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All Posts Tagged: Headache

Infantile Hydrocephalus

This is probably the most common pediatric neurosurgical condition. The causes may vary. Hydrocephalus may generally be due to obstruction in the the circulation, insufficient reabsorption or overproduction of cerebrospinal fluid. It is often necessary to divert the cerebrospinal fluid circulation by placing a valve. The fluid can then drain into the abdomen, or more rarely into a large vein, and from there to the heart or to the chest, between the lungs and the thoracic wall. Early diagnosis of this condition prevents possible serious neurological problems that can be life threatening for the child. Sometimes the diagnosis is made before birth, with ultrasound during pregnancy. Although it is usually a benign condition, sometimes the valve can become blocked or infected, and the increased intracranial pressure could be life-threatening. Early diagnosis and decompression can be life saving.

Symptoms

Symptoms of increased intracranial pressure are vomiting, headache, dizziness, drowsiness, and the fundoscopy may reveal papilledema, an important sign of increased intracranial pressure. The valve may need repair on numerous occasions during the child’s lifespan. Modern imaging methods such as cine-MRI may give us new information about the pathophysiology of hydrocephalus.

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Chronic subdural hematoma

 

 

Chronic subdural hematoma is a collection of bloody fluid between the meninges and the brain. It may occur following a head injury and can even occur 1-2 months after the blow. It is most commonly seen in the elderly, and chronic anticoagulant therapy (incl. aspirin) appears to increase its incidence. Clinically, the patient presents with headache, gradual onset of gait instability, confusion, agitation, or weakness on one side of the body. There may also be drowsiness and lethargy. The patient’s history usually includes a blow to the head, which may not have been particularly severe. The diagnosis is made by CT. If it causes symptoms, it must be surgically removed. Usually 2 cranial trepanations are made (small holes in the skull measuring one centimeter in diameter) and the fluid is removed, decompressing the brain. The operation can be performed even with local anesthesia, in selected patients. Repeated removal of the fluid may be required, as recurrence is not uncommon. Sometimes the hematoma is small and does not require surgical removal; CT follow-up is required. Administration of medication (cortisone) may be required. This is a benign condition that usually has a good outcome.

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