Occult hydrocephalus in children with cerebral palsy.
OBJECTIVE
Many children with cerebral palsy have chronic ventriculomegaly as a consequence of perinatal intraventricular hemorrhage or periventricular leukomalacia, without symptoms of hydrocephalus. Children with cerebral palsy who are treated with intrathecal baclofen have a higher rate of cerebrospinal fluid (CSF) leaks along the baclofen catheter than do adults treated with intrathecal baclofen. We postulated that the cause of the increased frequency of CSF leaks was increased CSF pressure, that is, occult hydrocephalus.


METHODS
Lumbar punctures were performed in 24 children with cerebral palsy and asymptomatic ventriculomegaly. Their median age was 4.7 years. Mild or moderate ventriculomegaly was present in 23 children and severe ventriculomegaly was present in 1 child.


RESULTS
Opening pressures were abnormally high in 23 (96%) of 24 children and ranged from 22 to 41 cm H2O (mean, 27.3 cm H2O). Opening pressures did not correlate with the extent of ventriculomegaly.


CONCLUSIONS
Children with cerebral palsy and ventriculomegaly seem to have a high incidence of increased CSF pressure, and thus, of occult hydrocephalus. The increased pressure is probably a significant cause of the increased frequency of CSF leaks for these children during intrathecal baclofen therapy. The long-term risks of untreated increased CSF pressures in this patient population are not known but are cause for concern. Treatment with CSF shunts offers the potential of improved development, which was reported anecdotally in some children who were treated with ventriculoperitoneal shunts after their pressure was found to be increased. Prospective multicenter studies of this problem are needed.
Albright
A Leland
AL
Department of Neurosurgery, University of Pittsburgh, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. Leland.Albright@chp.edu
Ferson
Susan
S
Carlos
Signe
S
D002547:Cerebral Palsy / Q000150:complications*; D015170:Cerebrospinal Fluid Pressure; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis / Q000209:etiology*; D007223:Infant; D012720:Severity of Illness Index