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Hypodense extracerebral images on computed tomography in children. "External hydrocephalus": a misnomer?
1Department of Neurosurgery, Hamad General Hospital, Doha, Qatar.
Insights
External hydrocephalus (EH) in infants is a heterogeneous condition with varied clinical presentations. This study questions the term EH, proposing "hypodense extracerebral images" for CT findings.
Area of Science:
- Pediatric Neurology
- Neuroradiology
- Developmental Pediatrics
Background:
- External hydrocephalus (EH) is a condition observed in infants, characterized by enlarged extracerebral spaces.
- Previous literature often describes EH with a benign prognosis, but this requires further investigation in diverse infant populations.
Purpose of the Study:
- To compare radiological and clinical features of external hydrocephalus (EH) with cerebral atrophy (CA) in infants under 3 years.
- To evaluate the clinical significance and diagnostic terminology for hypodense extracerebral images in infants.
Main Methods:
- Retrospective analysis of 58 infants diagnosed with external hydrocephalus (EH) between 1986 and 1990.
- Comparison of radiological images and clinical data with 11 cases of cerebral atrophy (CA).
- Inclusion of data from lumbar punctures, cerebrospinal fluid (CSF) flow studies, and metrizamide cisternography in select cases.
Main Results:
- Significant differences were noted between EH and CA groups regarding delivery factors, head circumference, and motor/developmental abnormalities.
- The EH cohort exhibited heterogeneity, with a male predominance and normal intracranial pressure in 15 cases.
- Cerebrospinal fluid (CSF) flow was normal in 6 cases, suggesting varied underlying pathologies.
Conclusions:
- The prognosis for external hydrocephalus (EH) may not be as benign as previously reported, necessitating a re-evaluation of the term.
- The term "hypodense extracerebral images" is proposed as a less committal alternative for computed tomography (CT) findings.
- Encephalocranial disproportion is hypothesized as the fundamental entity underlying these CT images.
Abstract:
External hydrocephalus (EH) was identified in 58 infants under 3 years of age during the period 1 June 1986 to 28 February 1990. Radiological images and clinical features were compared with 11 cases of cerebral atrophy (CA). Significant differences were found in delivery, head circumference, and the incidence of motor and developmental abnormalities. The population with EH was found to be quite heterogeneous, with a male preponderance. Intracranial pressure was normal in 15 cases in which lumbar puncture was done. The flow of cerebral spinal fluid was considered to be within the normal range in 6 cases. The results of a few cases examined with metrizamide cisternography are presented. The prognosis in our cases was not as benign as previously published, and use of the name EH is questioned. The less committal term "hypodense extracerebral images" is proposed when computed tomography (CT) is the only study done. The hypothesis that encephalocranial disproportion is the basic underlying entity for the CT images is proposed.