Pediatric communication of hydrocephalus with intraventricular CSF turbulence: case report

This was a case report of a pediatric patient with progressive macrocephaly published in Neurology. The patient received a ventriculoperitoneal shunt that successfully treated communicating hydrocephalus and intraventricular cerebrospinal fluid (CSF) turbulence.

A girl, age 3, presented to Yale University in the United States with progressive macrocephaly. The patient previously had an open myelomeningocele that was later successfully repaired surgically at birth.

The clinicians found no evidence of intracranial bleeding or meningitis.

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A physical examination revealed that the patient had a head circumference of 54 cm, which was above the 99th percentile for her age. She also had impaired motor function in her lower extremities.

On magnetic resonance imaging (MRI) of the brain’s transverse relaxation time (T2), the patient presented with extreme communicating ventriculomegaly, strong turbulent intraventricular CSF flow, and diffuse cortical atrophy.

The clinicians decided that the patient should be operated on and a ventriculoperitoneal shunt should be placed to relieve pressure on the skull. During the operation, the patient had an intraoperative intracranial pressure of 13.2 mm Hg (18 cm CSF). This was well above the expected pressure on children.

7 weeks after surgery, an MRI scan showed the patient a complete resolution of the intraventricular CSF turbulence and a reduction in ventriculomegaly. The patient’s progressive macrocephaly was stopped. However, she continued to have mild neurocognitive impairment.

reference

Duy PQ, Bald KT. Intraventricular cerebrospinal fluid turbulence in pediatric communicating hydrocephalus. Neurology. Published online May 24, 2021. doi: 10.1212 / WNL.000000000000012237

Subjects:

Pediatric Neurology Vascular Neurology