Retrospektiv wurden das stationäre Kurzzeit-Outcome, Komorbiditäten sowie das 2-Jahres-Outcome von Frühgeborenen (Schwangerschaftswoche < 32, geboren zwischen 1998 - 2016) mit intraventrikulärer Hirnblutung und daraus resultierender Hydrocephalus-Entwicklung am Universitätsklinikum Leipzig untersucht. Diese Kinder wurden 2 Gruppen gegenübergestellt - Frühgeborene mit niedriggradiger Hirnblutung (°I-II) ohne Hydrocephalus und cerebral unauffällige Kinder. Die Auswertung erbrachte für die Hydrocephalus-Gruppe signifikant erhöhte Mortalität und Komorbiditäten, auch das kognitive und motorische Bayley-Outcome nach 2 Jahren war stark eingeschränkt. Hingegen die Kinder mit milder Hirnblutung ohne Hydrocephalus zeigten bei leicht erhöhter Komorbiditätsrate jedoch ein ebenbürtiges 2-Jahres-Outcome, verglichen mit der cerebral unauffälligen Gruppe. An dieser Stelle werden weiterführende, prospektive Multicenter-Studien zur Evaluierung des Sachverhaltes empfohlen.:I Bibliographische Beschreibung II Abkürzungsverzeichnis 1 Einleitung 2 Zielstellung 3 Material und Methoden 3.1 Kollektiv 3.2 Parameter-/Datenaufnahme 3.3 Diagnostik 3.4 Statistische Auswertung 4 Ergebnisse 4.1 Basisdaten aller Kinder bei Geburt und Entlassung 4.2 stationäres Outcome aller Kinder 4.3 Bayley-Outcome aller Kinder 4.4 Subgruppenanalyse PHHC ± IVH °IV 4.4.1 Vergleich der Basisdaten 4.4.2 stationäres Outcome 4.5 Subgruppenanalyse: ELBW 4.5.1 stationäres Outcome verglichen nach Geburtsgewicht: ELBW und ≥ 1000 g 4.5.2 Basisdaten und Outcome für ELBW 4.6 Subgruppenanalyse: Geschlecht 4.7 Subgruppenanalyse: Geburtsjahr vor / nach 2009 4.8 Subgruppenanalyse: Therapie mit rekombinantem, aktiviertem Faktor VII (rFVIIa) 4.9 Subgruppenanalyse: VPS ja / nein 4.10 Subgruppenanalyse: Therapie-Option Lavage 4.10.1 Basisdaten 4.10.2 stationäres Outcome 4.10.3 Bayley-Outcome 4.11 Zusammenfassung der Ergebnisse 5 Diskussion 6 Zusammenfassung Literaturverzeichnis Tabellenverzeichnis Selbstständigkeitserklärung Erklärung über die Vorbehaltlichkeit Lebenslauf Danksagung

Orientador: Marla Andréia Garcia de Avila / Resumo: Introdução – Em geral, as crianças com hidrocefalia são submetidas a várias cirurgias e requerem cuidados diários, principalmente devido ao uso de derivação ventrículo peritoneal. Embora toda a família seja afetada, um de seus membros, denominado cuidador informal, assume a responsabilidade pelo cuidado, nem sempre com preparo técnico e emocional. Cabe aos profissionais de saúde a realização do processo educativo, tendo como foco o conhecimento e como objetivos a promoção de saúde e a prevenção de complicações. Artigo 1: Objetivo –Avaliar o conhecimento, a atitude e a prática de cuidadores informais de crianças com hidrocefalia antes e após intervenção com material educativo previamente desenvolvido. Método –Trata-se de um estudo quase-experimental, do tipo antes e depois, realizado com 32 cuidadores informais de crianças com hidrocefalia de um hospital universitário do interior de São Paulo. A coleta de dados ocorreu em três etapas: pré-teste, intervenção educativa através do material educativo e pós-teste. Foi utilizado o inquérito conhecimento, atitude e prática como instrumento de avaliação pré e pós-teste. Para análise da comparação pré-teste e pós-teste foi utilizado o teste t pareado e Teoria Clássica dos Testes. Resultados –Após a leitura do material educativo, os domínios conhecimento e prática obtiveram um aumento na taxa de acertos de 17% e 21,4%, respectivamente, e valor p<0,01. Artigo 2: Objetivo - Compreender se o material educativo “Diário de Laura: conhecendo ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction - In general, children with hydrocephalus are submitted to many surgeries and require daily care, mainly due to the use of peritoneal ventricle shunt. Although the whole family is affected, one of its members, called informal caregiver, assumes responsibility for care, not always with technical and emotional preparation. It is up to health professionals to carry out the educational process, focusing on knowledge and the objectives of health promotion and prevention of complications. Article 1: Objective - To assess the knowledge, attitude and practice of informal caregivers of children with hydrocephalus before and after intervention with previously developed educational material. Method - This is a quasiexperimental before and after study conducted with 32 informal caregivers of children with hydrocephalus from a university hospital in the inland of São Paulo State. Data collection took place in three stages: pre-test, educational intervention through educational material and posttest. The knowledge, attitude and practice survey was used as a pre- and post-test assessment tool. For analysis of pre-test and post-test comparison, the paired t-test and Classical Test Theory were used. Results – After caregivers read the educational material, the correct answer rate increased by 17% in the knowledge domain and 21.4% in the practice domain, with pvalues of < 0.01. Article 2: Objective - To understand if the educational material “Laura's Diary: Knowing Hydrocephalus a... (Complete abstract click electronic access below) / Mestre

The purpose of this study was to investigate further the characteristics of hearing loss in ventriculoperitoneal (VP) shunted hydrocephalus. Twelve (VP) shunt treated hydrocephalus children participated in this study. The etiology of the hydrocephalus was either intraventricular hemorrhage or spina bifida. A recent neurological examination reported the shunt to be patent in each child. Audiometric examination included pure tone air conduction thresholds, tympanometry, contralateral and ipsilateral acoustic reflex thresholds and distortion product otoacoustic emissions (DPOAEʹs). A unilateral, high frequency, sensorineural hearing loss was found in the ear ipsilateral to shunt placement in 10 (83%) of the 12 shunt treated hydrocephalic children. No hearing loss was observed the ear contralateral to shunt placement. Based on the pure tone findings coupled with the decrease in DPOAE amplitude in the shunt ear, the hearing loss appears to be cochlear in nature. It is hypothesized that the cochlear hydrodynamics are disrupted as the result of fluid pressure reduction within the perilymph being transmitted via a patent cochlear aqueduct as a reaction to the reduction of CSF via a patent shunt. In addition, a concomitant brainstem involvement is evidenced in the ART pattern possibly produced by the paten shunt draining CSF from the subdural space resulting in cranial base hypoplasia.

No description available.

Indiana University-Purdue University Indianapolis (IUPUI) / Hydrocephalus is a debilitating disease characterized by an increase in cerebrospinal fluid (CSF) in the brain, leading to increases in pressure that can ultimately result in death. Current treatments for hydrocephalus include only invasive brain surgery. Therefore, the need for a pharmaceutical therapy is great. In order to develop a suitable treatment, we first must be able to study the disease and the mechanisms by which it develops. By characterizing appropriate in vivo and in vitro models, we are better able to study this disease. In this thesis, the Wpk rat model and the PCP-R cell line are described as such appropriate models. In addition to suitable models, we also require a target for drug treatment. Transient Receptor Potential Vanilloid 4 (TRPV4) is a non-selective cation ion channel present in the main CSF-producing organ in the brain, the choroid plexus (CP). Preliminary data suggest this channel plays a role in the development of hydrocephalus. In the following work, some of the mechanisms by which TRPV4 functions in the brain are also described, including through calcium-sensitive potassium channels and inflammation. From this research, we are able to achieve a better understanding of the function of TRPV4 and how it can affect the development and progression of hydrocephalus.

Purpose: This study sought to determine the previously undescribed cytologic and metabolic alterations that accompany endoscopic third ventriculostomy with choroid plexus cauterization (ETV/CPC). Methods: Cerebrospinal fluid (CSF) samples were collected from infant patients with hydrocephalus at the time of index ETV/CPC and again at each reintervention for persistent hydrocephalus. Basic CSF parameters, including glucose, protein, and cell counts, were documented. A multivariable regression model, incorporating known predictors of ETV/CPC outcome, was constructed for each parameter to inform time-dependent normative values. Results: A total of 187 infants were treated via ETV/CPC for hydrocephalus; initial laboratory values were available for 164 patients. Etiology of hydrocephalus included myelomeningocele (53, 32%), intraventricular hemorrhage of prematurity (43, 26%), aqueductal stenosis (24, 15%), and others (44, 27%). CSF parameters did not differ significantly with age or etiology. Glucose levels initially drop below population average (36 to 32 mg/dL) post-operatively before slowly rising to normal levels (42 mg/dL) by 3 months. Dramatically elevated protein levels post-ETV/CPC (baseline of 59 mg/dL up to roughly 200 mg/dL at 1 month) also normalized over 3 months. No significant changes were appreciated in WBC. RBC counts were very elevated following ETV/CPC and quickly declined over the subsequent month. Conclusion: CSF glucose and protein deviate significantly from normal ranges following ETV/CPC before normalizing over 3 months. High RBC values immediately post-ETV/CPC decline rapidly. Age at time of procedure and etiology have little influence on common clinical CSF laboratory parameters. Of note, the retrospective study design necessitates ETV/CPC failure, which could introduce bias in the results.

Non-invasive techniques to explore intracranial compliance and pressure have been extensively explored in recent years. Previous techniques have used expensive technologies to make these measurements, often with difficulty. We present a novel, inexpensive provocative test to observe trends in intracranial compliance measurement targeted towards the treatment and management of hydrocephalus. Two techniques are proposed which derive data from the digital and supraorbital arteries as well as tympanic membrane displacement. This requires the use of two photo-plethysmographic sensors and a TMD sensor. A common tilt table apparatus is used to methodically and artificially increase intracranial pressure to stress the cranial system during the test. The results from this test are computed using a digital signal processing algorithm to determine phase difference between the waveforms. Further research is also proposed.

Yes / Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular.CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation.Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius.CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear.

No description available.

Bakgrund: Normaltryckshydrocefalus (NPH) är ett neurologiskt tillstånd som innefattar psykiska funktionsnedsättningar, demenssymtom, inkontinens samt problem med gång. Behandlingen för detta är via shuntoperation. Gångförmågan undersöks via gångtester innan och efter ett tapptest, som sedan ligger till grund för att diagnos ska kunna ställas.   Syfte: Syftet med arbetet var att undersöka gångförmågan hos patienter med NPH genom att jämföra gångtesters resultat mätt i sekunder innan tapptest och shuntoperation med resultat efter shuntoperation, samt jämföra skillnader mellan män och kvinnor.    Metod: För studien valdes en kvantitativ metod med en deskriptiv komparativ design. Data som bearbetats i den aktuella studien kommer från ett pågående forskningsprojekt på ett universitetssjukhus där det samlats in resultat av tre gångtester innan shuntoperation och tre månader efter. Totalt var det 161 patienter med NPH i forskningsstudien varav 129 inkluderades i den aktuella studien. Av dessa var 65 stycken män och 64 stycken kvinnor. Gångtesterna som jämförs är Timed up and go (TUG), 10 meter walk test (10 MWT) och 3 meter backwards walk (3 MBW).   Resultat: Resultatet visade på en signifikant förbättring i alla gångtester tre månader efter shuntoperation jämfört med innan operation, samt att det inte förelåg någon signifikant skillnad mellan män och kvinnor. TUG förbättrades med 5 sekunder, 10 MWT förbättrades med 4 sekunder samt att 3 MBW förbättrades med 4 sekunder.   Konklusion: Resultaten visar på att det sker en signifikant förbättring i gångtester för patienter med NPH som genomgått en shuntoperation. Vidare forskning krävs för att säkerställa att gångtesterna är relevanta för personer med NPH, samt för att uppnå ett standardiserat testbatteri som går att applicera över hela populationen. / Background: Normal pressure hydrocephalus (NPH) is a neurological condition that causes cognitive symptoms, dementia, incontinence and difficulties with walking. The treatment for this is shunt surgery. The ability to walk is examined with walking tests before and after a tap test, which then forms the basis for a diagnosis.   Purpose: The purpose of the study was to examine patients with NPH ability to walk through comparison of the results of walking tests measured in seconds before lumbar puncture test and shunt surgery with the results three months after shunt surgery, as well as comparing differences between men and women.   Method: A quantitative method with a descriptive and comparative design was chosen for this study. Data in the current study comes from an ongoing research project at a university hospital that has c ollected data of results of three walking tests before and three months after shunt surgery. In total data from 161 patients with NPH was collected of which 129 patients was included in the current study. Of these were 65 men and 64 women. The walking tests compared are Timed up and go (TUG), 10 meter walk test (10MWT) and 3 meter backwards walk (3MBW)  Results: The results showed a significant improvement in all walking tests before compared to three months after shunt surgery and that there was no significant difference between men and women. The results of TUG improved by 5 seconds, 10MWT by 4 seconds and 3MBW by 4 seconds.  Conclusion: The results show that there is a significant improvement in walking tests for patients with NPH who have undergone shunt surgery. Further research is required to ensure that the walking tests are relevant for people with NPH, as well as to achieve a standardized test battery that can be applied to the entire population.