This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (23)  • Contact me when this article is cited  Related Content  • Related articles  • Similar articles in this journal  Topic Collections  • Neurology, Other  • Alert me on articles by topic

Marvin Bergsneider, MD; Warwick J. Peacock, MD; John C. Mazziotta, MD, PhD; Donald P. Becker, MD

Arch Neurol. 1999;56:1224-1229.

Objective  To increase awareness about the treatment of adult patients with shunt-nonresponsive hydrocephalus—a state characterized by marked ventriculomegaly, low intracranial pressure, and a patent cerebrospinal fluid diversionary shunt.

Design  Retrospective analysis of hospital and outpatient records.

Patients  Four patients with symptomatic ventriculomegaly and patent ventriculoperitoneal shunts treated with a protocol of progressive ventricular hypotension induced by external cerebrospinal fluid drainage.

Results  Severe clinical manifestations exhibited by the patients, including parkinsonian features, Parinaud syndrome, and extensor posturing, completely reversed once a normalization of ventricular size was achieved. External ventricular drainage pressures as low as -30 cm H₂O were required to reduce ventricular size. All patients finally received a shunt incorporating a standard medium differential pressure valve with no antisiphon device.

Conclusions  Shunt siphoning may be an essential mechanism by which cerebrospinal fluid shunting is effective in many patients with adult hydrocephalus. Cerebrospinal fluid shunts that contain an antisiphon device are ineffective in these patients, despite the attainment of "physiologic" intracranial pressures. Based on reported experimental and clinical evidence, it seems that the cause of this condition may be related to abnormally high intracranial compliance.

From the Division of Neurosurgery (Drs Bergsneider and Becker), the Brain Research Institute (Dr Bergsneider), and the Departments of Neurology, Radiology, and Pharmacology (Dr Mazziotta), University of California at Los Angeles School of Medicine; and the Department of Neurosurgery, University of California at San Francisco School of Medicine (Dr Peacock).

RELATED ARTICLES

Ventricular Volume and Transmural Pressure Gradient in Normal Pressure Hydrocephalus
Samuel J. Pleasure and Robert A. Fishman
Arch Neurol. 1999;56(10):1199-1200.
EXTRACT | FULL TEXT  

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 1999;56(10):1302-1303.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Ventricular Volume and Transmural Pressure Gradient in Normal Pressure Hydrocephalus
Pleasure and Fishman
Arch Neurol 1999;56:1199-1200.
FULL TEXT