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[Hydrocephalus in Paget's disease--a case report].

J Ikeda, M Tsuyumu, Y Takada

    No Shinkei Geka. Neurological Surgery
    |May 1, 1986
    PubMed
    Summary

    Paget's disease complicated by hydrocephalus improved after a ventriculoperitoneal shunt. A novel "soft landing maneuver" prevented complications from rapid cerebrospinal fluid pressure changes.

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    Area of Science:

    • Neurology
    • Neurosurgery
    • Endocrinology

    Background:

    • Paget's disease of bone can lead to neurological complications, including hydrocephalus.
    • Basilar impression is a potential complication of Paget's disease, causing increased intracranial pressure.

    Observation:

    • An elderly female with Paget's disease presented with headache, ataxic gait, and dementia.
    • Skull X-ray revealed characteristic "cotton wool appearance"; elevated serum alkaline phosphatase and urinary hydroxyproline confirmed the diagnosis.
    • CT scan showed triventricular dilatation, and neck tomography revealed basilar impression.

    Findings:

    • Calcitonin treatment was discontinued due to side effects, leading to clinical deterioration.
    • A ventriculoperitoneal (V-P) shunt was surgically placed to alleviate hydrocephalus.
    • A "soft landing maneuver" involving gradual pressure reduction and head elevation post-operatively facilitated favorable recovery.

    Implications:

    • Ventriculoperitoneal shunting can be an effective treatment for hydrocephalus in Paget's disease.
    • The "soft landing maneuver" may mitigate risks associated with rapid intracranial pressure changes in patients with basilar impression.
    • This case highlights the importance of managing neurological complications in Paget's disease.

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