Congenital hydrocephalus is a health problem in many countries and in Romania the pediatric neurosurgical department of the Emergency Hospital “Bagdasar-Arseni” has a large number of such patients. This is a retrospective study and it includes the patients with congenital hydrocephalus operated between 1992 and 2012 in the pediatric neurosurgical department of the Emergency Hospital “Bagdasar-Arseni”. The functional outcome was assessed using Karnofsky Performance Scale, Hydrocephalus Outcome Questionnaire and Glasgow outcome scale. The total number of the patients was 372, with a predominance of boys (212 boys versus 160 girls) and at the time of our study 168 patients were over 16 years old. Functional outcome of the children over 16 years old assessed using Karnofsky Performance Scale, showed that 73 patients were above 80 and leading independent lives, and 95 were less than 80 points. The results would be better if all these patients would benefit from schooling for children with special needs.
Several studies showed that the phosphorylated form of the neurofilament subunit NF-H (pNF-H) are related to neuronal injuries and its detection provide information about the presence and degree of neuronal loss. Neurofilaments are three subunits, namely NF-L, NF-M and NF-H. The phosphorylated neurofilament subunit NF-H (pNF-H) is present into serum and CSF in significant amounts following neuronal injury and may be detected. The pNF-H can be a biomarker of the neuronal injuries and its detection allows the monitoring neuronal pathology and may provide diagnosis and prognosis in humans. We are interested in pNF-H as biomarker of neuronal injury in spinal cord injury and we used a pNF-H ELISA test capable of detecting the levels of phosphorylated NF-H (pNF-H) to patients with spinal cord injury. We studied the pNF-H levels in CSF in two patients with spinal cord injury (SCI) and for normal values of pNF-H we determined the CSF pNF-H level from individuals without neurological damage. The pNF-H values of CSF from the two patients with SCI were 5-10 times higher than the normal and its higher values were related to an unfavorable outcome. In conclusion, although the number of cases is very low - only two, in the context of experimental studies in animals with SCI, we can say that pNF-H is marker in SCI in humans and its increased values are consistent with an unfavorable outcome.
Normal pressure hydrocephalus (NPH) is characterized by normal CSF pressure, less than 18 cm H2O, classical clinical triad: gait disturbance, dementia and incontinence in patients with communicating hydrocephalus on CT or MRI. We analyzed retrospectively the NPH hospitalized patients in three neurosurgical departments between July 2007 and December 2012. Only the cases who met all diagnostic criteria were selected for this study. There were 47 selected cases of patients with NPH, including 24 patients with secondary NPH and 23 patients with idiopathic NPH. Ventriculo-peritoneal shunt was performed in all 24 patients with secondary NPH and at 11 patients with IdNPH. The short-term and long-term results were good and very good for cases of secondary NPH and good in 60% and poor in 40% in cases of IdNPH. The MR imaging showed the absence of CSF passage through the ventricular wall and the ventricular wall in cases of IdNPH with poor results after shunting: ependyma and glia limitans interna represents a fluid - parenchymal barrier between the brain parenchyma and the ventricles as a glialependymal barrier. We can consider that secondary NPH and some cases of idiopathic NPH with repeated small increases of ICP, with transependymal migration of CSF and hydrocephalus causing clinical triad because of the open glial-ependymal barrier, as an Active Normal Pressure Hydrocephalus and the shunt has good results. Other cases of IdNPH have not increases of intracranial pressure, no transependymal migration of CSF and there are periventricular deep lesions, without brain atrophy, causing clinical triad, as a passive hydrocephalus, it is a Passive Normal Pressure Hydrocephalus.
Abstract:Spinal cord injury (SCI) is one of the most devastating traumas for an individual because the complete traumatic spinal cord injury leads to paraplegia or tetraplegia. The mechanical injuries directly cause axonal destruction in fiber tracts, destruction of the neurons and of the glial cells, and their destruction releases substances whose presence, quantity and dynamics can be lesional biomarkers. The reactions of partially injured cells simultaneously start and the occurring substances and their quantity may be reaction biomarkers. The lesional biomarkers appear immediately postinjury and after several hours there are both lesional biomarkers and reaction biomarkers. The most important lesional biomarkers are the phosphorylated neurofilament subunits resulting from the axonal neurofilament destruction. The heavy phosphorylated neurofilament subunit (pNF-H) is a predictive lesional biomarker because its values pattern can show the reducing or stopping of the secondary lesions and the favorable outcome. The complete SCI patients with a favorable development had a specific pattern of daily values of pNF-H: a sudden increase up to a maximum value then a progressive decrease to normal. The patients with unfavorable outcome or neurological stabilisation had two patterns: an increase to a plateau of pNF-H values or a progressive increase up to a peak followed by a progressive decrease to quasi-normal values.
The phosphorylated form of the high-molecular-weight neurofilament subunit NF-H (pNF-H) in serum or in cerebro-spinal fluid (CSF) is a specific lesional biomarker for spinal cord injury. The lesional biomarkers and the reaction biomarkers are both presented after several hours post-injury. The specific predictive patterns of lesional biomarkers could be used to aid clinicians with making a diagnosis and establishing a prognosis, and evaluating therapeutic interventions. Diagnosis, prognosis, and treatment guidance based on biomarker used as a predictive indicator can determine ethical difficulties by differentiated therapies in patients with spinal cord compression. At this point based on studies until today we cannot take a decision based on biomarker limiting the treatment of neurological recovery in patients with complete spinal cord injury because we do not know the complexity of the biological response to spinal cord compression.
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