Monday, 2 December 2013

Hydrocephalus Treatment In Conventional medicine perspective

Hydrocephalus, also known as "water in the brain" is defined as complex and multifactorial neurological disorders of accumulation of cerebrospinal fluid (CSF) in the cavity of brain of that can lead to intracranial pressure inside the side, resulting of brain trauma, stroke, infection, tumor, etc.
Other than structures abnormalities caused by genetic defects, accidence, etc., most acquired hydrocephalus can be prevented by enhancing the immune system in fighting against forming of free radicals causes of irregular cells growth and foreign invasion such virus and bacteria and reduce the risk of diseases cause of Hydrocephalus, such as dementia.

A. In Conventional medicine perspective
A.1. Surgical treatment
In general, treatment of Hydrocephalus involves the placement of a tube made of silastic, into the cerebral ventricles to bypass the flow obstruction and drain the excess fluid into other body cavities, where the fluid can be reabsorbed. In the study of Lumboperitoneal shunts for the treatment of normal pressure hydrocephalus, Dr. Bloch O,  and Dr.McDermott MW. indicated that Studies have reported shunt complication rates up to 38%, with subdural hemorrhage rates as high as 10%. Lumboperitoneal (LP) shunts with horizontal-vertical valves (HVV) are an alternative for cerebrospinal fluid (CSF) diversion that avoids direct cerebral injury and may reduce the risk of overdrainage. They also showed that
 in 33 patients with LP-HVV shunts inserted for the treatment of iNPH from 1998 to 2009. Patients were evaluated for improvements in gait, urinary function, and dementia after shunt placement. All patients had evidence of ventriculomegaly and a positive response to pre-operative lumbar puncture or extended lumbar drainage. All 33 (100%) patients had pre-operative gait dysfunction, 28 (85%) had incontinence, and 20 (61%) had memory deficits. Mean follow-up time was 19 months. Following shunt placement, 33/33 (100%) patients demonstrated improved gait, 13/28 (46%) had improvement in incontinence, and 11/20 (55%) had improvement in memory. Shunt failures requiring revision occurred in nine patients (27%), with an average time to failure of 11 months. Infections occurred in two patients (6%). There were no neurologic complications, including no hemorrhages. Thus, LP-HVV shunt placement is a safe and effective alternative to ventriculoperitoneal shunting for iNPH, resulting in significant symptomatic improvement with a low risk of overdrainage. It should be considered as an option for the treatment of patients with iNPH who demonstrate clinical improvement following lumbar drainage(61).
Other cautioned of The incidence of infection and malfunction with an LP shunt is significantly lower than that with a VP shunt. An LP shunt is also indicated for pediatric patients, although a relatively higher incidence of malfunction is noted compared to adults(62)

A.2. Non Medical treatment
1. Occupational therapy and physical therapy
In the study to examine effectiveness of standardized occupational therapy and physical therapy assessments in detecting functional changes and predicting clinical improvement in patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage, indicated that specific occupational therapy and physical therapy assessments demonstrate sensitivity to change and predictive value with patients with suspected normal pressure hydrocephalus undergoing cerebrospinal fluid drainage(63).

2. Psycological and Speech therapy
In the review of the literature on psychic disturbance in normal pressure hydrocephalus, showed that in the 26 cases of CSF drainage, impairment of memory and concentration were always present in normal pressure hydrocephalus; behaviour disorders were very frequent and characterized by both types of frontal behaviour; the mental picture also comprised difficulties of calculation, writing, visuoconstructive praxis and, less frequently, impaired speech and reading ability. CSF drainage brought clinical improvement in 73% of the cases. Disorders of consciousness, mental function and behaviour regressed generally progressively as soon as the operation had been performed(64).

3. Etc.

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