Consideraciones sobre el hidrocefalo de baja presion

Herskovits, E.; Matera Jr., R.; Matera, R.

doi:10.1590/S0004-282X1976000400007

Resúmenes

Se analizan las condiciones fisiopatológicas del sindrome de hidrocéfalo de presión normal. De un grupo de 21 pacientes con sintomatologia clínica correspondiente a esta entidad, se seleccionan 10 que presentan un diagnóstico clínico, radiológico y cisternográfico indudable de la entidad en estudio. Se observó que, a pesar de esta selección solamente un 50% de ellos se vió beneficiado con la colocación de una válvula de baja presión. Surge entonces la hipotésis de que este cuadro es un sindrome multicausal; que por un proceso fisiopatogenico común produce un cuadro clínico, radiológico y cisternográfico similar y que serían beneficiados únicamente aquellos enfermos en los que se soluciona el problema mecánico.

The physiopathological conditions of the normal pressure hydrocephalus syndrome are analysed. Within a group of 21 patients with clinical sinto- mathology pertaining this entity, only were 10 selected with a clinical, radiological and cisternografic indubitable diagnosis. It has been noticed that in spite of the stricked selection only a 50% of them have been beneficed by the application of a low pressure valve. Then, the hypothesis that the disease is a multicausal syndrome appears, which by an identical physiopathologic process produces or exhibits a similar clinical, radiological and cisternographic picture. Only those patients on whom the mechanical problem is solved would be beneficed by neurosurgery.

Consideraciones sobre el hidrocefalo de baja presion

Considerations on low pressure hydrocephalus

E. Herskovits^II; R. Matera Jr.^I; R. Matera^III

^ICentro de Investigaciones Neurológicas, Buenos Aires, Argentina: Médico residente, Neurologia

IICentro de Investigaciones Neurológicas, Buenos Aires, Argentina: Professor Auxiliar de Clinica Neurológica U.N.B.A.

^IIICentro de Investigaciones Neurológicas, Buenos Aires, Argentina: Professor Titular de Neurocirugía U.N.B.A.

RESUMEN

Se analizan las condiciones fisiopatológicas del sindrome de hidrocéfalo de presión normal. De un grupo de 21 pacientes con sintomatologia clínica correspondiente a esta entidad, se seleccionan 10 que presentan un diagnóstico clínico, radiológico y cisternográfico indudable de la entidad en estudio. Se observó que, a pesar de esta selección solamente un 50% de ellos se vió beneficiado con la colocación de una válvula de baja presión. Surge entonces la hipotésis de que este cuadro es un sindrome multicausal; que por un proceso fisiopatogenico común produce un cuadro clínico, radiológico y cisternográfico similar y que serían beneficiados únicamente aquellos enfermos en los que se soluciona el problema mecánico.

SUMMARY

The physiopathological conditions of the normal pressure hydrocephalus syndrome are analysed. Within a group of 21 patients with clinical sinto- mathology pertaining this entity, only were 10 selected with a clinical, radiological and cisternografic indubitable diagnosis. It has been noticed that in spite of the stricked selection only a 50% of them have been beneficed by the application of a low pressure valve. Then, the hypothesis that the disease is a multicausal syndrome appears, which by an identical physiopathologic process produces or exhibits a similar clinical, radiological and cisternographic picture. Only those patients on whom the mechanical problem is solved would be beneficed by neurosurgery.

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Clínica Neurológica Hospital Ramos Mejia Urquiza 609 Buenos Aires Argentina.

1. ADAMS, R.D.; FISCHER, C.M. & HAKIM, S. Symptomatic occult hydrocephalus with normal cerebrospinal fluid pressure. N. England J. Med. 273: 117, 1965.
2. ALMEIDA, G.M.; PEREIRA, W.C.; FACURE, N.O. Ventriculo-auriculostomia nos bloqueios ao trânsito do líquido cefalorraqueano na cisticercose encefálica. Arq. Neuro-Psiquiat. (São Paulo) 24:163, 1966.
3. BARINI, O. Hidrocefalo de pressão normal: análise crítica. Seara Médica Neurocirúrgica 1:261, 1973.
4. BENSON, D.F.; LE MAY, M. & PATTEN, D.M. Diagnosis of normal pressure hydrocephalus. N. England J. Med. 283:609, 1970.
5. BRANDEN, J. & MEYERS, R. Behaviour of the systemic blood pressure, pulled rate and spinal fluid pressure artificially produced. Arch. Surg. (Chicago) 36:1, 1938.
6. BROWN, D.G. ,& GOLDENSOHN, E.S. The electroencephalorgam in normal pressure hydrocephalus. Arch. Neurol. (Chicago) 29:70, 1973.
7. EKBOM, K.; GREITZ, T. & KUGELBERG, E. Hydrocephalus due to ectasia of the basilar artery. J. Neurol. Sci. 8:465, 1969.
8. FISHMAN, R.A. Occult hydrocephalus. New England J. Med. 274:466, 1966.
9. GESCHWIND, N. The mechanism of normal pressure hydrocephalus. J. Neurol. Sci. 7:481, 1968.
10.- HAKIM, S. Algunas observaciones sobre la presión del líquido cefalorraquídeo. Sindrome hidrocefálico en el adulto con presión normal del liquido cefalorraquídeo. Tesis 957, Universidad Javeriana, Bogotá (Colombia), 1964.
11. HAKIM, S. & ADAMS. R.D. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. J. Neurol. Sci. 2:307, 1965.
12. HAKIM, S. Biomechanics of hydrocephalus. Acta Neurol. Latinoamer. Supl. 1, 17:169, 1971.
13. HEINZ, E.R.; DAVIS, D.O. & KARP, H.R. Abnormal isotope cisternography in symptomatic occult hydrocephalus. Radiology 95:109, 1970.
14. HILL, M.E.; LOUGHEED, W.M. & BARNETT, H.J.M. A treatable form of dementia due to normal pressure communicating hydrocephalus. Canad. Med. Assoc. J. 97:1309, 1967.
15. KIBLER, R.F.; COUCH, R.S.C. & COMPTON, M.R. Hydrocephalus in the adult following spontaneous subarachnoid hemmorrage. Brain 84:45, 1961.
16. LE MAY, M. & NEW, P.F.J. Radiological diagnosis of occult normal-pressure hydrocephalus. Radiology 96:347, 1970.
17. LEWIN, W. Preliminary observations on external hydrocephalus after severe head injury. Brit. J. Surg. 55:747, 1969.
18. McCULLOUGH, D.C.; HARBERT, J.C.; DI CHIRO, G. & OMMAYA, A.K. Prognostic criteria for cerebrospinal fluid shunting from isotope cisternography in communicating hydrocephalus. Neurology (Minneapolis) 20:594, 1970.
19. MILHOT, T.H.; CLARK, R.G. & HAMMOCK, M.K. Gross pathological findings in acute and sub-acute obstructive hidrocephalus in dog and monkey. J. Neurosurg. 32:390, 1970.
20. NORRELL, H.; WILSON, C.K.; HARRISON, J.; MEAISON, L. & BERTAN, V. Venous factors in infantile hâdrocephalus. J. Neurosurg. 31:561, 1969.
21. OJEMANN, R.G. Normal pressure hydrocephalus. Clin. Neurosurg. 18:337, 1971.
22. OJEMAN, R.G.; FISCHER, C.M.; ADAMS, R.D.; SWEET, W.H. & NEW, P.J. Further experience with the syndrome of normal pressure hydrocephalus. J. Neurosurg. 31:279, 1969.
23. OJEMANN, R.G. Normal pressure hydrocephalus. In Scientific Foundations of Neurology. William Heinemann Medical Books, London, 1972.
24. RYDER, H.W.; RESENAUR, A.; PENKA, E.J.; ESPEY, F. & EVANS, J.P. Failure of abnormal cerebrospinal fluid pressure to influence cerebral function. Arch. Neurol. Psychiat. (Chicago) 70:563, 1953.
25. SCAFF, H.; TSANACLIS, A.M.C. & SPINA-FRANÇA, A. Hidrocefalo com pressão normal e neurocisticercose. Arq. Neuro-Psiquiat. (São Paulo) 32:223, 1974.
26. SJAASTAD, O. & NORDVIK, L. The corpus callosum angle in the diagnosis of cerebral ventricular enlargement. Acta Neurol. Scand. 49:396, 1973.
27. THOMPSON, R.K. & MALINA, S. Dinamic axial brain-stem distortion as a mechanism explaining the cardiorespiratory changes in increased intracranial pressure. J. Neurosurg. 16:664, 1959.
28. TSUBOKAWA, T. The factors of indication on shunt operation for normal pressure hydrocephalus. Neurol. Med. Cir. (Tóquio) 12:316, 1972.
29. WOLINSKY, J.S.; BARNES, B.D. & MARGOLIS, T. Diagnostic tests in normal pressure hydrocephalus. Neurology (Minneapolis) 23:706, 1973.

Fechas de Publicación

Publicación en esta colección
25 Feb 2013
Fecha del número
Dic 1976

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[1] 1. ADAMS, R.D.; FISCHER, C.M. & HAKIM, S. Symptomatic occult hydrocephalus with normal cerebrospinal fluid pressure. N. England J. Med. 273: 117, 1965.

[2] 2. ALMEIDA, G.M.; PEREIRA, W.C.; FACURE, N.O. Ventriculo-auriculostomia nos bloqueios ao trânsito do líquido cefalorraqueano na cisticercose encefálica. Arq. Neuro-Psiquiat. (São Paulo) 24:163, 1966.

[3] 3. BARINI, O. Hidrocefalo de pressão normal: análise crítica. Seara Médica Neurocirúrgica 1:261, 1973.

[4] 4. BENSON, D.F.; LE MAY, M. & PATTEN, D.M. Diagnosis of normal pressure hydrocephalus. N. England J. Med. 283:609, 1970.

[5] 5. BRANDEN, J. & MEYERS, R. Behaviour of the systemic blood pressure, pulled rate and spinal fluid pressure artificially produced. Arch. Surg. (Chicago) 36:1, 1938.

[6] 6. BROWN, D.G. ,& GOLDENSOHN, E.S. The electroencephalorgam in normal pressure hydrocephalus. Arch. Neurol. (Chicago) 29:70, 1973.

[7] 7. EKBOM, K.; GREITZ, T. & KUGELBERG, E. Hydrocephalus due to ectasia of the basilar artery. J. Neurol. Sci. 8:465, 1969.

[8] 8. FISHMAN, R.A. Occult hydrocephalus. New England J. Med. 274:466, 1966.

[9] 9. GESCHWIND, N. The mechanism of normal pressure hydrocephalus. J. Neurol. Sci. 7:481, 1968.

[10] 10.- HAKIM, S. Algunas observaciones sobre la presión del líquido cefalorraquídeo. Sindrome hidrocefálico en el adulto con presión normal del liquido cefalorraquídeo. Tesis 957, Universidad Javeriana, Bogotá (Colombia), 1964.

[11] 11. HAKIM, S. & ADAMS. R.D. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. J. Neurol. Sci. 2:307, 1965.

[12] 12. HAKIM, S. Biomechanics of hydrocephalus. Acta Neurol. Latinoamer. Supl. 1, 17:169, 1971.

[13] 13. HEINZ, E.R.; DAVIS, D.O. & KARP, H.R. Abnormal isotope cisternography in symptomatic occult hydrocephalus. Radiology 95:109, 1970.

[14] 14. HILL, M.E.; LOUGHEED, W.M. & BARNETT, H.J.M. A treatable form of dementia due to normal pressure communicating hydrocephalus. Canad. Med. Assoc. J. 97:1309, 1967.

[15] 15. KIBLER, R.F.; COUCH, R.S.C. & COMPTON, M.R. Hydrocephalus in the adult following spontaneous subarachnoid hemmorrage. Brain 84:45, 1961.

[16] 16. LE MAY, M. & NEW, P.F.J. Radiological diagnosis of occult normal-pressure hydrocephalus. Radiology 96:347, 1970.

[17] 17. LEWIN, W. Preliminary observations on external hydrocephalus after severe head injury. Brit. J. Surg. 55:747, 1969.

[18] 18. McCULLOUGH, D.C.; HARBERT, J.C.; DI CHIRO, G. & OMMAYA, A.K. Prognostic criteria for cerebrospinal fluid shunting from isotope cisternography in communicating hydrocephalus. Neurology (Minneapolis) 20:594, 1970.

[19] 19. MILHOT, T.H.; CLARK, R.G. & HAMMOCK, M.K. Gross pathological findings in acute and sub-acute obstructive hidrocephalus in dog and monkey. J. Neurosurg. 32:390, 1970.

[20] 20. NORRELL, H.; WILSON, C.K.; HARRISON, J.; MEAISON, L. & BERTAN, V. Venous factors in infantile hâdrocephalus. J. Neurosurg. 31:561, 1969.

[21] 21. OJEMANN, R.G. Normal pressure hydrocephalus. Clin. Neurosurg. 18:337, 1971.

[22] 22. OJEMAN, R.G.; FISCHER, C.M.; ADAMS, R.D.; SWEET, W.H. & NEW, P.J. Further experience with the syndrome of normal pressure hydrocephalus. J. Neurosurg. 31:279, 1969.

[23] 23. OJEMANN, R.G. Normal pressure hydrocephalus. In Scientific Foundations of Neurology. William Heinemann Medical Books, London, 1972.

[24] 24. RYDER, H.W.; RESENAUR, A.; PENKA, E.J.; ESPEY, F. & EVANS, J.P. Failure of abnormal cerebrospinal fluid pressure to influence cerebral function. Arch. Neurol. Psychiat. (Chicago) 70:563, 1953.

[25] 25. SCAFF, H.; TSANACLIS, A.M.C. & SPINA-FRANÇA, A. Hidrocefalo com pressão normal e neurocisticercose. Arq. Neuro-Psiquiat. (São Paulo) 32:223, 1974.

[26] 26. SJAASTAD, O. & NORDVIK, L. The corpus callosum angle in the diagnosis of cerebral ventricular enlargement. Acta Neurol. Scand. 49:396, 1973.

[27] 27. THOMPSON, R.K. & MALINA, S. Dinamic axial brain-stem distortion as a mechanism explaining the cardiorespiratory changes in increased intracranial pressure. J. Neurosurg. 16:664, 1959.

[28] 28. TSUBOKAWA, T. The factors of indication on shunt operation for normal pressure hydrocephalus. Neurol. Med. Cir. (Tóquio) 12:316, 1972.

[29] 29. WOLINSKY, J.S.; BARNES, B.D. & MARGOLIS, T. Diagnostic tests in normal pressure hydrocephalus. Neurology (Minneapolis) 23:706, 1973.

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Consideraciones sobre el hidrocefalo de baja presion

Considerations on low pressure hydrocephalus

Resúmenes

Fechas de Publicación