Clinical Neuroscience

Complex hydrocephalus

JD MA Pickard1

MAY 20, 1994

Clinical Neuroscience - 1994;47(05-06)

The majority of patients with acute symptomatic hydrocephalus are treated perfectly satisfactorily on the basis of clinical history, a CT scan and a conventional shunt. However, more chronic forms of hydrocephalus in all age groups may be difficult to distinguish from cerebral atrophy of various types on the basis of clinical symptoms/signs and CT scan alone, although Hakim's classical triad of gait disorder, urinary incontinence and dementia (mental dullness and recent memory loss) is very useful. Various forms of CSF tap test (Wikkelso, Hakim, continuous drainage) will reveal the immediate responders but not those who improve with shabunting only after some weeks or even months. Subdural collections remain a considerable threat following conventional shunting. Finally, 80% of shunts fail by 12 years and many patients return with a variety of symptoms attributed to shunt dysfunction which are very difficult to elucidate including headache and cognitive decline. How far have new investigations and shunt tech- niques helped manage these intractable problems that can lead on occasion to disaster?

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  1. Academic Neurosurgical Unit Addenbrooke's Hospital, Cambridge

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