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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Graph showing the relationship between clinical status&#44; valve pressure changes secondary to the different events &#40;&#35;&#41; described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and mean ICP&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0005" class="elsevierStylePara elsevierViewall">This was a 57-year-old male with a history of HTN&#44; DLP and hypothyroidism&#46; He had severe COVID infection with two months in the ICU&#46; Two months later he developed vision loss with papilloedema&#46; MRI and MR angiography were initially considered normal&#44; although prominent extracranial venous vascularisation in the calvaria was reported and after revision&#44; mild venous thrombosis could be seen&#46; He was diagnosed with IIH after CSF manometry and treated with diuretics&#46; In view of the progressive clinical worsening of his vision and headache&#44; he was referred to our centre&#46; A right parieto-occipital VPS was placed &#40;Miethke ProGAV 2&#46;0&#41;&#44; with an opening pressure of 15 cm&#47;H<span class="elsevierStyleInf">2</span>O and an antigravity pressure of 20 cmH2O&#44; with both clincal and visual field improvement&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">One month later&#44; the patient came to the clinic with further worsening of papilloedema and headache&#44; so his doctor decided to lower the valve pressure to 10&#47;20 cm&#47;H<span class="elsevierStyleInf">2</span>O&#46; Two days later he was referred with headache&#44; vomiting and drowsiness and ICP monitoring &#40;Camino&#41; was started&#44; which was maintained for 10 days using Neuropicture2 software&#46; The clinical and monitoring details are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; which shows how the patient developed signs and symptoms of encephalopathy with low level of consciousness and focality with mean ICP within normal range&#44; while with the non-functioning shunt or high pressures he improved clinically&#44; as the ICP monitoring values worsened&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Once the patient was stabilised with a Strata NSC LPS at maximum pressure &#40;20 cm&#47;H<span class="elsevierStyleInf">2</span>O&#41;&#44; the sensor was removed and MRI and MRI angiography were repeated&#46; In this study&#44; indirect signs of thrombosis of the right transverse and sigmoid sinuses were observed&#44; as well as intracranial vascular dilation in the left hemisphere&#46; In view of the suspicion of AV fistula secondary to venous thrombosis&#44; a selective angiographic study was performed&#46; Arteriography confirmed a type IIA&#8239;&#43;&#8239;B arteriovenous fistula according to the Cognard classification&#44; with retrograde drainage to the TSS and cortical and deep veins&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After the diagnostic test&#44; the patient had a low level of consciousness&#44; probably due to worsening venous stasis&#44; and was sedated&#44; intubated and transferred to the ICU&#46; A new ICP sensor was placed and the shunt was externalised to maintain pressures above 20&#8239;mmHg&#46; The following day&#44; the fistulous inflow from the right external carotid artery was embolised with coils and liquid agents &#40;middle meningeal and right occipital arteries&#41; and then surgical exclusion of the lesion was performed&#44; with supra- and infratentorial craniotomy for skeletonisation and sealing of the sinus&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">After extubation&#44; the patient had a GCS of 15 with bradypsychia and was dependent on drainage to control ICP&#44; maintained after exclusion of the fistula between 15&#8722;20&#8239;mmHg&#46; Three days later&#44; a new angiogram confirmed complete exclusion of the AVF and worsening of the venous thrombosis&#44; with no opacification of the right transverse or sigmoid sinus or distal third of the SSS&#44; so anticoagulation was started&#46; On the following day&#44; the patient&#39;s level of consciousness abruptly decreased&#44; with right hemiplegia and left mydriasis&#46; An urgent CT scan revealed a left subdural haematoma with midline shift&#44; and he underwent evacuation and decompressive hemicraniectomy&#46; The externalised LPS was removed and ELD was placed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">After a few days of stability&#44; the patient had a new episode of left mydriasis&#44; with a CT image of left temporal venous haemorrhage&#44; which was not treated&#46; The lumbar drain and ICP sensor were removed&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">After seven days the mydriasis reversed&#44; but it was a further two weeks before a neurological response was identified&#46; After that&#44; progress was slow but very satisfactory&#44; and the patient was discharged to a rehabilitation hospital a month and a half after the DC&#46; Three months later he had an mRS of 3 and was readmitted for cranioplasty&#44; with ICP monitoring found to be normalised&#46; One year after the event&#44; he has a mRS of 2 due to decreased visual acuity&#44; he can walk normally&#44; his family reports no cognitive impairment and he has returned to work in the same job&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion&#58; rationale for the clinical case</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patient was diagnosed with IIH with fulminant visual worsening&#44; and was treated urgently by VPS&#44; with initial improvement both clinically and in his visual field&#46; Retrospectively&#44; the initial MRI showed partial thrombosis of the right transverse and sigmoid sinus with extracranial congestive vessels &#40;probably secondary to severe viral infection&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In 1998&#44; Cognard analysed 13 cases of intracranial AVF with clinical signs of IIH and established the relationship between the two conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> He also described the complications resulting from the abrupt decrease in intracranial pressure&#58; one patient developed acute neurological deterioration after LP&#44; another died and a third went into coma after LPS&#44; improving after the LPS was removed&#46; The rapid decrease in CSF pressure was considered to generate a sharp pressure gradient leading to brain herniation at the foramen magnum&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">However&#44; both LP and LPS are part of the routine diagnosis and treatment of IIH patients&#44; with a very low incidence of acute complications&#44; meaning the pathophysiology must be different&#46; CSF absorption depends on a pressure gradient between the subarachnoid space and the sagittal sinus which must be maintained at around 5&#8722;7&#8239;mmHg&#46; In the case of AVF&#44; there is an increase in the intracranial venous component due to the meningeal arterial shunt to the dural venous sinus&#46; The Monro-Kellie doctrine states that an increase in any of the normal intracranial components &#40;parenchyma&#44; CSF&#44; venous and arterial blood&#41; leads to compensatory reductions in other elements to maintain ICP within normal range&#46; In the event of an increase in the venous vascular compartment &#40;AV shunt&#41; together with a hindrance in venous drainage due to ectasia and venous thrombosis&#44; the outflow of CSF from the intracranial to the spinal compartment has a poor compensatory capacity&#44; causing an increase in ICP by a double mechanism&#58; the increase in the venous compartment and a resistance to CSF drainage &#40;increase also in the CSF component&#41;&#46; Far from solving the problem&#44; shrinking the CSF compartment by implanting a shunt system without resolving the cause of the increased venous component actually aggravates it by hindering the physiological mechanisms of CSF drainage by altering the CSF-venous sinus pressure differential&#46; Sato et al&#46; published a case of growth of the venous portion of an AVF immediately after fluid diversion which supports this hypothesis&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">However&#44; untreated AVF can lead to hydrocephalus&#46; The paradigm of this situation is hydrocephalus secondary to malformation of the vein of Galen&#44; and since the 2010s it has been established that treatment should be aimed at disconnecting the malformation and not at the hydrocephalus itself&#46; Multiple cases of complications secondary to shunt placement have been reported in these patients&#46; In 1992&#44; Schneider et al&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> described a complication rate of up to 70&#37; in patients treated with VPS&#44; and in 2016&#44; Meila<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> reported severe complications such as hygromas&#44; haemorrhages and status epilepticus in seven out of nine children who had a VPS placed due to VGM before 2009&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">The pathophysiology of ICHT-hydrocephalus in patients with AVF is still not fully understood&#46; Arun et al&#46; collectively speak of &#34;a spectrum of hydrovenous disorders&#34; and propose an interesting framework for cerebral venous congestion according to its aetiology&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The continuous interactions between CSF&#44; the venous system and the interstitial space&#44; together with the consequent involvement of the glymphatic system&#44; may lead to secondary ventricular dilation&#46; However&#44; while this phenomenon is common in children&#44; probably due to the immaturity of CSF reabsorption&#44; very few cases of dilation have been reported in adults&#44; where IIH tends to occur without ventricular enlargement&#46; Castle et al&#46; use the theory of transmantle and transvenous pressure gradients to explain the pathophysiology of different types of CSF hydrodynamic abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> In the case of IIH in adults&#44; venous hypertension increases CSF pressure in both the ventricular system and the subarachnoid space without generating a true transmural pressure&#44; or a gradient between superficial and deep venous pressure&#44; and nor&#44; therefore&#44; ventricular dilation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Two months after referral&#44; the patient reported a new worsening of his vision and it was when the system pressure was lowered &#40;from 15 to 10 cm&#47;H<span class="elsevierStyleInf">2</span>O&#41; that the clinical signs and symptoms described above began&#46; At first we suspected encephalopathy secondary to spontaneous intracranial hypotension due to overdrainage&#46; We decided to perform continuous ICP monitoring&#44; which ruled out the suspected diagnosis&#44; although almost 50&#37; of cases of hypotensive encephalopathy have normal ICP values&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Spontaneous intracranial hypotension can lead to dementia&#44; drowsiness and encephalopathy&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The relationship between rapid ICP reduction and posterior reversible encephalopathy syndrome &#40;PRES&#41; is established&#44; with multiple published cases secondary to LP or post-surgical CSF fistula after lumbar or posterior fossa surgery&#46; In addition&#44; the development of PRES after ventriculoperitoneal&#44; lumboperitoneal or cystoperitoneal shunting has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> There are also reports of hypothalamic impairment with hypersomnolence or hyperpyrexia secondary to valve overdrainage which improved after valve reprogramming&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> as well as brainstem involvement mimicking encephalitis&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">The prognosis is generally good&#44; but it is important to be aware of this relationship in order for our clinical suspicions to be raised and to address the cause early&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Although the monitoring was not suggestive of overdrainage&#44; the patient did clinically improve&#44; so we raised the valve opening pressure back to maximum&#46; Continuous monitoring and the different events that manifested &#40;valve pressure rise&#44; LPS kinking&#44; LPS programming error at minimum&#44; rise to maximum&#44; deprogramming by MRI with valve at minimum again and another rise&#41; provide sufficient information to demonstrate that the patient had venous congestive encephalopathy secondary to the subsequently diagnosed AVF&#44; aggravated by CSF drainage through the shunt&#46; It was paradoxical to observe that the more &#34;normal&#34; the ICP reading was&#44; the worse the patient&#39;s clinical status&#44; and vice versa &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The concept of venous congestive encephalopathy in the context of AVF was first used in 1994 to define non-haemorrhagic neurological symptoms secondary to venous hypertension&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Congestion is generated by the overload of arterial blood on the venous system and its extent depends on the flow volume of the fistula and the resistance to venous return&#46; While stenosis of the draining vein is the factor most frequently associated with AVF bleeding&#44; the main cause of congestion is the absence of an alternative venous drainage route&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Venous congestion can sometimes be seen on CT or MRI as white matter oedema with mass effect&#44; while angiography shows a delayed circulation time&#46; Extensive venous congestive encephalopathy is a sign of aggressive AVF that predicts a very unfavourable natural history&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Similar to the case reported by Sato et al&#46;&#44; we believed that intracranial hypertension acted in our patient as a blockage of blood flow to the fistula &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; It is clear that untreated venous thrombosis is primarily responsible for the development of the condition&#44; but a contributing factor to the rapid deterioration that occurred in a short time &#40;from initial &#34;normal&#34; MRI to obvious signs of AVF within three months&#41; may have been the decrease in ventricular pressure secondary to VPS&#46; Interestingly&#44; each of the pressure changes resulted in a consistent and almost immediate clinical change&#59; for example&#44; minutes before the MRI the patient&#39;s level of counsciousness was normal and on returning to his room after the valve pressure was deprogrammed to minimum&#44; he had severe bradypsychia and a progressive decrease in arousal&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">After fistula treatment&#44; the patient&#39;s venous thrombosis worsened&#46; He was anticoagulated and developed ischaemic and haemorrhagic complications which required surgical treatment for control of the ICHT&#46; The available evidence encourages us to aggressively treat ICHT secondary to venous pathology &#40;ischaemic or haemorrhagic&#41;&#44; as the chance of good functional recovery is much higher than in cases of traumatic brain injury or arterial ischaemic pathology&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Even extensive venous infarctions have a chance of recovery and up to one third of comatose patients with unreactive pupils have a good neurological outcome after DC&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The mortality rate in these patients is estimated at 15&#46;9&#8211;20&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> and good neurological recovery is seen in 50&#8211;56&#46;5&#37;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> of patients with mRS of 0&#8722;1&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Cranioplasty was performed three months after DC&#44; as we believe it should be performed as soon as possible to avoid complications&#46; ICP monitoring after skull placement recorded no remarkable abnormalities&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Declaration of conflicts of interest</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have no financial or personal interests that might have influenced the work carried out&#46; The patient signed a consent form for the dissemination of his clinical case&#46;</p></span></span>"
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    "fechaAceptado" => "2024-02-11"
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        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:5 [
            0 => "Intracranial hypertension"
            1 => "Arteriovenous malformation"
            2 => "Venous congestion"
            3 => "Overdrainage"
            4 => "Encephalophaty"
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        1 => array:4 [
          "clase" => "abr"
          "titulo" => "Abbreviations"
          "identificador" => "xpalclavsec1845024"
          "palabras" => array:24 [
            0 => "HTN"
            1 => "DLP"
            2 => "ICU"
            3 => "MRI"
            4 => "ICHT"
            5 => "IIH"
            6 => "VPS"
            7 => "ICP"
            8 => "GCS"
            9 => "CT"
            10 => "LAB&#47;HAB"
            11 => "EEG"
            12 => "BT"
            13 => "LPS"
            14 => "AVF"
            15 => "TSS"
            16 => "RTS"
            17 => "SSS"
            18 => "ELD"
            19 => "DC"
            20 => "mRS"
            21 => "LP"
            22 => "CSF"
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            0 => "Hipertensi&#243;n intracraneal"
            1 => "Malformaci&#243;n arteriovemosa"
            2 => "Congesti&#243;n venosa"
            3 => "Hiperdrenaje"
            4 => "Encefalopat&#237;a"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We present a unique clinical case of venous congestive encephalopathy in the context of a cerebral arteriovenous fistula with clinical worsening secondary to valvular overdrainage&#46;</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ICP monitoring&#44; the different pressure settings of the programable CSF shunt and the detailed clinical description that is carried out offer us enough data to understand that this case provides important pathophysiological knowledge to a little-known disease&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Presentamos un caso cl&#237;nico &#250;nico de encefalopat&#237;a congestiva venosa en el contexto de una f&#237;stula arteriovenosa cerebral con empeoramiento cl&#237;nico secundario a hiperdrenaje valvular&#46;</p><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El registro continuo de la presi&#243;n intracraneal al que fue sometido al paciente&#44; los diferentes cambios de presi&#243;n de la v&#225;lvula ajustable que se realizaron y la detallada descripci&#243;n cl&#237;nica que se lleva a cabo nos ofrecen suficientes datos para comprender que este caso aporta un importante conocimiento fisiopatol&#243;gico a una entidad poco conocida&#46;</p></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Graph showing the relationship between clinical status&#44; valve pressure changes secondary to the different events &#40;&#35;&#41; described in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> and mean ICP&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Graphical representation of the probable pathophysiology of the case&#46; On the left&#44; baseline image of the AVF to transverse sinus&#46; On the right&#44; decreased intraventricular pressure due to the VPS&#44; with increased stasis and venous congestion&#46; Author&#58; LBLL&#46;</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Day&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Event&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Shunt&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pressure &#40;cmH2O&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GCS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Symptoms&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">mean P &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Mean amplitude &#40;mmHg&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ICP monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Other tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Impression&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Decision&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Outpatient&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">ProGAV 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bradypsychia &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Papilloedema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">iICHT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; pressure15 &#8594; 10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emergency&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProGAV 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Confusion&#44; bradypsychia &#43;&#43;&#44; headache&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CT&#58; collapse&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overdrainage&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Monitor ICP&#46; Admit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ICP monitoring&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProGAV 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Somnolence&#44; bradypsychia&#44; dysarthria&#44; left hemiparesis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAB&#58; 30&#37;Pre-plateau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CT &#61;EEG NBT N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overdrainage&#63; Poor position&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure10 &#8594; 15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProGAV 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Disorientation&#46; Strength symmetrical&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAB&#58; 70&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overdrainage&#63; Poor position&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure15 &#8594; 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ProGAV 2&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orientated&#46; No deficit&#46; Bradypsychia &#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LAB 50&#37;HAB&#44; pre-plateau&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Acute oedema OS&#44; chronic oedema OD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OverdrainagePoor position&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Remove VPS and place LPS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LPS &#40;&#35;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strata NSC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40 &#40;kinked&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">GCS 15&#44; no focality&#44; no bradypsychia&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pre-plateau&#44; HAB and LAB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Kinking&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8595; pressureReview&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&#8722;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Catheterrevision &#40;&#35;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strata NSC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Somnolent&#46; Dysmetria&#46; Intention tremor&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LPS X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overdrainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure1&#46;5 &#8594; 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#8722;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure &#40;&#35;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strata NSC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 lying down&#44; 14 sitting&#44; tremor&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Overdrainage&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MRI Sensor removed &#40;&#35;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strata NSC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#8594; 1&#46;5&#40;by MRI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Somnolent&#46; Dysmetria&#46; Intention tremor&#46; CN VI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X-ray&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Pressure change by MRI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressureAV fistula&#63;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8593; pressure &#40;&#35;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Strata NSC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 lying down&#44; 14 sitting&#44; with tremor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">X&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">AV fistula&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Arteriogram&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3586683.png"
              ]
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        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Clinical course of the patient from visual deterioration to diagnosis of AVF&#46; &#35;&#58; events shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:15 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dural arteriovenous fistulas as a cause of intracranial hypertension due to impair- ment of cranial venous outflow"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; Cognard"
                            1 => "A&#46; Casasco"
                            2 => "M&#46; Toevi"
                            3 => "E&#46; Houdart"
                            4 => "J&#46; Chiras"
                            5 => "J&#46;J&#46; Merland"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Neurol Neurosurg Psychiatry"
                        "fecha" => "1998"
                        "volumen" => "65"
                        "paginaInicial" => "308"
                        "paginaFinal" => "316"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous varix enlargement after cerebrospinal fluid diversion in a neonate with pial arteriovenous fistula complicated with hydrocephalus&#46; A&#8232;case report"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Sato"
                            1 => "M&#46; Ezura"
                            2 => "T&#46; Kimiwada"
                            3 => "T&#46; Tominaga"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Interdisciplinary Neurosurgery"
                        "fecha" => "2021"
                        "volumen" => "23"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications of ventriculoperitoneal shunt procedures or hydrocephalus associated with vein of Galen malformations in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;J&#46; Schneider"
                            1 => "J&#46;S&#46; Wisoff"
                            2 => "F&#46;J&#46; Epstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurgery"
                        "fecha" => "1992"
                        "volumen" => "30"
                        "paginaInicial" => "706"
                        "paginaFinal" => "708"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1584382"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hydrocephalus in vein of Galen malformation&#58; etiologies and therapeutic management implications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Meila"
                            1 => "D&#46; Grieb"
                            2 => "K&#46; Melber"
                            3 => "C&#46; Jacobs"
                            4 => "H&#46; Maslehaty"
                            5 => "A&#46; Petridis"
                          ]
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                        "tituloSerie" => "Acta Neurochir &#40;Wien&#41;"
                        "fecha" => "2016"
                        "volumen" => "158"
                        "paginaInicial" => "1279"
                        "paginaFinal" => "1284"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27173099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A proposed framework for cerebral venous congestion"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Arun"
                            1 => "M&#46;R&#46; Amans"
                            2 => "N&#46; Higgins"
                            3 => "W&#46; Brinjikji"
                            4 => "M&#46; Sattur"
                            5 => "S&#46;R&#46; Satti"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
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                        "tituloSerie" => "Neuroradiol J"
                        "fecha" => "2022"
                        "volumen" => "35"
                        "paginaInicial" => "94"
                        "paginaFinal" => "111"
                        "link" => array:1 [
                          0 => array:2 [
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                            "web" => "Medline"
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                ]
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              "referencia" => array:1 [
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                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Transmantle and transvenous pressure gradients in cerebrospinal fluid disorders"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Castle Kirszbaum"
                            1 => "T&#46; Goldschlager"
                          ]
                        ]
                      ]
                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s10143-021-01622-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurosurg Rev"
                        "fecha" => "2022"
                        "volumen" => "45"
                        "paginaInicial" => "305"
                        "paginaFinal" => "315"
                        "link" => array:1 [
                          0 => array:2 [
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                          ]
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              "etiqueta" => "7"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Behavioral Variant Frontotemporal Dementia as a Serious Complication of Spontaneous Intracranial Hypotension"
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                            3 => "F&#46;G&#46; Moser"
                            4 => "S&#46; Jean-Pierre"
                            5 => "A&#46;D&#46; Waxman"
                            6 => "M&#46; Nu&#241;o"
                          ]
                        ]
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                    ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Oper Neurosurg"
                        "fecha" => "2018"
                        "volumen" => "15"
                        "paginaInicial" => "505"
                        "paginaFinal" => "515"
                      ]
                    ]
                  ]
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              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Rapid intracranial pressure drop as a cause for posterior reversible encephalopathy syndrome&#58; Two case reports"
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                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Niwa"
                            1 => "S&#46; Oya"
                            2 => "T&#46; Nakamura"
                            3 => "T&#46; Hana"
                            4 => "T&#46; Matsui"
                          ]
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                      "doi" => "10.4103/sni.sni_55_17"
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                        "tituloSerie" => "Surg Neurol Int"
                        "fecha" => "2017"
                        "volumen" => "8"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28695050"
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                            0 => "O&#46; Hussein"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s12028-017-0481-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Neurocrit Care"
                        "fecha" => "2018"
                        "volumen" => "28"
                        "paginaInicial" => "395"
                        "paginaFinal" => "399"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29150776"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Ventriculoperitoneal shunt-related intracranial hypotension mimicking brainstem encephalitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;B&#46; Hong"
                            1 => "Y&#46;W&#46; Shing"
                            2 => "S&#46;K&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Neurol Sci"
                        "fecha" => "2020"
                        "volumen" => "415"
                        "paginaInicial" => "116937"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Venous congestion&#58; an MR finding in dural arteriovenous malformations with cortical venous drainage"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "R&#46; Willinsky"
                            1 => "K&#46; Terbrugge"
                            2 => "W&#46; Montanera"
                            3 => "D&#46; Mikulis"
                            4 => "M&#46;C&#46; Wallace"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "AJNR Am J Neuroradiol"
                        "fecha" => "1994"
                        "volumen" => "15"
                        "paginaInicial" => "1501"
                        "paginaFinal" => "1507"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7985570"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cerebral venous drainage in patients with dural arteriovenous fistulas&#58; correlation with clinical presentation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;F&#46; Melo Neto"
                            1 => "E&#46;E&#46; Pelinca da Costa"
                            2 => "N&#46; Pinheiro Junior"
                            3 => "A&#46;L&#46; Andr&#233; L Batista"
                            4 => "G&#46; Georges Rodesch"
                            5 => "S&#46; Serge Bracard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3171/jns.1956.13.1.0001"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Neurosurg"
                        "fecha" => "2020"
                        "volumen" => "13"
                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/13286725"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Should decompressive surgery be performed in malignant cerebral venous thrombosis&#63;&#58; A series of 12 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Theaudin"
                            1 => "I&#46; Crassard"
                            2 => "D&#46; Bresson"
                            3 => "G&#46; Saliou"
                            4 => "P&#46; Favrole"
                            5 => "K&#46; Vahedi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/STROKEAHA.109.572909"
                      "Revista" => array:6 [
                        "tituloSerie" => "Stroke"
                        "fecha" => "2010"
                        "volumen" => "41"
                        "paginaInicial" => "727"
                        "paginaFinal" => "731"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20185780"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Decompressive surgery in malignant cerebral venous sinus thrombosis&#58; what predicts its outcome&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R&#46; Mahale"
                            1 => "A&#46; Mehta"
                            2 => "R&#46;G&#46; Varma"
                            3 => "A&#46;S&#46; Hegde"
                            4 => "P&#46;T&#46; Acharya"
                            5 => "R&#46; Srinivasa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thromb Thrombol"
                        "fecha" => "2017"
                        "volumen" => "43"
                        "paginaInicial" => "530"
                        "paginaFinal" => "539"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European stroke organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;M&#46; Ferro"
                            1 => "M&#46;G&#46; Bousser"
                            2 => "P&#46; Canhao"
                            3 => "J&#46;M&#46; Coutinho"
                            4 => "I&#46; Crassard"
                            5 => "F&#46; Dentali"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/ene.13381"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Neurol"
                        "fecha" => "2017"
                        "volumen" => "24"
                        "paginaInicial" => "1203"
                        "paginaFinal" => "1213"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28833980"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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July - August 2024 Venous congestive encephalopathy secondary to arteriovenous fistula aggravated by...
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Vol. 35. Issue 4.
Pages 210-214 (July - August 2024)
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Vol. 35. Issue 4.
Pages 210-214 (July - August 2024)
Case Report
DOI: 10.1016/j.neucie.2024.03.001
Venous congestive encephalopathy secondary to arteriovenous fistula aggravated by cerebrospinal fluid shunt
Encefalopatía congestiva venosa secundaria a fístula arteriovenosa agravada por derivación de líquido cefalorraquídeo
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Juan Casado Pellejero
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jcasado@salud.aragon.es

Corresponding author.
, Silvia Vázquez Sufuentes, Laura Beatriz López López, Rosario Barrena Caballo
Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, Spain
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Table 1. Clinical course of the patient from visual deterioration to diagnosis of AVF. #: events shown in Fig. 1.
Abstract

We present a unique clinical case of venous congestive encephalopathy in the context of a cerebral arteriovenous fistula with clinical worsening secondary to valvular overdrainage.

ICP monitoring, the different pressure settings of the programable CSF shunt and the detailed clinical description that is carried out offer us enough data to understand that this case provides important pathophysiological knowledge to a little-known disease.

Keywords:
Intracranial hypertension
Arteriovenous malformation
Venous congestion
Overdrainage
Encephalophaty
Abbreviations:
HTN
DLP
ICU
MRI
ICHT
IIH
VPS
ICP
GCS
CT
LAB/HAB
EEG
BT
LPS
AVF
TSS
RTS
SSS
ELD
DC
mRS
LP
CSF
VOGM
Resumen

Presentamos un caso clínico único de encefalopatía congestiva venosa en el contexto de una fístula arteriovenosa cerebral con empeoramiento clínico secundario a hiperdrenaje valvular.

El registro continuo de la presión intracraneal al que fue sometido al paciente, los diferentes cambios de presión de la válvula ajustable que se realizaron y la detallada descripción clínica que se lleva a cabo nos ofrecen suficientes datos para comprender que este caso aporta un importante conocimiento fisiopatológico a una entidad poco conocida.

Palabras clave:
Hipertensión intracraneal
Malformación arteriovemosa
Congestión venosa
Hiperdrenaje
Encefalopatía

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