Headache and NPH

Septum pellucidum cyst is rare and is defined as a fluid-filled space between the lateral ventricles; it has a width of 10 mm or more. In this case report, a surgical patient of symptomatic septum pellucidum cyst (SPC) in extreme age is described. To the best our knowledge, this is the first report of an extremely aged patient with symptomatic SPC that was successfully treated using a flexible neuroendoscope. An 85-year-old male complained of gradually worsening gait disturbance, dementia, and urinary incontinence without headache and was admitted to our hospital...

BACKGROUND: Lumboperitoneal shunt is a known procedure for communicating hydrocephalus. Being an extracranial procedure, it can also be utilized in normal-sized ventricles. OBJECTIVE: To report our experience of lumboperitoneal shunt done with a minimal follow-up of 12 months with an emphasis on patient selection, technique, and complication avoidance. METHODS: This was a retrospective analysis of patients who underwent LP shunt during October 2014-October 2019 at the authors' institute...

BACKGROUND: Arachnoid cysts (AC) may cause hydrocephalus and neurological symptoms, necessitating surgical intervention. Cyst drainage may result in postoperative complications, however, these interventions are not normally associated with the subsequent development of acute hydrocephalus. Herein, we present two unique cases of AC drainage with postoperative development of acute communicating hydrocephalus. CASE DESCRIPTION: Case 1. A 75-year-old female presented with progressive headaches, cognitive decline, and questionable seizures...

Hydrocephalus induced by low cerebrospinal fluid (CSF) pressure is extremely rare and sporadically reported. Subarachnoid hemorrhage, head trauma, and spinal drainage were reported to be causative factors for surgical treatment. A 33-year-old man with subarachnoid hemorrhage caused by right vertebral artery aneurysm rupture developed headache. Trapping surgery was performed, and a spinal drain was inserted from L4/5 for subarachnoid hemorrhage washout. On postoperative day 3, subdural fluid accumulation had increased at the posterior fossa craniotomy site and the cerebellar sulci had narrowed; the ventricles were slightly enlarged...

BACKGROUND: Comprehensively describe and compare (pre⁄postoperatively) the clinical symptomatology in adult non-communicated hydrocephalus. Associated hydrocephalus signs were analyzed with the idiopathic Normal Pressure Hydrocephalus Scale (iNPH Scale). A standardized clinical scale for non-communicated hydrocephalus is currently not in use. METHODS: Ten patients with hydrocephalus occlusus (HO) were analyzed. Hydrocephalus signs were examined with the iNPH Scale in gait, neuropsychology, continence, and balance before and three months after treatment with shunt operation or third endoscopic ventriculostomy...

BACKGROUND: Normal pressure hydrocephalus (NPH) is frequently treated with ventriculoperitoneal shunt (VPS) surgery. However, VPS implantation can lead to overdrainage and complications such as headaches, hygroma, and subdural hematoma due to a siphon effect in an upright position. Gravitational valves prevent overdrainage through position-dependent adjustment of valve resistance. Flow-regulated valves that increase resistance in presence of high cerebrospinal fluid flow may provide similar protection against overdrainage and present an alternative to gravitational valves...

Diagnosis of symptomatic valve malfunction in hydrocephalic patients treated with VP-Shunt (VPS) might be difficult. Clinical symptoms such as headache or nausea are nonspecific, hence cerebrospinal fluid (CSF) over- or underdrainage can only be suspected but not proven. Knowledge concerning valve malfunction is still limited. We aim to provide data on the flow characteristics of explanted shunt valves in patients with suspected valve malfunction. An in vitro shunt laboratory setup was used to analyze the explanted valves under conditions similar to those in an implanted VPS...

Leptomeningeal carcinomatosis (LC) and optic nerve metastasis are uncommon occurrences in breast cancer. We report a rare case of LC with optic nerve infiltration secondary to breast cancer. A 45-year-old lady who was a known case of treated right breast carcinoma six years ago presented with a blurring of vision in both eyes, floaters, and diplopia for one month. She also had recurrent attacks of seizure-like episodes, headache, and vomiting. Examination revealed high blood pressure with tachycardia. Her right eye visual acuity was counting fingers at two feet and 6/36 in the left eye...

The central nervous system was thought to be devoid of lymphatics. Recently, the existence of an authentic brain lymphatic system, known as the glymphatic system, composed of paravascular channels penetrating arterial and venous brain vessels and dural lymphatics cleaning the interstitial space, has been demonstrated. Aquaporin-4, located in astrocyte feet attached to the paravascular spaces, plays a key role in the clearance of waste molecules, such as beta-amyloid or tau proteins. The activity of this system is increased during sleep, mainly in the slow wave phase and while sleeping on one side, and with exercise, and is reduced with aging...

INTRODUCTION: Cerebrospinal fluid (CSF) analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits...

Normal-sized ventricles and absence of papilledema do not rule out shunt failure and raised intracranial pressure (ICP). Raised ICP can present with false localizing signs which may be cranial nerve palsies or extensive polyradiculopathy. Our patient with a history of ventriculoperitoneal (VP) shunt presented with rapidly progressive vision loss without papilledema, as well as multiple cranial nerve palsies and radiculopathy. Imaging did not reveal hydrocephalus, however, cerebrospinal fluid (CSF) manometry revealed high CSF opening pressure...

STUDY DESIGN: case report and literature review OBJECTIVE.: To report a rare case of hydrocephalus due to ventriculoperitoneal shunt (VPS) malfunction following kyphosis correction that resulted in paraplegia in the post-operative period. The available English literature to explain the possible cause of paraplegia is reviewed. SUMMARY OF BACKGROUND DATA: 12 year male child presented with a severe dorsal kypho-scoliosis deformity with spastic paraparesis since 4 months...

OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a shunt that drains CSF. The cause of the disease is unknown, but a vascular pathway has been suggested. The INPH-CRasH (Comorbidities and Risk Factors Associated with Hydrocephalus) study was a modern epidemiological case-control study designed to prospectively assess parameters regarding comorbidities and vascular risk factors (VRFs) for INPH, quality of life (QOL), and adverse events in patients with shunted INPH...

BACKGROUND: Idiopathic intracranial hypertension (IIH) and normal pressure hydrocephalus (NPH) are disorders of the cerebrospinal fluid (CSF) flow dynamics. Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade astrocytoma (World Health Organization grade II) representing <1% of astrocytomas. Combination of IIH and NPH with PXA is unheard of, with few published cases discussing the association of CNS tumors with either IIH or NPH, but never combined. We present a case of a 51-year-old woman with such a rare combination...

Ventriculoperitoneal shunt catheter migration is a rare but documented complication. The exact mechanism of this occurrence is not well understood. We report the case of an 81-year-old male who initially presented with symptoms consistent with normal pressure hydrocephalus. A ventriculoperitoneal shunt was placed uneventfully. Four months later, the patient presented complaining of a persistent headache despite multiple adjustments in the shunt setting. Shunt series radiographs demonstrated the distal catheter passing through the superior vena cava and looping into the right cardiac atrium and ventricle...

BACKGROUND: In patients with normal pressure hydrocephalus (NPH), lumbar puncture (LP) is an effective method for assessing both the diagnosis as well as the possible efficacy of ventriculoperitoneal shunting based on symptom improvement. However, it should be considered that there exists a low risk of complications and that these risks may result in morbidity and mortality. We present a patient who developed hematoma in the basal ganglia following LP. CASE DESCRIPTION: A 56-year-old man presented with progressive dementia, ataxia, and urinary incontinence for 8 months...

Although lumbar puncture is recognized as a great contributor to the diagnosis of some neurological diseases, the modalities of learning this procedure are still poorly defined in training programs for students attending their hospital internships. Apprehension related to the lack of experience and the fear of failure accelerates the abandonment of the practice. This study aims to assess lumbar puncture skills in the students at the Faculty of Medicine in Nouakchott as well as their subjective experience of this procedure...

Developmental venous anomalies (DVAs) are generally asymptomatic; however, they can sometimes cause central nervous disorders. Aqueductal stenosis caused by DVAs is so rare that only 14 cases have been reported to date. Moreover, most patients are children or young adults, presenting with headaches or consciousness disturbances, associated with raised intracranial pressure. Here, we report on an 83-year-old man presenting with mimic symptoms of idiopathic normal pressure hydrocephalus (cognitive disorder, gait disturbance, and urinary urgency: Hakim's triad) because of obstructive hydrocephalus caused by a DVA located in the aqueduct...

OBJECTIVE: Chronic ventriculomegaly in the absence of raised intracranial pressure (ICP) is a known entity in adult hydrocephalus practice. The natural history and indication for treatment is, however, poorly defined. A highly heterogeneous group, some adults with ventriculomegaly are asymptomatic, while others have life-threatening deteriorations. The authors hypothesized that the various presentations can be subtyped and represent different stages of decompensation. A cluster analysis was performed on a cohort of patients with chronic ventriculomegaly with the aim of elucidating typical clinical characteristics and outcomes in chronic ventriculomegaly in adults...

A 82-year-old male experiencing headaches, dementia, urinary incontinence and gait instability was diagnosed with normal pressure hydrocephalus (NPH) and underwent a resting state magnetoencephalography (MEG) examination. MEG data were recorded in a magnetically shielded room with a whole-head 122 channel biomagnetometer. Following MEG, a ventriculoperitoneal (VP) shunt was placed in his head and greatly improved his symptomatology. Spontaneous MEG recordings revealed lower magnetic fields at frontal and frontotemporal regions compared to central and posterior regions...