RESUMO
Purpose Experimental models might help understand the pathophysiology of neurocysticercosis-associated hydrocephalus. The present study aimed to compare the extent of hydrocephalus and tissue damage in rats with subarachnoid inoculation of different concentrations of Taenia crassiceps cyst proteins. Methods Sixty young rats were divided into two groups: low- and high-concentration groups. The animals in the low concentration group received 0.02ml of 2.4mg/ml T. crassiceps cyst proteins while those in the high concentration group received 0.02 ml of 11.6mg/ml T. crassiceps cyst proteins. The animals underwent magnetic resonance imaging at 1, 3, and 6 months postinoculation to assess the ventricle volume. Morphological assessment was performed at the end of the observation period. Results Repeated measures of ventricle volumes at 1, 3, and 6 months showed progressive enlargement of the ventricles. At 1 and 3 months, we observed no differences in ventricle volumes between the 2 groups. However, at 6 months, the ventricles were larger in the high concentration group (median » 3.86mm3, range: 2.3712.68) compared with the low concentration group (median » 2.00mm3, range: 0.3711.57), p » 0.003. The morphological assessment revealed a few inflammatory features in both groups. However, the density of oligodendrocytes and neurons within the periventricular region was lower in the high concentration group (5.18 versus 9.72 for oligodendrocytes and 15.69 versus 21.00 for neurons; p < 0.001 for both). Conclusion Our results suggest that, in rats, a higher concentration of T. crassiceps cyst proteins in the subarachnoid space could induce ventricle enlargement and reduce the number of neurons within the periventricular area.
Assuntos
Animais , Ratos , Ventrículos Cerebrais/fisiopatologia , Neurocisticercose/patologia , Hidrocefalia/parasitologia , Antígenos de Helmintos , Espaço Subaracnóideo/fisiopatologia , Taenia , Imageamento por Ressonância Magnética/métodos , Ratos Wistar , Estatísticas não Paramétricas , Infecções Parasitárias do Sistema Nervoso Central , Interações Hospedeiro-Parasita , Hidrocefalia/fisiopatologiaRESUMO
OBJECTIVE: To demonstrate that a novel noninvasive index of intracranial pressure (ICP) derived from diffuse optics-based techniques is associated with intracranial hypertension. STUDY DESIGN: We compared noninvasive and invasive ICP measurements in infants with hydrocephalus. Infants born term and preterm were eligible for inclusion if clinically determined to require cerebrospinal fluid (CSF) diversion. Ventricular size was assessed preoperatively via ultrasound measurement of the fronto-occipital (FOR) and frontotemporal (FTHR) horn ratios. Invasive ICP was obtained at the time of surgical intervention with a manometer. Intracranial hypertension was defined as invasive ICP ≥15 mmHg. Diffuse optical measurements of cerebral perfusion, oxygen extraction, and noninvasive ICP were performed preoperatively, intraoperatively, and postoperatively. Optical and ultrasound measures were compared with invasive ICP measurements, and their change in values after CSF diversion were obtained. RESULTS: We included 39 infants, 23 with intracranial hypertension. No group difference in ventricular size was found by FOR (P = .93) or FTHR (P = .76). Infants with intracranial hypertension had significantly higher noninvasive ICP (P = .02) and oxygen extraction fraction (OEF) (P = .01) compared with infants without intracranial hypertension. Increased cerebral blood flow (P = .005) and improved OEF (P < .001) after CSF diversion were observed only in infants with intracranial hypertension. CONCLUSIONS: Noninvasive diffuse optical measures (including a noninvasive ICP index) were associated with intracranial hypertension. The findings suggest that impaired perfusion from intracranial hypertension was independent of ventricular size. Hemodynamic evidence of the benefits of CSF diversion was seen in infants with intracranial hypertension. Noninvasive optical techniques hold promise for aiding the assessment of CSF diversion timing.
Assuntos
Circulação Cerebrovascular/fisiologia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/fisiopatologia , Hipertensão Intracraniana/diagnóstico , Derivações do Líquido Cefalorraquidiano , Estudos de Viabilidade , Feminino , Humanos , Hidrocefalia/cirurgia , Recém-Nascido , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/fisiopatologia , Pressão Intracraniana/fisiologia , Masculino , Imagem Óptica , Projetos Piloto , Reprodutibilidade dos Testes , Análise EspectralRESUMO
INTRODUCTION: Spontaneous ventriculomegaly has been observed in rats that were presumed normal. Because the external phenotype of these animals is unremarkable, they can be inadvertently included in behavioral experiments, despite the considerable enlargement of the ventricular system, reduced cortical thickness, and hippocampal atrophy upon imaging. Given the role of such structures in memory consolidation, we evaluated long-term memory retention while decision making in rats with spontaneous ventriculomegaly. METHODS: We studied adult male Sprague Dawley rats, identified as having spontaneous ventriculomegaly, while performing baseline magnetic resonance imaging scanning intended for a different research protocol. Control (n = 7) and experimental (n = 6) animals were submitted to a delayed-alternation task (no delay, 30, 60, and 180 s) and an object-in-context recognition task. During the first task, we evaluated the number of correct choices as well as the latency to reach any of the cavities located at the end of each branch arm during each trial. The second task assessed the rodents' ability to remember where they had previously encountered a specific object, calculating the context recognition index. RESULTS: When compared to control animals, rats with spontaneous ventriculomegaly required significantly more training sessions to reach the 80% criterion during the training phase. Moreover, they showed reduced delayed-alternation performance in the evaluated times, reaching significance only at 180 s. Increased latencies while trying to reach the cavity were also observed. Evaluation of the long-term memory formation during the object-in-context recognition task showed that subjects with ventriculomegaly spent less time investigating the familiar object, resulting in a significantly decreased recognition index value. CONCLUSION: Our results are the first to show how spontaneous ventriculomegaly-induced cerebral structural damage affects decision-making behaviors, particularly when comparing between immediate and delayed trials. Moreover, this lesion disrupts the animals' ability to recall or express contextual information.
Assuntos
Hidrocefalia/complicações , Transtornos da Memória/complicações , Transtornos da Memória/fisiopatologia , Memória , Animais , Hipocampo/patologia , Hipocampo/fisiopatologia , Hidrocefalia/patologia , Hidrocefalia/fisiopatologia , Masculino , Transtornos da Memória/patologia , Memória de Longo Prazo , Ratos , Ratos Sprague-Dawley , Reconhecimento PsicológicoRESUMO
INTRODUCTION: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. METHODS: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. RESULTS: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. DISCUSSION: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. CONCLUSION: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.
Assuntos
Cistos Aracnóideos/cirurgia , Hidrocefalia/cirurgia , Pseudotumor Cerebral/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cistos Aracnóideos/fisiopatologia , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Hidrocefalia/fisiopatologia , Hidrodinâmica , Pressão Intracraniana/fisiologia , Masculino , Pessoa de Meia-Idade , Pseudotumor Cerebral/fisiopatologia , Reoperação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos , Adulto JovemRESUMO
Abstract Introduction: Cerebral hydrodynamics complications in shunted patients are due to the malfunction of the system. The objective of this retrospective, single-center, single-arm cohort study is to confirm the safety and performance of Sphera® Duo when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cysts. Methods: Data were generated by reviewing 112 adult patient's charts, who were submitted to a ventriculoperitoneal shunt surgery and followed for one year after surgery. Results: The results show us that 76% of patients had their neurological symptoms improved and that the reoperation rate was 15% in the first year following surgery. Discussion: Sphera Duo® shunt system is an applicable shunt option in routine neurosurgical management of hydrocephalus by several causes. It has presented good results while mitigating effects of overdrainage. Overdrainage is especially important in adults with non-hypertensive hydrocephalus and can cause functional shunt failure, which causes subnormal ICP (particularly in the upright position) and is associated with characteristic neurological symptoms, such as postural headache and nausea. Conclusion: Sphera Duo® shunt system is safe when used in adult patients suffering from hydrocephalus, pseudotumor cerebri or arachnoid cyst.
Resumo Introdução: As complicações da hidrodinâmica cerebral em pacientes com derivação ventriculoperitoneal são frequentemente relacionadas ao malfuncionamento do sistema. O objetivo deste estudo retrospectivo de coorte de centro único é avaliar a segurança e performance clínica do Sistema Sphera® Duo quando utilizado em adultos com hidrocefalia, pseudotumor cerebral ou cistos aracnoides. Métodos: Avaliamos os prontuários de 112 pacientes adultos submetidos a cirurgia de derivação ventriculoperitoneal e acompanhados por 1 ano após a cirurgia. Resultados: O resultado mostra que 76% dos pacientes melhoraram dos sintomas neurológicos e a taxa de reoperação foi de 15% no primeiro ano após a cirurgia. Discussão: O sistema de derivação Sphera Duo® é uma opção de shunt adequada a ser usada no tratamento neurocirúrgico da hidrocefalia por causas diversas. Ele demonstrou bons resultados clínicos enquanto reduziu riscos de hiperdrenagem. A hiperdrenagem é especialmente preocupante e mórbida em pacientes adultos com hidrocefalia não hipertensiva e pode levar a prejuízo clínico e disfunção da válvula, com sintomas de hipotensão craniana, como cefaléia ortostática e náuseas. Conclusão: O sistema de derivação Sphera Duo® é seguro para tratamento da hidrocefalia, pseudotumor cerebri ou cistos aracnóides em adultos.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pseudotumor Cerebral/cirurgia , Cistos Aracnóideos/cirurgia , Derivação Ventriculoperitoneal/instrumentação , Hidrocefalia/cirurgia , Reoperação , Fatores de Tempo , Pseudotumor Cerebral/fisiopatologia , Pressão Intracraniana/fisiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Seguimentos , Cistos Aracnóideos/fisiopatologia , Resultado do Tratamento , Derivação Ventriculoperitoneal/métodos , Desenho de Equipamento , Hidrodinâmica , Hidrocefalia/fisiopatologiaAssuntos
Hemorragia Cerebral/diagnóstico por imagem , Artéria Cerebral Média/diagnóstico por imagem , Milrinona/uso terapêutico , Transtornos Puerperais/tratamento farmacológico , Vasodilatadores/uso terapêutico , Vasoespasmo Intracraniano/tratamento farmacológico , Adulto , Angiografia Digital , Afasia de Broca/fisiopatologia , Edema Encefálico/diagnóstico por imagem , Edema Encefálico/etiologia , Edema Encefálico/fisiopatologia , Edema Encefálico/cirurgia , Hemorragia Cerebral/complicações , Hemorragia Cerebral/fisiopatologia , Angiografia por Tomografia Computadorizada , Craniectomia Descompressiva , Progressão da Doença , Drenagem , Feminino , Humanos , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Hidrocefalia/cirurgia , Hiperemia/diagnóstico por imagem , Artéria Cerebral Média/fisiopatologia , Nimodipina/uso terapêutico , Paresia/fisiopatologia , Transtornos Puerperais/diagnóstico por imagem , Transtornos Puerperais/fisiopatologia , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler Transcraniana , Vasoespasmo Intracraniano/complicações , Vasoespasmo Intracraniano/diagnóstico por imagem , Vasoespasmo Intracraniano/fisiopatologia , VentriculostomiaRESUMO
Aneurysmal subarachnoid hemorrhage is a condition with a considerable incidence variation worldwide. In Brazil, the exact epidemiology of aneurysmal SAH is unknown. The most common presenting symptom is headache, usually described as the worst headache ever felt. Head computed tomography, when performed within six hours of the ictus, has a sensitivity of nearly 100%. It is important to classify the hemorrhage based on clinical and imaging features as a way to standardize communication. Classification also has prognostic value. In order to prevent rebleeding, there still is controversy regarding the ideal blood pressure levels and the use of antifibrinolytic therapy. The importance of definitely securing the aneurysm by endovascular coiling or surgical clipping cannot be overemphasized. Hydrocephalus, seizures, and intracranial pressure should also be managed. Delayed cerebral ischemia is a severe complication that should be prevented and treated aggressively. Systemic complications including cardiac and pulmonary issues, sodium abnormalities, fever, and thromboembolism frequently happen and may have na impact upon prognosis, requiring proper management.
Assuntos
Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Humanos , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Hidrocefalia/terapia , Fatores de Risco , Convulsões/etiologia , Convulsões/fisiopatologia , Convulsões/terapia , Hemorragia Subaracnóidea/terapiaRESUMO
ABSTRACT Aneurysmal subarachnoid hemorrhage is a condition with a considerable incidence variation worldwide. In Brazil, the exact epidemiology of aneurysmal SAH is unknown. The most common presenting symptom is headache, usually described as the worst headache ever felt. Head computed tomography, when performed within six hours of the ictus, has a sensitivity of nearly 100%. It is important to classify the hemorrhage based on clinical and imaging features as a way to standardize communication. Classification also has prognostic value. In order to prevent rebleeding, there still is controversy regarding the ideal blood pressure levels and the use of antifibrinolytic therapy. The importance of definitely securing the aneurysm by endovascular coiling or surgical clipping cannot be overemphasized. Hydrocephalus, seizures, and intracranial pressure should also be managed. Delayed cerebral ischemia is a severe complication that should be prevented and treated aggressively. Systemic complications including cardiac and pulmonary issues, sodium abnormalities, fever, and thromboembolism frequently happen and may have na impact upon prognosis, requiring proper management.
RESUMO Hemorragia subaracnoidea aneurismática (aHSA) é uma condição com grande variação de incidência mundialmente. No Brasil, não dispomos de números epidemiológicos exatos. A apresentação clínica mais comum da HSA é a cefaleia, usualmente descrita como a pior da vida. A tomografia de crânio, quando feita nas primeiras 6 horas do ictus, tem uma sensibilidade próxima a 100%. É importante classificar a hemorragia utilizando escalas clínicas e radiológicas, como forma de padronizar a comunicação, e também predizer prognóstico. Para prevenção de ressangramento, ainda há controvérsias quanto aos níveis pressóricos ideais e uso de antifibrinolíticos. O tratamento definitivo do aneurisma, por sua vez, é fundamental, seja por meio endovascular ou cirúrgico. Hidrocefalia, crises epilépticas e a pressão intracraniana devem ser manejadas de forma apropriada. Isquemia cerebral tardia é uma complicação grave que deve ser prevenida e tratada agressivamente. Complicações sistêmicas, incluindo cardíacas, pulmonares, anormalidades de sódio, febre e tromboembolismo ocorrem frequentemente e podem ter impacto no prognóstico, necessitando de manejo adequado.
Assuntos
Humanos , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/fisiopatologia , Convulsões/etiologia , Convulsões/fisiopatologia , Convulsões/terapia , Hemorragia Subaracnóidea/terapia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/terapia , Fatores de Risco , Hidrocefalia/etiologia , Hidrocefalia/fisiopatologia , Hidrocefalia/terapiaRESUMO
In hydrocephalus, the progressive accumulation of cerebrospinal fluid (CSF) causes dilatation of the lateral ventricles affecting the third ventricle and diencephalic structures such as the hypothalamus. These structures play a key role in the regulation of several neurovegetative functions by the production of the hormones. Since endocrine disturbances are commonly observed in hydrocephalic children, we investigated the impact of progressive ventricular dilation on the hypothalamus of infant rats submitted to kaolin-induced hydrocephalus. Seven-day-old infant rats were submitted to hydrocephalus induction by kaolin 20% injection method. After 14â¯days, the animals were decapitated and brain was collected to analyze mitochondrial function, neuronal activity by acetylcholinesterase (AChE) enzyme, oxidative damage, glial activation, and, neurotransmission-related proteins and anti-apoptotic processes in the hypothalamus. The hydrocephalic animals showed reduction in respiratory rates in the States of phosphorylation (Pâ¯<â¯0.01) and non-phosphorylation (Pâ¯<â¯0.05); increase in AChE activity in both the cytosol (Pâ¯<â¯0.05) and the membrane (Pâ¯<â¯0.01); decrease in synaptophysin (Pâ¯<â¯0.05) and Bcl-2 (Pâ¯<â¯0.05) contents and; increase in protein carbonyl (Pâ¯<â¯0.01), GFAP (Pâ¯<â¯0.01) and Iba-1 (Pâ¯<â¯0.05) levels. The results demonstrate that ventricular dilation causes hypothalamic damage characterized by cholinergic dysfunction and suggests further investigation of the synthesis and secretion of hormones to generate new approaches and to assist in the treatment of hydrocephalic patients with hormonal alterations.
Assuntos
Acetilcolinesterase/metabolismo , Hidrocefalia/metabolismo , Hipotálamo/fisiopatologia , Acetilcolinesterase/fisiologia , Animais , Animais Recém-Nascidos , Encéfalo/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Modelos Animais de Doenças , Hidrocefalia/fisiopatologia , Hipotálamo/metabolismo , Caulim/efeitos adversos , Caulim/farmacologia , Ventrículos Laterais/fisiopatologia , Masculino , Neurônios , Ratos , Ratos WistarRESUMO
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a cause of dementia that can be reversed when treated timely with cerebrospinal fluid (CSF) diversion. Understanding CSF dynamics throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts. OBJECTIVE: To explore the cerebral aqueduct CSF flow dynamics with phase-contrast magnetic resonance imaging (MRI) in a novel rodent model of adult chronic communicating hydrocephalus. METHODS: Kaolin was injected into the subarachnoid space at the convexities in Sprague-Dawley adult rats. 11.7-T Bruker MRI was used to acquire T2-weighted images for anatomic identification and phase-contrast MRI at the cerebral aqueduct. Aqueductal stroke volume (ASV) results were compared with the ventricular volume (VV) at 15, 60, 90, and 120 days. RESULTS: Significant ventricular enlargement was found in kaolin-injected animals at all times (P < 0.001). ASV differed between cases and controls/shams at every time point (P = 0.004, 0.001, 0.001, and <0.001 at 15, 60, 90, and 120 days, respectively). After correlation between the ASV and the VV, there was a significant correlation at 15 (P = 0.015), 60 (P = 0.001), 90 (P < 0.001), and 120 days. Moreover, there was a significant positive correlation between the VV expansion and the aqueductal CSF stroke between 15 and 60 days. CONCLUSIONS: An initial active phase of rapid ventricular enlargement shows a strong correlation between the expansion of the VV and the increment in the ASV during the first 60 days, followed by a second phase with less ventricular enlargement and heterogeneous behavior in the ASV. Further correlation with complementary data from intracranial pressure and histologic/microstructural brain parenchyma assessments are needed to better understand the ASV variations after 60 days.