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ENG findings of shunt-treated hydrocephalus in children
1Department of Otolaryngology, University of Oulu, Finland.
Insights
Most children with hydrocephalus experience abnormal eye movements and vestibular issues, impacting their motor skills. Early shunting does not prevent these long-term neurological deficits.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Ophthalmology
Background:
- Hydrocephalus is a condition characterized by excess cerebrospinal fluid in the brain's ventricles.
- Shunt placement is a common treatment for hydrocephalus, but long-term neurological effects require further investigation.
- Vestibular and ocular motor functions are crucial for motor control and overall development in children.
Purpose of the Study:
- To assess the prevalence and characteristics of ocular motor and vestibular abnormalities in children with hydrocephalus.
- To investigate the relationship between these abnormalities and motor performance in the pediatric hydrocephalus population.
- To determine if hydrocephalus etiology or sex influences the presence of these neurological deficits.
Main Methods:
- Electronystagmography (ENG) was performed on 38 children with hydrocephalus (mean age 11.5 years) an average of 7.9 years post-shunting.
- ENG included tests for spontaneous/positional nystagmus, eye tracking, saccadic movements, optokinetic, and caloric reactions.
- Neurological examinations assessed motor performance; hydrocephalus etiology was categorized.
Main Results:
- A high prevalence of abnormal ENG findings was observed, with only 13% of children having normal results.
- 82% exhibited central type ENG pathology, and 44% of those studied had abnormal caloric reactions (vestibular pathology).
- 18% of children demonstrated normal motor performance, suggesting a link between vestibular/ocular deficits and motor impairment.
Conclusions:
- Children with hydrocephalus frequently present with significant central and vestibular ocular motor abnormalities, persisting years after shunting.
- These neurological deficits are prevalent across various hydrocephalus etiologies and do not differ between sexes.
- The high incidence of vestibular pathology may contribute to the observed impaired motor performance in this cohort.
Abstract:
Thirty-eight hydrocephalic children (mean age 11.5 years; range 5.1-17.9) were examined on average 7.9 years after initial shunting. The etiology of the hydrocephalus was divided into 5 groups: perinatal intraventricular hemorrhage 14, congenital obstructive hydrocephalus 14, central nervous system infections 4, intracranial cysts 3, and intracranial anomalies 3 children. Electronystagmographic (ENG) examination included recording of spontaneous and positional nystagmus, the pendular eye tracking test, saccadic eye movements, optokinetic and caloric reactions. Only 5 children (13%) had a normal ENG. Thirty-one children (82%) had ENG pathology of the central type and 12 (44%) of the 27 successfully studied had pathological caloric reactions. Ten children (26%) had a combination of both central and vestibular pathology. There was no statistical difference between the boys and the girls or between different etiological groups. The high prevalence of vestibular pathology among these hydrocephalic children may be relevant to their impaired motor performance, because only 7 (18%) of the children studied exhibited normal motor performance in the neurological tests.