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Abstract
ABSTRACT
Adult hydrocephalus is considered a rare disease in the elderly. Its pathophysiology remains unclear to this day despite the incrimination of several risk factors (arterial hypertension, diabetes, heart rhythm disorders). Axial computed tomography and magnetic resonance are the diagnostic instruments par excellence. Its seemingly simple surgical treatment is based on ventricular bypass. This treatment is often complicated by serious postoperative infections. Hence the need to treat this pathology only in hospitals with a good technical platform. The aim of our work was to prove that the management of hydrocephalus can also be carried out without risk in hospital structures such as the Henry Dunant Hospital of the Cameroon Red Cross in Yaoundé, which implements the infection prevention and control program. We reported 2 cases: a 62-year-old woman and a 72-year-old man who presented similar symptoms, characterized by a gait disorder, cognitive disorders associated with headaches and amnesia. The ECG showed a regular atrial and left ventricular hypertrophy, secondary repolarization disorders. These two patients therefore benefited from a surgical treatment which consists in setting up an internal ventriculoperitoneal bypass valve. The postoperative course was marked by a clear improvement in general condition. No infectious signs or symptoms were observed during this period.
RÉSUMÉ
L'hydrocéphalie de l'adulte est considérée comme une maladie rare chez les personnes âgées. Sa physiopathologie reste à ce jour peu claire malgré l'incrimination de plusieurs facteurs de risque (hypertension artérielle, diabète, troubles du rythme cardiaque). La tomodensitométrie axiale et la résonance magnétique sont les instruments diagnostiques par excellence. Son traitement chirurgical, apparemment simple, repose sur la dérivation ventriculaire. Ce traitement est souvent compliqué par des infections postopératoires graves. D'où la nécessité de ne traiter cette pathologie que dans les hôpitaux disposant d'un bon plateau technique. Le but de notre travail était de prouver que la prise en charge de l'hydrocéphalie peut aussi se faire sans risque dans des structures hospitalières comme l'hôpital Henry Dunant de la Croix Rouge Camerounaise à Yaoundé, qui met en œuvre le programme de prévention et de contrôle des infections. Nous avons rapporté 2 cas : une femme de 62 ans et un homme de 72 ans qui ont présenté des symptômes similaires, caractérisés par un trouble de la marche, des troubles cognitifs associés à des céphalées et une amnésie. L'ECG a montré une hypertrophie auriculaire régulière et ventriculaire gauche, des troubles secondaires de la repolarisation. Ces deux patients ont donc bénéficié d'un traitement chirurgical qui consiste en la mise en place d'une valve de dérivation ventriculo-péritonéale interne. Les suites opératoires ont été marquées par une nette amélioration de l'état général. Aucun signe ou symptôme infectieux n'a été observé durant cette période.
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References
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- – Chazal L., Vanneuville G., Sheye T., et al., Mise au point sur résorption lymphatique du liquide cérébro-spinal. Revue de la littérature : Bull Assoc. Dnat. 73.p. 222, 1989.
- – Elsenberg H.M MC comb J.G Lorenzo AV. « Cérébrospinal fluid over production and hydrocephalus associated with choroid plexus papilloma ». J Neurosurg. 40. P .381-385. 1974
- - Hakim S. Venegas J.G. Burton J.D « the physics of crânial cavity hydrocephalus and normal pressure hydrocephalus. Mechanical interprétation and math model. Surge Neurol 5. P. 187-260. 1976.
- - Kidas S. Yamashina T. Kubota T. étal « A light and électron microscopie and immunohistochemical study of human arachnoïd Vili » J. neurosurg . 69.1 429-438, 1988.
- - Lorenzo A, V., page C.K, watters O.V « relationships, between celebro- spinal fluid formation absorption and pressure in human hydrocephalus Brain 93, P. 679-692, 1970
- - Nulsen FE, Spitz E.B, « treatment of hydrocephalus by direct shunt from ventricul to jugular vein », Surg forum 2, P. 399- 403, 1956
- - Renier D, Lacombe J, pierre- Khan A. et al, « factors causing acute shunt infection computer analysis of 1174 opérations » J Neurosurg. 61 P. 1072-1078, 1984.
- - Sainte- Rose C, « shunt obstruction; A preventable- complication » Pediatr. Neurosurg. 69. P. 156-164, 1993
- - SHINNARS, GAMMON K, Bergman E.W et al, « management of hydrocephalus in infancy ; use of a cetazolamide and furosémide to avoid cérébrospinal fluid shunts », J. pediatr. 107, P. 31-37, 1985.
- - Vannetse J, van Asker R, « normal pressure hydrocephalus, did publications after management » J Neurol, Neurosurg. Psychiatry, 1990, 53, 564-568
- - Vanneste J, Augustin P, Diven C, Tau WF, goedh and Z.D, « shunting normal » pressure hydrocephalus ; do the benefits outweigh the risk ? A mutiplicenter study and littérature review », neurology, 1992, 42 ; 54-59.
- - Zaccaria V, Bacigahipo I, Gervasi G canevelli M, Corbo M, Vanacore N, et al. A systematic review on the epidemiology of normal pressure hydrocephalus Acta Neurol scand. Fevri 2020 ; 146 (2) ; 101-14
- - Martin- Lae R, Caballero-A rzapele H, Valle- Sau, Roman N, Lopez- Menendez LR Arango- Lasprilla JC, vasquez- Barquero A, Incidence of idiopatic normal pressure hydreocephalus in Northem Spain world neurosurg. Mars 2016 ; 87 ; 298-310
- - KLINGE- XHENASLIP, HEISSLER HE, FISHER J, KONIG K, VM KELLER M, RICKELS E. cérébral Blood flow in chronic hydrocephalus ; a parameter indicating shunt faillure new aspects Acta neurochirurgie 1998 ; 76 ;374-9
- - Cinalli G. Sainte- Rose c, chumas P et A.
- Faillure of third ventriculostomy in treatment of aqueducal stenosis in children J. Neurosurg 1999; 90; 448-454
- - Ann LIU, Eric W. Sankey, Ignacio jusue Torres, Mira A. Patel, Benjamin D, Elder, C. Rosy Godwin, Jamie Haffberger, Jennifer lu, danielle Rigamonti clinical outcomes after venticuloatrial shunting fer idiopathic normal pressure hydrocephalus. United States Clinical Neurology and Neurosurgery (2016) 34-38
- - SAKAKIBARA R, Kanda T, Sekido T, Uchlyamat, Awa Y, O T Lin Z Yamamoto T, Yamanishi T, Yuasa T, Shiral K, Hattori T. Mechanism of bladder dysfunction in idiopathic L normal pressure hydrocephalus neurourol urodyn 2008, 27; 507-10
- - Anthony Marmarou, Harold F. Young, Cunes, A. Aygok, Satoshi Sawanchi, Osamu Tsuji, Takuji, Yamamoto, Jana Dunbar.
- Diagnosis and management of idiopathic normal pressure hydrocephalus; a prospective study in151 patients 5 Neurosurg 102 ;987-997, 2005
- - Kitagaki H, Mori E, Ishil K, Yamaji s, hirono N, Imamura T.
- CSF spaces in idiopathic normal pressure hydrocephalus; morphology and volumetry AM journal of Neuroradiology 1998 ;19 1277-1284
- - Marmarou A, bergsnelder M, Kling P, Relkin N, Black PM
- The value of supplemental pronostic tests for the preoperative asssessment of idiopathic normal pressure hydrocephalus. Neurosurgery 2005 ;57 (Suppl) S 17-28
- - Bech R. Waldeman G, G Jerris F, Klinken L, Juher M. S shunting effets in patients with idioparthic normal pressure hydrocephalus corrélation with cérébral and leptomeningeal and biopsy findings Act or neurochirurgica (wieu), 1999 ;146; 633-639
- - KLing P, Berding G. PET studies in idioparthic chronic hydrocephalus before and after shunt treatment; the rôle of risk factors for cerebro vascular disease and cérébral hemodynamics. Acta Neurochir suppl. 2002; 43-46
- - Kang K. H Wang K. Lee H-W. Shunt response idiopathic normal pressure hydrocephalus patient with delayed improvement after taptest. J korean neurosurg SOC 2013; 54; U37- 40
- - Kling P Marmarou, bergsnelder M. Relkin N, black PM outcome of Shunting in idiopathic normal pressure hydrocephalus and the value of outcome assessment in shunted patient’s neurosurgery 2005; 57; 540-52
References
– Bret PH, Chazal L., Hydrocéphalie chronique de l’Adulte », Neurochirurgie 36, suppl. 1 ; P. 1. 159, 1990
– Chazal L., Vanneuville G., Sheye T., et al., Mise au point sur résorption lymphatique du liquide cérébro-spinal. Revue de la littérature : Bull Assoc. Dnat. 73.p. 222, 1989.
– Elsenberg H.M MC comb J.G Lorenzo AV. « Cérébrospinal fluid over production and hydrocephalus associated with choroid plexus papilloma ». J Neurosurg. 40. P .381-385. 1974
- Hakim S. Venegas J.G. Burton J.D « the physics of crânial cavity hydrocephalus and normal pressure hydrocephalus. Mechanical interprétation and math model. Surge Neurol 5. P. 187-260. 1976.
- Kidas S. Yamashina T. Kubota T. étal « A light and électron microscopie and immunohistochemical study of human arachnoïd Vili » J. neurosurg . 69.1 429-438, 1988.
- Lorenzo A, V., page C.K, watters O.V « relationships, between celebro- spinal fluid formation absorption and pressure in human hydrocephalus Brain 93, P. 679-692, 1970
- Nulsen FE, Spitz E.B, « treatment of hydrocephalus by direct shunt from ventricul to jugular vein », Surg forum 2, P. 399- 403, 1956
- Renier D, Lacombe J, pierre- Khan A. et al, « factors causing acute shunt infection computer analysis of 1174 opérations » J Neurosurg. 61 P. 1072-1078, 1984.
- Sainte- Rose C, « shunt obstruction; A preventable- complication » Pediatr. Neurosurg. 69. P. 156-164, 1993
- SHINNARS, GAMMON K, Bergman E.W et al, « management of hydrocephalus in infancy ; use of a cetazolamide and furosémide to avoid cérébrospinal fluid shunts », J. pediatr. 107, P. 31-37, 1985.
- Vannetse J, van Asker R, « normal pressure hydrocephalus, did publications after management » J Neurol, Neurosurg. Psychiatry, 1990, 53, 564-568
- Vanneste J, Augustin P, Diven C, Tau WF, goedh and Z.D, « shunting normal » pressure hydrocephalus ; do the benefits outweigh the risk ? A mutiplicenter study and littérature review », neurology, 1992, 42 ; 54-59.
- Zaccaria V, Bacigahipo I, Gervasi G canevelli M, Corbo M, Vanacore N, et al. A systematic review on the epidemiology of normal pressure hydrocephalus Acta Neurol scand. Fevri 2020 ; 146 (2) ; 101-14
- Martin- Lae R, Caballero-A rzapele H, Valle- Sau, Roman N, Lopez- Menendez LR Arango- Lasprilla JC, vasquez- Barquero A, Incidence of idiopatic normal pressure hydreocephalus in Northem Spain world neurosurg. Mars 2016 ; 87 ; 298-310
- KLINGE- XHENASLIP, HEISSLER HE, FISHER J, KONIG K, VM KELLER M, RICKELS E. cérébral Blood flow in chronic hydrocephalus ; a parameter indicating shunt faillure new aspects Acta neurochirurgie 1998 ; 76 ;374-9
- Cinalli G. Sainte- Rose c, chumas P et A.
Faillure of third ventriculostomy in treatment of aqueducal stenosis in children J. Neurosurg 1999; 90; 448-454
- Ann LIU, Eric W. Sankey, Ignacio jusue Torres, Mira A. Patel, Benjamin D, Elder, C. Rosy Godwin, Jamie Haffberger, Jennifer lu, danielle Rigamonti clinical outcomes after venticuloatrial shunting fer idiopathic normal pressure hydrocephalus. United States Clinical Neurology and Neurosurgery (2016) 34-38
- SAKAKIBARA R, Kanda T, Sekido T, Uchlyamat, Awa Y, O T Lin Z Yamamoto T, Yamanishi T, Yuasa T, Shiral K, Hattori T. Mechanism of bladder dysfunction in idiopathic L normal pressure hydrocephalus neurourol urodyn 2008, 27; 507-10
- Anthony Marmarou, Harold F. Young, Cunes, A. Aygok, Satoshi Sawanchi, Osamu Tsuji, Takuji, Yamamoto, Jana Dunbar.
Diagnosis and management of idiopathic normal pressure hydrocephalus; a prospective study in151 patients 5 Neurosurg 102 ;987-997, 2005
- Kitagaki H, Mori E, Ishil K, Yamaji s, hirono N, Imamura T.
CSF spaces in idiopathic normal pressure hydrocephalus; morphology and volumetry AM journal of Neuroradiology 1998 ;19 1277-1284
- Marmarou A, bergsnelder M, Kling P, Relkin N, Black PM
The value of supplemental pronostic tests for the preoperative asssessment of idiopathic normal pressure hydrocephalus. Neurosurgery 2005 ;57 (Suppl) S 17-28
- Bech R. Waldeman G, G Jerris F, Klinken L, Juher M. S shunting effets in patients with idioparthic normal pressure hydrocephalus corrélation with cérébral and leptomeningeal and biopsy findings Act or neurochirurgica (wieu), 1999 ;146; 633-639
- KLing P, Berding G. PET studies in idioparthic chronic hydrocephalus before and after shunt treatment; the rôle of risk factors for cerebro vascular disease and cérébral hemodynamics. Acta Neurochir suppl. 2002; 43-46
- Kang K. H Wang K. Lee H-W. Shunt response idiopathic normal pressure hydrocephalus patient with delayed improvement after taptest. J korean neurosurg SOC 2013; 54; U37- 40
- Kling P Marmarou, bergsnelder M. Relkin N, black PM outcome of Shunting in idiopathic normal pressure hydrocephalus and the value of outcome assessment in shunted patient’s neurosurgery 2005; 57; 540-52