Infection of central nervous system by motile Enterococcus: first case report.
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A 66-year-old man with four indwelling ventriculoperitoneal shunts for multiloculated hydrocephalus from a complicated case of meningitis a year before developed shunt infection based on a syndrome of fever, drowsiness, and cerebrospinal fluid neutrophil pleocytosis in the background of repeated surgical manipulation to relieve successive shunt blockages. The cerebrospinal fluid culture, which yielded a motile Enterococcus species, was believed to originate from the gut. This isolate was lost in storage and could not be characterized further. The patient improved with vancomycin and high-dose ampicillin therapy. He relapsed a month later with Enterococcus gallinarum shunt infection, which responded to high-dose ampicillin and gentamicin therapy. This is probably the first case report of motile Enterococcus infection of the central nervous system. (+info)
Corpus callosal signal changes in patients with obstructive hydrocephalus after ventriculoperitoneal shunting.
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BACKGROUND AND PURPOSE: Few reports have documented signal abnormalities within the corpus callosum on MR studies obtained after ventricular decompression in patients with hydrocephalus. Our purpose was to establish the frequency of this finding in shunted patients and attempt to elucidate its cause and clinical significance. METHODS: All patients with hydrocephalus shunted between 1989 and 1999 with postoperative MR studies available for review were included in the study group. Imaging analysis consisted of documenting hypointense signal on T1-weighted sagittal images and hyperintense signal on double-echo T2-weighted axial images within the corpus callosum. RESULTS: Characteristic signal abnormalities in the corpus callosum were noted in nine of 161 patients with shunted hydrocephalus studied with MR imaging. All nine patients were asymptomatic in regard to these MR findings. Comparison with preoperative scans and surgical records revealed that all patients with signal changes on postshunt scans had chronic obstructive hydrocephalus at presentation. Preshunt MR images were notable for marked elevation of the corpus callosum, which subsequently descended after ventricular decompression, suggesting that the cause of the signal changes was related to compression of the corpus callosum against the rigid falx. CONCLUSION: Signal abnormalities within the corpus callosum after ventricular shunting for obstructive hydrocephalus are not uncommon and are probably produced by compression of the corpus callosum against the falx before ventricular decompression. This distinctive appearance should not be mistaken for significant disease. Recognition of this pattern of signal abnormality will help avoid unnecessary intervention. (+info)
Brain specific proteins in posthaemorrhagic ventricular dilatation.
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Median neurofilament and glial fibrillary acidic protein concentrations in the cerebrospinal fluid of 18 infants with posthaemorrhagic ventricular dilatation were 20-200 times higher than control values. S-100 protein in cerebrospinal fluid was four times higher than control values. Glial fibrillary acidic protein concentrations correlated with death or disability and with parenchymal lesions but not with shunt dependence. (+info)
Migration of a lumboperitoneal shunt catheter into the spinal canal--case report.
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A 50-year-old female suffered upward migration of a lumboperitoneal (LP) shunt catheter into the spinal canal, manifesting as disturbance of short-term memory. Revision of the shunt confirmed that the tube had migrated into the spinal canal. The tube was pulled back into the peritoneal cavity and attached firmly to the fascia with a new anchoring device. LP shunts have the advantages of technical simplicity and extracranial procedure, but firm fixation is recommended since movements of the spine may cause proximal tube migration. (+info)
Rupture of a giant posterior inferior cerebellar artery aneurysm in an infant following a ventriculoperitoneal shunt--Case report.
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A 4-month-old female child presented with a huge posterior fossa mass lesion and severe hydrocephalus. Six hours after a ventriculoperitoneal shunt procedure, her condition worsened and she died. Autopsy showed extensive intracranial hemorrhage due to rupture of a posterior inferior cerebellar artery aneurysm. The probable causes of the rupture of the aneurysm were mechanical effects or changes in cerebral blood flow. (+info)
Chronic hypernatremia derived from hypothalamic dysfunction: impaired secretion of arginine vasopressin and enhanced renal water handling.
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We analyzed the disorder of water metabolism in a 32 year-old female with chronic hypernatremia. She had meningitis at 4 years, and ventriculo-peritoneal shunt operation at 13 years because of normal pressure hydrocephalus. At 14 years hypernatremia of 166 mmol/l was initially found and thereafter hypernatremia ranging from 150 to 166 mmol/l has been persisted for the last 18 years. Physical and laboratory findings did not show dehydration. Urine volume was 750-1700 ml per day and urinary osmolality (Uosm) 446-984 mmol/kg, suggesting no urinary concentrating defect. Plasma arginine vasopressin (AVP) levels ranged from 0.4 to 1.2 pmol/l despite hyperosmolality of 298 through 343 mmol/kg under ad libitum water drinking. There was no correlation between plasma osmolality (Posm) and plasma AVP levels, but Uosm had a positive correlation with Posm (r=0.545, P < 0.05). Hypertonic saline (500 NaCl) infusion after a water load increased Uosm from 377 to 679 mmol/kg, and plasma AVP from 0.2 to 1.3 pmol/l. There was a positive correlation between Posm and plasma AVP levels in the hypertonic saline test (r=0.612, P<0.05). In contrast, an acute water load (20 ml/kg BW) verified the presence of impaired water excretion, as the percent excretion of the water load was only 8.5% and the minimal Uosm was as high as 710 mmol/kg. Urinary excretion of aquaporin-2 remained low in concert with plasma AVP levels. No abnormality in pituitary-adrenocortical function was found. These results indicate that marked hypernatremia is derived from partial central diabetes insipidus and elevated threshold of thirst, and that enhanced renal water handling may contribute to maintenance of body water in the present subject. (+info)
Ventriculo-peritoneal shunt and breast carcinoma.
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Ventriculo-peritoneal (V-P) shunt is a frequently performed surgical procedure for treating hydrocephalus. The incidence of breast carcinoma in the UK is 20,000 cases per year. We present a case of a patient with breast carcinoma in association with V-P shunt. (+info)
Vascular compression by a ventricular shunt catheter: clinical value of volume-rendered CT angiography.
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One of the strongest advantages of CT angiography (CTA) lies in its unique ability to display simultaneously the anatomy of the vascular system and the topographic relationships existing between the vessels and the neighboring structures. The case we report, a 76-year-old man who underwent an intraventricular shunt placement complicated by a stroke, shows how this topographic assessment also provides important diagnostic information when vascular lesions resulting from an extrinsic compression mechanism are suspected. (+info)