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Hydrocephalus: Obliterated Perimesencephalic Cisterns and the Danger of Sudden Death

Published online by Cambridge University Press:  18 September 2015

Marjorie A. Garvey  and
Robert Laureno
Marjorie A. Garvey
Affiliation:
Department of Neurology, Washington Hospital Center, and George Washington University Medical Center, Washington, DC
Robert Laureno*
Affiliation:
Department of Neurology, Washington Hospital Center, and George Washington University Medical Center, Washington, DC
*
Department of Neurology, Washington Hospital Center, 110 Irving Street, NW Washington, District of Columbia, U.S.A. 20010
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Abstract:

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Objective:

We report a possible risk factor which could identify patients with chronic hydrocephalus who are at risk for sudden death.

Methods:

A retrospective review of medical records and computed tomographic (CT) scans was conducted on three patients with chronic hydrocephalus who suffered acute cardiorespiratory arrest without those signs which are normally associated with a progressive worsening of hydrocephalus.

Results:

All three of these patients were awake and communicative shortly before the life threatening or terminal event. All had experienced some recent worsening of neurologic signs or symptoms, but none had shown a progressive impairment of consciousness or major neurologic decline ordinarily associated with life threatening elevation of intracranial pressure. Absence of the perimesencephalic cisterns on head CT scans done prior to or just after the life threatening event was the only new radiologic finding common to all these patients.

Conclusions:

The absence of the perimesencephalic cisterns in an awake and alert patient with severe hydrocephalus indicates that the patient may be at risk for neurogenic cardiorespiratory failure. In such cases, (especially when there has been a recent, albeit mild, change in neurologic signs or symptoms), the neurologist should urge emergency ventriculostomy or shunting for the hydrocephalus.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 25 , Issue 2 , February 1998 , pp. 154 - 158
Copyright
Copyright © Canadian Neurological Sciences Federation 1998

References

REFERENCES

1.Bradley, WG, Daroff, RB, Fenichel, GM, Marsden, CD, eds. Neurology in Clinical Practice. 2nd ed. Boston: Butterworth Heinemann, 1996.Google Scholar
2.Walton, J, ed. Brain’s Diseases of the Nervous System. 10th ed. Oxford: Oxford University Press, 1993.Google Scholar
3.Johnson, RT, ed. Current Therapy in Neurologic Disease. Philadelphia: BC Decker, 1993.Google Scholar
4.Samuels, M, ed. Manual of Neurology: Diagnosis and Therapy. 5th ed. Boston: Little, Brown Company, 1996.Google Scholar
5.Atlas, SW, ed. Magnetic Resonance Imaging of the Brain and Spine. 2nd ed. Philadelphia: Lippincott-Raven, 1996.Google Scholar
6.Osborne, A, ed. Diagnostic Radiology. St Louis: Mosby, 1994.Google Scholar
7.Youmans, JR, ed. Neurological Surgery. 3rd ed. Philadelphia: WB Saunders & Company, 1990.Google Scholar
8.Wilkins, RH, Rengachary, SS, eds. Neurosurgery. 2nd ed. New York: McGraw Hill, 1996.Google Scholar
9.Ropper, AH, ed. Neurological and Neurosurgical Intensive Care. New York: Raven Press, 1993.Google Scholar
10.Salcman, M, ed. Neurological Emergencies. 2nd ed. New York: Raven Press, 1990.Google Scholar
11.Milhorat, TH. Acute hydrocephalus. New Engl J Med 1970; 283: 857–859.CrossRefGoogle ScholarPubMed
12.Cotton, MF, Reiley, T, Robinson, CC, et al. Acute aqueductal stenosis in a patient with Epstein-Barr virus infectious mononucleosis. Pediatr Inf Dis J 1994; 13: 224–227.CrossRefGoogle Scholar
13.Yanofsky, CS, Hanson, PA, Lepow, M. Parainfectious acute obstructed hydrocephalus. Ann Neurol 1981; 10: 62–63.CrossRefGoogle Scholar
14.McHugh, PR. Occult hydrocephalus. Quart J Med 1964; 33: 297–308.Google ScholarPubMed
15.Hayden, PW, Shurtleff, DB, Stuntz, TJ. A longitudinal study of shunt function in 360 patients with hydrocephalus. Dev Med Child Neurol 1983; 25: 334–337.CrossRefGoogle ScholarPubMed
16.Staal, MJ, Meihuizen-de Regt, MJ, Hess, J. Sudden death in hydrocephalic spina bifida aperta patients. Pediatr Neurosci 1987; 13: 13–18.CrossRefGoogle ScholarPubMed
17.Johnson, DL, Fitz, C, McCullough, DC, Schwarz, S. Perimesencephalic cistern obliteration: a CT sign of life-threatening shunt failure. J Neurosurg 1986; 64: 386–389.CrossRefGoogle Scholar
18.van Dongen, KJ, Braakman, R, Gelpke, GJ. The prognostic value of computerized tomography in comatose head-injured patients. J Neurosurg 1983; 59: 951–957.CrossRefGoogle ScholarPubMed
19.Toutant, SM, Klauber, MR, Marshall, LF, et al. Absent or compressed basal cisterns on first CT scan: ominous predictors of outcome in severe head injury. J Neurosurg 1984; 61: 691–694.Google Scholar
20.Tasker, RC, Matthew, DJ, Kendall, B. Computed tomography in the assessment of raised intracranial pressure in non-traumatic coma. Neuropediatrics 1990; 21: 91–94.CrossRefGoogle ScholarPubMed
21.Nguyen, JP, Djindjian, M, Brugieres, P, et al. Anatomy - computerized tomography correlations in transtentorial brain herniation. J Neuroradiol 1989; 16: 181–196.Google ScholarPubMed
22.Klug, N, Hoffman, O, Buss, K, Laun, A, Agnoli, AL. Decerebrate rigidity and vegetative signs in the acute midbrain syndrome with special regard to motor activity and intracranial pressure. Acta Neurochir 1984; 72: 219–233.CrossRefGoogle ScholarPubMed
23.Thuömas, KA, Vlajkovic, JC, Ganz, JC, et al. Progressive brain compression. Changes in vital physiological variables, correlated with brain tissue water content and brain tissue displacement. Experimental MR imaging in dogs. Acta Radiol 1993; 34: 289–295.CrossRefGoogle ScholarPubMed