Ventricular enlargement in new-onset pediatric epilepsies

Purpose: To examine baseline and prospective (2‐year) changes in third, fourth, and lateral ventricle volumes in children with new‐onset idiopathic epilepsies and controls (age 8–18 years). Methods: Structural magnetic resonance imaging (MRI) were collected from children with idiopathic generalized epilepsy (IGE, n = 29), idiopathic localization‐related epilepsy (ILRE, n = 30), and healthy controls (HCs, n = 49). Volumes of the third, fourth, and lateral ventricles were derived and compared across groups, followed by shape analyses, to identify specific regions of ventricular abnormality. Of the initial cohort, a consecutive sample of 71 children returned 2 years later for reimaging and determination of progressive changes in the ventricular system. Key Findings: At baseline, children with new‐onset IGE had significantly larger lateral and third ventricle volumes relative to the HC group. In addition, lateral ventricle enlargement in IGE was significantly greater compared to new‐onset ILRE. Shape analysis of the lateral ventricles revealed that volume expansion in IGE was selective for the anterior horn, a region surrounded by the lateral and medial frontal lobes as well as basal ganglia. These abnormalities did not progress over a 2‐year interval. Significance: Abnormalities in brain development prior to onset and diagnosis of epilepsy are evident and reflected in expansion of the ventricular system, especially among children with IGE. These abnormalities appear to represent an antecedent and possibly static finding given the lack of progressive ventricular expansion over the 2‐year interval following diagnosis and treatment.     

Motor neuron disease-like syndrome secondary to trapped fourth ventricle and obstruction of cerebrospinal fluid pathway

The trapped fourth ventricle is caused by occlusion of outlets of fourth ventricle, including cerebral aqueduct and foramina of Luschka and Magendie. It is an uncommon entity that mainly occurs in children with hydrocephalus after successful shunting of lateral ventricles. The most common etiologies of obstruction to outflow of the fourth ventricle are infection and hemorrhage. Typical manifestation of trapped fourth ventricle is posterior fossa syndrome. Here, we report a 22-year-old man with hydrocephalus developed after successful removal of traumatic subdural hemorrhage. After shunting of lateral ventricles, hydrocephalus resolved initially. However, trapped fourth ventricle occurred 9 months later. Unlike previous reports of trapped fourth ventricle, his presentation was motor neuron disease-like syndrome, including hand muscle weakness and atrophy, generalized brisk deep tendon reflexes, and absence of sensory deficits. Imaging study showed isolated dilatation of fourth ventricle and edema of cervical cord from obex to C7 level. After surgical decompression and lysis of adhesion of posterior fossa, neurological deficits well recovered. The pathogenesis of hand muscle atrophy is secondary to cervical cord edema caused by trapped fourth ventricle and obstruction of cerebrospinal fluid (CSF) pathway. Furthermore, the anterior horn cells and lateral corticospinal tract are located in the highly vulnerable region of spinal cord, either possibly due to venous engorgement or arterial insufficiency.     

MRI study of posterior fossa structures and brain ventricles in bipolar patients

Previous brain imaging studies have suggested anatomical abnormalities in posterior fossa structures and brain ventricles in bipolar patients. Such abnormalities could possibly be implicated in the pathophysiology of bipolar disorder. Twenty-two DSM-IV bipolar outpatients (mean age±S.D.=36±10 years) and 22 healthy controls (mean age±S.D.=38±10 years) underwent an 1.5T MRI (3D-gradient echo-imaging SPGR), performed in the coronal plane (TR=25 ms, TE=5 ms, slice THICKNESS=1.5 mm). The brain structures of interest were traced blindly with a semi-automated software. No significant differences were found between bipolar patients and healthy controls for any posterior fossa measures, or for measures of third or lateral ventricles (MANOVA, age covariate, P>0.05). Age was directly correlated with 3rd ventricle volumes in bipolar patients (Pearson correlation COEFFICIENT=0.458, P=0.032), but not in healthy controls (Pearson correlation COEFFICIENT=0.313, P=0.155). There was a significant direct correlation between the number of prior illness episodes and right lateral ventricle volumes (Partial correlation COEFFICIENT=0.658, P=0.011). Familial patients had smaller left and right cerebellar hemispheres and total vermis volumes, and larger left lateral ventricle volumes compared with non-familial ones (MANOVA, age covariate, P<0.05). In this preliminary study, we were not able to replicate previous findings of abnormalities in cerebellum or brain ventricles in bipolar individuals. However, there were suggestions that abnormalities in cerebellum, vermis, and lateral ventricle sizes may be present in familial cases of the disorder, which should be further examined in future studies with larger patient samples.     

Unilateral traumatic posterior fossa subdural effusion in an infant.

Supratentorial subdural effusion is common after infection and trauma, but rarely occurs in the posterior fossa, and is even less commonly unilateral. The authors report a rare case of unilateral traumatic posterior fossa subdural effusion with secondary hydrocephalus. A 6-month-old female infant presented with lethargy, poor appetite, and persistent vomiting after head trauma 2 weeks previously. A non-enhanced brain CT scan revealed a right posterior fossa subdural fluid collection that displaced the fourth ventricle and brainstem and dilated lateral ventricles. While monitoring the intracranial pressure, the baby was treated with temporary external subdural drainage, followed by a permanent subdural peritoneal shunt. The treatment and likely physiopathology of this unique case are discussed.     

宝石能谱计算机断层扫描70 keV单能量图像在后颅窝成像中应用的探讨

目的 探讨宝石能谱计算机断层扫描（computed tomography,CT）70 keV单能量图像在后颅窝成像中提高图像质量及去除硬化伪影的价值。
方法 ①将2011年6月至2012年10月在首都医科大学附属北京天坛医院进行头部宝石能谱CT 70 keV单能量模式平扫的87例以及同期头部宝石能谱CT常规混合能量CT平扫400例患者影像学资料分别建立数据库。②从上述两个数据库中采用随机序数法分别抽取20例患者资料,测定双侧内听道中点、四脑室最大层面桥脑中心及小脑白质20 mm2感兴趣区CT值及其标准差,图像质量用噪声水平（CT值标准差）衡量,比较两组图像质量。另外,从上述两个数据库中采用随机序数法分别抽取30例患者资料,进行后颅窝伪影评分,比较两组评分差异。
结果 能谱扫描模式下70 keV单能量图像所测得两组双侧内听道中点、四脑室最大层面桥脑中心及小脑白质的噪声水平中位数（四分位数）分别为（单位：HU）：70 keV单能量图像3.96（3.60,4.24）、3.66（3.40,3.92）、3.37（3.06,3.65）,混合能量图像5.52（5.16,5.80）、4.52（4.15,5.36）、4.26（3.95,4.74）,与混合能量组比较,70 keV单能量组图像后颅窝脑组织不同位置噪声水平均降低,差异有显著性,P均<0.001。后颅窝伪影方面,70 keV单能量组图像评分高于混合能量组,两组中位数和四分位数分别为单能量组4（3,4）和混合能量组3（2,3）,差异有显著性（P<0.001）。
结论 能谱扫描模式下70 keV单能量图像经初步研究显示,能够满足后颅窝诊断需要,并且与常规混合能量图像相比较,能够显著降低后颅窝脑实质图像噪声,提高后颅窝图像质量、抑制后颅窝伪影。     

Ante- and postnatal evaluation of the dandy-walker syndrome

In three cases an antenatal diagnosis of isolated Dandy-Walker cyst was made at 22–28 weeks of gestation by ultrasound examination. Biparietal growth and the relative severity of the anomaly remained constant, so that all cases could be safely delivered at term. Postnatally, the diagnosis was confirmed during the first days of life by ultrasound and computed tomography (CT). Early neonatal shunting procedures were performed. Dual shunts were inserted in all three cases, and mental and physical development were observed to be normal during a follow-up of from 1.5 to 4.5 years. Early antenatal diagnosis of Dandy-Walker cyst may improve the prognosis and reduce the mortality, which has been reported to be 30%–48%. Dual shunting of both the cyst in the posterior fossa and the lateral ventricles has proved to be a safe and reliable method during the neonatal period.     

First report of occurrence of choroid plexus papilloma and medulloblastoma in the same patient

Introduction Choroid plexus papilloma is a benign epithelial brain tumour showing a striking predilection for infants and occurring most frequently in the lateral and fourth ventricles. Medulloblastoma, on the other hand, is a primitive neuroectodermal tumour and is the most frequent malignant brain tumour of the posterior fossa in children. In this study, we report a metachronous occurrence of choroid plexus papilloma and medulloblastoma in the same patient, which has not been reported before to the best of our knowledge. Case report The authors describe the case of a girl who presented with an atypical choroid plexus papilloma on the posterior wall of the left lateral ventricle at 3 months of age that was resected completely. She was followed up regularly after surgery and made good progress with normal development. At 8 years of age, she presented with right cerebellar medulloblastoma. Discussion The authors review literature for incidence and aetiology of the two tumours.     

Colpocephaly: frequency and associated findings

Colpocephaly is an abnormal enlargement of the occipital horn of the lateral ventricle, also described as persistence of the fetal configuration of the lateral ventricles. Since it was first described, colpocephaly has been found in association with a number of abnormalities of the brain. In order to determine the frequency of this ventricular configuration at our hospital, we reviewed 3,411 computed tomographic (CT) scans done over a 26-month period. Fourteen cases were identified in which the CT scan had the appearance of colpocephaly. These CT scans were performed during the evaluation of a number of different clinical problems. Agenesis of the corpus callosum was the most frequently associated malformation. The types of malformations commonly associated with colpocephaly suggest that colpocephaly is merely a marker of disordered brain formation and that insults occurring anytime between one and four months of gestation may result in this anomaly.     

脑室内脑膜瘤的分布及显微手术治疗

目的 探讨脑室内脑膜瘤的分布及显微手术的疗效.方法 对35例行显微手术治疗的脑室内脑膜瘤患者的临床资料及手术效果进行分析总结.结果 30例位于一侧侧脑室,2例位于双侧侧脑室,1例位于侧脑室+第三脑室,1例位于第三脑室,1例位于第四脑室;其中30例全切(SimponⅠ,Ⅱ),4例次全切(Simpon Ⅲ),Ⅰ例大部分切除;术中去骨瓣减压3例,手术死亡1例.术前有颅高压23例术后早期缓解20例,加重3例;随访3个月-8年,7例肢体活动障碍者6例改善,1例加重;4例偏盲者2例改善,2例无变化;伴有脑积水5例,3例缓解,1例行脑室-腹腔分流术,1例行第三脑室底造瘘术.全切病例中,1例肿瘤复发行二次手术;失访3例.结论 脑室内脑膜瘤多位于侧脑室三角区,其位置深在,但显微手术的疗效良好.     

Caudate hemorrhage

Eight patients had computed tomographic (CT) evidence of caudate hemorrhage. In all cases, the initial clinical findings were most suggestive of subarachnoid rather than intracerebral hemorrhage. The CSF was bloody and xanthochromic in all cases. In caudate hemorrhage due to ruptured carotid artery aneurysms, the CT scan showed hyperdense lesions contiguous with the anterior frontal horn of the lateral ventricles. In caudate hemorrhage related to hypertension, the CT scan showed a small hematoma that appeared contiguous with the anterior portion of the body of the lateral ventricle, and there was prominent intraventricular extension.     

Developmental Changes in Normal Cranial Measurements by Computed Tomography

Computed tomography (CT) scans were examined for 89 selected patients in an attempt to establish normal values at various ages for longitudinal and transverse diameters of the brain, the greatest distance between the right and left sides of the anterior horn of the lateral ventricle, the width of the lateral ventricles in the region of the caudate nuclei, and the greatest width of the third ventricle. The patients' ages ranged from less than one year to over 40 years. These measurements and their ratios to one another are reported. The cerebral longitudinal fissure, Sylvian fissure and subarachnoid space were evident to some degree below the age of two years, especially below the age of one year, and again above the age of 40 years. The cortical sulcus was occasionally found to have a width of less than 1.9mm below the age of one year and above the age of 40 years.     

四脑室囊虫病的诊断和治疗

目的 探讨四脑室囊虫病的诊断及治疗方法。方法 对我院2000年1月～2006年11月收治的15例四脑室囊虫病患者进行回顾性总结、分析。结果 CT扫描示脑积水、四脑室囊状扩张,4例可见囊虫头节;MRI矢状位T1加权像示四脑室内有一囊性病灶,10例可见囊虫头节。血清囊虫ELISA检查10例阳性。13例术后颅高压症状均立即解除,2例误诊为脑积水,摘除囊虫后症状消失,随访1.5年未见复发。结论 MRI是诊断四脑室囊虫病的首选影像学检查方法,血清囊虫ELISA检查简便,可协助诊断。枕下正中入路四脑室囊虫摘除术是有效的治疗方法。     

Cortical and subcortical computed tomographic study in schizophrenia

Thirty-six chronic schizophrenics and 24 controls, all males, were evaluated by computed tomography (CT) scans. The lateral, third and fourth ventricles, the Sylvian fissure and the largest sulcus from each lobe were measured. In the schizophrenic patients there was a significant increase in third ventricle, ventricular brain ratio (VBR) and cortical measures. The possible implications of these findings in the aetiopathology of schizophrenia are discussed.     

Rate of ventricular enlargement in dementia of the Alzheimer type correlates with rate of neuropsychological deterioration

We studied twelve men and six women with dementia of the Alzheimer type (DAT) and twelve healthy men at intervals of 6 months to 5 years. In the male DAT patients, mean CT rates of enlargement of third ventricle and of total lateral ventricular volumes differed significantly from zero and exceeded respective control values (p less than 0.05). The rate of neuropsychological decline correlated with rates of enlargement of the third ventricle or right lateral ventricle. Women with DAT also had significant rates of enlargement of the third and total lateral ventricles. The rate of lateral ventricular dilatation discriminated DAT patients from controls.     

第四脑室肿瘤的显微外科治疗

目的总结第四脑室肿瘤的显微外科治疗效果及手术策略。方法第四脑室肿瘤患者36例,均在显微镜下或神经内镜辅助下切除肿瘤。肿瘤全切除24例,次全切除12例。结果术后恢复良好13例,死亡3例,缄默症4例,脑积水16例,其中12例行侧脑室．腹腔分流术,4例行脑室心房分流术。术后随访：29例生活、学习良好,3例死亡,1例失访。结论正确及时的诊断、熟悉四脑室的显微解剖、选择合适的手术入路、熟练的显微手术技巧、适当应用神经内镜、积极处理术后脑积水是提高第四脑室肿瘤疗效的关键。     

Slit ventricles as a cause of isolated ventricles after shunting

In a follow-up study of 164 hydrocephalic children without tumors treated with ventriculoperitoneal shunts, 46 (28.0%) developed slit ventricles, 5 (3.0%) developed isolated fourth ventricles, and 4 (2.4%) developed isolated unilateral hydrocephalus. All of the patients with isolated unilateral hydrocephalus and 3 with isolated fourth ventricles had associated slit ventricles, 2 of whom had enlarged ventricles as double-compartment hydrocephalus. Reopening of the foramen of Monro or the aqueduct was achieved in one of the former and two of the latter cases with re-expansion of the slit ventricles. It is suggested that in some cases, the slit ventricle could be a causative factor in post-shunt isolated ventricle.     

Post-dexamethasone cortisol levels and computerized tomographic findings in manic patients

The relations of post-dexamethasone cortisol levels to computerized tomography (CT) scan findings of lateral and third ventricle size and cortical sulcal prominence rated separately for frontal and parieto-occipital distributions were examined in 15 manic patients. Failure to suppress endogenous cortisol after a dexamethasone challenge was associated with larger third ventricles, but not to any of the other CT scan measures.     

成人后颅窝巨大蛛网膜囊肿的诊断与手术治疗

目的 探讨成人后颅窝蛛网膜囊肿的诊断和治疗方法.方法 回顾性总结分析10例成人后颅窝巨大蛛网膜囊肿的临床资料和手术效果,10例全部采取开颅囊壁切除造口粘连松解术,并使之与第四脑室和蛛网膜下腔交通,1例同期行颅内多发性硬膜下积液钻孔引流术.结果 所有病人术后恢复良好,出院前症状改善6例,无变化4例.术后1周常规复查头部MRI,囊肿缩小、小脑部分复位6例.3个月后随访复查头部CT,无囊肿复发.其中小脑完全复位4例,大部分复位6例;脑积水消失、脑室恢复正常4例,脑积水减轻6例;临床症状消失7例,好转3例.结论 开颅在显微镜下获得囊肿腔与脑室及蛛网膜下腔的交通是避免后颅窝巨大蛛网膜囊肿复发和治疗脑积水的关键,手术效果良好.     

Brain tumors of early infants.

The authors describe their experience with ten cases of brain tumors in children in whom the onset of symptoms occurred within the first year of life, but who were operated on when they were 2 months to 4 years of age. The series includes 5 gliomas (4 supratentorial, 1 cerebellar; 3 astrocytomas, 1 spongioblastoma, 1 ependymoblastoma), 2 teratomas of the lateral ventricle, and 3 single cases of third ventricle choroid plexus papilloma, temporal lobe sarcoma, and a parasellar craniopharyngioma. Six cases were partially removed, one of them was shunted. Only biopsy was carried out in two, one of which was shunted. The only case of radical removal was a lateral ventricle teratoma; this patient died at operation. Nine patients survived at surgery, three of whom are alive on the 3rd, 4th, and 7th postoperative year. There were two late deaths: one at 2 years (lateral ventricle astrocytoma, which was only biopsied) and one at 7 years and 3 months (spongioblastoma) following surgery. This series from a 40-year period (1933-1973) represents 0.4% of 2,832 brain tumors and 1.9% of 528 brain tumors in the pediatric age. The authors emphasize the need to treat brain tumors in early infancy and insist on the use of radiotherapy and chemotherapy when the lesions are not radically removed at surgery.     

Computerized Tomographic Study on the Brain of Patients with Alcohol Dependence

Abstract: One hundred ten patients with alcohol dependence and 56 psychiatric patients with either senile dementia, amphetamine psychosis, epilepsy or chronic schizophrenia were investigated with a CT scan of the brain. The maximum width of the 3rd ventricle was measured, and the presence/absence of enlargement of the lateral ventricle and of atrophy of the frontal lobe was determined independently by 3 physicians. The width of the 3rd ventricle in alcoholic and the other patients examined was gradually enlarged with aging, and the width in these patients was significantly larger than that in the age-matched control patients who were selected from the patients with amphetamine psychosis, epilepsy or schizophrenia. The enlargement of the lateral ventricles observed in the alcoholic patients always accompanied the enlargement of the 3rd ventricle, but not vice versa. The alcoholic patients with frontal lobe atrophy showed a higher incidence of withdrawal delirium than the patients without atrophy. These findings suggest that the chronic intake of alcohol might affect primarily the area around the 3rd ventricle, resulting in enlargement of this ventricle and consequential enlargement of the lateral ventricles and also that the alcoholic patients with frontal lobe atrophy could have a high risk for a manifestation of alcoholic withdrawal delirium.