11/113. Sudden unexpected death in young adults with chronic hydrocephalus.We present four cases of sudden unexpected death in young adults with chronic hydrocephalus. The patients were between 20 and 28 years of age and had suffered from aqueduct stenosis (two patients), spina bifida in combination with arnold-chiari malformation (type II) and fragile X-syndrome. The patients suddenly collapsed with cardiorespiratory failure and could not be resuscitated and none had a history of headache or seizures. The post-mortem examinations revealed no unusual findings and a definite cause of death could not be established. Neuropathological examination revealed chronically hydrocephalic brains without any signs of uncal or tonsillar herniation. We hypothesise that a sudden pressure-induced decompensation of cerebral neuronal pathways involving insular and limbic cortex, hypothalamus and brain stem nuclei, may have caused disturbances of the cardiopulmonary control centres in the reticular formation of the brain stem, which in turn may have led to instantaneous cardiorespiratory arrest resulting in sudden "neurogenic" cardiac death.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
12/113. Double compartment hydrocephalus in a patient with cysticercosis meningitis.The authors discuss encystment of the fourth ventricle and upward herniation complicating a case of cysticercosis cerebri. The "double compartment" hydrocephalus followed occlusion of the aqueduct of Sylvius and the foramena of Luschka and Magendie in a patient who had previously received a ventriculo-atrial shunt for communicating hydrocephalus. The clinical presentation of this particular form of double compartment hydrocephalus is discussed.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
13/113. Alterations in ventricular fluid pressure during ketamine anesthesia in hydrocephalic children.We studies ventricular fluid pressure changes in 26 hydrocephalic children following administration of ketamine. The increase in VFP previously found with intravenously administered ketamine was compared with changes after ketamine given intramuscularly, and the possible alteration of this increase with sedative premedicants was studies. Changing the route of administration did not change the time to peak VFP changes or the duration of pressure elevation. There was no demonstrable alteration of the increase in VFP by premedication with secobarbital, dorperidol, or diazepam in clinical dosage. We feel that acute rises of VFP may affect areas of marginal cerebral blood flow and may increase the risk of herniation of brain tissue.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
14/113. Chronic meningitis presenting with acute obstructive hydrocephalus.A previously healthy 24-year-old woman presented to the Emergency Department unresponsive with a glasgow coma scale score of 4 and evidence of brainstem herniation. She was intubated and hyperventilated. Computed axial tomography scan of the brain demonstrated four-chamber hydrocephalus. Continued hyperventilation and mannitol diuresis were sufficient to arrest the impending herniation while emergent ventriculostomy was arranged. The patient recovered without sequelae and ultimately received a diagnosis of chronic idiopathic meningitis. This case highlights a rarely diagnosed disorder that presented with an acutely life threatening condition.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
15/113. Cervical diastematomyelia in cervico-oculo-acoustic (Wildervanck) syndrome: MRI findings.Cervico-oculo-acoustic (COA) or Wildervanck syndrome is characterized by the triad of Klippel-Feil anomaly, bilateral abducens palsy with retracted bulbs (Duane 'syndrome') and hearing loss. The clinical findings of this syndrome have been well documented. A few case reports with MRI findings have appeared in the literature showing brainstem and cerebellar hypoplasia and vertebral segmentation anomalies. Our case is unique in that diastematomyelia of the lower medulla and cervical cord was accompanied by vermian hypoplasia, tonsillar herniation and resulting triventricular hydrocephalus in a child with Wildervanck syndrome. This case is presented with MR images. Children with Wildervanck syndrome should be investigated for craniospinal abnormalities with MR imaging.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
16/113. Uncommon third ventricle herniation with cyst formation as a possible result of obstructive hydrocephalus.An adult man with an unusual cyst formation, originating from the suprapineal recess is described. The cyst may partly be caused by and may partly have contributed to aqueductstenosis.- - - - - - - - - - ranking = 4keywords = herniation (Clic here for more details about this article) |
17/113. Pathogenesis and diagnostic pitfalls of ventricular diverticula: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Ventricular diverticula are local herniations of the ventricular system occurring in association with severe, long-standing hydrocephalus. Variability in the extent and location of these ventricular pouches may produce misleading radiological conformations and raise diagnostic challenges. In this report, we discuss the pathogenesis and differential diagnosis of ventricular diverticula on the basis of a case illustration. CLINICAL PRESENTATION: We report the case of a 38-year-old woman presenting with hydrocephalus secondary to an obstructive lesion of the third ventricle. A large, dilated structure compressing the brainstem was present in the posterior fossa. INTERVENTION: The posterior fossa lesion was identified as an atrial diverticulum by injection of contrast medium into the right lateral ventricle, which led to immediate enhancement of the infratentorial cavity. Ventricular drainage and removal of the third ventricular lesion, a colloid cyst, allowed progressive collapse of the diverticulum and symptom resolution. CONCLUSION: This report discusses the pathogenesis of ventricular diverticula and demonstrates that ventriculography can be used to differentiate atrial diverticula from other posterior fossa lesions when time-consuming multiplanar magnetic resonance imaging cannot be afforded on an emergency basis.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
18/113. hydrocephalus due to idiopathic stenosis of the foramina of Magendie and Luschka. Report of three cases.Idiopathic stenosis of the foramina of Magendie and Luschka is a rare cause of obstructive hydrocephalus involving the four ventricles. Like other causes of noncommunicating hydrocephalus, it can be treated with endoscopic third ventriculostomy (ETV). Three patients who were 21, 53, and 68 years of age presented with either headaches (isolated or associated with raised intracranial pressure) or vertigo, or a combination of gait disorders, sphincter disorders, and disorders of higher functions. In each case, magnetic resonance (MR) imaging demonstrated hydrocephalus involving the four ventricles (mean transverse diameter of third ventricle 14.15 mm; mean sagittal diameter of fourth ventricle 23.13 mm; and mean ventricular volume 123.92 ml) with no signs of a Chiari Type I malformation (normal posterior fossa dimensions, no herniation of cerebellar tonsils). The diagnosis of obstruction was confirmed using ventriculography (in two patients) and/or MR flow images (in two patients). All patients presented with marked dilation of the foramen of Luschka that herniated into the cisterna pontis. All patients were treated using ETV. No complications were observed. All three patients became asymptomatic during the weeks following the surgical procedure and remained stable at a mean follow-up interval of 36 months. Postoperative MR images demonstrated regression of the hydrocephalus (mean transverse diameter of third ventricle 7.01 mm; mean sagittal diameter of fourth ventricle 16.6 mm; and mean ventricular volume 79.95 ml), resolution of dilation of the foramen of Luschka, and good patency of the ventriculostomy (flow sequences). These results confirm the existence of hydrocephalus caused by idiopathic fourth ventricle outflow obstruction without an associated Chiari Type I malformation, and the efficacy of ETV for this rare indication.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
19/113. Unusual intraventricular herniation of the suprasellar arachnoid cyst and its successful endoscopic management.A child with a benign intrinsic tectal tumor and obstructive hydrocephalus developed a huge intraventricular cystic lesion following insertion of a shunt, which was complicated by a subdural-subarachnoid bleeding. The lesion was identified to be an entrapped chiasmatic cistern, which disrupted the septum pellucidum in front of the third ventricle and filled gradually the anterior horn of the lateral ventricle. The condition was successfully treated endoscopically by fenestration of the cyst and a third ventriculostomy. Probable mechanisms of such unusual cyst formation and general management strategies in patients with obstructive hydrocephalus are discussed.- - - - - - - - - - ranking = 4keywords = herniation (Clic here for more details about this article) |
20/113. Segmental spinal cord hypoplasia and meningocele with preservation of medullary function: case report.BACKGROUND: In very rare dysraphic cases, it is not clear whether the primary abnormalities are in the neural elements, or in the bony elements. CASE DESCRIPTION: We describe a case of segmental hypoplasia of the spinal cord, with absent nerve roots in the afflicted segments, and associated meningocele and vertebral abnormalities. We illustrate the arguments for and against the classification of this lesion either as an atypical case of myelomeningocele (MMC) or as a mild case of segmental spinal dysgenesis (SSD). CONCLUSIONS: Possibly, in this exceptional case, the primary defect is in the neural tissue like in more usual cases of MMC and not in the spine, like in segmental spinal dysgenesis.- - - - - - - - - - ranking = 2.1073243151604keywords = meningocele (Clic here for more details about this article) |
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