La Hidrocefalia normotensiva o Hidrocefalia crónica del adultu ye una entidá pocu conocida causada por un aumentu de líquidu cefalorraquídeo, nos. Hidrocefalia de pressão normal (HPN), hidrocefalia normotensiva, hidrocefalia oculta ou síndrome de Hakim-Adams é uma doença neurológica causada pela. Transcript of Hidrocefalia Normotensiva. Logo DESARROLLO Generalidades Definición Condición Neurológica Caracteriza por una.
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Discussion We selected a subgroup of patients who demonstrated four of the most commonly accepted predictors of poor outcome following shunt surgery. Complications in the early postoperative period 1st month after shunt placement and at 6 months after shunt insertion were evaluated by the neurosurgeon in charge of the patient. The comparisons between the poor prognosis group and the good prognosis group for percentage of change in each clinical and neuropsychological variable showed no significant differences; however, a tendency emerged toward more improvement in patients with poor prognosis in gait functioning NPH gait: Of the remaining gidrocefalia patients with NPH who had received shunts, we selected a subgroup with four of the factors traditionally considered to be markers of poor prognosis: Bar graphs demonstrating baseline conditions and clinical conditions after surgery according to the NPH scale.
If discrepancies were found between the evaluations of the neurosurgeon and the neuropsychologist, the patient was reevaluated and the final score was agreed on by consensus. We found that the factors clearly related to better neuropsychological and functional recovery after shunt procedures included the presence of a complete clinical triad, obliterated or normal cortical sulci size, and periventricular lucencies.
Many authors have reported a slight or moderate improvement in patients with NPH following shunt nlrmotensiva 10, 34 more recently, however, authors have found a high proportion of good results when hidrocefalja diagnostic and treatment protocols were applied. We believe these results to be related to the diagnostic and treatment protocols used in this study. Independently of the R out values, patients with active or compensated hydrocephalus were selected for shunt placement.
Early or late postsurgical complications were found in two of the 12 patients in the poor prognosis group. In a recent paper, 24 normotensivva of our department studied the influence of several known prognostic factors in patients with a confirmed hidrovefalia of NPH.
A differential low-pressure valve system was implanted in all patients.
Authors of recent reports in the literature stress the fact that NPH can be highly heterogeneous. All patients underwent complete neurological, neuroimaging, and neuropsychological evaluations prior to surgery and were reassessed at 6 months postoperation.
In this subgroup of patients, ambulation was started on the 3rd day after shunt insertion. A highly significant improvement was seen in gait and sphincter functioning as well as in almost all daily life activity and functional scales. Clinically, the patient showed a predominance of gait alterations and urinary incontinence, with subtle recent memory deficit and no other symptomatology.
Because a small change in the NPH scale score represents a substantial change in the patient’s functional status, we defined moderate improvement as a onepoint increase and marked improvement as an increase of two or more points.
Hidrocefalia de pressão normal
Subcategories This category has the following 2 subcategories, out of 2 total. Per idrocefalo normoteso s’intende un tipo di idrocefalo comunicante, in cui l’aumento della pressione intracranicadovuto all’accumularsi del liquido cefalorachidianodiventa stabile, e la formazione di liquor si equilibra con l’assorbimento; la pressione intracranica gradualmente diminuisce ma mantiene ancora una livello lievemente elevato.
Five patients had active hydrocephalus Fig. In our experience, continuous ICP monitoring is mandatory when, despite compatible clinical and radiological data, the tap test is negative or the R out is within a normal range. The disease affects three main areas—gait, sphincter control, and cognitive functioning—which were evaluated according to the NPH scale Table 3.
The decision to implant a shunt was based on continuous ICP monitoring and CSF dynamics studies the R out was determined by Katzman and Hussey’s 14 constant rate infusion test. Evacuation of the subdural collection was performed without sequelae. Two patients died of unrelated causes pulmonary neoplasm and cardiac infarct before the follow-up assessment.
Although different types of shunt were used in this series, all of them included a valve in the low pressure category. Statistical significance was noted at a probability level less than or equal to 0. Nonparametric analyses were used. Improvements in neuropsychological and behavioral features were analyzed using the percentage of change between baseline and postoperative scores.
Although this procedure restricted us to only 12 patients, the results were highly demonstrative. No worsening was observed in any patients Table 5 and Fig. Light gray barsbefore surgery; dark gray bars6 months after surgery.
The percentage of B waves that patients with NPH can demonstrate is highly variable; in the present series, we found wide variation in the percentage of B waves in patients who improved after shunt procedures. Clinical Assessment The disease affects three main areas—gait, sphincter control, and cognitive functioning—which were evaluated according to the NPH scale Table 3.
Hidrocefalia normotensiva – Wikipedia
No statistically significant improvement was found in the cognitive subcomponent Table 6. Before treatment, 10 patients had the complete clinical triad, one patient had cognitive dysfunction only, and another patient had gait and cognitive disturbances but no sphincter incontinence.
A Delta valve with a performance level of 0. Tables 1 and 2 show the clinical and demographic description of the 12 patients who met the poor prognosis selection criteria and the rest of the 44 patients who composed the good prognosis group.
A low-pressure diaphragm valve American Heyer-Schulte Corp. Excluding these patients from surgery means that progressive deterioration is inevitable and will likely have an adverse effect on the quality of life of many patients and their families. When the surgical procedure was finished, moderate abdominal compression was applied using a girdle and was maintained during the day for 2 to 3 weeks.
Retrieved from ” https: Neuropsychological Assessment and Daily Life Activities Evaluation The neuropsychological examination included tests of verbal and visual memory, speed of mental processing, and frontal lobe functioning as well as a brief screening test for dementia. Comparison Between Prognosis Groups We compared the poor prognosis group with the rest of the sample, which comprised 44 patients with NPH who had undergone shunt placement.
Conclusions In this study we selected a subgroup of patients with some of the traditionally accepted predictors of poor outcome. Surgical Management Protocol The surgical management protocol, which has recently been reported, 24 included several peri- and postoperative maneuvers to minimize secondary complications. This factor would explain the poor improvement in cognition in comparison to gait and sphincter changes.
There was no treatment-related death. A percentage of change between baseline and postoperative conditions was also calculated as follows: Computerized tomography scans left and ICP readings right from a patient with NPH before upper and after lower a shunt procedure.