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Related Concept Videos

Cerebral Edema ll: Pathophysiology01:22

Cerebral Edema ll: Pathophysiology

Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this barrier loses...
Increased Intracranial Pressure l: Introduction01:14

Increased Intracranial Pressure l: Introduction

Intracranial hypertension is a sustained elevation of intracranial pressure (ICP) above 22 mm Hg. In supine adults, normal ICP is ~7–15 mm Hg.The rigid, nonexpandable cranium contains three components—brain tissue, blood, and cerebrospinal fluid (CSF)—that total ~1,700 mL in a typical adult: 1,400 mL brain (~80%), 150 mL blood (~10%), and 150 mL CSF (~10%). According to the Monro–Kellie doctrine, total intracranial volume is effectively fixed. When one component expands, CSF and venous blood...
Increased Intracranial Pressure ll: Pathophysiology01:29

Increased Intracranial Pressure ll: Pathophysiology

Increased intracranial pressure (ICP) refers to a potentially life-threatening rise in pressure inside the skull. This usually happens when there is a major change in the volume of brain tissue, blood, or cerebrospinal fluid (CSF) — the three components inside the skull. According to the Monro-Kellie doctrine, if the volume of one component increases, the volumes of the other components must decrease to maintain normal pressure. If this does not happen, ICP rises.The process often begins with...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...
Cerebral Edema l: Introduction01:19

Cerebral Edema l: Introduction

Cerebral edema is a pathological increase in brain water content that disrupts intracranial pressure regulation and impairs neurological function. Because the cranial vault is rigid, even modest increases in tissue volume can compromise cerebral perfusion, distort neural structures, and initiate secondary injury. Cerebral edema develops through four principal mechanisms: vasogenic, cytotoxic, interstitial, and ionic.Vasogenic EdemaVasogenic edema arises from disruption of the blood–brain...
Cytotoxic Edema: Pathophysiology01:21

Cytotoxic Edema: Pathophysiology

Cytotoxic edema is a form of cerebral edema characterized by intracellular swelling of neurons, astrocytes, and other glial cells. It develops when the mechanisms responsible for maintaining ionic gradients across the cell membrane become impaired. Under normal physiological conditions, the sodium–potassium ATPase actively transports sodium ions out of the cell and potassium ions into the cell, preserving osmotic balance and enabling electrical signaling. This pump requires a continuous supply...

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Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
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Hydrocephalus in Paget's disease.

A V Moiyadi1, S S Praharaj, V S Pillai

  • 1Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India. aliasgarmoiyadi@yahoo.com

Acta Neurochirurgica
|November 7, 2006
PubMed
Summary

Neurological complications of Paget's disease, like hydrocephalus, are rare but manageable. This case highlights the importance of specialized anesthetic and surgical care for a safe patient outcome.

Area of Science:

  • Neurology
  • Neurosurgery
  • Anesthesiology

Background:

  • Paget's disease of bone can present with rare neurological complications.
  • Hydrocephalus is an infrequent manifestation, often multifactorial in etiology within Paget's disease.

Observation:

  • An elderly patient with Paget's disease developed dementia, gait issues, and incontinence due to hydrocephalus from posterior fossa crowding.
  • The patient required a ventriculo-peritoneal shunt for cerebrospinal fluid (CSF) diversion.

Findings:

  • Surgical and anesthetic procedures in these patients present unique challenges, necessitating specific precautions.
  • Difficult endotracheal intubation and modified surgical techniques were required, ensuring a safe procedure.
  • Immediate improvement in symptoms was observed post-CSF diversion.

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Implications:

  • Timely cerebrospinal fluid diversion is crucial for favorable outcomes in hydrocephalus associated with Paget's disease.
  • Adherence to specific anesthetic and surgical precautions ensures a safe peri-operative period for patients with Paget's disease.
  • This case underscores the need for multidisciplinary care in managing complex neurological presentations of Paget's disease.