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1
Noser-Isenschmid, Eva. "Hydrocephalus bei congenitaler Toxoplasmose /." [S.l : s.n.], 1987. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Owler, Brian Kenneth. "Pathophysiology of normal pressure hydrocephalus." Thesis, The University of Sydney, 2004. http://hdl.handle.net/2123/685.
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Normal pressure hydrocephalus (NPH), a CSF circulation disorder, is important as a reversible cause of gait and cognitive disturbance in an aging population. The inconsistent response to CSF shunting is usually attributed to difficulties in differential diagnosis or co-morbidity. Improving outcome depends on an increased understanding of the pathophysiology of NPH. Specifically, this thesis examines the contribution of, and inter-relationship between, the brain parenchyma and CSF circulation in the pathophysiology of NPH. Of the four core studies of the thesis, the first quantifies the characteristics of the CSF circulation and parenchyma in NPH using CSF infusion studies to measure the resistance to CSF absorption and brain compliance. The second study assesses cerebral blood flow (CBF) was using O15-labelled positron emission tomography (PET) with MR co-registration. By performing CSF infusion studies in the PET scanner, CBF at baseline CSF pressure and at a higher equilibrium pressure is measured. Regional changes and autoregulatory capacity are assessed. The final study examines the microstructural integrity of the parenchyma using MR diffusion tensor imaging. These studies confirm the importance of the inter-relationship of the brain parenchyma and CSF circulation. NPH symptomatology and its relationship to the observed regional CBF reductions in the basal ganglia and thalamus are discussed. Regional CBF reductions with increased CSF pressure and the implications for autoregulatory capacity in NPH are considered. The reduction in CBF when CSF was increased was most striking in the periventricular regions. In addition, periventricular structures demonstrated increased diffusivity and decreased anisotropy. The relationship between these changes and mechanisms such as transependymal CSF passage are reviewed. The findings of this thesis support a role of both the CSF circulation and the brain parenchyma in the pathophysiology of NPH. The results have implications for the approach to the management of patients with NPH.
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Owler, Brian Kenneth. "Pathophysiology of normal pressure hydrocephalus." University of Sydney. Surgery, 2004. http://hdl.handle.net/2123/685.
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Normal pressure hydrocephalus (NPH), a CSF circulation disorder, is important as a reversible cause of gait and cognitive disturbance in an aging population. The inconsistent response to CSF shunting is usually attributed to difficulties in differential diagnosis or co-morbidity. Improving outcome depends on an increased understanding of the pathophysiology of NPH. Specifically, this thesis examines the contribution of, and inter-relationship between, the brain parenchyma and CSF circulation in the pathophysiology of NPH. Of the four core studies of the thesis, the first quantifies the characteristics of the CSF circulation and parenchyma in NPH using CSF infusion studies to measure the resistance to CSF absorption and brain compliance. The second study assesses cerebral blood flow (CBF) was using O15-labelled positron emission tomography (PET) with MR co-registration. By performing CSF infusion studies in the PET scanner, CBF at baseline CSF pressure and at a higher equilibrium pressure is measured. Regional changes and autoregulatory capacity are assessed. The final study examines the microstructural integrity of the parenchyma using MR diffusion tensor imaging. These studies confirm the importance of the inter-relationship of the brain parenchyma and CSF circulation. NPH symptomatology and its relationship to the observed regional CBF reductions in the basal ganglia and thalamus are discussed. Regional CBF reductions with increased CSF pressure and the implications for autoregulatory capacity in NPH are considered. The reduction in CBF when CSF was increased was most striking in the periventricular regions. In addition, periventricular structures demonstrated increased diffusivity and decreased anisotropy. The relationship between these changes and mechanisms such as transependymal CSF passage are reviewed. The findings of this thesis support a role of both the CSF circulation and the brain parenchyma in the pathophysiology of NPH. The results have implications for the approach to the management of patients with NPH.
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Lindquist, Barbro. "Hydrocephalus in children : cognition and behaviour /." Göteborg : Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/2557.
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Persson, Eva-Karin. "Hydrocephalus in children : epidemiology and outcome /." Göteborg : Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at Göteborg University, 2007. http://hdl.handle.net/2077/2556.
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Rodgers, Jackie Michele. "The immunology of hydrocephalus shunt infections." Thesis, University College London (University of London), 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.246215.
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Manwaring, Preston K. "A provocative test to determine brain compliance in the management of patients with hydrocephalus /." Diss., CLICK HERE for online access, 2005. http://contentdm.lib.byu.edu/ETD/image/etd1103.pdf.
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Pauer, Anke. "Zytokine als prognostische Faktoren beim kindlichen Hydrocephalus." Doctoral thesis, Universitätsbibliothek Leipzig, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-110071.
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Wir untersuchten Liquor- und Serumproben von 40 an einem shuntversorgten Hydrocephalus erkrankten Kindern auf die Konzentration der Zytokine bFGF, TGF-β1, VEGF, IL-6, IGF-1 und Leptin sowie deren Korrelation mit dem Risiko von Shuntinsuffizienzen.
Dabei konnten wir die Hypothese bestätigen, dass erhöhte Konzentration der fibrogenen Zytokine bFGF und TGF-β1 im Serum bzw. Liquor mit einem erhöhten Risiko für operationspflichtige Shuntinsuffizienzen durch Obstruktion des Schlauchsystems einhergehen, und dass diese Komplikationen mit steigenden Zytokinkonzentrationen umso eher eintreten. Außerdem war bFGF im Liquor von Kindern, die zum Abnahmezeitpunkt an einer Shuntdysfunktion durch Obstruktion oder Einwachsen des Shunts litten, signifikant höher als bei Kindern, die zum Zeitpunkt der Abnahme keine Shuntdysfunktion aus eben genannten Gründen hatten.
Des Weiteren fanden wir Konzentrationsunterschiede für IL-6 im Liquor zwischen den einzelnen Ursachen der Erkrankung, wobei das Zytokin am höchsten bei Tumorpatienten war, gefolgt von posthämorrhagischem und postmeningitischem Hydrocephalus, und am niedrigsten bei Kindern mit kongenitaler ZNS-Fehlbildung.
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Jouet, Monique Marie Helene. "The molecular genetics of X-linked hydrocephalus." Thesis, Open University, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.295639.
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Gaston, Hannah. "Ophthalmic complications of spina bifida and hydrocephalus." Thesis, University of Southampton, 1986. https://eprints.soton.ac.uk/209759/.
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This thesis represents an attempt to further our knowledge of the ophthalmic complications of spina bifida and hydrocephalus by means of literature review and a long term clinical study, and to determine whether regular ophthalmic supervision can assist in the general management of affected children. The ophthalmic complications of spina bifida have often been reported in the literature and thought to merit regular supervision of affected children, yet few centres currently offer this service. In this study 322 children attending one regional centre were examined repeatedly over a six year period by one ophthalmologist. Ophthalmic complications were found to be very common. They frequently provided evidence of raised intracranial pressure due to shunt dysfunction even when other objective evidence was lacking. Every spina bifida and hydrocephalus clinic should have an ophthalmalogist in its medical team. Preservation of visual function and early diagnosis of raised intracranial pressure in these children should result from this arrangement.
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Wall, Vanessa L. "Social-Emotional Outcomes in Children with Hydrocephalus." BYU ScholarsArchive, 2020. https://scholarsarchive.byu.edu/etd/9035.
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Hydrocephalus can impact all areas of health, including physical, cognitive, and social-emotional functioning. The social-emotional health of children who have had surgery for their hydrocephalus is not well characterized. This study examined social-emotional and behavioral functioning using the Behavioral Assessment System for Children, Third Edition (BASC-3) and the Hydrocephalus Outcome Questionnaire (HOQ) in children aged 5-17 years old. BASC-3 parent report scores were compared to the BASC-3 normative sample using one-sample t-tests to evaluate overall social-emotional functioning. BASC-3 scores were correlated with the social-emotional domain of the HOQ using Pearson's r to determine if the HOQ accurately captures the social-emotional functioning of children with hydrocephalus in a neurosurgery setting. BASC-3 and HOQ scores of children with different etiologies of hydrocephalus were compared using one-way ANOVAs. Children with hydrocephalus of all etiologies had more difficulties with social-emotional functioning compared to normative populations, but there were no differences in functioning between etiologies. The social-emotional domain of the HOQ correlated more strongly with the BASC-3 than did the physical and cognitive domains. These results provide evidence that children who have had surgery for their hydrocephalus may be at increased risk of social-emotional and behavioral difficulties, but etiology may not be particularly helpful in predicting what kinds or degree of difficulty. This study also supports the content and divergent validity of the social-emotional domain of the HOQ.
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Peterson, Katie Ann. "Cognition and apathy in normal pressure hydrocephalus." Thesis, University of Cambridge, 2018. https://www.repository.cam.ac.uk/handle/1810/274898.
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Normal pressure hydrocephalus (NPH) is characterised by a build-up of cerebrospinal fluid (CSF) in the brain despite apparently normal CSF pressure at lumbar puncture. In addition to movement and urinary symptoms, patients commonly display cognitive decline and apathy. NPH is recognised as an important cause of cognitive decline as it is thought be reversible with surgical CSF diversion (e.g. shunt surgery). However, this remains controversial and the neuropsychology of NPH is relatively poorly understood. Further, despite being the most commonly reported neuropsychiatric symptom in NPH, the significance of the symptom of apathy has not yet been elucidated. This thesis aims to expand on the neuropsychological and neuropsychiatric research in NPH, with the main objectives being to investigate neuropsychological outcome, and the significance of the symptom of apathy in NPH. In order to investigate neuropsychological outcome following shunt surgery in NPH, a systematic review and meta-analysis was conducted (Chapter 2). The findings from studies which used a battery of neuropsychological tests to assess cognitive outcome in NPH were combined. Meta-analyses were conducted on pre-operative and difference scores for the most commonly used neuropsychological tests. These were seven tests which spanned global cognitive function, learning and memory, executive function and psychomotor speed. Results for all tests were significant in the direction of improvement. However, the significance of the results for two measures of executive function were deemed not to be robust. This is discussed in line with previous research which suggests that executive function may be less likely to improve following shunt surgery than other neuropsychological domains. Next, the thesis focuses on the symptom of apathy. Chapter 3 investigated whether apathy in NPH relates to cognitive outcome and to a measure of ventricular enlargement. A reduction in apathetic symptoms following treatment was associated with better performance in a measure of global cognitive function. Further, larger ventricles (which may indicate greater disease severity/ brain damage) was associated with more severe apathy. A structural MRI study was then conducted to expand on these findings and to define brain structural correlates of apathy in NPH (Chapter 4). Results from this study suggested a potential role of the caudate nuclei in apathetic symptoms in NPH. Finally, consideration is given to the assessment of apathy in NPH. Since apathy is rarely investigated in patients with NPH it is unclear which assessment method is most appropriate for this patient group. Chapter 5 presents findings from a feasibility study of a novel reward learning task to determine whether it might be useful as an objective measure of motivation and apathy in NPH.
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Wood, David L. "Health Care Transition for Youth with Hydrocephalus." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5163.
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Wood, David L. "Health Care Transition for Youth with Hydrocephalus." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/5157.
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Will, Beate. "Beitrag zu Wachstumsverhältnissen am Hydrocephalus eine quantitative Studie /." [S.l.] : [s.n.], 2001. http://deposit.ddb.de/cgi-bin/dokserv?idn=963984330.
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Lee, Jenny Hei Man. "Numerical Study of a Viscoelastic Model for Hydrocephalus." Thesis, University of Waterloo, 2006. http://hdl.handle.net/10012/2924.
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Hydrocephalus is a clinical conditon where the brain tissue is deformed by the expanding ventricules. In this thesis, the mechanical deformation of a hydrocephalic brain is studied using a biomechanical model, where the material properties of the tissue are described by a viscoelastic model. A set of governing equations is derived when the motion is quasi-static motion and deformation is small. Then, finite element method is used for spatial discretization, and finite difference and trapezoidal rule are used for time-stepping. Moreover, the computational meshes are generated from medical images of patient's brain using level set method and a program called DistMesh. Numerical stability of the time-stepping scheme is also studied. Several numerical studies are conducted to investigate several aspect of the brain with hydrocephalus. The state of stress of the tissue is found to be compressive everywhere in the brain. The viscoelastic properties of the brain are investigated and found to be dominated by elastic response. Lastly, the displacement made by the ventricular wall as it expands and shrinks is found to be non-uniform.
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Chumas, Paul D. "Cerebral metabolic changes occurring in feline neonatal hydrocephalus." Thesis, Queen Mary, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268905.
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Massicotte, Eric M. "Adjunctive drug therapy for treatment of experimental hydrocephalus." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape4/PQDD_0011/MQ53184.pdf.
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Toma, Ahmed Kassem Abbass. "Conservative versus treatment of idiopathic normal pressure hydrocephalus." Thesis, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.558383.
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Objectives: Idiopathic normal pressure hydrocephalus (INPH) is a condition that affects the elderly population with clinical presentation of gait and balance impairment, cognitive impairment and urinary incontinence. Brain imaging shows -. ventriculomegaly in the absence of raised intracranial pressure. Shunt insertion is the standard method of treatment. However; there is a lack of good quality evidence of its effectiveness. As a result, many physicians and even few surgeons are sceptic about the existence of this condition as a separate entity. The aim of this thesis is to provide evidence supporting or refuting the role of surgical management in INPH, through a prospective randomized controlled double blinded study. Methods: Fourteen probable INPH patients who showed clinical improvement following extended lumbar drainage were randomized to have ventriculoperitoneal shunt insertion with an open or closed adjustable valve. Closed shunts were opened after three months. Primary endpoint was improvement in walking speed. Secondary endpoints were improvement in cognitive function, urinary symptoms and incidence of complications. Results: There was a statistically significant advantage of the open shunt in improving walking speed compared with the closed shunt at the study endpoint (43% vs. 0% p=0.02). In addition, the prospectively collected data has shown that both groups improved in terms of mobility one year following shunt insertion (47% and 46.7% respectively). There was a trend suggesting that delay in opening the shunt has delayed improvement beyond the 3 months hypothesized in study design. However; this delay was not statistically significant (p=0.08). 4 us.
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Tarnaris, A. "Biomarkers in patients with idiopathic normal pressure hydrocephalus." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1360351/.
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Idiopathic normal pressure hydrocephalus (iNPH) is a condition affecting a small percentage of the elderly population; however it is the only known treatable cause of dementia. Surgical cerebrospinal fluid (CSF) diversion is the only known treatment for the condition today. However, such a procedure is not to be offered lightly and any expected benefit has to balance the associated surgical risks. The prognosis of a favourable surgical outcome has been problematic since the conception of the syndrome. None of current prognostic tests reaches 100% sensitivity or specificity and it is felt that there might be a need for a combination of tests, rather than a single one to maximize the chances of selecting the right patients to offer a surgical CSF diversion procedure. Biomarkers are biological substances that may act as surrogate markers of response to a treatment or to characterise a disease’s progression over time. The aim of this study was to identify CSF markers of favourable surgical outcome in patients with iNPH undergoing the insertion of a ventriculoperitoneal shunt (VPS). We first describe the effects of external lumbar drainage (ELD) on the CSF biochemistry of these patients. Correlations are made with imaging data obtained from volumetric analysis and neuropsychological tests in order to obtain a complete profile of these patients. The rostrocaudal gradients of the CSF markers examined are reported showcasing the need to understand that commonly reported values from lumbar CSF do not necessarily reflect pathological changes occurring at cerebral level. Finally, we report on the individual as well as combined prognostic value of 7 CSF markers on surgical outcomes at 6 months. The pathophysiological significance of these markers is discussed individually. It is concluded that the combined power of total tau and Aβ 1-42 may be useful in predicting favourable surgical outcomes at 6 months; further studies applying the findings in a larger cohort and correlating findings with longer outcomes are warranted to enhance the clinical application. The biochemical profile of patients with iNPH appears unique and different than patients with Alzheimer’s dementia or control subjects.
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Smith, Joanna. "Parents' management of their child's hydrocephalus and shunt." Thesis, University of Leeds, 2010. http://etheses.whiterose.ac.uk/1911/.
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Introduction Shunts are the main treatment for hydrocephalus. When shunts malfunction the consequences are serious and can be life threatening. Identifying shunt malfunction requires effective parent-professional collaboration: parents need to recognise and respond appropriately to the symptoms of shunt malfunction in their child; professionals need to integrate parents' information about their child's symptoms during clinical decision-making and diagnosis. This thesis explored parents' experiences of living with a child with hydrocephalus and parents' and professionals' contribution to the diagnosis of shunt malfunction in acute hospital admissions. Methods Two exploratory studies were undertaken using interview and observational methods to elicit data. The framework approach and conversation analysis were used to analyse and interpret data. Findings Parents gain considerable skills and knowledge about their child's health needs. They are able to distinguish between symptoms indicating shunt problems from other childhood illnesses. Deciding where or when to seek help is influenced by minimising disruption for the whole family and prior experiences of healthcare services. Parents' perceive that their expertise is not always valued by health professionals and not always used to make clinical decisions. Analysis of parent-professional interactions suggests health professionals' involvement of parents' in decisions about their child's care is variable. There was evidence of some collaborative practice but tensions were evident within the interactions when parents disagreed with professionals' judgments. Conclusion A collaborative paradigm is appropriate when engaging with expert parents living with a child with hydrocephalus. The challenge for health professionals is to integrate parents' expertise of their child's presenting symptoms within their clinical assessment when planning the child's care.
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Hakim, Carlos A. "The physics and physicopathology of the hydraulic complex of the central nervous system (the mechanics of hydrocephalus and normal pressure hydrocephalus)." Thesis, Massachusetts Institute of Technology, 1985. http://hdl.handle.net/1721.1/15309.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1985.MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING.
Bibliography: leaves 144-150.
by Carlos A. Hakim.
Ph.D.
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Williams, Michael A., Tessa van der Willigen, Patience H. White, Cathy C. Cartwright, David L. Wood, and Mark G. Hamilton. "Improving Health Care Transition and Longitudinal Care for Adolescents and Young Adults with Hydrocephalus: Report from the Hydrocephalus Association Transition Summit." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5142.
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The health care needs of children with hydrocephalus continue beyond childhood and adolescence; however, pediatric hospitals and pediatric neurosurgeons are often unable to provide them care after they become adults. Each year in the US, an estimated 5000–6000 adolescents and young adults (collectively, youth) with hydrocephalus must move to the adult health care system, a process known as health care transition (HCT), for which many are not prepared. Many discover that they cannot find neurosurgeons to care for them. A significant gap in health care services exists for young adults with hydrocephalus. To address these issues, the Hydrocephalus Association convened a Transition Summit in Seattle, Washington, February 17–18, 2017. The Hydrocephalus Association surveyed youth and families in focus groups to identify common concerns with HCT that were used to identify topics for the summit. Seven plenary sessions consisted of formal presentations. Four breakout groups identified key priorities and recommended actions regarding HCT models and practices, to prepare and engage patients, educate health care professionals, and address payment issues. The breakout group results were discussed by all participants to generate consensus recommendations. Barriers to effective HCT included difficulty finding adult neurosurgeons to accept young adults with hydrocephalus into their practices; unfamiliarity of neurologists, primary care providers, and other health care professionals with the principles of care for patients with hydrocephalus; insufficient infrastructure and processes to provide effective HCT for youth, and longitudinal care for adults with hydrocephalus; and inadequate compensation for health care services. Best practices were identified, including the National Center for Health Care Transition Improvement’s “Six Core Elements of Health Care Transition 2.0”; development of hydrocephalus-specific transition programs or incorporation of hydrocephalus into existing general HCT programs; and development of specialty centers for longitudinal care of adults with hydrocephalus. The lack of formal HCT and longitudinal care for young adults with hydrocephalus is a significant health care services problem in the US and Canada that professional societies in neurosurgery and neurology must address. Consensus recommendations of the Hydrocephalus Association Transition Summit address 1) actions by hospitals, health systems, and practices to meet local community needs to improve processes and infrastructure for HCT services and longitudinal care; and 2) actions by professional societies in adult and pediatric neurosurgery and neurology to meet national needs to improve processes and infrastructure for HCT services; to improve training in medical and surgical management of hydrocephalus and in HCT and longitudinal care; and to demonstrate the outcomes and effectiveness of HCT and longitudinal care by promoting research funding.
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Davy, Brian Edwin. "Identification and characterization of hydin, a large novel gene disrupted in a murine model of congenital hydrocephalus." Connect to this title online, 2004. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1086103379.
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Thesis (Ph. D.)--Ohio State University, 2004.Document formatted into pages; contains 157 p. Includes bibliographical references. Abstract available online via OhioLINK's ETD Center; full text release delayed at author's request until 2005 June 1.
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Botfield, Hannah Florence. "Modelling and preventing the development of chronic communicating hydrocephalus." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4791/.
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In post-haemorrhagic communicating hydrocephalus, CSF drainage is obstructed by subarachnoid fibrosis in which the fibrogenic cytokine transforming growth factor-β1 (TGF-β1) has been aetiologically implicated. Here, the hypothesis that the TGF-β antagonist Decorin has therapeutic potential for (1) reducing fibrosis and the development of hydrocephalus and (2) degrading fibrosis and resolving hydrocephalus, was tested using a rat model of juvenile communicating hydrocephalus. In the acute study, hydrocephalus was induced by a basal cistern injection of kaolin in 3-week-old rats, immediately followed by continuous intraventricular infusion of either human recombinant Decorin or PBS. In the chronic study, hydrocephalus was allowed to develop for 7 days before starting the treatment of Decorin or PBS. Ventricular expansion was measured by magnetic resonance imaging. Inflammation, fibrosis, Decorin, TGF-β/Smad2/3 activation and hydrocephalic brain pathology were evaluated by immunohistochemistry and basic histology. In the acute study continuous Decorin infusion prevented the development of hydrocephalus by blocking TGF-β- induced subarachnoid fibrosis and protected against hydrocephalic brain damage. In the chronic study Decorin had no impact on hydrocephalus, TGF-β1 levels or subarachnoid fibrosis, however the efficiency of Decorin infusion was in disrepute. The results suggest that Decorin is a potential clinical therapeutic for the prevention of juvenile post-haemorrhagic communicating hydrocephalus.
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Di, Curzio Domenico. "Preclinical treatments for hydrocephalus in juvenile ferrets and rats." BioMed Central, 2013. http://hdl.handle.net/1993/31647.
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Hydrocephalus is a common neurological condition characterized by altered cerebrospinal fluid (CSF) flow that results in ventricular expansion due to an accumulation of CSF inside the cranial vault. It is the second most frequent congenital neurologic malformation, but it can manifest at any age, as it is associated with multiple acquired etiologies related to CSF blockage or impaired CSF absorbance. The type and severity of brain damage is dependent on the age of onset, the rate of ventricular enlargement, the magnitude of ventriculomegaly, and how near the impaired brain structure(s) is/are to the cerebral ventricles.
The purpose of this thesis was to gain an understanding of potential pharmacological therapies for treating pediatric hydrocephalus that are aimed to supplement commonly used surgical procedures, such as ventricular shunting and endoscopic third ventriculostomy (ETV). In this endeavour, we experimentally induced hydrocephalus by injection of kaolin (aluminum silicate) into the cisterna magna of juvenile rats at 3 weeks age and ferrets at 2 weeks age to mimic the human condition in infants and children. Prior to drug testing, we characterized the ferret model of hydrocephalus and examined the behavioural, brain structural, cellular, and neurobiochemical changes associated with the condition. From there, we treated hydrocephalic rats for 2 weeks with a combination of antioxidant agents, including α-tocopherol, L-ascorbic acid, coenzyme Q10 (CoQ10), reduced glutathione, and reduced lipoic acid to determine if they showed any improvements compared to sham-treated hydrocephalic rats. Afterwards, we used MgSO4 to treat hydrocephalic ferrets for 2 weeks and compared their outcome to sham-treated hydrocephalic ferrets. In both experiments, the pharmacological therapies did not show any significant biochemical and neurological benefits, nor did the animals improve behaviourally compared to sham-treated animals. Overall, it is suggested that therapeutic benefits were not observed in these studies potentially because ventriculomegaly was not severe enough, the route and/or timing of treatment was not maximally effective, or these treatments should be supplemented with surgical interventions to determine their potential synergistic effects, which would be expected to be implemented in the clinical setting. In conclusion, surgical procedures for treating hydrocephalus are rife with complications, which adds to its morbidity and mortality, so it is important to investigate new therapeutic avenues to effectively treat and hopefully cure hydrocephalus one day.October 2016
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Halliday, Melissa Ann. "Narrative Skills in Children with Spina Bifida and Hydrocephalus." Diss., CLICK HERE for online access, 2007. http://contentdm.lib.byu.edu/ETD/image/etd1943.pdf.
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Schmid, Urs Dieter. "Management of obstructive hydrocephalus secondary to posterior foss tumors /." [S.l : s.n.], 1986. http://www.ub.unibe.ch/content/bibliotheken_sammlungen/sondersammlungen/dissen_bestellformular/index_ger.html.
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Solomon, Daniel L. "Evaluation of normal pressure hydrocephalus with diffusion tensor imaging." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12226.
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Thesis (M.A.)--Boston UniversityPurpose: Normal Pressure Hydrocephalus (NPH) is a clinical diagnosis with no formal definition. Textbooks describe NPH as a clinical triad of gait abnormality, dementia, and urinary incontinence. Few patients present with all three symptoms, forcing the clinician to rely on a “preponderance of evidence” approach, which involves weighing triad symptoms with radiological findings, Cerebrospinal Fluid (CSF) opening pressure, response to Tap Test, external lumbar CSF drainage, lumbar infusion, and finally shunting. Radiological findings in NPH are limited to enlarged ventricles out of proportion to sulcal atrophy, callosal angles greater than 40 degrees, and ventricles with Evan’s ratios greater than 0.3. When radiologists evaluate suspected NPH patients they are limited to excluding disease, as opposed to searching for any particular finding. In this study we used Diffusion Tensor Imaging (DTI) to determine if differences can be identified on a group basis between NPH and normal groups to see if DTI (including tractography) can be a useful tool for understanding disease morphology and laying the groundwork for future clinical use of DTI for identification of NPH. Materials and Methods: A retrospective study of patients who underwent brain MRI imaging with a Philips 3T magnet. NPH patients were classified as “definite” or “probable NPH” by their referring physicians. Normal subjects were patients found to have no anatomical brain abnormality. DTI and tractography data were acquired using Philips Fibertrak software, and post-processing was done using Tract Based Spacial Statistics (TBSS). Conclusion: NPH patients were found to have higher Fractional Anisotropy (FA) values in the upper corticospinal tract, lower FA values in the Corpus Callosum and mixed results in the internal capsule, to p ≤ 0.05 levels, consistent with previous reports. NPH tractography was also characterized with a distinct “heart-shaped” sign. Possible uses for tractography for patients under suspicion of NPH will be discussed.
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Wood, David L. "Promoting Health Care Transition Readiness Among Youth with Hydrocephalus." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5170.
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Wood, Helen Louise. "Isolation of novel bacterial antigens associated with ventriculoperitoneal shunt infections." Thesis, University of Nottingham, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.342498.
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Lenfeldt, Niklas. "The search for reversibility of idiopathic normal pressure hydrocephalus : aspects on intracranial pressure measurements and advanced MRI techniques in combination with CSF volume alteration /." Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1422.
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Momani, Lina Mutasem Salim. "Intelligent system for the personalised management and treatment of hydrocephalus." Thesis, University of Liverpool, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.533962.
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Al-Zubi, Nayel Suleiman. "Personalised shunt optimisation for the management and treatment of hydrocephalus." Thesis, University of Liverpool, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.539558.
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Gelling, Leslie. "The illness experiences of people with idiopathic normal pressure hydrocephalus." Thesis, Anglia Ruskin University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442143.
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Alkharabsheh, Abdel Rahman Ahmad. "Designing and programming an intelligent implantable wireless hydrocephalus shunting system." Thesis, University of Liverpool, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.548804.
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Wood, David L. "White Paper on Health Care Transition for Youth with Hydrocephalus." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/5184.
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Bim, Camila [UNESP]. "Estudo experimental de sistemas de drenagem externa do líquido cefalorraquidiano." Universidade Estadual Paulista (UNESP), 2012. http://hdl.handle.net/11449/88856.
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Hidrocefalia, também conhecida como “água no cérebro”, é uma condição médica que afeta adultos e crianças e pode ser causada por má formação congênita, anomalias cerebrais, tumores, inflamações, infecções, encefalite, hemorragia intracraniana, traumatismos e outros. A hidrocefalia pode ser seguida por aumento significativo da pressão intracraniana (PIC), que ocorre em razão do acúmulo excessivo do líquido cefalorraquidiano (LCR) nos ventrículos ou cavidades do cérebro, resultando em danos cerebrais permanentes e até em morte. Após o diagnóstico de hidrocefalia há poucas opções de tratamento, exceto cirúrgicas. O processo envolve a implantação de um cateter ventricular para controlar o fluxo de LCR que, geralmente, é drenado das cavidades intracranianas para outro lugar. A drenagem pode ser feita por diferentes métodos. A drenagem do LCR para um reservatório fora do corpo humano é um tratamento provisório, também conhecido como drenagem ventricular externa (DVE). Também é possível realizar um tratamento permanente implantando-se um “shunt”, a fim de promover a drenagem do líquor para outra cavidade corporal, sendo a cavidade abdominal a mais comum. Esse procedimento é chamado de drenagem ventricular interna (DVI). No presente trabalho, experimentos foram realizados com alguns tipos de válvulas unidirecionais de drenagem externa do LCR, a fim de verificar seus comportamentos quando submetidas a vários gradientes de pressão encontrados no organismo humano. Para isso, houve uma sondagem quanto à metodologia de estudo mais adequada para essa investigação, a fim de proporcionar maior segurança aos resultados obtidos nessa pesquisa e em trabalhos futuros
Hydrocephalus, also known as “water on the brain”, is a medical condition that affects both adults and children, and it can be caused by birth defects, brain abnormalities, tumors, inflammations, infections, encephalitis, intracranial hemorrhage, trauma and others. The hydrocephalus may be followed by a significant increase of the intracranial pressure (ICP) with occurs due to the excessive accumulation of cerebrospinal fluid (CSF) in the ventricles or cavities of the brain, this can result in permanent brain damage and even death. After the diagnosis of hydrocephalus, there are some options for treatment except surgical. The process involves the placement of a ventricular catheter to control the flow of CFS with, usually, is drained of the intracranial cavity for other place. The draining can be done by different methods. Draining the CSF into a bag outside the body human is a temporary treatment, also known as external ventricular drainage (EVD). It is also possible make a permanent treatment, in this case, a “shunt” system is placed in order to promote the drainage of CSF to another body cavity, and the abdominal cavity is one of the most common, this procedure is called internal ventricular drainage (IVD). In the present work experiments were performed with some types of one-way valves for external drainage of CSF, to verify their behavior when subjected to various pressure gradients found in human organism. Para isso houve uma sondagem quanto à methodology of study more appropriate for this investigation to provide greater security in results obtained in this work and future works
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Ågren, Wilsson Aina. "On the pathophysiology of idiopathic adult hydrosephalus syndrome : energy metabolism, protein patterns, and intracranial pressure." Umeå : Univ, 2005. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-520.
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Aquino, Humberto Belem de. "Estudo da variabilidade do tratamento das infecções de um sistema de derivação ventriculo peritoneal entre neurocirurgiões brasileiros." [s.n.], 2009. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308904.
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Orientador: Edmur Franco CarelliTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Complicações infecciosas decorrentes do tratamento cirúrgico da hidrocefalia, através do implante de um sistema de derivação ventricular (SDV) permanecem como condição de grande desafio na prática diária do neurocirurgião, seja para adultos e crianças. Algumas estratégias cirúrgicas e clínicas são adotadas em todo o mundo, mas ainda não há consenso sobre qual estratégia poderia ser considerada a melhor. Prevenir a infecção parece ser a melhor opção, assim, discute-se a validade do uso rotineiro e rígido de protocolos pré, intra e pós-operatório, a avaliação dos possíveis fatores de risco para o desenvolvimento de uma infecção, a experiência do cirurgião, o meio ambiente cirúrgico e o tempo de cirurgia, o uso de antibióticos como profilaxia e mais recentemente o uso de cateteres impregnados com antibióticos. No entanto, a incidência para infecção de um SDV é considerada alarmante (1% a 40% com uma média de 8,5% a 10%), a morbidade e mortalidade são altas (30% a 40%), o tratamento requer um longo tempo de permanência hospitalar (mais de 3 semanas), apresenta um alto custo operacional, além de uma alta taxa de reinfecção ao redor de (26%). O objetivo do trabalho é apresentar uma pesquisa entre Neurocirurgiões Brasileiros, realizada através de um questionário, sobre o estado atual do tratamento das infecções em um sistema de derivação ventricular entre eles e suas variabilidades. Neurocirurgiões Brasileiros foram pesquisados através de um questionário eletrônico, via página oficial da Sociedade Brasileira de Neurocirurgia (SBN), via e-mail do autor, e questionários entregues pessoalmente em 2 grandes Congressos Brasileiros de Neurocirurgia no ano de 2007. O questionário apresentava um caso clínico hipotético como referência de infecção em um SDV e perguntas sobre critérios clínicos, laboratoriais e/ou radiológicos de infecção e cura e a estratégia de tratamento. Trezentos e trinta e sete respostas foram envolvidas na pesquisa, o que corresponde a (14,04%) de 2.400 Neurocirurgiões cadastrados Na SBN, na época da pesquisa. Os questionários foram analisados, interpretados e posicionados em ordem de preferência de respostas dos pesquisados em um banco de dados. É nossa impressão que há uma significante variabilidade de informações sobre o estado atual de tratamento das infecções de um SDV entre os Neurocirurgiões pesquisados e com tendências similares à literatura
Abstract: Infectious complications following surgical treatment of hydrocephalus with shunt implantation remains a very challenging condition in pediatric and adult neurosurgical practice. Some surgical strategies and clinical therapy have been used by many neurosurgical centers around the world but still now there isn't a consensus regarding what general strategy can be considered better. To prevent it seems to be the best option but. The literature discusses about protocols, risk factors, expertise of the surgeons, operating room environment, surgery time, antibiotic prophylaxis, antibiotic-impregnated shunts and specifics strategies of surgical treatment and antibiotics. The incidence ranging from 1% to 40% with an average of 8.5% - 15%, raised morbidity and mortality (40%), long hospital stay (more than 3 weeks), elevated costs and elevated rate of reinfection (26%). We presented a practice survey among Brazilian Neurosurgeons to know the current state of treatment strategies of shunt infections and variabilities. Brazilian neurosurgeons were surveyed by a questionnaire by Brazilian Neurosurgery Society (SBN) and questionnaires by personal e-mail and personally taken to and handed in two important Brazilian Neurosurgery Congresses (2007), about treatment strategy facing shunt infections and criteria used to define diagnosis and cure. About 337 questionnaires were evolved on the survey (14.04%) from the 2,400 neurosurgeons. All the questionnaires were analyzed, interpreted and inserted in the database and all answers were termed using at same literature words. It is our impression that there is a significant variability among the Brazilian Neurosurgeons surveyed, with tendencies and there is similarity with literature
Doutorado
Neurologia
Doutor em Ciências Médicas
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Bim, Camila. "Estudo experimental de sistemas de drenagem externa do líquido cefalorraquidiano /." Ilha Solteira, 2012. http://hdl.handle.net/11449/88856.
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Orientador: Sérgio Said MansurCoorientador: Edson Del Rio Vieira
Banca: André Luiz Seixlack
Banca: Marcos Pinotti Barbosa
Resumo: Hidrocefalia, também conhecida como "água no cérebro", é uma condição médica que afeta adultos e crianças e pode ser causada por má formação congênita, anomalias cerebrais, tumores, inflamações, infecções, encefalite, hemorragia intracraniana, traumatismos e outros. A hidrocefalia pode ser seguida por aumento significativo da pressão intracraniana (PIC), que ocorre em razão do acúmulo excessivo do líquido cefalorraquidiano (LCR) nos ventrículos ou cavidades do cérebro, resultando em danos cerebrais permanentes e até em morte. Após o diagnóstico de hidrocefalia há poucas opções de tratamento, exceto cirúrgicas. O processo envolve a implantação de um cateter ventricular para controlar o fluxo de LCR que, geralmente, é drenado das cavidades intracranianas para outro lugar. A drenagem pode ser feita por diferentes métodos. A drenagem do LCR para um reservatório fora do corpo humano é um tratamento provisório, também conhecido como drenagem ventricular externa (DVE). Também é possível realizar um tratamento permanente implantando-se um "shunt", a fim de promover a drenagem do líquor para outra cavidade corporal, sendo a cavidade abdominal a mais comum. Esse procedimento é chamado de drenagem ventricular interna (DVI). No presente trabalho, experimentos foram realizados com alguns tipos de válvulas unidirecionais de drenagem externa do LCR, a fim de verificar seus comportamentos quando submetidas a vários gradientes de pressão encontrados no organismo humano. Para isso, houve uma sondagem quanto à metodologia de estudo mais adequada para essa investigação, a fim de proporcionar maior segurança aos resultados obtidos nessa pesquisa e em trabalhos futuros
Abstract: Hydrocephalus, also known as "water on the brain", is a medical condition that affects both adults and children, and it can be caused by birth defects, brain abnormalities, tumors, inflammations, infections, encephalitis, intracranial hemorrhage, trauma and others. The hydrocephalus may be followed by a significant increase of the intracranial pressure (ICP) with occurs due to the excessive accumulation of cerebrospinal fluid (CSF) in the ventricles or cavities of the brain, this can result in permanent brain damage and even death. After the diagnosis of hydrocephalus, there are some options for treatment except surgical. The process involves the placement of a ventricular catheter to control the flow of CFS with, usually, is drained of the intracranial cavity for other place. The draining can be done by different methods. Draining the CSF into a bag outside the body human is a temporary treatment, also known as external ventricular drainage (EVD). It is also possible make a permanent treatment, in this case, a "shunt" system is placed in order to promote the drainage of CSF to another body cavity, and the abdominal cavity is one of the most common, this procedure is called internal ventricular drainage (IVD). In the present work experiments were performed with some types of one-way valves for external drainage of CSF, to verify their behavior when subjected to various pressure gradients found in human organism. Para isso houve uma sondagem quanto à methodology of study more appropriate for this investigation to provide greater security in results obtained in this work and future works
Mestre
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Schrander-Stumpel, Constance Theresia Rimbertha Maria. "Clinical and genetic aspects of the X-linked hydrocephalus/masa spectrum." Maastricht : Maastricht : Rijksuniversiteit Limburg ; University Library, Maastricht University [Host], 1995. http://arno.unimaas.nl/show.cgi?fid=5773.
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Elixmann, Inga [Verfasser]. "Mechatronisches Implantat für die geregelte Liquorableitung bei Hydrocephalus / Inga Margrit Elixmann." Aachen : Shaker, 2015. http://d-nb.info/1070151793/34.
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d'Arcangues, Charlotte [Verfasser]. "Neuroendoscopic lavage for the treatment of posthemorrhagic neonatal hydrocephalus / Charlotte d'Arcangues." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2020. http://d-nb.info/1223927636/34.
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Samuel, Madan. "Quantitative assessment of the tympanic membrane displacement test in children and adolescents with shunted hydrocephalus : reproducibility of tympanic membrane displacement test measurements in children with shunted hydrocephalus." Thesis, University of Southampton, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.266378.
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Wichern, Donald Monte. "A Framework for an Implantable Wireless Pressure and Volume Sensor Focusing on the Diagnosis and Treatment of Shunt Failure in Hydrocephalus Patients." Diss., CLICK HERE for online access, 2006. http://contentdm.lib.byu.edu/ETD/image/etd1162.pdf.
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Paech, Christian, Roman Gebauer, and Matthias Knüpfer. "Life-threatening QT prolongation in a preterm infant." Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-155989.
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Introduction: Temporary QT-interval prolongation following intracranial hemorrhage and hydrocephalus has been repeatedly reported in adults. Case: We report a case of excessive QT prolongation with sudden bradycardia resulting in 2:1 atrioventricular conduction in a preterm infant most likely associated with a congenital hydrocephalus. Pathomechanisms are discussed. Conclusion: Congenital hydrocephalus predisposes to excessive QT prolongation in preterm infants.
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Lundin, Fredrik. "Idiopathic Normal Pressure Hydrocephalus : Aspects on Pathophysiology, Clinical Characteristics and Evaluation Methods." Doctoral thesis, Linköpings universitet, Neurologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-84243.
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Introduction. Idiopathic normal pressure hydrocephalus (iNPH) is a condition with enlargement of the cerebral ventricular system and an intracranial pressure (ICP) within normal limits. Cerebrospinal fluid circulation is disturbed but the mechanisms behind the symptoms: gait and balance difficulties, cognitive dysfunction and micturition problems, are as yet mostly unexplained. Aim. In Studies I and II the aim was to investigate cerebral metabolism in the frontal deep white matter (FDWM) and the thalamus in iNPH using Magnetic Resonance Spectroscopy (MRS) before and after shunt surgery and to compare this with healthy individuals (HI). In Study III the aim was, by use of actigraphy, to measure motor function, energy expenditure and resting/sleeping time in iNPH patients before and after shunt surgery, in comparison with HI. In Study IV the aim was to study postural function using computerised dynamic posturography (CDP) before and after shunt surgery as well as in comparison with HI. Patients and Methods. In all studies the patients had a neurological examination and baseline bedside assessments of motor, balance and cognitive function were performed. Motor function was assessed using a motor score (MOS) consisting of the following items: 10 metre walk time in seconds and number of steps and TUG time in seconds and number of steps. MOS was considered significant if there was an increase of 5% or more. The HI were also tested for motor, balance and cognitive function. In Study I the patients (n=16) and the HI (n=15) were examined with MRS (absolute quantification) with voxels placed in the thalamus and in FDWM and compared with one another. In Studies III and IV the preoperative results of actigraphy and CDP respectively in patients (Study III n=33; study IV n=35) were compared with the HI: Study III, n=17; Study IV, n=16. The HI performed these examinations twice and the average was calculated. In Study II, 14 patients, and in Studies III and IV, 20 patients underwent shunt surgery and new MRS/actigraphy/CDP examinations were performed three months postoperatively and compared with the preoperative results. Results. In the patients decreased total N-acetyl compounds (tNA) and N-acetyl aspartate (NAA) were found in the thalamus compared to the HI. No metabolic differences were seen in the FDWM between the groups. Postoperatively there were no metabolic changes in the thalamus but an increased total Choline (tCho) and a borderline significant decrease in myo-inositol (mIns).During the day the patients took fewer steps and had also lower total energy expenditure (TEE) than the HI. There was no difference concerning resting/sleeping time between patients and the HI. Postoperatively there were no differences of either number of steps, TEE or time spent resting or sleeping compared with the preoperative state. Postural function was worse in the patients compared to the HI, this difference being more pronounced in tests measuring vestibular function, where loss of balance (LOB) was frequent. There was only a slight improvement in balance after shunt surgery. A positive response to the shunt operation was seen in 86% in Study II, 85% in Study III and 90% in Study IV. Conclusions. Our results suggest that the thalamus may be involved in the pathogenesis of iNPH. In contrast to others, we did not find any metabolic abnormalities in the FDWM, nor detect an increment of tNA or NAA postoperatively in the thalamus. The postoperative increase in tCho and borderline decrease in mIns in the FDWM might reflect a state of metabolic recovery since high tCho, a major component of the cell membrane, may be a sign of increased membrane turnover, and a decrease in mIns may indicate diminished gliosis. The low gait capacity seen in the iNPH patients was not surprising but well that time spent resting/sleeping did not differ from the HI. Another unexpected finding was the unchanged ambulatory activity after shunt surgery despite improvement in a point test to determine capacity to walk a short distance. We believe this could be due to strong habits that are difficult to break and/or shortage of rehabilitation after surgery. There was a profound postural dysfunction in the patients with many falls, especially in test situations intended to measure vestibular function. This implies that there is a central vestibular disturbance. The discrete improvement in postural function postoperatively was lower than previously reported.
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Jartti, P. (Pekka). "Computed tomography in subarachnoid haemorrhage:studies on aneurysm localization, hydrocephalus and early rebleeding." Doctoral thesis, University of Oulu, 2010. http://urn.fi/urn:isbn:9789514262890.
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Abstract
Subarachnoid haemorrhage (SAH) is a life-threatened disease with poor outcome. It is usually caused by an intracranial aneurysm (IA) rupture and rapid diagnosis and treatment are of great importance. Computed tomography (CT) is a reliable method to detect the blood in the subarachnoid (SA) spaces. Digital subtraction angiography (DSA) offers dynamic and morphological information of a ruptured IA. The treatment options for excluding an aneurysm from the main circulation are neurosurgical clipping and endovascular procedures.
The purpose of the present study was to evaluate the risk factors of acute hydrocephalus (HC) and the reliability to localize the ruptured aneurysm based on non-contrast CT. The aim was also to compare the effect of neurosurgical and endovascular treatment on the development of chronic HC, and evaluate the incidence and the risk factors of early rebleeding (< 30 days) after coiling.
The data of 180 operated patients with a ruptured IA were checked. Two neuroradiologists separately located the IAs based on non-contrast CT. The analyses of blood amount and distribution was a reliable method for estimating the location of ruptured middle cerebral artery (MCA) aneurysms and anterior communicate artery (ACoA) aneurysms. Intracerebral haemorrhage (ICH) was a predictor for detecting the precise site. The results confirmed that intraventricular haemorrhage (IVH) was the most consistent single risk factor for the development of acute HC. Haemorrhage in the basal region and the large total blood amount in the SA spaces were strong predictors.
The effect of early treatment modality for ruptured IAs on the development of chronic HC with 102 clipped and 107 coiled patients was compared. The treatment method used was not significantly associated with the occurrence of chronic HC or the need for shunt operation.
The incidence and risk factors of early rebleeding after coiling were investigated in 194 consecutive acutely (within 3 days) coiled patients with ruptured IAs. The incidence of early rehaemorrhage was 3.6%. The presence of ICH at admission and poor clinical condition were significant predictors for rebleeding. An early rehaemorrhage appeared as an enlargement of the ICH in all of these patients.
In conclusion, the non-contrast CT is a reliable method to detect the location of ruptured IA in patients with MCA and ACoA aneurysms. The risk factor for the development of acute HC is IVH. Other predictors are the total SA blood amount and blood in the basal regions. The treatment method used for acutely ruptured IA has no significant effect on the occurrence of chronic HC. The incidence of early rebleeding after coiling is low. The risk factors of rebleeding are the presence of ICH and poor clinical condition. Rehaemorrhage appears often as an enlargement of the ICH.
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Balamurali, Gopal. "Predicting the response to ventriculoperitoneal shunt in patients with normal pressure hydrocephalus." Thesis, University of Central Lancashire, 2011. http://clok.uclan.ac.uk/2391/.
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The diagnosis and management of normal pressure hydrocephalus (NPH) remains controversial. The aim of this prospective study was to assess the usefulness of clinical and radiological criteria together with supplemental neuropsychological and gait tests, cerebrospinal fluid (CSF) hydrodynamic studies and external lumbar drainage (ELD) in identifying those who may respond to a shunt and to compare the outcomes with the non-shunted patients at one year. Method: Forty patients with a clinical diagnosis of NPH were prospectively studied according to a fixed management protocol. Resistance to CSF (Rcsf) was measured using a lumbar infusion study and an ELD was used to determine improvement in neuropsychological and gait tests following CSF drainage. Based on specific criteria those who showed improvement were shunted. Clinical and radiological outcomes were assessed at one year in all patients. Results: Twenty three (57.5%) patients were shunted. Improvement was observed in 74% of shunted patients, while 17% did not improve and 9% deteriorated following surgery. Age, etiology, presentation, duration of symptoms and presence of co-morbid factors were unrelated to outcome. Improvement was found in 63% of shunted patients with RCSF of 12 mmHg/ml/min or higher. The sensitivity was 64% with a positive predictive value of 68%. Both Rcsf testing and ELD enhanced the positive predictive outcome of shunt operation. Using the non-shunted patients as controls, the mean difference between the two groups over time differed significantly in all the neuropsychological tests and some gait test. Conclusions: No single test was able to predict overall success with shunting but the results showed that a high percentage of improvement could be achieved by using continuous ELD and a rigorous protocol. Greater improvements were observed in cognitive and gait function than in sphincter control. An Rcsf of 12mmHg/ml/min or more was related to better outcomes. Consideration was given to the significant limitations in the study design and outcome measures.