title: Acute two-compartment low pressure hydrocephalus--a case report.
abstract: A case of an 8-year-old-boy with shunt-dependent occlusive hydrocephalus after resection of a cerebellar medulloblastoma is presented, who experienced repeated episodes of severe neurologic deterioration with signs and symptoms of raised intracranial pressure after spinal tapping. However, intracranial pressure was recorded within low ranges, only up to the opening pressure of the implanted adjustable shunt valve. Multiple shunt revisions were performed, until the condition was recognized as acute normal pressure hydrocephalus. Either enforced recumbency and downadjustment of the valve system to 0 cm H(2)O alone or external ventricular drainage seems to be successful to resolve the critical condition, depending on severity of the symptoms. The case illustrates that acute pathologic enlargement of the ventricular system is not always associated with increased intracranial pressure, even when typical signs and symptoms are present. The very rare entity of acute normal pressure hydrocephalus by two separated compartments is postulated based on the pulsatile vector force theory of brain water circulation.
authors.affiliation: Dept. of Neurosurgery, Pediatric Neurosurgery, University Hospital of Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany, preuss@neurosurgeon.ch.
authors.forename: M
authors.initials: M
authors.lastname: Preuß
authors.forename: P
authors.initials: P
authors.lastname: Evangelou
authors.forename: W
authors.initials: W
authors.lastname: Hirsch
authors.forename: M
authors.initials: M
authors.lastname: Reiss-Zimmermann
authors.forename: L
authors.initials: L
authors.lastname: Fischer
authors.forename: A
authors.initials: A
authors.lastname: Merkenschlager
authors.forename: W
authors.initials: W
authors.lastname: Kieß
authors.forename: M
authors.initials: M
authors.lastname: Siekmeyer
authors.forename: J
authors.initials: J
authors.lastname: Meixensberger
authors.forename: U
authors.initials: U
authors.lastname: Nestler
mesh_terms: D000208:Acute Disease; D002528:Cerebellar Neoplasms / Q000601:surgery; D002648:Child; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000503:physiopathology*; D008297:Male; D008527:Medulloblastoma / Q000601:surgery; D013129:Spinal Puncture / Q000009:adverse effects; D017287:Ventriculoperitoneal Shunt