Document Detail

The Genesis of Low Pressure Hydrocephalus.
MedLine Citation:
PMID:  21523524     Owner:  NLM     Status:  Publisher    
BACKGROUND: Low pressure hydrocephalus (LPH) is an uncommon entity. Recognition of this treatable condition is important when clinicians are faced with the paradox of symptomatic hydrocephalus despite low intracranial pressures (ICP). Its etiology remains enigmatic. METHODS: We identified patients with LPH from the prospective, inpatient neuro-intensive care database over a 4-year period (2006-2010). RESULTS: Nine patients with LPH were identified over a 4-year period. The time from diagnosis of the initial neurosurgical condition to development of LPH varied from 7 days to 5 years. The sub-zero drainage method of Pang and Altschuler was successful in all cases. LPH was accompanied by transependymal edema in five patients despite low ICP. Four patients developed LPH during their initial admission for intracranial bleeding. As patients entered the LPH state, the ICP remained in a normal range yet daily CSF output from the external ventricular drain was reduced. When LPH patients were drained at sub-zero levels, daily CSF output exceeded baseline values for several days and then receded to baseline. Long-term management was achieved with low pressure shunt systems: six programmable shunts; one valveless ventriculoperitoneal shunt; two ventriculopleural shunts. Conditions most commonly associated with LPH are: subarachnoid hemorrhage, chronic hydrocephalus, brain tumors, and chronic CNS infections. CONCLUSIONS: Low pressure hydrocephalus is a challenging diagnosis. The genesis of LPH was associated with a drop in EVD output, symptomatic ventriculomegaly, and a remarkable absence of intracranial hypertension. When LPH was treated with the sub-zero method, a 'diuresis' of CSF ensued. These observations support a Darcy's flux of brain interstitial fluid due to altered brain poroelastance; in simpler terms, a boggy brain state.
Paul T Akins; Kern H Guppy; Yekaterina V Axelrod; Indro Chakrabarti; James Silverthorn; Alan R Williams
Related Documents :
21240644 - The relationship between aortic baroreceptor activity and arterial pressure is not mono...
21473934 - Fetal development of baroreflex sensitivity: the chicken embryo as a case model.
21497644 - Radial die-wall pressure as a reliable tool for studying the effect of powder water act...
21514044 - Temperature and pressure influence on maximum rates of pressure rise during explosions ...
16269964 - Blockade of angiotensin ii provides additional benefits in hypertension- and ageing-rel...
16666084 - Pressure probe technique to study transpiration in phycomyces sporangiophores.
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-27
Journal Detail:
Title:  Neurocritical care     Volume:  -     ISSN:  1556-0961     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101156086     Medline TA:  Neurocrit Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Neurosurgery, Kaiser Sacramento Medical Center, Permanente Medical Group, 2025 Morse Avenue, Sacramento, CA, 95825, USA,
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  The Ketogenic Diet for Medically and Surgically Refractory Status Epilepticus in the Neurocritical C...
Next Document:  Limitations of Threshold-Based Brain Oxygen Monitoring for Seizure Detection.