These can be remembered with the unkind mnemonic Wet, Wacky, and Wobbly. Pathology The underlying cause remains controversial. One theory is that the condition is an obstructive type of communicating hydrocephalus due to reduced of CSF resorption. A second theory suggests it results from weakening of the ventricular wall due to periventricular white matter ischemic damage 3. The periventricular white matter ischemic change has also been hypothesized to slow the flow of CSF through the extracellular spaces, resulting in a "back-pressure" effect, leading to ventricular enlargement.
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Several authors have investigated the predictive values of distinct symptoms and ancillary methods for improving prognoses. Eleven of the 12 implanted valves were also combined with an normottensiva device, which probably reduced the number of subdural collections in these patients.
Twelve patients met these criteria. Good outcome in patients with normal-pressure hydrocephalus and factors indicating poor prognosis Of the remaining 56 patients with NPH who had received shunts, we selected a subgroup with four of the factors traditionally considered hidrkcefalia be markers of poor prognosis: Type of Shunt Selected A differential low-pressure valve system was implanted in all patients.
Attention to new genetic and biochemical factors as well as to new neuroimaging procedures may shed new light on this old but still littleknown entity. Light gray barsbefore surgery; dark gray bars6 months after surgery. Clinical Assessment The disease affects three main areas—gait, sphincter control, and cognitive functioning—which were evaluated according to the NPH scale Table 3.
Also administered were the TMT, Parts A and B, 28 to evaluate motor speed, visual scanning, attention, and mental flexibility; a word fluency task consisting of naming as many animals as possible during 1 minute; and the MMSE, 8 which provides a global measure of the severity of cognitive impairment. In the subgroup of patients with a differential-pressure valve and no antisiphon or gravity-compensating accessory, the beds were kept flat for at least 7 to 9 days, after which ambulation was begun.
Because of this factor and the potential risks of the treatment, some authors still question whether the benefits of shunt insertion outweigh the risks. This factor would explain the poor improvement in cognition in comparison to gait and sphincter changes. Many investigators have tried to elucidate which factors are associated with a normotensova outcome in this patient population; however, an effective means of predicting shunt responsiveness remains elusive.
Comparison Between Prognosis Groups We compared the poor prognosis group with the rest of the sample, which comprised 44 patients with NPH who had undergone shunt placement. In our group hidrocdfalia patients, cognition improved little in comparison to gait and sphincter changes.
In this subgroup of patients, ambulation was started on the 3rd day after shunt insertion. The main objective of this paper was to challenge the widespread belief that patients with the classic symptoms or signs of bad outcome cannot improve after shunt procedures, especially when more than one of these signs are present. Early or late postsurgical complications were found in two of the 12 patients in the poor prognosis group. Our study data partially confirm these results, because traditional prognostic factors cannot help to predict response to a shunt and thus should not be used as criteria for ruling out shunt surgery in patients with NPH.
Hidrocefalia normotensiva In five patients, this valve was combined with an infraclavicular gravity-compensating accessory NMT Neurosciences Implants S. The percentage of B waves that patients with NPH can demonstrate is highly variable; in the present series, we found wide variation in the percentage of B waves in patients who improved after shunt procedures. The following factors have traditionally been associated with unfavorable outcome: A percentage of change between baseline and postoperative conditions was also calculated as follows: Hidrcefalia achieve this goal, we describe the clinical and neuropsychological outcome 6 months after shunt surgery in a pilot study of a subgroup of patients with NPH who simultaneously presented the following four factors traditionally considered to be markers of poor prognosis in addition to old age: A differential low-pressure valve system was implanted in all patients.
Complications in the early postoperative period 1st month after shunt placement and at 6 months after shunt insertion were evaluated by the neurosurgeon in charge of the patient. When the surgical procedure was finished, moderate abdominal compression was applied using a girdle and was maintained during the day for 2 to 3 weeks. In our experience, continuous ICP monitoring is mandatory when, despite compatible clinical and radiological data, the tap test is negative or the R out is within a normal range.
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