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Intracranial pressure changes in arrested hydrocephalus
Insights
Many children with arrested hydrocephalus experience dangerous intracranial hypertension. Continuous monitoring of intracranial pressure (ICP) and cognitive tests are crucial for ongoing assessment of this progressive disorder.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Neuroscience
Background:
- Arrested hydrocephalus is often diagnosed clinically.
- Previous treatment with cerebrospinal fluid diversion may lead to shunt malfunction.
Purpose of the Study:
- To evaluate the utility of continuous intracranial pressure (ICP) monitoring in children and adolescents with clinically diagnosed arrested hydrocephalus.
- To determine the prevalence of intracranial hypertension in this patient population.
Main Methods:
- Continuous ICP monitoring was performed on 46 children and adolescents with arrested hydrocephalus.
- Patients were divided into two groups: those with prior cerebrospinal fluid diversion (Group A) and those without (Group B).
- Serial psychometric testing was conducted to assess cognitive functioning.
Main Results:
- 80% of Group A and 63% of Group B patients exhibited intracranial hypertension.
- ICP monitoring revealed decompensation in 25% of patients with initially normal or equivocal ICP.
- Abnormal ICP was detected in 88% of patients with declining cognitive function.
Conclusions:
- Apparent arrested hydrocephalus can be an insidiously progressive disorder.
- Continuous ICP monitoring and serial psychometric evaluation are essential for managing arrested hydrocephalus.
- These monitoring methods aid in detecting decompensation and guiding treatment decisions.
Abstract:
Continuous intracranial pressure (ICP) monitoring was used to assess 46 children and adolescents in whom a clinical diagnosis of arrested hydrocephalus had been made. Thirty patients (Group A) had previously been treated with cerebrospinal fluid diversion and 16 patients (Group B) had no prior treatment of their hydrocephalus. All patients in Group A either had a confirmed nonfunctioning shunt or had undergone shunt removal. Continuous ICP monitoring showed that 80% of the patients in Group A and 63% of those in Group B had episodic or persistent intracranial hypertension. In four patients (25%) whose initial ICP had been normal or equivocal, repeat ICP monitoring later revealed decompensation or reversal of arrest. When serial psychometric testing demonstrated a fall in cognitive functioning, ICP monitoring revealed abnormal ICP's in 88% of patients. This study shows that many patients with apparent arrest of hydrocephalus in fact have an insidiously progressive disorder. Monitoring of ICP and serial psychometric evaluation are therefore valuable tools in the continuing assessment of arrested hydrocephalus.