Document Detail

Evaluation of cerebral vascular reserve by single photon emission tomography in children with congenital hydrocephalus.
MedLine Citation:
PMID:  12776238     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIMS: Single photon emission tomography scan (SPECT) is used to measure cerebral blood flow (CBF) and also cerebral vascular reserve (CVR) after intravenous acetazolamide (ACZ) challenge. This prospective study was designed to test the utility of CVR in congenital hydrocephalus (CHC). METHODS: Patients (n = 21, mean age 6.2 m) with CHC underwent a baseline ultrasonography (US), retinal fundus examination (RF), neurological score (NS), and SPECT to evaluate CVR after intravenous ACZ. Monthly US, RF, NS, CBF, and CVR were evaluated. RESULTS: Ten patients showed good CVR and also had stable NS and RF despite mild to moderate ventriculomegaly and were followed up on conservative treatment. None of these patients in a mean follow-up period of 9.8 months showed deterioration. Eleven patients, who had poor CVR initially, were also treated conservatively. Over a period of 4 months, 8 patients showed a fall in CVR to < 30 % of baseline and a fall in NS despite RF and US remaining the same and hence were operated. Five of these operated cases showed an improvement in CVR and NS over a mean follow-up period of 4 months and the remaining 3 patients failed to show improvement in CVR and NS. CONCLUSIONS: In CHC, CVR measured by ACZ challenge test is a sensitive parameter as alterations in CVR occur prior to changes in other conventional parameters such as ventriculomegaly and RF. Patients with normal CVR at presentation are unlikely to deteriorate and can safely be managed conservatively. Patients who show a deterioration in CVR should be considered for prompt surgery.
A Pratap; M Srinivas; P Hentok; C S Bal; V Bhatnagar
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie     Volume:  13     ISSN:  0939-7248     ISO Abbreviation:  Eur J Pediatr Surg     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-05-30     Completed Date:  2003-09-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9105263     Medline TA:  Eur J Pediatr Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  87-91     Citation Subset:  IM    
The Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.
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MeSH Terms
Brain / blood supply*
Cerebrovascular Circulation*
Hydrocephalus / physiopathology*
Neurologic Examination
Tomography, Emission-Computed, Single-Photon*

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