The Prognosis of Shunted Hydrocephalus

Numerous variables influence the long-term neurological and cognitive outcome of shunted hydrocephalus. Whilst a number of studies have attempted to elucidate the relative importance of some of these factors, they need to be interpreted with caution. Donders et al. [31] cite sample bias, variable means of assessment of intellectual outcome, inadequate statistical analysis and the failure to account for coexistent medical problems as the main methodological inadequacies of many of these previous studies. Regression analysis of their own series of patients (in whom they attempted to overcome these design shortcomings) highlighted neonatal problems, including anoxia, respiratory distress, CNS infection and early seizures, and also ocular defects (gaze, movement and refraction) as particularly poor prognostic factors for long-term intellectual outcome.

The timing as well as the nature of the cerebral insult also appear to be important determinants of long-term outcome. A prenatal or neonatal cause for hydrocephalus has been associated with a worse outcome when compared with cases in which postnatal onset was identified or where the etiology of the hydrocephalus was unknown [32].

Academic placement may serve as more tangible criterion of outcome than IQ. In a cohort of 155 shunted patients after a follow-up of at least 10 years, Casey et al. [33] found that over half of the children were able to attend a normal school. Forty-one percent, however, required special schooling. Children whose hydro-cephalus was the consequence of intraventricu-lar hemorrhage or infection were much more likely to require special schooling.

In this study, more than half (55%) required one or more shunt revisions during the 10-year follow-up period. Furthermore, a mortality rate of 11% for non-tumor-related hydrocephalus was revealed in this study. Precipitous deterioration and sudden death following shunt blockage are well recognized. The adage Once a shunt, always a shunt should at least be assumed to be true and serves as a reminder that when the shunted patient presents with new or unexplained symptoms, the possibility of shunt malfunction must be borne in mind and investigated promptly.

Cure Your Yeast Infection For Good

Cure Your Yeast Infection For Good

The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.

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