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Neurology India 2021Malignant meningitis (MM) is the diffuse involvement of the leptomeninges by infiltrating cancer cells, most frequently from lung and breast cancers. This review is... (Review)
Review
Malignant meningitis (MM) is the diffuse involvement of the leptomeninges by infiltrating cancer cells, most frequently from lung and breast cancers. This review is aimed to discuss the current advances in the diagnosis and management of MM, along with management of MM-associated hydrocephalus. We reviewed the literature using PubMed and Google Scholar search engines, focusing on various recent randomized controlled trials and clinical trials on MM. Given the hallmark multifocal involvement, the clinical symptoms and signs are also random and asymmetric. There are three important pillars for establishing a diagnosis of MM: clinical examination, neuroimaging, and CSF cytological findings. Several factors should be considered in decision-making, including performance status, neurological findings (clinical, MRI, and CSF flow dynamic), and evaluation of the primary tumor (nature and systemic dissemination). Response Assessment in Neuro-Oncology (RANO) working group recommended the objective assessment of disease for evaluating the progression and response to therapy. Pillars of current management are mainly focal irradiation and intrathecal or systemic chemotherapy. Symptomatic hydrocephalus is managed with a ventriculoperitoneal shunt, lumboperitoneal shunt, or endoscopic third ventriculostomy as palliative procedures, providing significant improvement in performance scores in the limited survival time of patients with MM. Studies using novel therapeutic approaches, such as new biological or cytotoxic compounds, are ongoing. Despite the use of all the combinations, the overall prognosis remains grim; therefore, decision-making for treatment should predominantly be based on attaining an optimal quality of life.
Topics: Breast Neoplasms; Female; Humans; Hydrocephalus; Meningeal Carcinomatosis; Meningitis; Quality of Life
PubMed: 35103001
DOI: 10.4103/0028-3886.332278 -
International Journal of Molecular... Dec 2016The aquaporin (AQP) family of water channels are a group of small, membrane-spanning proteins that are vital for the rapid transport of water across the plasma membrane.... (Review)
Review
The aquaporin (AQP) family of water channels are a group of small, membrane-spanning proteins that are vital for the rapid transport of water across the plasma membrane. These proteins are widely expressed, from tissues such as the renal epithelium and erythrocytes to the various cells of the central nervous system. This review will elucidate the basic structure and distribution of aquaporins and discuss the role of aquaporins in various neuropathologies. AQP1 and AQP4, the two primary aquaporin molecules of the central nervous system, regulate brain water and CSF movement and contribute to cytotoxic and vasogenic edema, where they control the size of the intracellular and extracellular fluid volumes, respectively. AQP4 expression is vital to the cellular migration and angiogenesis at the heart of tumor growth; AQP4 is central to dysfunctions in glutamate metabolism, synaptogenesis, and memory consolidation; and AQP1 and AQP4 adaptations have been seen in obstructive and non-obstructive hydrocephalus and may be therapeutic targets.
Topics: Animals; Aquaporins; Brain Edema; Cell Movement; Epilepsy; Humans; Hydrocephalus; Water-Electrolyte Balance
PubMed: 28036023
DOI: 10.3390/ijms18010055 -
Journal of Postgraduate Medicine 2024
Topics: Humans; Hydrocephalus
PubMed: 38197334
DOI: 10.4103/jpgm.jpgm_780_23 -
Neurology India 2021Hydrocephalus is characterized by the increased volume of cerebrospinal fluid (CSF) with enlarged cerebral ventricles. In nearly 50% of the patients, if left untreated,... (Review)
Review
Hydrocephalus is characterized by the increased volume of cerebrospinal fluid (CSF) with enlarged cerebral ventricles. In nearly 50% of the patients, if left untreated, the balance between CSF production and absorption is achieved, resulting in arrested hydrocephalus (AH). However, 15% of them who are diagnosed as arrested can progress over a period of time. Importantly, a large fraction of patients with hydrocephalus in India, may not have access to tertiary level care. Therefore, both progressive hydrocephalus and insidious progression of AH with related mortality and morbidity could be higher in India. The pathophysiology behind AH and insidious progression of AH are poorly established. Unfortunately, there are no established clinical or radiological parameters identifying or predicting AH from progressive hydrocephalous. Diagnosis is often based on a combination of neurological, psychometric, and magnetic resonance imaging (MRI) findings. Invasive monitoring of intracranial pressure (ICP) and telemetric ICP measurement is increasingly helping surgeons to detect insidious progressive AH in the early stages. In patients with AH, surgery may not be always necessary and a conservative approach is often adopted. On the contrary, AH that becomes progressive may require intervention. Surgical intervention should not be delayed and endoscopic third ventriculostomy (ETV) is preferable over shunt placement. Importantly, comprehensive counseling and the appropriate selection of patients are pivotal in improving outcomes and reducing complications.
Topics: Humans; Hydrocephalus; India; Intracranial Pressure; Magnetic Resonance Imaging; Ventriculostomy
PubMed: 35102985
DOI: 10.4103/0028-3886.332262 -
Neurologia Medico-chirurgica 2010Classification of hydrocephalus is the most crucial but the most complicated academic challenge within the hydrocephalus research field. The major difficulty in this... (Review)
Review
Classification of hydrocephalus is the most crucial but the most complicated academic challenge within the hydrocephalus research field. The major difficulty in this challenge arises from the fact that the classification is based on almost all subjects in hydrocephalus research, i.e., definition and terminology of hydrocephalus, pathophysiology, hydrocephalus chronology, specific forms of hydrocephalus, associated congenital anomalies/syndrome and underlying conditions, diagnostic procedures for hydrocephalus, and treatment modalities in hydrocephalus. The current status of the classification of hydrocephalus in individual subgroups was reviewed and summarized from publications in the last 60 years (1950-2010), and discussed focusing on the variety of characteristics in hydrocephalus, with more and more new aspects recently disclosed not only in fetal and pediatric but also in adult hydrocephalus. A recently-reported classification of hydrocephalus, "Multi-categorical Hydrocephalus Classification" provides comprehensive coverage of the entire aspects of hydrocephalus with current important classification categories and subtypes.
Topics: Adult; Cerebral Ventricles; Female; Humans; Hydrocephalus; International Classification of Diseases; Pregnancy; Subarachnoid Space
PubMed: 20885121
DOI: 10.2176/nmc.50.859 -
BMC Neuroscience May 2022The kaolin induced obstructive hydrocephalus (OHC) model is well known for its ability to increase intracranial pressure (ICP) in experimental animals. Papilledema (PE)...
BACKGROUND
The kaolin induced obstructive hydrocephalus (OHC) model is well known for its ability to increase intracranial pressure (ICP) in experimental animals. Papilledema (PE) which is a predominant hallmark of elevated ICP in the clinic has not yet been studied in this model using high-resolution digital fundus microscopy. Further, the long-term effect on ICP and optic nerve head changes have not been fully demonstrated. In this study we aimed to monitor epidural ICP after induction of OHC and to examine changes in the optic disc. In addition, we validated epidural ICP to intraventricular ICP in this disease model.
METHOD
Thirteen male Sprague-Dawley rats received an injection into the cisterna magna containing either kaolin-Ringer's lactate suspension (n = 8) or an equal amount of Ringer's lactate solution (n = 5). Epidural ICP was recorded post-operatively, and then continuously overnight and followed up after 1 week. The final epidural ICP value after 1 week was confirmed with simultaneous ventricular ICP measurement. Optic disc photos (ODP) were obtained preoperatively at baseline and after one week and were assessed for papilledema.
RESULTS
All animals injected with kaolin developed OHC and had significant higher epidural ICP (15.49 ± 2.47 mmHg) compared to control animals (5.81 ± 1.33 mmHg) on day 1 (p < 0.0001). After 1 week, the epidural ICP values were subsided to normal range in hydrocephalus animals and there was no significant difference in epidural ICP between the groups. Epidural ICP after 1 week correlated with the ventricular ICP with a Pearson's r = 0.89 (p < 0.0001). ODPs from both groups showed no signs of acute papilledema, but 5 out of 8 (62.5%) of the hydrocephalus animals were identified with peripapillary changes.
CONCLUSIONS
We demonstrated that the raised ICP at day 1 in the hydrocephalus animals was completely normalized within 1 week and that epidural ICP measurements are valid method in this model. No acute papilledema was identified in the hydrocephalus animals, but the peripapillary changes indicate a potential gliosis formation or an early state of a growing papilledema in the context of lateral ventricle dilation and increased ICP.
Topics: Animals; Hydrocephalus; Intracranial Pressure; Kaolin; Male; Optic Disk; Papilledema; Rats; Rats, Sprague-Dawley; Ringer's Lactate
PubMed: 35606718
DOI: 10.1186/s12868-022-00716-w -
Neurology India 2021Tuberculous meningitis (TBM) is associated with high mortality. A large proportion of patients with TBM, who survive, live with disabling neurological sequelae.... (Review)
Review
Tuberculous meningitis (TBM) is associated with high mortality. A large proportion of patients with TBM, who survive, live with disabling neurological sequelae. Hydrocephalus is one of the common complications of TBM, seen in up to 80% of patients. Hydrocephalus may be a presenting feature or may develop paradoxically after the commencement of antituberculosis treatment. The Hallmark pathological feature of TBM is a thick gelatinous exudate, dominantly present at basal parts of the brain. Exudate encases and strangulates cranial nerve trunks like optic nerve, optic chiasma, and vessels of the circle of Willis. Basal exudate also blocks the cerebrospinal fluid (CSF) flow in the brain, resulting in ventriculomegaly. It is often difficult to differentiate between two common types (communicating and obstructive) of hydrocephalus on basis of routine neuroimaging. Progressive hydrocephalus, clinically manifests with a potentially life-threatening high intracranial pressure. Patients with deteriorating vision loss and deteriorating consciousness, often need a surgical CSF diversion procedure (ventriculoperitoneal shunt or endoscopic third ventriculostomy) to be performed. CSF diversion may be life-saving. However, the long-term benefits of CSF diversion are largely unknown.
Topics: Brain; Humans; Hydrocephalus; Tuberculosis, Meningeal; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 35102984
DOI: 10.4103/0028-3886.332275 -
Annals of the Royal College of Surgeons... Jan 1953
Topics: Humans; Hydrocephalus
PubMed: 13017507
DOI: No ID Found -
Journal of Neurology May 2022Hydrocephalus is reported in approximately one-tenth of neurosarcoidosis patients. However, data on clinical characteristics and outcome are lacking. In this...
Hydrocephalus is reported in approximately one-tenth of neurosarcoidosis patients. However, data on clinical characteristics and outcome are lacking. In this retrospective study, we present 11 patients with neurosarcoidosis and hydrocephalus on neuroimaging. Median age was 52 years and seven were female (64%). Presenting symptoms consisted of headache in 8 out of 11 (73%), vertigo in 5 (46%), gait abnormalities in 4 (36%), diplopia in 2 (18%) and decreased visual acuity in 1 (9%). Cranial imaging showed obstructive hydrocephalus in 10 (91%) and non-obstructive hydrocephalus in 1 (9%) out of 11, obstruction occurred at the level of the fourth ventricle in 6 out of 10 (60%). Treatment consisted of glucocorticoids in all the patients with additional methotrexate or azathioprine in 6 (55%) and infliximab in 1 (9%) patient. Neurosurgical intervention was performed in 10 out of 11 (91%) patients. Treatment led to remission, improvement or stabilization of disease in 9 out of 10 (90%) of patients. One patient died due to cerebral herniation despite neurosurgical decompression and CSF shunting. Median modified Rankin scale score at last follow-up was 2 (range 0-6). A systematic review and meta-analysis of studies on hydrocephalus due to neurosarcoidosis identified 36 patients that compared to our patients had a lower median age at onset and a higher mortality. Acute obstructive hydrocephalus due to neurosarcoidosis is a potentially fatal medical emergency requiring neurosurgical intervention and initiation of immunosuppressive therapy. If patients survive the initial phase, the outcome is generally favorable.
Topics: Central Nervous System Diseases; Female; Humans; Hydrocephalus; Male; Middle Aged; Retrospective Studies; Sarcoidosis; Systematic Reviews as Topic; Treatment Outcome
PubMed: 34743227
DOI: 10.1007/s00415-021-10882-2 -
Ugeskrift For Laeger Aug 2021Endoscopic treatment of hydrocephalus provides an opportunity to reach deeply located intraventricular obstacles and, as such, it is currently the primary treatment for... (Review)
Review
Endoscopic treatment of hydrocephalus provides an opportunity to reach deeply located intraventricular obstacles and, as such, it is currently the primary treatment for obstructive hydrocephalus in Denmark. This review provides an overview of conditions treatable with endoscopic neurosurgery including the surgical principles, success rate and challenges with this neurosurgical procedure.
Topics: Endoscopy; Humans; Hydrocephalus; Neurosurgery; Neurosurgical Procedures; Treatment Outcome
PubMed: 34477093
DOI: No ID Found