Third Ventriculostomy in Late-onset Idiopathic Aqueductal Stenosis Treatment: A Focus on Clinical Presentation and Radiological Diagnosis

Background: Few cases of adult idiopathic occlusion of the foramen of Monro (AIOFM) are described in the literature. The diagnosis of AIOFM after an endoscopic procedure is even more infrequent. Case Description: We described the case of a 50-year-old woman who developed bilateral membranous occlusion of both Monro foramina 20 years after an endoscopic third ventriculostomy (ETV) for triventricular hydrocephalus due to an aqueductal stenosis. The patient underwent an endoscopic treatment (left foraminoplasty and septostomy) to check the patency of the stoma on the floor of the third ventricle. After the endoscopic procedure, the symptoms improved and the postoperative magnetic resonance imaging (MRI) demonstrated the resolution of the biventricular hydrocephalus. Conclusion: Bilateral occlusion of both FM with consequent bilateral lateral ventricles enlargement is an extremely rare condition, especially if we consider the cases of biventricular hydrocephalus after endoscopic procedures. In our opinion, an endoscopic approach should be attempted as first choice procedure, avoiding any intraventricular stent or shunt placement.

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Adult Aqueductal Stenosis Presenting as a Thunderclap Headache: A Case Report

Cephalalgia ◽

10.1111/j.1468-2982.2007.01379.x ◽

2007 ◽

Vol 27 (10) ◽

pp. 1171-1173 ◽

Cited By ~ 10

Author(s):

M Mucchiut ◽

L Valentinis ◽

F Tuniz ◽

B Zanotti ◽

M Skrap ◽

...

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Late Onset ◽

Aqueductal Stenosis ◽

Thunderclap Headache ◽

Third Ventriculostomy ◽

Raised Intracranial Pressure ◽

Headache Disorders ◽

Aqueduct Stenosis ◽

Primary Form

Thunderclap headache is well known to be a presenting feature of a variety of causal events. Indeed, a primary form is considered in the International Classification of Headache Disorders-II, but such diagnosis must be made only after exclusion of a possible secondary cause. We report a case of late-onset idiopathic aqueductal stenosis presenting with thunderclap headache, in the absence of abnormal neurological findings or indirect signs of raised intracranial pressure. The patient recovered completely after endoscopic third ventriculostomy. This case indicates primary aqueduct stenosis as a possible, never previously reported, cause of thunderclap headache.

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Epilepsy in Down Syndrome: A Highly Prevalent Comorbidity

Journal of Clinical Medicine ◽

10.3390/jcm10132776 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2776

Author(s):

Miren Altuna ◽

Sandra Giménez ◽

Juan Fortea

Keyword(s):

Down Syndrome ◽

Functional Outcomes ◽

Clinical Presentation ◽

Late Onset ◽

Current Knowledge ◽

Epileptic Seizures ◽

Myoclonic Epilepsy ◽

Increased Risk ◽

Number Of Individuals

Individuals with Down syndrome (DS) have an increased risk for epilepsy during the whole lifespan, but especially after age 40 years. The increase in the number of individuals with DS living into late middle age due to improved health care is resulting in an increase in epilepsy prevalence in this population. However, these epileptic seizures are probably underdiagnosed and inadequately treated. This late onset epilepsy is linked to the development of symptomatic Alzheimer’s disease (AD), which is the main comorbidity in adults with DS with a cumulative incidence of more than 90% of adults by the seventh decade. More than 50% of patients with DS and AD dementia will most likely develop epilepsy, which in this context has a specific clinical presentation in the form of generalized myoclonic epilepsy. This epilepsy, named late onset myoclonic epilepsy (LOMEDS) affects the quality of life, might be associated with worse cognitive and functional outcomes in patients with AD dementia and has an impact on mortality. This review aims to summarize the current knowledge about the clinical and electrophysiological characteristics, diagnosis and treatment of epileptic seizures in the DS population, with a special emphasis on LOMEDS. Raised awareness and a better understanding of epilepsy in DS from families, caregivers and clinicians could enable earlier diagnoses and better treatments for individuals with DS.

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Hydrocephalus presenting as idiopathic aqueductal stenosis with subsequent development of obstructive tumor: report of 2 cases demonstrating the importance of serial imaging

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.5.peds1779 ◽

2017 ◽

Vol 20 (4) ◽

pp. 329-333 ◽

Cited By ~ 1

Author(s):

Jarod L. Roland ◽

Richard L. Price ◽

Ashwin A. Kamath ◽

S. Hassan Akbari ◽

Eric C. Leuthardt ◽

...

Keyword(s):

Late Onset ◽

Diagnostic Testing ◽

Subsequent Development ◽

Mass Effect ◽

Aqueductal Stenosis ◽

Pineal Region ◽

Serial Imaging ◽

Cerebrospinal Fluid Diversion ◽

First Case

The authors describe 2 cases of triventricular hydrocephalus initially presenting as aqueductal stenosis that subsequently developed tumors of the pineal and tectal region. The first case resembled late-onset idiopathic aqueductal stenosis on serial imaging. Subsequent imaging revealed a new tumor in the pineal region causing mass effect on the midbrain. The second case presented in a more typical pattern of aqueductal stenosis during infancy. On delayed follow-up imaging, an enlarging tectal mass was discovered. In both cases hydrocephalus was successfully treated by cerebrospinal fluid diversion prior to tumor presentation. The differential diagnoses, diagnostic testing, and treatment course for these unusual cases are discussed. The importance of follow-up MRI in cases of idiopathic aqueductal stenosis is emphasized by these exemplar cases.

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Obliteration of the choroid plexus after endoscopic coagulation

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.6.peds1438 ◽

2014 ◽

Vol 14 (3) ◽

pp. 230-233 ◽

Cited By ~ 11

Author(s):

Hideki Ogiwara ◽

Kodai Uematsu ◽

Nobuhito Morota

Keyword(s):

Choroid Plexus ◽

Demographic Data ◽

Aqueductal Stenosis ◽

Third Ventriculostomy ◽

Infantile Hydrocephalus ◽

Foramen Of Monro ◽

Initial Surgery ◽

Endoscopic Observation ◽

The Mean

Object Endoscopic choroid plexus coagulation (CPC) with or without endoscopic third ventriculostomy (ETV) has been shown to be effective for selected patients with hydrocephalus. However, whether the effect of the coagulation is temporary and the choroid plexus regenerates or can be obliterated has remained largely unknown. The authors evaluate the effectiveness of CPC and report 3 cases of obliteration demonstrated by direct endoscopic observation. Methods The authors retrospectively analyzed the surgical results of patients with hydrocephalus primarily treated by CPC with or without ETV. Charts were reviewed for demographic data, clinical presentations, surgical therapies, and clinical outcomes. Results Eighteen patients with hydrocephalus were surgically treated using endoscopic CPC between July 2002 and July 2012. In 12 patients, ETV was concurrently performed. The etiology of hydrocephalus was posthemorrhagic in 5 patients, myelomeningocele in 3, postmeningitis in 2, congenital aqueductal stenosis in 1, hydranencephaly in 1, porencephaly in 1, and idiopathic in 5. The mean age at surgery was 8 months (range 0.3–24 months). The mean follow-up was 64 months. In 9 cases (50%), control of hydrocephalus was successful and the patients did not require further surgeries. In 9 patients (50%), treatment failed. Of these, 3 patients underwent repeat ETV 2, 3, and 38 months after the initial surgery. Endoscopic observation of the previous coagulation site revealed no regeneration of the choroid plexus in 2 patients, who underwent repeat ETV 2 and 3 months after CPC. In 1 patient who underwent repeat ETV 38 months after CPC, no regeneration of the choroid plexus, except for that in the proximity of the foramen of Monro, was observed. Conclusions Endoscopic CPC with or without ETV can be a safe and effective treatment alternative to shunt placement in infantile hydrocephalus. Obliteration of the choroid plexus can persist in the relatively long term following CPC, which may contribute to the long-term control of hydrocephalus in successful cases.

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Differentiated clinical presentation of early and late-onset Alzheimer’s disease: is 65 years of age providing a reliable threshold?

Journal of Neurology ◽

10.1007/s00415-015-7698-3 ◽

2015 ◽

Vol 262 (5) ◽

pp. 1238-1246 ◽

Cited By ~ 15

Author(s):

Antonio Palasí ◽

Belén Gutiérrez-Iglesias ◽

Montse Alegret ◽

Francesc Pujadas ◽

Mikel Olabarrieta ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Clinical Presentation ◽

Late Onset

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Endoscopic Third Ventriculostomy in Infants Less than One Year of Age: A Short Series of 14 Cases

Pediatric Neurosurgery ◽

10.1159/000513359 ◽

2021 ◽

Vol 56 (2) ◽

pp. 105-109

Author(s):

Sarita Chowdhary ◽

Shyamendra Pratap Sharma ◽

Pranaya Panigrahi ◽

Manoj Kumar Yadav ◽

Shiv Prasad Sharma

Keyword(s):

Endoscopic Third Ventriculostomy ◽

Obstructive Hydrocephalus ◽

Aqueductal Stenosis ◽

Csf Shunt ◽

Third Ventriculostomy ◽

Occipital Encephalocele ◽

Shunt Implantation ◽

Permanent Morbidity ◽

One Year

Background: Endoscopic third ventriculostomy (ETV) is currently considered as an alternative to cerebrospinal fluid (CSF) shunt systems in the treatment of obstructive hydrocephalus. This procedure allows the CSF to drain in the basal cisterns and reabsorbed by arachnoid granulations, and avoiding implantation of exogenous material. Aims and Objectives: The purpose of this study was to assess the success rate of ETV in infants less than 1 year of age with congenital noncommunicating hydrocephalus. Material and Methods: This study was a 2-year prospective study from August 2017 to July 2019. ETVs were performed in 14 patients younger than 1 year with diagnosis of noncommunicating hydrocephalous. A failure was defined as the need for shunt implantation after ETV. Phase-contrast MRI of the brain was done after 6 months to see patency of ETV fenestration and CSF flow through ventriculostomy. Results: ETV was tried in 18 patients and successfully performed in 14 patients. Out of the 14 patients, shunt implantation after ETV was performed in 3 patients (failed ETV). In the successful cases, etiology was idiopathic aqueductal stenosis in 8, shunt complications in 2, and 1 case was a follow-up case of occipital encephalocele; the mean age was 7.7 months (range 3–12). In the 3 failed cases, etiology was aqueductal stenosis, mean age was 7.6 months (range 3–11). In all ETVs, failed patients MPVP shunting was done. Follow-up of nonshunted patients was done from 6 to 24 months (mean 15 months). There was no mortality or permanent morbidity noted following ETV. Conclusion: ETV is a good surgical procedure for less than 1-year-old children.

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Very late-onset behavioral variant frontotemporal dementia

Dementia & Neuropsychologia ◽

10.1590/s1980-57642013dn70100020 ◽

2013 ◽

Vol 7 (1) ◽

pp. 136-139

Author(s):

Henrique Cerqueira Guimarães ◽

Tatiana de Carvalho Espindola

Keyword(s):

Case Report ◽

Frontotemporal Dementia ◽

Frontotemporal Lobar Degeneration ◽

Clinical Presentation ◽

Late Onset ◽

Ground Level ◽

Dementia Diagnosis ◽

Behavioral Variant Frontotemporal Dementia ◽

Genetically Determined ◽

Late Onset Dementia

ABSTRACT Current concepts regarding frontotemporal lobar degeneration (FTLD) have evolved rapidly in recent years. Genetically determined FTLD cohorts have broadened our knowledge pertaining to its clinical presentation, neuroimaging findings and demographics. In this study we present a case report of a patient diagnosed with behavioral variant frontotemporal dementia diagnosis in her nineties during hospital admission for a ground-level fall. We believe this case reinforces the pervasive nature of this clinical entity, and may contribute to an increased awareness of this diagnostic possibility in late-onset dementia.

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Antenatally Diagnosed Posterior Urethral Valve: A Case Report

Community Based Medical Journal ◽

10.3329/cbmj.v5i1.53920 ◽

2016 ◽

Vol 5 (1) ◽

pp. 42-45

Author(s):

Mahzabeen Islam ◽

Masudur Rahman ◽

Sankar Narayan Dey ◽

Netay Kumer Sharma ◽

Mir Naz Farzana

Keyword(s):

Clinical Presentation ◽

Antenatal Diagnosis ◽

Late Onset ◽

Obstructive Uropathy ◽

Lower Abdominal Pain ◽

Posterior Urethral Valve ◽

Caesarian Section ◽

Common Cause ◽

Obstructive Lesion ◽

Urethral Valve

Posterior urethral valve (PUV) are the most common congenital obstructive lesion of the urethra and a common cause of obstructive uropathy in infancy. Clinical presentation depends on the severity of the obstruction. In case of severe obstruction, the diagnosis is usually made antenatally. Here, we present a case of antenatally diagnosed PUV of a fetus of a lady in her 9th month of pregnancy with mild lower abdominal pain for several hours. On ultrasound (US) examination, we found 36.5±2 weeks of pregnancy with mild to moderate oligohydramnios. Fetal urinary bladder was over distended; both the kidneys were grossly hydronephrotic and PUV like echo lucent area was seen at the prostatic region (Key hole sign). Emergency caesarian section (CS) was done and US of the baby showed typical US finding of PUV. The prognosis of antenatal diagnosis of PUV in early pregnancy is poor. But in this case due to the late onset of symptoms and as immediate necessary steps were taken, the baby was totally cured. This case was reported to aware about importance of antenatal anomaly scan and to share our experience. CBMJ 2016 January: Vol. 05 No. 01 P: 42-45

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Periaqueductal Tumor as a Cause of Late-onset Aqueductal Stenosis

Annual Review of Hydrocephalus ◽

10.1007/978-3-662-11152-9_98 ◽

1990 ◽

pp. 138-138

Author(s):

Paul Steinbok ◽

Michael Charles Boyd

Keyword(s):

Late Onset ◽

Aqueductal Stenosis ◽

Periaqueductal Tumor

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