Management of hydrocephalus associated with autoimmune diseases: a series of 19 cases

Ma, Baitao; Wu, Hao; Yin, Hexiang; Chang, Jianbo; Wang, Li; Wang, Renzhi; Ma, Wenbin; Li, Yongning; Guan, Jian; Liu, Jinjing; Wei, Junji

doi:10.1080/08916934.2017.1344976

Cited by 7 publications

(11 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Outcomes of VPS are much better in secondary NPH with improvement in >70% of secondary cases (including >50% “excellent” recovery) compared to 30–50% improvement in idiopathic cases reported elsewhere [ 2 ]. This trend holds true in secondary NPH associated with autoinflammatory conditions treated with steroids [ 8 ]. Our patient's initially reported walk improvement is most likely due to VPS, even though we know that a predictive test showing a good response to large volume tap or an immediate neurological examination after the shunt could have brought more certainty.…”

Section: Discussion/conclusionmentioning

confidence: 99%

Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

et al. 2021

View full text Add to dashboard Cite

Normal-pressure hydrocephalus (NPH) is a common cause of gait apraxia, cognitive impairment, and urinary incontinence in the elderly. It is usually a primary idiopathic disorder but can be secondary. We present a case of secondary NPH due to biopsy-confirmed rheumatoid meningitis initially refractory to intravenous (IV) immunotherapy. Our patient reported an excellent response right after shunting. Her gait remains normal one and a half years later. We searched PubMed for similar cases of rheumatoid meningitis with gait abnormality for additional clinicopathologic discussion. The patient’s movement disorder initially improved with steroid taper. However, she developed progressive symptoms, later on, refractory to IV solumedrol and rituximab. She underwent ventriculoperitoneal shunting (VPS) and reported an outstanding outcome. This is the first reported biopsy-confirmed case of rheumatoid meningitis causing NPH to undergo shunting for immediate improvement. Previous cases of rheumatoid meningitis-associated Parkinsonism have improved with steroid induction. Although our patient’s rheumatoid arthritis is now controlled, her case illustrates that NPH in autoinflammatory conditions may not recover with immune suppression alone. VPS is an option for a faster response in secondary NPH due to rheumatoid meningitis or other inflammatory disorders with progressive symptoms despite standard induction therapy.

show abstract

Section: Discussion/conclusionmentioning

confidence: 99%

Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…ese include medical management with or without ventriculoperitoneal (VP) shunting [5]. Steroids have been considered as the cornerstone of medical management in autoimmune disorder-induced hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

“…Although the reported prevalence of neuropsychiatric manifestations of SLE is 50% which include stroke, meningitis, movement disorders, myelopathy, and psychiatric features, the occurrence of communicating hydrocephalus is extremely rare. So far, only a few case series and reports are available [ 5 ]. It has been seen that, in patients with coexistent SLE and ulcerative colitis, the overall course of SLE is benign with no marked renal impairment [ 2 ] and neurological involvement [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Coexistence of Lupus Nephritis, Ulcerative Colitis, and Communicating Hydrocephalus: A Report of a 21-Year-Old Male

Khan

Saleem

Hassan

et al. 2022

Case Reports in Nephrology

View full text Add to dashboard Cite

Systemic lupus erythematosus (SLE) and ulcerative colitis (UC) are multisystem autoimmune disorders that rarely coexist. We report a case history of a 21-year-old male, presenting with bloody diarrhea and, later, diagnosed to have ulcerative colitis on colonic biopsy. There was clinically silent renal impairment leading to end-stage kidney disease requiring hemodialysis possibly secondary to ongoing lupus nephritis as suggested by positive lupus-specific antibodies’ detection. Besides this, the diagnosis of lupus associated with early communicating hydrocephalus was made on CT brain findings which clinically responded well to the initiation of immunosuppressive therapy. It is imperative to keep in mind the remote possibility of ulcerative colitis in an SLE patient with gastrointestinal (GI) manifestations. Communicating hydrocephalus is a rare neurological manifestation of SLE leading to seizures and can respond well to the initiation of steroids and immunosuppressants. Therefore, a trial of immunosuppressant medications must be given even in a patient with end-stage renal disease (ESRD) to halter extra renal rare lupus manifestations.

show abstract

“…Hayden et al showed that the administration of mannitol induces rapidly decreased ICP, but this effect lasted only 3-4 h and was followed by a rebound of ICP above baseline [41]. Ma et al showed that mannitol and corticosteroids represent an effective treatment approach for patients with autoimmune diseases associated with hydrocephaly [42].…”

Section: Mannitolmentioning

confidence: 99%

“…Some studies have shown that in autoimmune diseases associated with hydrocephaly glucocorticoids have been beneficial and corticosteroids should be considered as first-line treatment choice [42,[48][49][50].…”

Section: Glucocorticoidsmentioning

confidence: 99%

Hydrocephaly: Medical Treatment

Gül¹,

Arslantaş²,

Kasapoğlu³

2018

Hydrocephalus - Water on the Brain

View full text Add to dashboard Cite

Hydrocephaly is a prevalent condition in all age groups. At present, the most frequent strategies used to treat hydrocephaly are surgical shunting procedures, which are still associated with multiple complications. The main goal of the medical therapy for the lowering of high ventricular pressure is to avoid shunting or to reduce and decrease intracranial pressure (ICP) until shunt surgery. Medications affect cerebrospinal fluid dynamics by decreasing secretion or increasing reabsorption. Medical treatment for manipulation of water balance or cerebrospinal fluid (CSF) production reduces mortality in both infants and adults with neurological disorders. Medical treatment has an important role in the management of hydrocephaly especially in patients not suitable for shunt and in patients whom the shunt alone is not able to control the hydrocephaly. The treatment is used to delay surgical intervention but is not effective in the long treatment of chronic hydrocephaly.

show abstract

Management of hydrocephalus associated with autoimmune diseases: a series of 19 cases

Abstract: VPS along with corticosteroids and immunosuppressants represents an effective treatment approach for patients who suffer from hydrocephalus associated with autoimmune diseases.

Cited by 7 publications

References 21 publications

Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

Coexistence of Lupus Nephritis, Ulcerative Colitis, and Communicating Hydrocephalus: A Report of a 21-Year-Old Male

Hydrocephaly: Medical Treatment

Contact Info

Product

Resources

About