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Prognosis in infantile hydrocephalus. Follow-up in adult patients, born 1946-1955
Insights
Long-term outcomes for infantile hydrocephalus reveal persistent neurological deficits and intellectual disability in many adults. Despite surgical interventions, abnormal head growth and motor impairments remain common challenges.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Developmental Pediatrics
Background:
- Infantile hydrocephalus presents significant long-term challenges.
- Early surgical interventions aim to manage cerebrospinal fluid (CSF) dynamics.
- Longitudinal studies are crucial for understanding developmental trajectories.
Purpose of the Study:
- To assess the long-term neurological and developmental outcomes in adults treated for infantile hydrocephalus.
- To evaluate the impact of surgical interventions and disease progression on cognitive and motor functions.
- To investigate correlations between neuroimaging findings and clinical outcomes.
Main Methods:
- Longitudinal follow-up of 26 patients with infantile hydrocephalus from childhood to adulthood (21-32 years).
- Clinical examinations assessing neurological signs, dexterity, and head growth.
- Psychological testing including intelligence quotient (IQ) assessments.
- Computerized tomography (CT) for ventricular-brain ratio (VBR) evaluation.
- Otoneurological investigations, including differential-caloric testing.
Main Results:
- One-third of patients achieved a normal life; half exhibited mental deficiency.
- All patients presented with neurological signs, including poor dexterity and clumsiness.
- Psychological testing showed uneven cognitive profiles in 4 patients (performance IQ < verbal IQ).
- CT scans showed varying degrees of hydrocephalus, with no clear correlation between VBR and IQ or surgical history.
- Abnormal differential-caloric examination (vestibular function) was noted in 60% of patients, asymptomatic.
Conclusions:
- Infantile hydrocephalus frequently leads to persistent neurological and cognitive impairments into adulthood.
- Abnormal head growth can continue post-operatively, indicating ongoing disease activity.
- Vestibular dysfunction is common but often subclinical in this patient cohort.
- Long-term multidisciplinary follow-up is essential for managing the complex needs of individuals with infantile hydrocephalus.
Abstract:
Twenty-six patients with infantile hydrocephalus were re-examined at ages ranging from 21-32 years. Operations had been performed in 11, but abnormal head growth continued post-operatively in 9. One third of the patients lead a normal life, while half of the patients are mentally deficient. All patients have neurological signs, poor dexterity and clumsiness being present in all. Psychological testing reveals uneven profiles, in 4 patients with performance IQ considerably lower than verbal IQ. Computerised tomography demonstrates all degrees of hydrocephalus with no correlation between ventricular-brain ratio and IQ or between ventricular-brain ratio and operative procedures. Full otoneurological investigation shows differential-caloric examination to be abnormal in 60%, although none of the patients have complaints referring to the vestibular system.