Low-pressure hydrocephalus

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Authors: T. Radovnický; F. Vokálek; K. Pištěk; M. Sameš
Authors‘ workplace: Neurochirurgická klinika Fakulty zdravotnických studií Univerzity J. E. Purkyně a Masarykovy nemocnice v Ústí nad Labem, o. z., Krajská zdravotní, a. s.
Published in: Cesk Slov Neurol N 2024; 87(1): 18-21
Category: Review Article
doi: https://doi.org/10.48095/cccsnn202418

Overview

Low-pressure hydrocephalus (LPH) is a serious disease characterized by ventricular dilatation and clinical signs of intracranial hypertension, although the pressure of the cerebrospinal fluid (CSF) in the cerebral ventricles is below the normal range. The pathophysiology of LPH remains complex and not fully understood, but it seems that a combination of mechanisms involving isolation of the ventricular system from the subarachnoid space, changes in brain tissue elasticity and compliance, and increased brain tissue permeability may play a key role. The diagnosis of LPH should be considered in patients with clinical signs of intracranial hypertension and ventricular dilatation on imaging with preserved patent CSF drainage and normal pressure settings. Treatment of LPH includes temporary therapy to ensure patient stabilization with external ventricular drainage and gradual weaning from drainage with the use of increasing intracranial pressure. Permanent treatment includes endoscopic ventriculostomy of the third ventricle and implantation of a shunt with a low differential pressure setting. The choice of the type of shunt may be individualized; only the lumbo-peritoneal type is not recommended. It should be emphasized that recognition and proper treatment of LPH are crucial, as improper treatment can lead to fatal consequences. Despite the ongoing challenges in the diagnosis and treatment of LPH, it is important that the disease is well known to the professional community.

Keywords:

Ventriculostomy – shunt – low-pressure hydrocephalus – external ventricular drainage

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