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APC exerts anti-inflammatory, antithrombotic, and neuroprotective effects in stroke. Central effects of APC are likely to be related to improved maintenance of the blood-brain barrier to neutrophils and to reduced microvascular obstructions and fibrin deposition.

EFORE recent diagnostic procedures were introduced for the diagnosis of hydrocephalus, one of the most accepted indicators for progressive hydrocephalus in infants was head circumference. However, formulating a diagnosis of arrested hydrocephalus on the basis of this indicator alone would be questionable. Whittle and colleagues 41 used continuous ICP monitoring to as-sess 46 children and adolescents in whom a clinical diagnosis of arrested hydrocephalus had been made. They found that 80% of patients who had previously been treated had a nonfunctioning shunt and that 63% of patients who had received no previous treatment had episodic or persistent increased ICP. When serial psychometric testing demonstrated a fall in cognitive functioning, ICP monitoring revealed abnormal ICPs in 88% of patients. The results of this study may indicate that CSF dynamics change over time, shifting hydrocephalus between active and inactive states; however, the factors affecting such changes remain uncertain.In 1996, we reported on the specific clinical features of infantile hydrocephalus that continues into adulthood, Object. Long-standing overt ventriculomegaly in adults (LOVA) is a unique form of hydrocephalus that develops during childhood and manifests symptoms during adulthood. The aim of the present study was to analyze the specific pathophysiological characteristics of LOVA.Methods. The specific diagnostic criteria for LOVA include severe ventriculomegaly in adults that is associated with macrocephalus measuring more than two standard deviations in head circumference and/or neuroradiological evidence of a significantly expanded or destroyed sella turcica. Twenty patients who fulfilled these criteria, 14 males and six females, were retrospectively studied. These patients' ages at diagnosis ranged from 15 to 61 years (mean 39.4 years). All had symptoms and/or signs indicating that hydrocephalus first occurred at birth or during infancy in the absence of any known underlying disease. The authors performed a pathophysiological study that included specific variations of magnetic resonance (MR) imaging, such as fluid-attenuated inversion recovery and cardiac-gated cine-mode imaging; intracranial pressure (ICP) monitoring; three-dimensional computerized tomography (CT) scanning; and other techniques.Hydrocephalus was caused by aqueductal stenosis in all patients. Severe ventriculomegaly involving the lateral and third ventricles was associated with a marked expansion or destruction of the sella turcica in 17 cases. Cardiac-gated cine-MR imaging did not reveal any significant movements of cerebrospinal fluid in the aqueduct. Three-dimensional CT ventriculography confirmed that the expanded third ventricle protruded into the sella and, sometimes, extended a diverticulum. Fourteen patients revealed symptoms and signs that indicated increased ICP with prominent pressure waves. Dementia or mental retardation was seen in 11 patients, gait disturbance in 12, and urinary incontinence in eight; all three of these symptoms were observed in sev...

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