1/14. An unusual complication of tapping a ventriculoperitoneal shunt.A case is reported describing a complication of an unsuccessful attempt to aspirate the reservoir of a ventriculoperitoneal shunt system with a suspected shunt infection. This arose due to a misunderstanding of the anatomy of the shunt and resulted in an intracerebral haematoma. The complications of cerebrospinal fluid shunting and the difficulty in the diagnosis thereof are outlined. We discuss the role and method of shunt tapping in diagnosing shunt problems before reviewing the literature describing the rationale. The variation in shunt design is emphasized. Guidelines are then proposed not to dissuade physicians from tapping shunts but to ensure that the procedure is performed safely and in collaboration with neurosurgical units.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/14. diagnosis of plasmodium vivax malaria complicated by abnormal neurological imaging.The number of patients presenting with malaria in the united states has increased. This is attributable to the growing ease and popularity of overseas travel. We present a 41-year-old man diagnosed with plasmodium vivax malaria after a 9-month symptom-free interval following return from an endemic area. The clinical picture was complicated by the results of neurological imaging that proved to be incidental and unrelated findings. Unfortunately, there are no pathognomonic signs or symptoms of malaria. The presenting complaints are often nonspecific and may be associated with a broad differential diagnosis. Thus, physicians must have a high index of suspicion and elicit a complete travel history to arrive at the correct diagnosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/14. Radionuclide cisternography in diagnostics of obstruction hydrocephalus in introduced ventriculoperitoneal shunt.BACKGROUND: To confirm or exclude a diagnosis of internal obstruction hydrocephalus in an 8-year old girl with an introduced ventriculoperitoneal (V-P) shunt. CASE REPORT: Establishing the V-P shunt is indisputably the route of choice in non-communicating hydrocephalus. The existence of a V-P shunt, however, is connected with numerous risks, especially of injuries, infection as well as increased intraabdominal pressure--e.g. in pregnancy. The development of endoscopy in neurosurgery allows the creation of communication via the bottom of the third ventricle with basal cisterns, and the subsequent cancellation of a V-P shunt. MATERIAL AND methods: We describe the case of an 8-year old girl with congenital internal hydrocephalus with an assumed obliteration of the Sylvian aqueduct with an established V-P shunt. An MR scan described the membrane in the area of the Sylvian aqueduct, but the disproportion between the dilatation of the lateral ventricles, third ventricle and fourth ventricle led the physician to doubt as to the accuracy of the diagnosis of internal obstruction hydrocephalus. Therefore we performed a radionuclide cisternography (in a modified manner), which proved an existing communication between the third and fourth cerebral ventricle and which contradicted the clinical diagnosis of obstruction hydrocephalus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/14. Infusion technique can be used to distinguish between dysfunction of a hydrocephalus shunt system and a progressive dementia.In a deteriorating shunted patient with hydrocephalus, an investigation of shunt function is often performed to distinguish a dysfunctioning shunt from an aggravated condition of the disease. The paper illustrates how a lumbar cerebrospinal fluid (CSF) infusion method can be used to evaluate post-operative deterioration in a shunted patient in order to give the physician valuable support in the shunt revision decision. A 77-year-old man with hydrocephalus was treated operatively by the insertion of a CSF shunt. Owing to shunt failure, the shunt was revised twice during a 5 year period. Using a computerised infusion technique method, with two needles placed in the lumbar subarachnoid space, the CSF dynamic system was determined pre- and post-operatively with the functioning as well as the dysfunctioning shunts. The data were verified with a bench-test of the extirpated CSF shunt. There was a significant difference in conductance G between CSF systems with an open shunt and CSF systems with no shunt or an occluded shunt (deltaG= 38 mm3 s(-1) kPa(-1), p = 0.014, n= 7, ANOVA). CSF dynamics investigations, with and without a shunt, can give valuable clinical support in the management of a deteriorating hydrocephalus patient. With further development of the lumbar infusion method moving towards easy-to-use equipment, there is potential for widespread clinical use.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/14. Acute symptomatic hydrocephalus in listeria monocytogenes meningitis.listeria monocytogenes meningitis appears to have increased in incidence. Although most reported cases of listeriosis involve the central nervous system, brain computed tomography is usually normal. hydrocephalus is a common complication of tuberculous meningitis, which has a high prevalence in taiwan. However, patients with L. monocytogenes meningitis rarely develop the complication of symptomatic hydrocephalus. We report a patient with L. monocytogenes meningitis who presented with persistent alteration of consciousness after appropriate antimicrobial therapy. Follow-up brain computed tomography revealed acute hydrocephalus. An Ommaya reservoir was implanted, and daily drainage of the cerebrospinal fluid was performed. The patient improved gradually and his mental status recovered completely 4 days later. This case should remind physicians to be aware of the possible occurrence of hydrocephalus in L. monocytogenes meningitis and that prompt cerebrospinal fluid drainage may achieve a good outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/14. papilledema in the assessment of ventriculomegaly.To determine whether ventriculomegaly is associated with ongoing increased intracranial pressure (ICP), physicians often rely on corroborative imaging features such as altered periependymal signal, distortion of ventricular shape, subarachnoid space flattening, and an increase in ventricular size over time. In 2 patients with new headache and altered mental status, symptoms and ventriculomegaly were dismissed as long-standing and not reflective of current ICP elevation. In the first patient, ICP was considered normal because there were no corroborative imaging features of elevated ICP. In the second patient, ICP was considered normal because ventricular size was stable over a 1-year period. The diagnosis of ICP elevation was finally made by ICP monitoring after papilledema was recognized. Ventriculoperitoneal shunting rapidly resolved the papilledema and markedly improved mentation. brain imaging may often be an unreliable guide to the presence of elevated ICP. In such patients, the finding of papilledema is a critical determinant of management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/14. Updates on the diagnosis and management of posttraumatic hydrocephalus.Posttraumatic hydrocephalus is a vital subject for the practitioner caring for patients with traumatic encephalopathy, as a large number of brain trauma patients develop ventricular enlargement. The managing physician should understand which ventriculomegalic patients are suffering from hydrocephalus, which have cerebral atrophy and which stand a reasonable chance of improvement on surgical placement of a ventricular shunt. This paper highlights this decision process in two patients, and offers the physician a practical overview of posttraumatic hydrocephalus and its management.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
8/14. A brief neurobehavioral exam useful for early detection of postoperative complications in neurosurgical patients.This article describes data from 11 patients evaluated before and after neurosurgical intervention for treatment of brain tumor, subdural hematoma and hydrocephalus. The Neurobehavioral Cognitive Status Examination (NCSE) was administered pre- and postoperatively. Improvement was documented by the NCSE in 6 of the 11 patients. In the remaining five patients, there was evidence of deterioration in cognitive functioning. After clinical and diagnostic re-evaluation by the physician, four patients had repeat operations. Follow-up evaluation after the second operation was useful in determining treatable and non-treatable causes of progressive cognitive deterioration. In these patients use of the NCSE may have expedited effective diagnostic evaluation and subsequently improved patient care. Such instruments have clinical utility since they are easily administered, pragmatic, and objectify subtle changes in cognitive functioning which may be early signs of increased intracranial pressure or complications of surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/14. Abdominal complications of ventriculoperitoneal shunts. case reports and review of the literature.Ventriculoperitoneal (VP) shunting of cerebrospinal fluid (CSF) is the standard therapy for the management of hydrocephalus. Before the advent of silastic, early abdominal complications were frequent and finally led to the abandonment of this technique for management of hydrocephalus. With the use of silastic shunt tubing, VP shunts have once again gained favor as the procedure of choice. Although there are now considerably fewer complications from VP shunts, the presence of an intraperitoneal catheter can still initiate various complications. Abdominal complications of VP shunts are reported to be from 10-30 per cent, thus remaining clinically important for early recognition and treatment in patient management. An awareness of these complications is necessary in creating an index of suspicion for the primary physician whose patients harbor a VP shunt and present with abdominal symptoms. This report presents five cases of children with abdominal complications of VP shunts (four pseudocysts and one umbilical granuloma with spontaneous drainage of CSF). Additional abdominal complications of VP shunts are discussed, as well as diagnostic and therapeutic alternatives in order to improve and expedite accuracy in diagnosis and provide simplicity and efficiency in treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/14. Propionibacterium shunt nephritis in two adolescents with medulloblastoma.The anaerobic diphtheroid propionibacterium acnes was identified as the organism responsible for "shunt" nephritis in two adolescents with ventriculoatrial shunts inserted previously for the management of medulloblastoma. Only three cases of "shunt" nephritis secondary to infection with this common skin commensal organism are known to have been reported. The rarity of such reports may be related to the lack of good anaerobic laboratories, the length of time necessary for cultures to show growth, the poor ability of certain blood culture media to support growth of this organism, and the failure of physicians to consider propionibacterium acnes as a true pathogen in certain clinical situations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
| | Next -> |