Reliability of cranial CT versus intracerebral pressure measurement for the evaluation of generalised cerebral oedema in children

OBJECTIVE

To examine the extent to which intracranial pressure (ICP) in children after severe brain trauma can be determined by cranial CT.

MATERIALS AND METHODS

Two experienced paediatric radiologists, without any knowledge of the clinical symptoms, evaluated 124 CT scans from 65 children (average age 5.4 years) who underwent intracranial measurement of their cerebral pressure.

RESULTS

CT had high sensitivity (99.1%) for 'high cerebral pressure' but a much lower specificity (78.1%). The examiners tended to estimate ICP as 'high' even when actual ICP was low. Since therapy for lowering cerebral pressure involves potential risks, actual cerebral pressure measurement, particularly in children, should be considered before intervention (e.g. hyperventilation or trepanation). We report the change in different intracerebral fluid compartments with varying cerebral pressure and modifications of the density of the brain tissue in an inter- and intraobserver comparison.

CONCLUSION

The radiologist cannot differentiate, for methodological reasons, between a change in the intracranial fluid compartments not associated with a change in ICP and one in which it is critically elevated. Before any interventional treatments such as decompression-trepanation or hyperventilation are instituted, measurement of ICP should be considered, especially in children.

[Noninvasive ventilation of a 4-year-old boy with severe central late onset hypoventilation syndrome]

BACKGROUND

In the literature we found only five reports about noninvasive ventilation in cases with central hypoventilation syndrome.

PATIENT AND METHOD

We report about a 4-year-old boy with severe late onset hypoventilation syndrome. During an interval of 3 months with nasal mask ventilation during sleep he showed an excellent cognitive and statomotoric development. After this time, he needed a noninvasive ventilation with a negative pressure system.

RESULTS AND DISCUSSION

In our opinion, noninvasive nasal mask ventilation is a modern method in the treatment of patients with central hypoventilation syndrome. Tracheotomy is only necessary during the first year of life.

Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature

The abdominal intraperitoneal cerebrospinal fluid pseudocyst is an infrequent but important complication in patients with ventriculoperitoneal shunts. Since 1954, 115 cases of paediatric pseudocysts have been reported in the literature. One additional report deals with an adult patient. We report on 14 cases of sonographically diagnosed abdominal pseudocysts. Their aetiology, diagnosis, clinical signs and symptoms and surgical management are investigated. In our hydrocephalus series we have an incidence of pseudocyst formation of 4.5%. The most common presentation of the paediatric patients is with symptoms of elevated intracranial pressure and abdominal pain, whereas the adults have predominantly local abdominal signs. Diagnosis is readily made with ultrasonography. Predisposing factors for pseudocyst formation are multiple shunt revisions and infection. Microscopically, the pseudocysts consist of fibrous tissue without epithelial lining. The treatment involves surgical removal of the catheter with or without excision of the pseudocyst wall and placement of a new catheter intraperitoneally in a different quadrant or an intra-atrial shunt. Recurrences are rare, especially under appropriate medical treatment of infection. In our series, microbiologically proven infection was present in 30% of the cases.