitis and present as a headache with or without meningeal signs. Pseudotumor presentation of NB has been reported to be accompanied by lymphocytic predominant cerebrospinal fluid(CSF) pleocytosis. NB is diagnosed by means of isolation of Brucella from blood or CSF and/or the presence of anti-Brucella antibodies in the CSF. Molecular techniques have been used in chronic or challenging cases of NB.Clinical findingsWe report on seven cases of NB presenting with different types of headache and signs of meningeal involvement. In five cases, signs of intracranial hypertension were evident in the form of papilledema, sixth nerve palsy and blurred vision.DiagnosisMRIs of the brain revealed signs of intracranial hypertension in three patients, basal meningeal enhancement in one patient and white matter lesions in one patient. Brucella serology in the blood and CSF was negative in all patients. It was interesting that four patients had normocellular CSF analysis with normal glucose and protein results. The diagnosis was made by Brucella PCR in all patients.ConclusionNB should be considered in the differential diagnoses of pseudotumor cerebri syndrome in endemic areas. It is important to employ molecular techniques using sterile CSF samples in the investigation of Brucella.

Life-threatening presentation of an acute cerebellar ischemic stroke secondary to a protein C deficiency.

Acute cerebellar ischemic stroke is a rare disease in children. Typically, patients present with ataxia and cranial nerve palsy. Rarely, some patients show a severe intracranial hypertension syndrome with a life-threatening clinical presentation. We report a case of a 2-year-old male child who was admitted for deterioration of his consciousness level and vomiting. Cerebral imaging revealed a right cerebellar and brainstem infarction with an obstructive hydrocephalus and a tonsillar herniation. Angiography identified an occlusion of the right anterior inferior cerebellar artery. The child was referred to a neurosurgeon for the treatment of acute hydrocephalus and posterior fossa craniectomy. Etiological investigations revealed a protein C deficiency. Initially, the patient was maintained under fluid restriction and received mannitol several times as he had clinical and radiological signs of intracranial hypertension. He was also kept on mechanical ventilation and monitored. However, the evolution was complicated by the occurrence of a thrombosis of the vena cava and the renal vein.

Suspected intracranial hypertension in COVID-19 patients with severe respiratory failure.

COVID-19 patients may exhibit neurological symptoms due to direct viral damage, systemic inflammatory syndrome, or treatment side effects. Mechanical ventilation in patients with severe respiratory failure often requires sedation and neuromuscular blockade, hindering thorough clinical examinations. This study aimed to investigate neurological involvement through clinical and noninvasive techniques and to detect signs of intracranial hypertension in these patients. We conducted a prospective observational study on mechanically ventilated COVID-19 adult patients admitted to our ICU, following standard of care protocols for ventilation and permissive hypercapnia. Data were collected at three time points: admission day (T1), day seven (T7), and day fourteen (T14). At each time point, patients underwent multimodal noninvasive neurological monitoring, including clinical examination, pupillary reactivity, transcranial color doppler of the middle cerebral artery (MCA), and optic nerve sheath diameter (ONSD) assessed via ultrasound (US). Head computer tomography (CT) was performed at T1 and T14. A limited subset of patients had a follow-up examination six months after ICU discharge. Seventy-nine patients were recruited; most were under deep sedation and neuromuscular blockade at T1. Pupillary size, symmetry, and reactivity were normal, as was the MCA mean velocity. However, ONSD, assessed by both US and CT, appeared enlarged, suggesting raised intracranial pressure (ICP). In a subgroup of 12 patients, increased minute ventilation was associated with a significant decrease in US-ONSD, corresponding to a drop in paCO2. At follow-up, twelve patients showed no long-term neurological sequelae, and US-ONSD was decreased in all of them. In this cohort, enlarged ONSD was detected during non-invasive neurological monitoring, suggesting a raised ICP, with hypercapnia playing a prominent role. Further studies are needed to explore ONSD behavior in other samples of mechanically ventilated, hypercapnic patients.

A Pathophysiological Approach to Spontaneous Orbital Meningoceles: Case Report and Systematic Review.

Spontaneous orbital cephaloceles are a rare condition. The purpose of this study is to provide a description of a clinical case and to carry out a systematic literature review. A systematic review of the English literature published on the Pubmed, Scopus, and Web of Science databases was conducted, according to the PRISMA recommendations. A 6-year-old patient was admitted for right otomastoiditis and thrombosis of the sigmoid and transverse sinuses, as well as the proximal portion of the internal jugular vein. Radiological examinations revealed a left orbital mass (22 × 14 mm) compatible with asymptomatic orbital meningocele (MC) herniated from the superior orbital fissure (SOF). The child underwent a right mastoidectomy. After the development of symptoms and signs of intracranial hypertension (ICH), endovascular thrombectomy and transverse sinus stenting were performed, with improvement of the clinical conditions and reduction of the orbital MC. The systematic literature review encompassed 29 publications on 43 patients with spontaneous orbital MC. In the majority of cases, surgery was the preferred treatment. The present case report and systematic review highlight the importance of ICH investigation and a pathophysiological-oriented treatment approach. The experiences described in the literature are limited, making the collection of additional data paramount.

402 Minimally Invasive Parafasicular Surgery for Hemorrhagic Stroke. First Experience. From January 2018 to December 2022. Panama

INTRODUCTION: Hemorrhagic stroke represents 10-15% of all strokes, with a mortality of 40% and independence of 25% at six months, and represents a significant burden for public health. Minimally invasive surgery (MIS) methods through parafasicular approaches are a new option. METHODS: A prospective study from January 2018 to December 2020. The evaluation includes age, gender, comorbidities, GCS, and mRS scales. CT was the only form of imaging, establishing size, signs of intracranial hypertension, hydrocephalus, intraventricular bleeding, and surgical planning. The craniotomy is done through craniometrics points, and employing a tubular port for the parafasicular approach was done within the first 24 hours. The ultrasound, microscope, and endoscope were used. The objective was the reduction of the hematoma to less than 15cc. The postoperative period was semi-intensive. RESULTS: 25 patients were included, mean age 56 years, 56% men and 44% women. Location: 5 frontal, 18 basal nuclei, and 2 temporal. 60% left. 32% intraventricular extension. The average ICH Score was 1.84. The average volume was 50 cc. Mean GCS of 10 and mean mRS of 4. The mean ICH reduction was 95%, and the mean residual volume was 2.4cc. Not deceased. A reoperation. Larger ICH and intraventricular hemorrhage had a worse outcome (p = 0.01 and p = 0.04). Higher ICH Scores were associated with a worse outcome than those with a lower score (2.4 vs. 1.5; p = 0.008). Average follow-up of 4 months. Mean mRS at the discharge of 4 and the follow-up of 3 GCS in the follow-up of 14. CONCLUSIONS: MIP surgery reduces the size of the hematoma, improves the quality of life, and is safe.

Intracranial Hypertension as a rare presentation of Sjögren's Syndrome: a case report

Introduction. A rare extraglandular manifestation of Sjögren's syndrome is presented, mimicking idiopathic intracranial hypertension. Case Report. A young eutrophic female, complained of persistent headache, followed by diplopia and bilateral sixth nerve paresis. Neuroimaging investigation showed classic signs of intracranial hypertension. As the patient had a normal weight, prompted evaluation of secondary causes, which revealed positive anti-SSA/Ro and anti-La/SSB antibodies. A salivary gland biopsy later confirmed the diagnosis of Sjögren's syndrome. Xerostomia and dysphagia developed weeks later. Conclusion. This case report is important to raise awareness about an atypical neurological manifestation of Sjögren's syndrome.

The Increasing Burden of Emergency Department and Inpatient Consultations for "Papilledema".

Increasing incidence of idiopathic intracranial hypertension (IIH), overreported radiologic signs of intracranial hypertension, difficult access to outpatient neuro-ophthalmology services, poor insurance coverage, and medicolegal concerns have lowered the threshold for emergency department (ED) visits for "papilledema." Our objective was to examine referral patterns and outcomes of neuro-ophthalmology ED and inpatient consultations for concern for papilledema. At one university-based quaternary care center, all adults referred for "papilledema" over one year underwent a standardized ED "papilledema protocol." We collected patient demographics, final diagnoses, and referral patterns. Over 1 year, 153 consecutive patients were referred for concern for papilledema. After papilledema protocol, 89 of 153 patients (58%) had bilateral optic disc edema, among whom 89% (79/89) had papilledema (intracranial hypertension). Of the 38 of 153 (25%) consultations for suspected disorder of intracranial pressure without previous fundus examination (Group 1), 74% (28/38) did not have optic disc edema, 21% (8/38) had papilledema, and 5% (2/38) had other causes of bilateral disc edema. Of the 89 of 153 (58%) consultations for presumed papilledema seen on fundus examination (Group 2), 58% (66/89) had confirmed papilledema, 17% (15/89) had pseudopapilledema, and 9% (8/89) had other causes of bilateral optic disc edema. Of the 26 of 153 (17%) patients with known IIH (Group 3), 5 had papilledema and 4 required urgent intervention. The most common diagnosis was IIH (58/79). Compared with IIH, patients with secondary causes of intracranial hypertension were older (P = 0.002), men (P < 0.001), not obese (P < 0.001), and more likely to have neurologic symptoms (P = 0.002). Inpatient and ED consultations for "papilledema" are increasing. Of the 153 ED and inpatient neuro-ophthalmology consultations seen for "papilledema" over 1 year, one-third of patients with optic disc edema of unknown cause before presentation to our ED had new vision- or life-threatening disease, supporting the need for prompt identification and evaluation of optic disc edema in the ED. In the face of limited access to neuro-ophthalmologists, this study supports the need for emergency department access to expert eye-care evaluation or ocular fundus camera for prompt identification of optic disc edema and standardized evaluation for neurologic emergencies.

Management of cerebrospinal-fluid-related intracranial abnormalities in frontoethmoidal encephalocele using "Shunt algorithm for frontoethmoidal encephalocele" (SAFE).

A cerebrospinal-fluid-related (CSF-related) problem occurred in 25-30% of frontoethmoidal encephalocele (FEE) cases. Since there was no algorithm or guideline, the judgment to treat the CSF-related problem often relies upon the surgeon's experience. In our institution, the early shunt was preferable to treat the problem, but it added risks to the children. We developed an algorithm, "Shunt Algorithm for Frontoethmoidal Encephalocele" (SAFE), to guide the surgeon in making the most reasonable decision. To evaluate the SAFE's efficacy in reducing unnecessary early shunting for FEE with CSF-related intracranial abnormality. Medical records of FEE patients with CSF-related abnormalities treated from January 2007 to December 2019 were reviewed. The patients were divided into two groups: before the SAFE group as group 1 (2007 - 2011) and after the SAFE group as group 2 (2012 - 2019). We excluded FEE patients without CSF-related abnormalities. We compared the number of shunts and the complications between the two groups. One hundred and twenty-nine patient's medical records were reviewed. The males were predominating (79 versus 50 patients) with an average age of 58.2±7.1 months old (6 to 276 months old). Ventriculomegaly was found in 18 cases, arachnoid cysts in 46 cases, porencephalic cysts in 19 cases, and ventricular malformation in 46 cases. Group 1, with a score of 4 to 7 (19 cases), received an early shunt along with the FEE repair. Complications occurred in 7 patients of this group. Group 2, with a score of 4-7, received shunts only after the complication occurred in 3 cases (pseudomeningocele unresponsive with conservative treatment and re-operation in 2 cases; a sign of intracranial hypertension in 1 case). No complication occurred in this group. Groups 1 and 2, with scores of 8 or higher (6 and 8 cases, respectively), underwent direct shunt, with one complication (exposed shunt) in each group. The SAFE decision algorithm for FEE with CSF-related intracranial abnormalities has proven effective in reducing unnecessary shunting and the rate of shunt complications.

Hemangioblastoma of the Fourth Ventricle Mimicking a Posterior Fossa Medulloblastoma in a Child

Hemangioblastomas are benign vascular tumors of the central nervous system, rarely affecting children with an incidence less than 1 per 1,000,000. The development of an intraventricular hemangioblastoma is exceptional, just a few cases have been reported in adults. We report a case of hemangioblastoma of the fourth ventricle in a 9-year-old girl without pathological history. Revealed by a rapidly progressive signs of intracranial hypertension and a static cerebellar syndrome. Magnetic resonance imaging (MRI) of the brain showed a homogeneous mass of the fourth ventricle measuring 44 x 36 x 32 mm. We first performed a ventriculoperitoneal shunt after a few days we proceeded to a partial resection of this lesion. Histopathological study confirmed the diagnosis of hemangioblastoma. Pediatric hemangioblastoma (PHB) of the fourth ventricle is the only case reported in the literature. This diagnosis can be evoked in front of a solid lesion of the fourth ventricle, especially in the context of von Hippel-Lindau disease.

Assessment of Reversibility of Transverse Venous Sinus Stenosis in Patients With Papilledema.

Bilateral transverse venous sinus stenosis (TVSS) or stenosis of a dominant venous sinus has been found to be very sensitive radiological findings in patients with intracranial hypertension (IH), yet there is still an ongoing debate whether they constitute reversible or permanent phenomena. Thus, the purpose of this study was to investigate the reversibility of TVSS in patients with IH, including conservatively treated patients with signs of IH as defined by the presence of papilledema. This was a retrospective chart review of all patients diagnosed with IH between 2016 and 2022, assessed from 2 tertiary university-affiliated neuro-ophthalmology practices. Inclusion criteria were the presence of papilledema, as quantified by optical coherence tomography, and bilateral TVSS, which is considered typical of IH on neuroimaging. During follow-up, included patients must have had confirmation of papilledema resolution as well as subsequent neuroimaging after conservative treatment or cerebrospinal fluid flow diversion. Patients with dural sinus vein thrombosis or intrinsic stenosis from sinus trabeculations or significant arachnoid granulations were excluded from the study. Either CT venography or MRI/MR venography was reviewed by a fellowship-trained neuroradiologist, and the degree of stenosis was scored through the combined conduit score (CCS), as described by Farb et al. The primary outcome was to assess TVSS changes after resolution or improvement of papilledema. From 435 patients, we identified a subset of 10 who satisfied all inclusion criteria. Our cohort comprised entirely women with a median age of 29.5 years and a median BMI of 32.5 kg/m2. Treatment consisted of acetazolamide in 7 patients, of which 1 had additional topiramate and 2 underwent cerebrospinal fluid flow diversion. Furthermore, 6 patients demonstrated significant weight loss during follow-up. For the primary outcome, 5 of 10 patients exhibited no appreciable TVSS change, and 5 patients demonstrated significant improvement in TVSS, of which 4 received conservative treatment only. Papilledema resolution or improvement was statistically significantly associated with increasing average CCS, TVSS diameter, and grade. We were able to demonstrate that TVSS can be both irreversible and reversible in patients with resolved papilledema. The finding of TVSS reversibility from conservative treatment alone is novel and has important implications to optimize patient care. Future studies should work to identify factors associated with irreversible TVSS for subsequent targeted intervention and prevention.

MRI signs of intracranial hypertension in morbidly obese and normal-weight individuals.

Idiopathic intracranial hypertension (IIH) is associated with intracranial abnormalities, although not obligatory, which can be detected with cranial MRI. Obesity is an important risk factor for IIH and a pathogenetic link is suspected but the extent to which these MRI signs are already related to obesity has not yet been examined. We investigated whether IIH-MRI signs are present more often in obese individuals with a BMI > 30 kg/m² than in individuals of normal weight. Brain MRI of 32 obese and 53 normal-weight participants from the Food-Chain-Plus cohort were analyzed for three main signs of IIH: (I) stenosis of the transverse sinus, (II) increased width of the optic nerve sheath, and (III) reduction of pituitary height. In addition, a scoring system for the MRI signs was applied. Furthermore, tortuosity of the optic nerve and flattening of the posterior globe were considered as additional MRI signs. Obese participants had a significantly higher MRI score (p < 0.001) than those in the normal-weight cohort, with significant differences in quantitative measurements of cerebral venous sinus stenosis (p < 0.001), widening of the optic nerve sheath (p < 0.05), and flattening of the pituitary gland (p < 0.05) also always being observed more frequently and in a more pronounced manner in the obese group. Furthermore, our findings correlated significantly with BMI and proportionately with hip and waist circumference. Obese individuals show a significantly higher prevalence of cerebral MRI signs related to IIH. This supports the hypothesis that obesity is a risk factor for possible intracranial hypertension and reinforces the suspicion that obesity is involved in the pathomechanism of IIH. · Obesity is associated with changes such as those seen in IIH.. · BMI, weight, and body measurements correlate with the expression of MRI signs of IIH.. · To prevent IIH symptoms in obesity, the pathomechanism must be further clarified..

Quantitative Detection and Follow-Up of Intracranial Hypertension in Craniosynostosis: An Optical Coherence Tomography Study.

In patients with craniosynostosis, the authors evaluated the diagnostic accuracy of fundoscopy and optical coherence tomography (OCT) to detect intracranial hypertension (ICH), the time course of retinal thickness after treatment of ICH, and the relationship between high hyperopia (HH) and fundoscopy/OCT scan findings. Patients with syndromic, multisuture, unicoronal, unilambdoid, or sagittal synostosis visiting the authors' national center were included in this longitudinal cohort study and formed a consecutive series. Retinal layers on OCT, OCT fundus images, and fundoscopy results were evaluated. ICH was scored according to presence of abnormal intracranial pressures, hydrocephalus, progressive cerebellar tonsillar herniation or fingerprinting, and growth arrest. Diagnostic accuracy of OCT, fundoscopy, and fundus image; the time course of retinal thickness after ICH; and interference of HH were analyzed using linear mixed models. A total of 577 OCT scans in 307 patients were included. ICH was found in 7.2%. Combining total retinal thickness (TRT), OCT fundus imaging and fundoscopy resulted in a sensitivity of 76% and 81% specificity to detect signs of ICH. TRT was increased in patients who had had signs of ICH versus patients who had never had signs of ICH (β +44.9 µm in patients who had had ICH [95% CI, 9.0 to 80.8]; P = 0.01). TRT decreased to normal in the years after surgery (β -3.6 µm/yr [95% CI, -7.2 to -0.05]; P = 0.047). There were greater odds of having increased TRT in patients with HH (OR, 2.9 [95% CI, 1.1 to 7.6]; P = 0.03). The correlation among TRT, OCT fundus image, fundoscopy, and particularly the combination of these measures with intracranial pressure surrogate markers is fair. Increased TRT in the presence of a clinical suspicion of ICH warrants further screening. Diagnostic, III.

Pineal cysts in children: a paediatric series treated over the last twenty years in Lyon.

Pineal cysts are a rare lesion of the pineal gland. Pineal cysts are benign lesions, generally asymptomatic, and are usually an incidental discovery on MRI performed for other problems. The management of pineal cysts in children remains a matter for debate. Here, we report our own retrospective paediatric cases that have been surgically treated and review the paediatric literature on this topic. This is a retrospective monocentric study. All patients operated by the senior author (CM) for a benign pineal cyst from 2000 to 2021 were included. All other pineal region cystic lesions were excluded. Medical and surgical data were extracted from the hospital medical database. Twelve patients were included. The clinical symptomatology was characterized by headaches in seven patients, visual troubles in two patients, precocious puberty in one patient, signs of intracranial hypertension in two patients, seizures associated with headache in one patient, and headaches associated with behavioural troubles in another patient. No major post-operative complications were observed in this series. It is to noted that surgery was performed because a suspicion of a true pineal parenchymal tumour has been made. Histopathological study came back with the diagnosis of pineal cyst. Pineal cyst is rare. If the radiological diagnosis is clear, no surgery is advocated except in cases associated with hydrocephalus and rapid growth. In case of a suspicion of a true pineal parenchymal tumour, a surgery may be needed to confirm the diagnosis. Lastly, we stress that only cystic lesions of the pineal gland itself should be considered as pineal cyst.

Degree of basal cisterns compression predicting mortality and functional outcome after craniotomy and primary decompressive craniectomy in acute subdural hematoma population.

The compression of basal cisterns on CT is one of the signs of intracranial hypertension in TBI population. This study evaluates the relationship between the degree of basal cisterns effacement and outcomes in aSDH population. The study includes prospectively collected data from 290 patients who underwent osteoplastic craniotomy (OC) or primary decompressive craniectomy (pDC) for aSDH from 2016 to 2021. Univariate and multivariate regression analyses were performed to evaluate the association of baseline characteristics and extent of basal cisterns compression on pre-operative and post-operative CT scans with the outcomes at the time of discharge. Outcomes were dichotomized into mortality (and unfavourable (GOS 1-3 vs GOS 4-5). The degree of cisternal compression was evaluated using the cisternal effacement score of perimesencephalic and quadrigeminal cisternal components. Critical thresholds associated with the outcomes were calculated. Age and pre-/post-operative degree of cisternal compression were the strongest independent predictors of intrahospital mortality in a whole sample and separately in OC and pDC subgroups. The unfavourable outcome was independently predicted by age, pre-/post-operative status of cisternal compression and initial GCS. Critical thresholds associated with the mortality and poor functional outcome were, respectively, age ≥ 70 (OR 3.14 [CI 95% 1.82-5.46], p < 0.001) and ≥ 67 (OR 3.87 [CI 95% 2.33-6.54], p < 0.001), pre-operative cisternal effacement score ≥ 9 (OR 6.39 [CI 95% 3.62-11.53], p < 0.001) and ≥ 7 (OR 4.93 [CI 95% 2.96-8.38], p < 0.001), post-operative cisternal effacement score ≥ 6 (OR 20.6 [CI 95% 10.08-45.10], p < 0.001) and ≥ 3 (OR 7.47 [CI 95% 3.87-15.73], p < 0.001) and initial GCS ≤ 8 (OR 0.24 [CI 95% 0.13-0.43], p < 0.001 and OR 0.12 [CI 95% 0.07-0.21], p < 0.001). After adjusting for baseline characteristics, age and degree of cisternal compression remained the independent predictors of mortality, whereas unfavourable outcomes were associated with age, cisternal obliteration and GCS on presentation.

Infratentorial choroid plexus tumors in children: Case report and review of literature

Background: Infratentorial choroid plexus tumors are rare lesions in the pediatric population. At diagnosis, they most often present with signs of intracranial hypertension and cranial nerve deficits. The main objective of the surgery is total resection and the prognosis is favorable in most cases.Case Report: A 16-year-old boy with gait disturbance, headaches and left side hypoacusia had a diagnosis of posterior fossa tumor with hypertensive hydrocephalus. He underwent urgent placement of a ventriculoperitoneal shunt and subsequently microsurgery with gross total resection. At follow up, the patient was asymptomatic and without deficits.Conclusion: Choroid plexus tumors should be included in the differential diagnosis of posterior fossa tumors in childhood. Preoperative planning, choosing the best surgical approach and interruption of the lesion's vascular supply as the initial step of surgery are fundamental strategies for successful treatment.

Analysis of intracranial pressure pulse waveform in traumatic brain injury patients: a CENTER-TBI study.

Intracranial pressure (ICP) pulse waveform analysis may provide valuable information about cerebrospinal pressure-volume compensation in patients with traumatic brain injury (TBI). The authors applied spectral methods to analyze ICP waveforms in terms of the pulse amplitude of ICP (AMP), high frequency centroid (HFC), and higher harmonics centroid (HHC) and also used a morphological classification approach to assess changes in the shape of ICP pulse waveforms using the pulse shape index (PSI). The authors included 184 patients from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) High-Resolution Sub-Study in the analysis. HFC was calculated as the average power-weighted frequency within the 4- to 15-Hz frequency range of the ICP power density spectrum. HHC was defined as the center of mass of the ICP pulse waveform harmonics from the 2nd to the 10th. PSI was defined as the weighted sum of artificial intelligence-based ICP pulse class numbers from 1 (normal pulse waveform) to 4 (pathological waveform). AMP and PSI increased linearly with mean ICP. HFC increased proportionally to ICP until the upper breakpoint (average ICP of 31 mm Hg), whereas HHC slightly increased with ICP and then decreased significantly when ICP exceeded 25 mm Hg. AMP (p < 0.001), HFC (p = 0.003), and PSI (p < 0.001) were significantly greater in patients who died than in patients who survived. Among those patients with low ICP (< 15 mm Hg), AMP, PSI, and HFC were greater in those with poor outcome than in those with good outcome (all p < 0.001). Whereas HFC, AMP, and PSI could be used as predictors of mortality, HHC may potentially serve as an early warning sign of intracranial hypertension. Elevated HFC, AMP, and PSI were associated with poor outcome in TBI patients with low ICP.

Sinusite con sorpresa

The diagnosis of cerebral abscess was eventually made in a 9-year-old boy presenting with headache and fever, who was initially diagnosed with sinusitis. Some typical signs of intracranial hypertension were present.

Twenty Year review for Craniofacial Distraction in syndromic craniosynostosis

Introduction: Craniosynostosis are cranial deformities resulting from the early closure of one or more sutures. Concomitant facial changes usually result from the involvement of multiple sutures, which may lead to restriction of cranial growth and brain expansion, ocular compression, and breathing difficulties. The distraction osteogenesis (DO)for frontofacial or posterior advancement have increased the safety of the procedure. The aim of this study was a critical evaluation of the use of DO in the surgical treatment of syndromic craniosynostoses, based on the experience of a single craniofacial team.&#x0D; Methods: Retrospective review of third six patients operated from 2003 to 2022 by the same craniofacial team.&#x0D; Results: 19 boys and 17 girls were operated, all with rigid distractors. Twenty-nine of them underwent monobloc frontofacial advancement. In seven patient a Le-Fort III/subcranial advancement was performed. A posterior craniofacial advancement was performed in 5. In 11 a fronto-orbital advancement was done in the first year of life. The mean age was 6.0 years (range, 6 months to 13 years). All patients presented with some degree of exorbitism, upper airway obstruction and signs of intracranial hypertension. Cerebrospinal fluid leakage was the most frequent complication (9 cases), pterygomaxillary disjunction was revised in 8, lateral rim orbital fracture in 3 cases, and 3 complication related to the device.&#x0D; Conclusions: The evolution of surgical techniques allowed DO with rigid distractors to be an important tool for treating the craniofacial issues related to syndromic craniosynostoses. The multidisciplinary team's learning curve is critical to reducing complications associated with osteogenic distraction.

Ventriculo-peritoneal shunt obstructions in the absence of radiological abnormalities: retrospective analysis of a pediatric cohort

Introduction: Ventriculoperitoneal shunts are still the mainstay treatment for pediatric&#x0D; hydrocephalus. They have a high complication and failure rate, requiring multiple revisions.&#x0D; In this study, we aim to investigate patients who required shunt replacement without any&#x0D; radiological findings.&#x0D; Methods: The files of patients under the age of 18, who underwent shunt revision between&#x0D; December 2015 and December 2020 in Bursa Uludag University Medical Faculty Neurosurgery clinic were reviewed retrospectively. All the radiological studies, laboratory results and clinical condition of the patients were examined.&#x0D; Results: We identified 127 patients who required a revision of ventriculoperitoneal shunt for suspected mechanical obstruction. 6 patients (5%) had symptoms of raised&#x0D; intracranial pressure, but showed no radiographic evidence of progressive ventricular&#x0D; dilatation.&#x0D; Conclusion: Dysfunction of a ventriculoperitoneal shunt does not always lead to associated radiological alterations. In a patient with signs of intracranial hypertension, revision of the system should be considered even in the absence of progressive ventricular dilatation on radiological studies.