Diagnosis and Differential Diagnosis of Hydrocephalus in Adults

Langner, Sönke; Fleck, Steffen; Baldauf, Jörg; Mensel, Birger; Kühn, Jens Peter; Kirsch, Michael

doi:10.1055/s-0043-108550

Cited by 48 publications

(33 citation statements)

References 49 publications

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“…It is most curious that IL-6, IL-8, and MMP-7 are signi cantly increased in both early implantation time and infant age groupings. As infants are arguably the most vulnerable group suffering from hydrocephalus 6,9 , the presence of neuroin ammation and dysregulated MMPs could be contributing to loss of tissue integrity, worsening of clinical symptoms and signs, and consequently impeding neurological development 3,4 . Therefore, the interplay of IL-6, IL-8, and MMP-7 and the role they play in hydrocephalus pathophysiology is worth future investigations to improve our understanding of the molecular and cellular events driving hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…Hydrocephalus predominately presents as an abnormal expansion of cerebral ventricles due to cerebrospinal uid (CSF) build up 1,2,3 . Left untreated, increased intracranial pressure and consequent compression of brain structures can lead to neurological defects, nausea, headaches, lethargy and ultimately be fatal 3,4,7 . Globally, hydrocephalus has a prevalence between 11-175/100,000 depending on the age 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…Upon deeper examination, clinicians and researchers have observed hydrocephalus to be a multifactorial and more complicated condition than its initial impression of being a "plumbing problem", containing a heterogenous group of etiologies 8 . Hydrocephalus can be caused by genetic defects or congenital malformation, or it can be acquired through hemorrhage, trauma, tumors, infection, or other causes 4,5,8 .…”

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid Biomarkers of Neuroinflammation in Children with Hydrocephalus and Shunt Malfunction

Harris

Morales

Arshad

et al. 2020

Preprint

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Background: Cerebrospinal fluid (CSF) shunt systems fail approximately 30% of the time within the first year of shunt implantation, while 98% of all patients with hydrocephalus (HCP) will suffer shunt failure in their lifetime. Perhaps due to the heterogeneity in etiology or the unique environment housing CSF shunt systems, the underlying reasons for shunt failure continue to elude researchers and clinicians. Still, obstruction remains the most common reason for shunt failure and it is vital to understand what factors may be contributing or driving shunt failure for improving patient outcomes and ultimately quality of life.Methods: Using multiplex ELISA, this study first examined the protein concentration profiles of select pro-inflammatory and anti-inflammatory cytokines, as well as select matrix metalloproteinases (MMPs) in 38 pediatric patients and their CSF obtained at shunt revision operation; all patients pediatric (<18). Shunt failure was further examined for interdependencies between the past number of previous revisions, length of time implanted, patient age, and the surgeon-described reason for revision noted as obstruction or non-obstruction. The pro-inflammatory cytokines were IL-1β, IL-2, IL-5, IL-6, IL-8, IL-12, IL-17, TNF-α, GM-CSF, IFN-γ. The anti-inflammatory cytokines were IL-4 and IL-10, and the MMPs are MMP-2, MMP-3, MMP-7, MMP-9. protein concentration is reported as pg/mL for each analyte. Results: IL-10, IL-6, IL-8 and MMP-7 demonstrated significantly increased concentrations in patient CSF for the non-obstructed subgroup compared to the obstructed subgroup (p=<0.05). Under generalized etiology, these analytes present within communicating HCP cases (15 of which were diagnosed with PHH) compared to non-communicating HCP or traumatic brain injury (TBI) cases. Further examination revealed that CSF IL-6 was significantly increased in both obstructed and non-obstructed cases, predominately for PHH and congenital HCP patients while IL-8 was significantly higher only in PHH patients. In terms of number of past revisions, IL-10, IL-6, IL-8, MMP-7 and MMP-9 significantly and progressively increased from zero to two past revisions and then significantly declined and remained low for subsequent revisions (p=<0.05). In terms of implantation time, CSF from shunts implanted for three months or less show significantly increased concentration for IL-6, IL-8, and MMP-7 (p=<0.05). Lastly, Six months or less was the age identified to coincide with significantly increased concentration of IL-6, IL-8, and MMP-7 (p=<0.05). Conclusion: Of all the cytokines and MMPs tested, IL-10, IL-6, IL-8, MMP-7 and MMP-9 were significantly elevated compared to other cytokines and MMPs in the various dependencies evaluated. IL-6 and IL-8 stand out in our study with significantly increased concentration in select etiologies, age, length of time implanted. The aforementioned cytokines and MMPs all showed an interesting relation with number of past revisions which warrants further examination. Non-obstruction cases were determined to be accompany significantly higher CSF cytokine MMP presence compared to obstructive cases. This suggests closer examination to the extent of the role neuroinflammation plays for causing obstruction in HCP patients. Additionally, IL-10 was associated with the length of time implanted as well as number of past revisions, and higher in non-obstructed cases compared to obstructed cases. A severity-dependent interplay between IL-10, IL-6 and IL-8 is an area for expansion and may provide foundation for therapeutic control of neuroinflammation.Trial registration: Not applicable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cerebrospinal Fluid Biomarkers of Neuroinflammation in Children with Hydrocephalus and Shunt Malfunction

Harris

Morales

Arshad

et al. 2020

Preprint

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“…One of the Dandy criteria states that in IIH there are symptoms of increased intracranial pressure without evidence of hydrocephalus, which is an accumulation of fluid in the brain due to an imbalance in the production and absorption of CSF [7]. There are multiple forms of hydrocephalus based on the precipitating factor.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic Intracranial Hypertension Masking as Obstructive Hydrocephalus: A Case Report

Maurer

Henry

Liu

et al. 2019

Cureus

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Idiopathic intracranial hypertension (IIH) is a poorly understood phenomenon and its presentation can both mimic and co-exist with other intra-cranial processes. Accurate diagnosis is imperative as ongoing advancements in treatment can yield dramatic positive results. Here we present the case of an individual with signs and symptoms of obstructive hydrocephalus who was ultimately found to have IIH secondary to venous sinus stenosis. After correction of the venous sinus stenosis, resolution in the patient's symptoms was noted. The case highlights some of the unique considerations in approaching patients with IIH and provides a framework for review of current literature related to IIH and venous sinus stenosis.

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“…Non-contrast material-enhanced head computed tomographic (CT) examination is an important method for the diagnosis of HYC because it can observe the enlargement of the ventricles, and sometimes determine the cause of HYC. [ 1 , 2 ] However, due to the lack of uniform standards, different range of patients’ ages and the various levels doctors’ expertise, it is rather difficult to reach a diagnosis. Therefore, using new technologies to explore diagnostic methods and standards has great value for HYC.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an artificial intelligent hydrocephalus diagnosis model based on transfer learning

Duan

Zhang

Zhang³

et al. 2020

Medicine

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To design and develop artificial intelligence (AI) hydrocephalus (HYC) imaging diagnostic model using a transfer learning algorithm and evaluate its application in the diagnosis of HYC by non-contrast material-enhanced head computed tomographic (CT) images. A training and validation dataset of non-contrast material-enhanced head CT examinations that comprised of 1000 patients with HYC and 1000 normal people with no HYC accumulating to 28,500 images. Images were pre-processed, and the feature variables were labeled. The feature variables were extracted by the neural network for transfer learning. AI algorithm performance was tested on a separate dataset containing 250 examinations of HYC and 250 of normal. Resident, attending and consultant in the department of radiology were also tested with the test sets, their results were compared with the AI model. Final model performance for HYC showed 93.6% sensitivity (95% confidence interval: 77%, 97%) and 94.4% specificity (95% confidence interval: 79%, 98%), with area under the characteristic curve of 0.93. Accuracy rate of model, resident, attending, and consultant were 94.0%, 93.4%, 95.6%, and 97.0%. AI can effectively identify the characteristics of HYC from CT images of the brain and automatically analyze the images. In the future, AI can provide auxiliary diagnosis of image results and reduce the burden on junior doctors.

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Diagnosis and Differential Diagnosis of Hydrocephalus in Adults

Cited by 48 publications

References 49 publications

Cerebrospinal Fluid Biomarkers of Neuroinflammation in Children with Hydrocephalus and Shunt Malfunction

Cerebrospinal Fluid Biomarkers of Neuroinflammation in Children with Hydrocephalus and Shunt Malfunction

Idiopathic Intracranial Hypertension Masking as Obstructive Hydrocephalus: A Case Report

Evaluation of an artificial intelligent hydrocephalus diagnosis model based on transfer learning

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