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??Children with postoperative hydrocephalus and brain trauma are often left with varying degrees of neurological dysfunction??and the comprehensive rehabilitation therapy for children with postoperative hydrocephalus and brain trauma plays an important role in the field of children’s severe rehabilitation medicine. Accurate rehabilitation assessment and early rehabilitation intervention are closely related to the prognosis of children with postoperative hydrocephalus and brain trauma. The article will briefly introduce the rehabilitation evaluation??timing of rehabilitation intervention??rehabilitation treatment for the children with postoperative hydrocephalus and brain trauma and the methods for promoting wakefulness in children with consciousness disorder ??so as to help the doctors to correctly evaluate and treat the children with postoperative hydrocephalus and brain trauma.     

Recovery of the brain after intraventricular hemorrhage

Intraventricular hemorrhage (IVH) remains a major complication of prematurity, worldwide. The severity of IVH is variable, ranging from a tiny germinal matrix bleed to a moderate-to-large ventricular hemorrhage or periventricular hemorrhagic infarction. Survivors with IVH often suffer from hydrocephalus and white matter injury. There is no tangible treatment to prevent post-hemorrhagic cerebral palsy, cognitive deficits, or hydrocephalus in these infants. White matter injury is attributed to blood-induced damage to axons and maturing oligodendrocyte precursors, resulting in reduced myelination and axonal loss. Hydrocephalus results from obstructed CSF circulation by blood clots, increased CSF production, and reduced CSF absorption by lymphatics and arachnoid villi. Several strategies to promote neurological recovery have shown promise in animal models, including the elimination of blood and blood products, alleviating cerebral inflammation and oxidative stress, as well as promoting survival and maturation of oligodendrocyte precursors. The present review integrates novel mechanisms of brain injury in IVH and the imminent therapies to alleviate post-hemorrhagic white matter injury and hydrocephalus in the survivors with IVH.     

Community-acquired <Emphasis Type="Italic">Pseudomonas</Emphasis> meningitis causes acute obstructive hydrocephalus

Introduction   Pseudomonas aeruginosa (PS) infection is serious in children and can cause malignant external otitis, endophthalmitis, endocarditis, meningitis, pneumonia, and septicemia (Huang et al. Pediatr Infect Dis J 1). The treatment of Pseudomonas infection requires prompt medical evaluation and appropriate antibiotic treatment. Case report  We report the case of a 6-month-old boy with an unusual presentation of acute obstructive hydrocephalus owing to Pseudomonas meningitis. Treatment with optimal antibiotic begun immediately after the pathogen was recognized and continued for 4 weeks. The patient received prompt surgical intervention for the complication of acute obstructive hydrocephalus. Conclusion  The early stage of obstructive hydrocephalus caused by community-acquired Pseudomonas is rare and should be immediately detected.     

临床教学中如何提高医学生与患者沟通技能

临床交流与沟通技能培养是医学生教育的重要内容。在临床教学中,应该加强医患交流与沟通技能重要性教育、强化医学生语言艺术培养,重视带教老师的表率作用,注重告知艺术和技巧的培训等。提高医学生与患者交流沟通技能,是医患纠纷减少的重要保证。     

Role of endoscopic third ventriculostomy in patients with communicating hydrocephalus: an evaluation by MR ventriculography

Post-tubercular meningitic hydrocephalus (TBMH) and post-traumatic hydrocephalus (PTH) is often considered a contraindication for endoscopic third ventriculostomy (ETV), as it is mostly of communicating type in these cases. The aim of the present study was to define the role of ETV in patients with communicating hydrocephalus. Ten consecutive patients of TBMH, PTH and postneurocysticercus (NCC) hydrocephalus were formed the study group. Diagnosis of communicating hydrocephalus was made using magnetic resonance ventriculography (MRV). If contrast was seen coming out from the ventricular system into the basal cisterns, it was considered as communicating hydrocephalus. Patients with clinical and imaging evidence of raised intracranial pressure and failed medical treatment were taken up for ETV. All patients were studied by preoperative and postoperative MRV. Success of the procedure was assessed by the improvement in clinical and imaging parameters on postprocedure follow-up in all these cases. Technically successful ETV was performed in all 10 patients. Overall success rate of ETV in communicating hydrocephalus was 70% (n = 7). The shunt surgery was performed in the remaining three patients with ETV failure. One patient developed complication following postoperative MRV and was managed conservatively. We conclude that ETV is effective in post-TBM, post-traumatic communicating and post-NCC communicating hydrocephalus and should be considered as initial surgical option for cerebrospinal fluid diversion in these patients. MRV is a relatively safe technique to ascertain the patency of subarachnoid space as well as ETV stoma.     

Normal pressure hydrocephalus co-existing with a second dementia disorder

An 87-year-old woman had both Lewy body dementia and normal pressure hydrocephalus simultaneously. One should not automatically exclude the possibility of normal pressure hydrocephalus simply because another neurodegenerative disorder is present, especially if the second disorder masks typical symptoms of normal pressure hydrocephalus. Better identification of dual diagnosis patients could lead to improvements in gait and incontinence following ventriculoperitoneal or lumboperitoneal shunting, even if the natural history of the other neurodegenerative disease remains unchanged.     

脑室、腰池外引流的应用与管理

目的探讨脑室、腰池外引流管的应用与管理,总结减少分流依赖性脑积水及颅内感染的经验。方法回顾性分析连续收治的102例破裂动脉瘤夹闭后对蛛网膜下腔出血的处理及28例脑室出血或积血脑室外引流的放置方法及疗效。破裂动脉瘤病人中,术中留置脑室外引流51例,术后行腰池引流或腰穿9例;对脑室出血病人均行脑室外引流。术中采用聚乙烯吡咯烷酮碘进行硬膜外冲洗;在留置脑室、脑池外引流期间,引流管内压力保持10～15cm H2O。结果本组外引流放置时间2～24d,术后无颅内感染发生。仅出现分流依赖性脑积水3例,均为动脉瘤病人。结论保持10～15cm H2O的脑室、脑池外引流压力及预防颅内感染是减少分流依赖性脑积水的重要措施。     

An unusual cause of neck pain: acquired Chiari malformation leading to brainstem herniation and death

Background

Chiari malformations are structural defects in which portions of the cerebellum are located below the foramen magnum. Of the four types of Chiari malformation, emergency physicians are most likely to encounter Type I (Chiari I). Chiari I malformations may be congenital or acquired. Congenital Chiari I malformations are most frequently encountered in the emergency department (ED) setting due to an exacerbation of subacute or chronic Chiari-related symptoms. However, acute Chiari-associated symptoms from an occult congenital or a secondary (acquired) Chiari malformation may occur.

Objective

To present a literature-guided approach to the identification and initial management of patients with Chiari I malformations in the ED setting.

Case Report

We present the case of a 30-year-old man who presented to the ED with isolated cervical region pain, and who subsequently died as a result of acute brainstem herniation from an acquired Chiari I malformation.

Conclusions

Although rare, acute Chiari I malformation may present to the ED. The new finding of a Chiari I malformation should be presumed acquired until proved otherwise, and should trigger an evaluation for central nervous system lesions or hydrocephalus. Brain imaging to exclude increased intracranial pressure and, in certain cases, specialty consultation, are important considerations.     

Hypertensive encephalopathy presenting as status epilepticus in a three year old

Background

Hypertensive encephalopathy is one of the few neurologic emergencies in which prompt diagnosis and treatment can prevent permanent neurological damage. This syndrome is rarely seen in children.

Objectives

To discuss the recognition of hypertensive encephalopathy as a cause of acute neurological changes in children.

Case Report

We present the case of a 3-year-old boy who presented to the Emergency Department with seizures due to hypertensive encephalopathy. A review of the literature on the subject follows the case report.

Conclusions

Hypertensive encephalopathy is a rare cause of acute neurological changes in children that can cause permanent damage if not recognized early. This case illustrates the importance of considering this syndrome as a potential cause of neurological symptoms, especially as neuroimaging can initially be misleading.