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Headache and NPH

Derya Kaya, Pinar Soysal, Ahmet Turan Isık
It is somewhat unexpected to have headaches in patients with idiopathic normal pressure hydrocephalus (INPH) for which the treatment is drainage of cerebrospinal fluid (CSF) using shunt. Moreover, intracranial hypotension syndrome (IHS) can be a challenging diagnosis, as CSF leak may be difficult to confirm as imaging findings can be normal. This report describes a woman with INPH who developed symptoms of IHS after a spinal tap test. There might be cases with IHS, like our case, who do not completely fulfill the current diagnostic criteria in terms of not having any objective evidence of intracranial hypotension but who also could not be explained by other conditions and recovered totally after classical IHS treatment...
September 2015: American Journal of Alzheimer's Disease and Other Dementias
Gustavo Noleto, Iuri Santana Neville, Wagner Malagó Tavares, Felippe Saad, Fernando Campos Pinto, Manoel Jacobsen Teixeira, Wellingson Silva Paiva
Cerebrospinal fluid over-drainage is a common complication of ventriculoperitoneal devices. In terms of haemorrhage, subdural haematomas are usually more frequent lesions than epidural hematomas, which, more rarely, may also be seen after ventricular shunt procedures and may lead to rapid neurological decline and even death unless a surgical procedure can be promptly performed. This study reports the case of a 47 years-old Dandy Walker man, with clinical condition compatible with the diagnosis of normal pressure hydrocephalus submitted to a ventriculoperitoneal shunt with a high fixed pressure valve...
2014: International Journal of Clinical and Experimental Medicine
Teppei Matsubara, Eiichi Ishikawa, Koji Hirata, Masahide Matsuda, Hiroyoshi Akutsu, Tomohiko Masumoto, Alexander Zaboronok, Akira Matsumura
Cerebrospinal fluid (CSF) overdrainage after lumboperitoneal (LP) shunt placement for the patients with idiopathic normal pressure hydrocephalus (iNPH) is mainly caused by insufficient management of pressure settings of the shunt valve and/or siphon effect of shunt systems induced by the patient's postural changes. We here report a unique case of intracranial hypotension (IH) due to CSF leakage after LP shunt placement in which another mechanism leads to the CSF leakage. A 67-year-old man suffered from persistent headache worsening with postural change 2 months after LP shunt reconstruction for iNPH...
2014: Neurologia Medico-chirurgica
Ullrich Meier, Dirk Stengel, Cornelia Müller, Michael J Fritsch, Uwe Kehler, Niels Langer, Michael Kiefer, Regina Eymann, Martin U Schuhmann, Andreas Speil, Friedrich Weber, Victor Remenez, Veit Rohde, Hans-Christoph Ludwig, Johannes Lemcke
BACKGROUND: Little is known about variables associated with overdrainage complications and neurofunctional and health-related quality of life outcomes in idiopathic normal-pressure hydrocephalus (iNPH) patients after shunt surgery. OBJECTIVE: To identify candidate demographic and disease-specific predictors of overdrainage and patient-related outcomes, allowing for more personalized care of patients with iNPH. METHODS: This was a secondary analysis of the dataset of the SVASONA study, a multicenter randomized trial comparing gravitational and conventional gravitational valves for treating iNPH...
December 2013: Neurosurgery
Leonie Gölz, Johannes Lemcke, Ullrich Meier
BACKGROUND: Modern ventriculoperitoneal shunts (VPS) are programmable, which enables clinicians to adjust valve-pressure according to their patients' individual needs. The aim of this retrospective analysis is to evaluate indications for valve-pressure adjustments in idiopathic normal pressure hydrocephalus (iNPH). METHODS: Patients operated between 2004 and 2011 diagnosed with iNPH were included. Kiefer-Scale was used to classify each patient. Follow-up exams were conducted 3, 6, and 12 months after shunt implantation and yearly thereafter...
2013: Surgical Neurology International
Qurat Ul Ain Khan, Robert E Wharen, Sanjeet S Grewal, Colleen S Thomas, H Gordon Deen, Ronald Reimer, Jay A Van Gerpen, Julia E Crook, Neill R Graff-Radford
OBJECT: Management of idiopathic normal-pressure hydrocephalus (iNPH) is hard because the diagnosis is difficult and shunt surgery has high complication rates. An important complication is overdrainage, which often can be treated with adjustable-shunt valve manipulations but also may result in the need for subdural hematoma evacuation. The authors evaluated shunt surgery overdrainage complications in iNPH and their relationship to lumbar puncture opening pressure (LPOP). METHODS: The authors reviewed the charts of 164 consecutive patients with iNPH who underwent shunt surgery at their institution from 2005 to 2011...
December 2013: Journal of Neurosurgery
Johannes Lemcke, Ullrich Meier, Cornelia Müller, Michael J Fritsch, Uwe Kehler, Niels Langer, Michael Kiefer, Regina Eymann, Martin U Schuhmann, Andreas Speil, Friedrich Weber, Victor Remenez, Veit Rohde, Hans-Christoph Ludwig, Dirk Stengel
OBJECTIVES: To investigate whether gravitational valves reduce the risk of overdrainage complications compared with programmable valves in ventriculoperitoneal (VP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). BACKGROUND: Patients with iNPH may benefit from VP shunting but are prone to overdrainage complications during posture changes. Gravitational valves with tantalum balls are considered to reduce the risk of overdrainage but their clinical effectiveness is unclear...
August 2013: Journal of Neurology, Neurosurgery, and Psychiatry
Hiroji Miyake, Yoshinaga Kajimoto, Hisayuki Murai, Sadahiro Nomura, Shigeki Ono, Yuji Okamoto, Yoshihiro Sumi
BACKGROUND: Management of overdrainage complications in shunted patients with idiopathic normal pressure hydrocephalus (INPH) remains a difficult task despite the use of programmable pressure valves. OBJECTIVE: To assess the usefulness of a quick reference table (QRT) algorithm for achieving a suitable initial programmable pressure valve setting in INPH patients who participated in the Study for INPH on Neurological Improvement (SINPHONI). METHODS: One hundred registered patients diagnosed with probable INPH were treated with ventriculoperitoneal shunts using Codman-Hakim programmable valves (CHPVs)...
September 2012: Neurosurgery
Toshiya Uchiyama, Tetsuyoshi Horiuchi, Takahiro Murata, Kazuhiro Hongo
A 40-year-old Brazilian man presented with headache followed by consciousness disturbance. Computed tomography showed subarachnoid hemorrhage with right frontal hematoma. Angiography revealed a dural arteriovenous fistula (dAVF) fed by the inferolateral trunk of the internal carotid artery and draining into the superficial sylvian vein with varix formation. The shunting point was directly obliterated through a pterional approach. Postoperative angiography showed complete disappearance of the fistula. A ventriculoperitoneal shunt was needed for normal pressure hydrocephalus during his hospitalization...
2011: Neurologia Medico-chirurgica
Daniel Bremell, Christer Säll, Magnus Gisslén, Lars Hagberg
INTRODUCTION: Lyme neuroborreliosis is the most common bacterial central nervous system infection in the temperate parts of the northern hemisphere. Even though human immunodeficiency virus (HIV) -1 infection is common in Lyme borreliosis endemic areas, only five cases of co-infection have previously been published. Four of these cases presented with typical Lyme neuroborreliosis symptoms such as meningoradiculitis and facial palsy, while a fifth case had more severe symptoms of encephalomyelitis...
2011: Journal of Medical Case Reports
Anja M Giesemann, H-Holger Capelle, Rolf Winter, Joachim K Krauss
Misplacement of the ventricular catheters of shunt systems may result in shunt dysfunction or a variety of neurological symptoms. Bilateral fourth nerve palsy has not been reported thus far after shunting. Here, we describe the occurrence of this unusual neurological deficit in a patient who underwent shunting for normal pressure hydrocephalus, and demonstrate its pathoanatomical correlate.
February 2012: British Journal of Neurosurgery
J Virhammar, K G Cesarini, K Laurell
BACKGROUND: The cerebrospinal fluid tap test (TT) is a diagnostic tool used to select patients with idiopathic normal pressure hydrocephalus (iNPH) for shunt surgery. The procedure and the evaluation of the TT vary between centres. We aimed to describe the evaluation time after the TT, to assess the variability between repeated measurements, the interrater agreement of the gait tests chosen and finally to investigate whether pain affects the gait performance post-TT. METHODS: Forty patients (21 men and 19 women) under evaluation for iNPH underwent a TT...
February 2012: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
J Malm, N Sundström, K G Cesarini, M Edsbagge, B Kristensen, G Leijon, A Eklund
OBJECTIVES: The cerebrospinal fluid (CSF) infusion test is frequently used when selecting hydrocephalus patients for shunt surgery. Very little has been reported regarding adverse events. We present a prospective feasibility study. METHODS: Standardized devices for measuring CSF dynamics were built and 562 patients investigated: Needles were placed by lumbar puncture (LP). An automatic CSF infusion protocol was performed. Course of events during the investigation as well as adverse events were registered...
March 2012: Acta Neurologica Scandinavica
Mitsunobu Kaijima, Hiroshi Fukuda, Kazuhide Yamamoto
This is a report on a few possible consequences of occasional side leakage of CSF into the lumbar epidural space. In this report, we refer to such CSF side leakage from around the inserted spinal tube which occurred during the early stages following our lumboperitoneal shunt operations in two of our patients. This leakage can lead to over-drainage of CSF, and such complications as post-operative orthostatic headache, subdural effusion, and/or subdural hematoma can also result. The diagnosis of these complications can be verified if CSF components in the lumbar epidural space are visible in T2 weighted-fat saturation images captured on MRI...
May 2011: No Shinkei Geka. Neurological Surgery
Masaaki Hashimoto, Masatsune Ishikawa, Etsuro Mori, Nobumasa Kuwana
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable neurological syndrome in the elderly. Although the magnetic resonance imaging (MRI) findings of tight high-convexity and medial subarachnoid spaces and the ventriculo-peritoneal (VP) shunt with programmable valve are reportedly useful for diagnosis and treatment, respectively, their clinical significance remains to be validated. We conducted a multicenter prospective study (Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement: SINPHONI) to evaluate the utility of the MRI-based diagnosis for determining the 1-year outcome after VP shunt with the Codman-Hakim programmable valve...
2010: Cerebrospinal Fluid Research
Andrew J Fabiano, Kristina Doyle, Walter Grand
OBJECTIVE: To describe 2 cases of delayed endoscopic third ventriculostomy (ETV) failure in 2 adult patients initially successfully treated for normal pressure hydrocephalus by ETV. The cause of ETV failure was stoma closure, and this was documented in both instances by direct endoscopic inspection. CLINICAL PRESENTATION: In the first case, a 67-year-old woman presented with progressive gait disturbance, incontinence, and memory problems. Brain magnetic resonance imaging exhibited ventricular dilation, including the fourth ventricle, disproportionate to cortical atrophy...
June 2010: Neurosurgery
Eulogio Pleguezuelos Cobo, M Engracia Pérez Mesquida, Elisabet Palomera Fanegas, Eva Moreno Atanasio, M Beatriz Samitier Pastor, Cristina Perucho Pont, Carlos Matarrubia Prieto, Genoveva Reverón Gómez, Lluis Guirao Cano
STUDY DESIGN: Prospective longitudinal study. OBJECTIVE: To identify prognosis factors that allow us to identify patients with risk of developing chronic symptoms and disabilities after a whiplash injury. SUMMARY OF BACKGROUND DATA: The prognosis factors for poor recovery in acute whiplash are not conclusive. METHODS: We included 557 patients who suffered whiplash injury after road traffic accident and visited the Department of Physical Medicine and Rehabilitation of Mataró Hospital (Spain) for medical evaluation and rehabilitation treatment...
April 20, 2010: Spine
Shu-Jui Lee, Yen-Yue Lin, Chin-Wang Hsu, Shi-Jye Chu, Shih-Hung Tsai
Lumbar puncture is a commonly practiced bedside technique for acquiring cerebrospinal fluid for the purposes of examination, spinal anesthesia, and as therapeutic trial for normal pressure hydrocephalus. Headache and backache after lumbar puncture are not uncommon. We report an elderly woman who suffered from altered consciousness and acute neurologic deficit after a difficult lumbar puncture. Serial imaging studies revealed active bleeding from the left first lumbar artery with the formation of spinal epidural hematoma and coexisting acute cranial intraventricular hematoma and subarachnoid hemorrhage...
February 2009: American Journal of the Medical Sciences
Lance S Governale, Nicole Fein, Jessica Logsdon, Peter M Black
OBJECTIVE: To describe our system of external lumbar drainage for normal pressure hydrocephalus, detail its complications, and discuss changes made to that system with time. METHODS: This is a retrospective analysis of lumbar drainage in 233 consecutive patients with symptoms treated at the Brigham and Women's Hospital, Boston, MA, from February 2002 to August 2006. RESULTS: The lumbar drain was successfully placed at the bedside in 223 of 233 patients; fluoroscopic guidance was used in 10 cases...
October 2008: Neurosurgery
Eulogio Pleguezuelos, María Engracia Pérez, Lluís Guirao, Elísabet Palomera, Eva Moreno, Beatriz Samitier
BACKGROUND AND OBJECTIVE: Factors of poor clinical recovery in acute whiplash are not conclusive. The goal of this prospective longitudinal study was to identify factors with influence in clinical evolution allowing us to identify patients with risk for developing chronic symptoms and disabilities after an acute whiplash. PATIENTS AND METHOD: We included 226 patients who suffered acute whiplash after road traffic accident and met the Department of Physical Medicine and Rehabilitation for medical evaluation and physiotherapy treatment...
July 12, 2008: Medicina Clínica
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