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Vol. 2. Issue 4.
Pages 344-353 (January 1991)
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Vol. 2. Issue 4.
Pages 344-353 (January 1991)
Hidrocefalia crónica del adulto (hidrocefalia “normotensiva”) y macrocefalia
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J. Sahuquillo, M.A. Poca, A. Chasampi, E. Gabas, E. Rubio
Servicios de Neurocirugía. Hospital Vall d’Hebron. Barcelona
A. Molins*, A. Rovira+
* Neurología. Hospital Vall d’Hebron. Barcelona
+ Neuroradiología. Hospital Vall d’Hebron. Barcelona
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Resumen

Presentamos 12 casos seleccionados de una serie de 71 pacientes incluidos en un estudio prospectivo e intervenidos con el diagnóstico de hidrocefalia crónica del adulto (HCA). Estos doce pacientes fueron seleccionados por presentar una macrocefalia (perímetro craneal igualo superior al percentil 98). Once casos presentaban transtoroos de la marcha a su ingreso. El patrón tomodensitométrico se caracterizó de una forma uniforme por la presencia de una ventriculomegalia masiva, con una media en el Indice de Evans de 0.48 (Intervalo de confianza al 95% de 0.42 a 0.54), una dilatación marcada de las astas temporales y ausencia de atrofia cortical. Los estudios de PIC e hidrodinámicos demostraron en 8 casos la existencia de una hidrocefalia compensada (PIC media inferior o igual a 12mmHg) y en 4 de una hidrocefalia activa (PIC media superior a los 12mmHg). Se discute la clínica, la respuesta al shunt y las características diferenciales respecto a otros grupos con un síndrome de HCA. La macrocefalia y otros hallazgos clinicoradiológicos sugieren en este grupo particular de pacientes la existencia de una hidrocefalia congénita oculta, descompensada de forma tardía. Se discuten los posibles mecanismos fisiopatológicos responsables de la descompensación, los probables factores etiológicos y la importancia clínica de este tipo particular de hidrocefalia dentro del contexto de la HCA.

Palabras clave:
Hidrocefalia
Estenosis de acueducto
Macrocefalia
Demencia
TC cerebral
Abstract

We are reporting 12 selected cases from a series of 71 patients included in a prospective study with the diagnosis of ACHS and in whom a cerebrospinal shunt was implanted. These twelve patients were selected because they had a head circumference at or greater than the 98th percentile. Eleven patients had gait disturbances on admission. CT scan findings were characterized by the presence of a severe ventricular dilatation with an average in the Evans Index of 0.48 (confidence interval at 95% of 0.42 to 0.54). A very important dilatation of the III ventricle (CI 0.116 to 0.160) and the temporal horos were found. Cortical hydrodynamic studies showed the existence of a compensated hydrocephalus in 8 cases (mean ICP equal or less than 12mmHg). Four patients were considered to have an active hydrocephalus (mean ICP above 12mmHg). Clinical findings, improvement after shunt and specific characteristics of these patients compared with other cases with ACHS are discussed. An increased head circumference and other clinical findings suggest the existence of an occult congenital hydrocephalus that becomes symptomatic later in life in this particular group of cases. The physiopathological mechanisms responsible for decompensation, etiological factors and the clinical importance of this type of hydrocephalus, are discussed.

Key words:
Hydrocephalus
Aqueduct stenosis
Macrocephalia
Dementia
CT scan

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