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Occult hydrocephalus in children with cerebral palsy

A Leland Albright1, Susan Ferson, Signe Carlos

  • 1Department of Neurosurgery, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. Leland.Albright@chp.edu

Neurosurgery
|December 25, 2004
PubMed

Insights

Children with cerebral palsy and ventriculomegaly often have high cerebrospinal fluid (CSF) pressure, indicating occult hydrocephalus. This increased pressure may explain higher CSF leak rates during intrathecal baclofen therapy.

Area of Science:

  • Neurology
  • Pediatrics
  • Neurosurgery

Background:

  • Cerebral palsy (CP) is frequently associated with chronic ventriculomegaly.
  • Children with CP treated with intrathecal baclofen experience higher rates of cerebrospinal fluid (CSF) leaks compared to adults.
  • The underlying cause for increased CSF leaks in this population is hypothesized to be elevated intracranial pressure.

Purpose of the Study:

  • To investigate the hypothesis that increased CSF pressure (occult hydrocephalus) is responsible for the higher incidence of CSF leaks in children with CP and ventriculomegaly.
  • To assess CSF pressure in children with CP and asymptomatic ventriculomegaly.

Main Methods:

  • Lumbar punctures were conducted on 24 children diagnosed with cerebral palsy and asymptomatic ventriculomegaly.
  • The participants had a median age of 4.7 years.
  • Ventriculomegaly was classified as mild, moderate, or severe.

Main Results:

  • Abnormally high opening pressures were detected in 96% (23 out of 24) of the children.
  • Measured opening pressures ranged from 22 to 41 cm H2O, with a mean of 27.3 cm H2O.
  • No correlation was found between the extent of ventriculomegaly and the measured opening pressures.

Conclusions:

  • Children with cerebral palsy and ventriculomegaly exhibit a high prevalence of elevated CSF pressure, suggesting occult hydrocephalus.
  • This increased pressure is a likely contributor to the heightened risk of CSF leaks during intrathecal baclofen therapy.
  • Further research, including prospective multicenter studies, is warranted to understand the long-term implications and optimal management strategies, such as CSF shunting.
Abstract

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