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Reversal of Normal Pressure Hydrocephalus Symptoms by Subdural Collections

Published online by Cambridge University Press:  14 September 2018

C. M. Fisher
Affiliation:
Neurology Service, Massachusetts General Hospital, Boston, MA, USA
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Abstract:

Background:

The pathogenesis of symptoms in normal pressure hydrocephalus (NPH) is unclear. One theory is that in the presence of enlarged lateral ventricles, the ventricular fluid exerts increased force on the ventricular walls, the cerebrospinal fluid pressure remaining normal. This is in accordance with Pascal’s principle of F = PxA. It has not been possible to obtain direct evidence for this view.

Method:

The opportunity to gain insight into the matter arose when it was observed that two patients with symptomatic NPH were relieved of their symptoms when they developed bilateral subdural collections, one after head trauma, the other after ventriculo-peritoneal shunting for NPH.

Result:

In each case, concomitant with the subdural collections and the reversal of symptoms, the ventricular system became smaller. In the first patient, symptoms returned when the subdural collections were resorbed. In the second patient, symptoms returned when the subdural collections became excessive.

Conclusion:

Although documentation was less thorough than desired, it was concluded that relief of symptoms was related to the decrease in the ventricular size rather than lowering of the intraventricular pressure, thus providing evidence for operation of the principle F = PxA as the mechanism of symptoms in NPH.

Résumé:

Résumé: Introduction:

La pathogenèse des symptômes de l’hydrocéphalie normotensive (HNT) est mal connue. Selon une théorie, si les ventricules latéraux sont agrandis, le liquide ventriculaire exerce une force accrue sur les parois ventriculaires et la pression demeure normale, selon le principe de Pascal F = P x S. Il n’a pas été possible d’obtenir de preuve directe en faveur de cette théorie.

Méthode:

L’occasion d’en connaître davantage sur ce sujet s’est présentée quand on a constaté que deux patients présentant une HNT symptomatique ont été soulagés de leurs symptômes quand ils ont développé une collection sous-durale bilatérale, l’un après un traumatisme crânien et l’autre après une dérivation ventriculo-péritonéale pour son HNT.

Résultats:

Dans chaque cas, avec la formation de collections sous-durales et la disparition des symptômes, le système ventriculaire a rétréci. Chez le premier patient, les symptômes sont réapparus quand les collections sous-durales se sont résorbées. Chez l’autre, les symptômes sont réapparus quand les collections sous-durales sont devenues importantes.

Conclusion:

Bien que la documentation n’ait pas été aussi exhaustive que souhaitée, le soulagement des symptômes a été attribué à la diminution de la taille ventriculaire plutôt qu’à une diminution de la pression intraventriculaire, ce qui est en faveur du principe F = P x S comme mécanisme responsable des symptômes de l’HNT.

Type
Case Reports
Copyright
Copyright © Canadian Neurological Sciences Federation 2002

References

1. Adams, RD, Fisher, CM, Hakim, S, Ojemann, RG, Sweet, WH. Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. N Engl J Med 1965;273:117-126.CrossRefGoogle Scholar
2. Bergsneider, M, Peacock, WJ, Mazziotta, JC, Becker, DP. Beneficial effect of siphoning in treatment of adult hydrocephalus. Arch Neurol 1999;56:1224-1229.CrossRefGoogle Scholar

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