Document Detail

Noninvasive detection of the distinction between progressive and compensated hydrocephalus in infants: is it possible?
MedLine Citation:
PMID:  20515327     Owner:  NLM     Status:  MEDLINE    
OBJECT: Clinical signs and symptoms of hydrocephalus can be clear and specific, but also subtle, nonspecific, or even absent. It may be difficult to decide whether shunt placement is indicated, especially in infants. Therefore, there is a need for the development of better noninvasive detection methods to distinguish between compensated and (slowly) progressive hydrocephalus. Early interference can reverse the cerebral damage, whereas the detection of a nonpathological state in infants with compensated hydrocephalus avoids the complications of unnecessary shunt procedures. Using MR imaging, the authors investigated cerebral blood flow (CBF) and apparent diffusion coefficients (ADCs) measured in infants with clinically compensated hydrocephalus. METHODS: The diagnosis of compensated hydrocephalus was made on the basis of clinical criteria, consisting of no signs or symptoms of increased intracranial pressure (ICP), measurement of a normal ICP, and standard MR imaging showing enlarged ventricles. Flow measurements through both internal carotid arteries and the basilar artery were considered to represent the total CBF. In addition, ADC values were assessed in 5 different regions of interest in the brain parenchyma using diffusion weighted imaging. Brain volumetric measurement was performed to express CBF in ml/100 cm(3) brain/min, thus compensating for physiological CBF growth over time. Mean arterial blood pressure was manually measured to exclude this factor as a cause of a possible change in CBF. Intracranial pressure measurement was performed noninvasively using the Rotterdam Teletransducer. RESULTS: Eighteen infants with clinically compensated hydrocephalus were included. The mean CBF was 53.5 ml/100 cm(3) of brain/min. The individual CBF values were graphically compared with age-related normal CBF values and fell in the normal range. Mean ADC value was 890.0 x10(-6) mm(2)/sec. Apparent diffusion coefficient values per region of interest were graphically compared with normal ADC values per region of interest and fell within the normal range. CONCLUSIONS: In infants with hydrocephalus, normal CBF and low ADC values, as measured using MR imaging, are associated with compensated hydrocephalus and may support a conservative approach with respect to the decision on whether to place a shunt.
Paul H Leliefeld; Rob H J M Gooskens; Cees A F Tulleken; Luca Regli; Cuno S P M Uiterwaal; K Sen Han; L Jaap Kappelle
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  5     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-02     Completed Date:  2010-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  562-8     Citation Subset:  IM    
Department of Neurosurgery, University Medical Center Utrecht, G 03.124, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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MeSH Terms
Blood Flow Velocity / physiology
Blood Pressure / physiology
Brain / blood supply*,  pathology
Brain Edema / diagnosis,  physiopathology,  surgery
Cerebrospinal Fluid Shunts*
Diagnosis, Differential
Diffusion Magnetic Resonance Imaging*
Disease Progression
Hydrocephalus / diagnosis*,  physiopathology,  surgery*
Hydrocephalus, Normal Pressure / diagnosis*,  physiopathology,  surgery*
Image Processing, Computer-Assisted*
Infant, Newborn
Intracranial Pressure / physiology*
Magnetic Resonance Angiography*
Magnetic Resonance Imaging*
Organ Size / physiology
Regional Blood Flow / physiology

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

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