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Neurology India 2021Post-infective hydrocephalus (PIH) arises as a complication of any CNS infection, and can be either communicating or noncommunicating. (Review)
Review
BACKGROUND
Post-infective hydrocephalus (PIH) arises as a complication of any CNS infection, and can be either communicating or noncommunicating.
OBJECTIVE
The aim of this article is to study the various causes of PIH and its pathophysiology and treatment.
MATERIAL AND METHODS
The literature was searched for articles describing the causes of PIH.
RESULTS
Common causes of PIH are CNS tuberculosis (TB), neurocysticercosis, and perinatal or neonatal infection. TBM is most likely to result in hydrocephalus out of all these manifestations of CNS TB, and hydrocephalus is more likely to occur early in the course, typically 4-6 weeks after the onset of TBM, and is more common among children as compared to adults. A trial of medical management (antitubercular therapy, steroids, and decongestants) can be given to patients with communicating hydrocephalus. Ventriculoperitoneal shunt is the most employed method of CSF diversion in these patients. Though traditionally considered contraindicated, many recent studies have found ETV to be a reasonable option in patients with PIH. HCP in patients with neurocysticercosis can be associated with intraventricular cysts and racemose cysts in the basal subarachnoid cisterns. Surgical intervention is required either for cyst removal or CSF diversion. Endoscopic approaches can be used to remove the intraventricular cysts, which takes care of the HCP. PIH in infants can result either from antenatal infections (TORCH infections) or postnatal infections such as meningitis.
CONCLUSIONS
Management of PIH can be challenging. Management has to be individualized.
Topics: Adult; Child; Female; Humans; Hydrocephalus; Infant; Infant, Newborn; Neurocysticercosis; Pregnancy; Subarachnoid Space; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 35102983
DOI: 10.4103/0028-3886.332273 -
Cellular and Molecular Life Sciences :... Mar 2021Cerebrospinal fluid (CSF) is produced by the choroid plexuses within the ventricles of the brain and circulates through the subarachnoid space of the skull and spinal... (Review)
Review
Cerebrospinal fluid (CSF) is produced by the choroid plexuses within the ventricles of the brain and circulates through the subarachnoid space of the skull and spinal column to provide buoyancy to and maintain fluid homeostasis of the brain and spinal cord. The question of how CSF drains from the subarachnoid space has long puzzled scientists and clinicians. For many decades, it was believed that arachnoid villi or granulations, outcroppings of arachnoid tissue that project into the dural venous sinuses, served as the major outflow route. However, this concept has been increasingly challenged in recent years, as physiological and imaging evidence from several species has accumulated showing that tracers injected into the CSF can instead be found within lymphatic vessels draining from the cranium and spine. With the recent high-profile rediscovery of meningeal lymphatic vessels located in the dura mater, another debate has emerged regarding the exact anatomical pathway(s) for CSF to reach the lymphatic system, with one side favoring direct efflux to the dural lymphatic vessels within the skull and spinal column and another side advocating for pathways along exiting cranial and spinal nerves. In this review, a summary of the historical and contemporary evidence for the different outflow pathways will be presented, allowing the reader to gain further perspective on the recent advances in the field. An improved understanding of this fundamental physiological process may lead to novel therapeutic approaches for a wide range of neurological conditions, including hydrocephalus, neurodegeneration and multiple sclerosis.
Topics: Animals; Arachnoid; Cerebrospinal Fluid; Cranial Nerves; Ethmoid Bone; Humans; Lymph Nodes; Lymphatic Vessels; Spine
PubMed: 33427948
DOI: 10.1007/s00018-020-03706-5 -
Asia Oceania Journal of Nuclear... 2023This series lists a pictorial quiz pertaining to identification of normal and abnormal anatomical structures and landmarks at a given level on computed tomography (CT)....
This series lists a pictorial quiz pertaining to identification of normal and abnormal anatomical structures and landmarks at a given level on computed tomography (CT). Readers are expected to identify and appreciate the changes from normal anatomy and variations of a given pathology. The main structures assessed in this quiz are the pons, ventricular system of the brain, and the basal cisterns. Particular emphasis is placed on the presentations of intra-cranial haemorrhages, particularly sub-arachnoid and epidural haemorrhages, and masses around the region of the pons, midbrain and cerebellum. There is also a question pertaining to increased intracranial pressure. Differential diagnoses are also given where necessary to guide clinical practice and further learning. A Points to remember section details key clinical pearls. Furthermore, key resources have been cited as recommendations for further reading. It is anticipated that this series will enhance the understanding of sectional anatomy of the brain to aid in brain CT interpretation.
PubMed: 36619182
DOI: 10.22038/AOJNMB.2022.55248.1382 -
Journal of the Belgian Society of... Jun 2021This case shows the MRI and CT features of a rare entity, namely arachnoiditis ossificans, which should be recognized in patients with long-standing history of multiple...
This case shows the MRI and CT features of a rare entity, namely arachnoiditis ossificans, which should be recognized in patients with long-standing history of multiple spine surgery.
PubMed: 34164602
DOI: 10.5334/jbsr.2458 -
Child's Nervous System : ChNS :... Nov 2021Multiple names within the literature refer to a clinical picture affecting infants and consisting of a large or fast growing head circumference with enlarged cortical... (Review)
Review
PURPOSE
Multiple names within the literature refer to a clinical picture affecting infants and consisting of a large or fast growing head circumference with enlarged cortical subarachnoid spaces (CSAS) while cranial sutures are open. This myriad of terms demonstrates the confusion about the entity, that may even group together different etiological processes. In this review, we aim to shed light on this matter in an effort to restate the defining features of the clinical picture and sum the evidence and current understanding of its pathophysiology and related imaging findings.
METHODS
Extensive and updated review of the literature with special focus on defining features, clinical history with long term evaluation and pathophysiological process.
RESULTS
Functional and molecular CSF studies as well as clinical evidence challenges the common pathophysiological theory based on non-functional arachnoid villi. Conversely, there is increasing evidence supporting cerebro-venous system abnormalities as the main pathophysiological factor. Additionally, long term cohorts studies show that it may have subtle but irreversible neurodevelopmental consequences.
CONCLUSION
Subarachnomegaly is an age-related condition of the infancy with radiological enlargement of CSAS and often self limiting course. However, considering the evidence on pathophysiology as outlined herein and long term outcome reports, further research effort is needed to assess the consequences of venous outflow impairment and enlarged CSAS and how this relates to imaging findings and neurodevelopment test results later in life.
Topics: Humans; Hyperemia; Infant; Subarachnoid Space
PubMed: 34687332
DOI: 10.1007/s00381-021-05328-z -
Current Opinion in Infectious Diseases Oct 2020Subarachnoid neurocysticercosis (SUBNCC) is caused by a morphologically unique proliferative form of Taenia solium involving the subarachnoid spaces. Prolonged therapy... (Review)
Review
PURPOSE OF REVIEW
Subarachnoid neurocysticercosis (SUBNCC) is caused by a morphologically unique proliferative form of Taenia solium involving the subarachnoid spaces. Prolonged therapy based upon the pathophysiology of SUBNCC and long-term follow-up have shed light on the course of disease and led to highly improved outcomes.
RECENT FINDINGS
SUBNCC has a prolonged incubation period of between 10 and 25 years characterized by cyst proliferation and growth and invasion of contiguous spaces leading to mass effect (Stage 1). With induction of the host-immune responses, cysts degenerate leading to a predominately inflammatory arachnoiditis (Stage 2) causing hydrocephalus, infarcts, and other inflammatory based neurological manifestations. Inactive disease (Stage 3) may occur naturally but mostly is a result of successful treatment, which generally requires prolonged intensive anthelminthic and antiinflammatory treatments. Cerebral spinal fluid cestode antigen or cestode DNA falling to nondetectable levels predicts effective treatment. Prolonged treatment with extended follow-up has resulted in moderate disability and no mortality. Repeated short intensive 8-14-day courses of treatment are also used, but long-term outcomes and safety using this strategy are not reported.
SUMMARY
SUBNCC gives rise to a chronic arachnoiditis. Its unique ability to proliferate and induce inflammatory responses requires long-term anthelmintic and antiinflammatory medications.
Topics: Animals; Anthelmintics; Anti-Inflammatory Agents; Antigens, Helminth; Arachnoiditis; Humans; Magnetic Resonance Imaging; Neurocysticercosis; Subarachnoid Space; Taenia solium
PubMed: 32868512
DOI: 10.1097/QCO.0000000000000669