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Evaluation of Late Onset Congenital Aqueductal Stenosis Hydrocephalus

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Evaluation of Late Onset Congenital Aqueductal Stenosis Hydrocephalus Journal of Neurology & Stroke Evaluation of Late Onset Congenital Aqueductal Stenosis Hydrocephalus Abstract Research Article Early onset hydrocephalus due to congenital aqueductal stenosis is well known Volume 5 Issue 1 - 2016 and fully studied. However, late onset one is not so. The present study is a trial to give spotlight on the late onset type which may be clinically confusing with other syndromes leading sometimes to mismanagement. Our study included 25 patients with late onset congenital aqueductal stenosis hydrocephalus. They verified into 18 males (72%) and 7 females (28%). Their Neurosurgery Department, Assiut University Hospital, Assiut, ages ranged from 5 years to 64 years. They presented with headache in 19 cases Egypt (76%), visual disturbance in 11 cases (44%), gait disturbance in 8 cases (32%) and disturbed level of consciousness in 4 cases (16%). Ventriculoperitoneal shunts *Corresponding author: Hassan Mohammed, Neurosurgery were done for all cases with improvement in 20 cases (80%), no improvement Department, Assiut University Hospital, Assiut, Egypt, Email: in 3 cases (12%) and deterioration in 2 cases (8%). Post-shunt complications occurred in 9 cases (32%) and include 6 cases with subdural hematoma (24%), 2 December 19, 2015 July 11, 2016 cases with infection (8%) and one case with shunt obstruction (4%). Received: | Published: Late onset aqueductal stenosis hydrocephalus is not uncommon cause of hydrocephalus in our locality. Proper diagnosis and management of such patients depended on the well manifest clinical data confirmed with the neuroimaging studies became easy. Keywords: Ventriculoperitoneal shunt; Aqueductal stenosis Introduction The most common shunt coplications include: infection, obstruction and overdrainage Prognosis of patients with Aqueductal stenosis is responsible for 20% of cases of aqueductal stenosis does not depend only on promptness and hydrocephalus. Its incidence ranges from 0.5 to 1.0 in 1,000 births, with a recurrence risk in siblings of 1.0% to 4.5%. The natal than congenital hydrocephalus [1]. onset of symptoms is usually insidious and can occur at any time efficacy of surgical treatment. Better outcome is observed in post- from birth to adulthood. Associated malformations in neighboring This study evaluates hydrocephalus due to late onset structures are common The presence of these malformations helps congenital aqueductal stenosis regarding preoperative patients’ to explain the intellectual, cognitive, and motor handicaps even characteristics (demographic data and clinical presentations), after the hydrocephalus is compensated by shunting. Aqueductal operative management, and postoperative patients’ characteristics obstruction constitutes three percent of adult hydrocephalus [1]. (complications and outcome). Patients and Methods [1], non-tumoral aqueduct stenosis can be subdivided into fourAccording types: Stenosis, to the histopathologicalForking, Septum classificationformation and of RussellGliosis. This study included 25 patients with late onset congenital Congenital aqueductal stenosis can present later in adult age Sylvius aqueductal stenosis admitted to the neurosurgery department in Assiut University Hospital from march 2012 till and normalization of clinical symptoms are more important march 2013. In this study, the patients were subjected to the due to compensation of CSF flow dynamics during childhood following inclusion and exclusion criteria ventricular size. A-Inclusion criteria: in evaluating the benefits of treatment than in the decrease in Hydrocephalus secondary to aqueductal stenosis may present • Patient complaining of manifestation of increased at any age. Clinical course may vary, according to the patient’s intracranial pressure, gait disturbance, urinary troubles, age and the anatomical deformation of the ventricular system. visual deterioration and/or disturbance of the conscious level. ventricles with marked upward bowing of corpus callosum. TreatmentImaging with of hydrocephalusCT and MRI will secondary show dilated to aqueductal third and stenosis lateral • (Age of the patient should exceed 4 years of age as there is can be achieved with implantation of extracranial shunt, such as no universally agreement on the age of late onset aqueductal ventriculo-peritoneal (VP) or ventriculoatrial shunts, or by the stenosis). means of neuroendoscopy (ETV) [1]. Submit Manuscript | http://medcraveonline.com J Neurol Stroke 2016, 5(1): 00163 Copyright: Evaluation of Late Onset Congenital Aqueductal Stenosis Hydrocephalus ©2016 Mohammed et al. 2/7 between 5-20 years (44.4%) whereas the males were dominant in • Post meningitic and post encephaltic aqueductal stenosis. B-Exclusion criteria: alljust the (28%). age groups Females especially showed thea significant age group peak between in the 41-60 age groupyears • Post traumatic aqueductal stenosis. (81.8 %) (Figure 1). • Post hemorrhagic aqueductal stenosis. Table 1: • Patients having brain tumors compressing the aqueduct of Age Relation group between sexMale and No.(%) age groups.Female No.(%) P value sylivus. Age group 5-20 years 5 (55.6%) 4 (44.4%) 0.15 All patients included in this study were subjected to the following: Age group 25-40 years 4 (80%) 1 (20%) 1. full general and neurological history and examination. Age group 40-64 years 9 (81.8%) 2 (18.2%) History: Presenting concerns: Total 18 (72%) 7 (28%) Headache, vomiting, visual disturbance, somnolence Physical Examination • Vital signs: In advanced acute hydrocephalus, Cushing triad • (hypertension,Mental status: reflexbehavioral bradycardia, changes respiratory in children irregularities). (acute or chronic) • Motor: Gait ataxia; spastic paraparesis in chronic hydrocephalus related to pressure on white matter tracts surrounding the ventricles 2. •Fundus Reflexes: examination Increased in chronic hydrocephalus 3. Neuroimaging studies: Figure 1: • Unenhanced CT of the brain. Table 2, Relationshows betweenthe demographic sex and age distributiongroups. as 64% of the patient were from Assiut city itself, whereas only 36% of the patient were from other cities, also shows that majority of cases • MRI. 4.Routine• Complete lab investigations: blood picture. don’twere marriedwork (72%) (64%) while while only only (28%)(36%) werewere singles.working Regarding (p=0.03) • Prothrombin time and concentration. (Figureoccupation, 2). there was a significant percent of the patient who Table 2: Numbers and percent of cases in relation to demographic data. • Renal function tests. Demographic data No.(%) 5.Surgical• Blood treatment: sugar level. Residence External ventricular shunt, where ventriculoperitoneal shunts Assiut 16 ( 64 %) were done for all patients and all shunt devices were PS whatever Outside Assiut 9 (36%) the pressure valves (Meditronic Neurosurgery 125 cermmon Drive, Goleta, Cag3117USA) Marital status Single 9 (36%) Results Married 16 (64%) Our study included 25 patients with late onset congenital Occupation aqueductal stenosis hydrocephalus. Working 7 (28%) In Table 1, patients were divided into 3 age groups. The highest incidence of late onset aqueductal stenosis was in the age group Not working 18 (72%) between (41-60) (44%) followed by the age group between (5- age group (21-40) in comparison to the duration of the other age the age group between (21-40) (20%). groups.Table 3 shows significant longer duration of illness among the 20) (36%), while the age group which showed least figures was Table 1, also showed sex predilection, where the highest Table 4 showed that the headache as a presenting manifestation incidence was in males in general (72%) while the females were has the highest incidence (76%) followed by visual manifestation Citation: Stroke 5(1): 00163. DOI: 10.15406/jnsk.2016.05.00163 Mohammed H, Elsatar AEA, Ragab M, Alghriany A (2016) Evaluation of Late Onset Congenital Aqueductal Stenosis Hydrocephalus. J Neurol Copyright: Evaluation of Late Onset Congenital Aqueductal Stenosis Hydrocephalus ©2016 Mohammed et al. 3/7 (44%) whereas the urinary incontinence showed the least incidence (4%) (Figure 3). Figure 3: Figure 2: Numbers and percent of cases in relation to demographic the patients had more than one clinical presentation. data. Clinical manifestation of the studied patients. N.B: Most of Table 5: Table 3: fundus examination. manifestation. Relation between late onset congenital aqueductal stenosis and Relation between age group of the cases and duration of No. of cases No. of cases with Duration (months) Mean±SD Range Total No. No. of cases with with Normal Blurred disc of cases Papillodema Total group (years) fundus margins 50.2±62.8 1-270 5-60 Age group 5-20 56±88.2 7-270 25 6 5 14 Age group 21-40 60.8±86.8 2-210 Table 6: Outcome of the patients after V-P shunt insertion. Age group 41-60 50.8±6.9 3-120 Total No. of No. of Cases No. of Cases P value 0.04 the cases of didn't improved No. of Cases late onset improved Table 4: after V-P deteriorated patients had more than one clinical presentation. congenital after V-P shunt and and (%) Clinical manifestation of the studied patients. N.B: Most of the aqueductal shunt and (%) Total No. (%) Male Female stenosis (%) No=25 No=18 No=7 Headache 19(76%) 12(63.2%) 7(36.8%) 25 20(80%) 3(12%) 2(8%) Visual manifestation 11(44%) 6(54.6%) 5(45.5%) Table 7: Schedule showing the incidence of the complications after shunt operation. Disturbed Conscious 4(16%) 4(100%) 0(0%) No. of cases level Total passed No. of cases developed complication No. of Gait disturbance 8(32%) 6(75%) 2(25%) without
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