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Query: UMLS:C0042024 (incontinence)
 13,409 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite emerging knowledge over 40 years, the postoperative results after shunt implantations in patients diagnosed for normal pressure hydrocephalus (NPH) did not improve significantly during the last decade. For that reason predictors have to be identified in order to predict preoperatively the course of disease. From 1982 until 2000 we examined in a prospective study 200 patients diagnosed for NPH. From the patients, who were surgically treated by a shunt implantation we could reexamine 155 (78%) in a meantime interval of seven month after the operation. The NPH was graduated according to the results of the intrathecal infusion test in an early state NPH (without brain atrophy) and late state NPH (with brain atrophy). In our study, we focussed the attention on the possible predictors: patients age, length of disease, clinical signs--like gait ataxia, dementia and bladder incontinence, aetiology idiopathic/secondary as well as implanted valve type and the value of resistance to cerebrospinal fluid outflow. To measure the outcome we used the NPH-Recovery-Rate, as statistical test the Chi-square according to Pearson. In 80 patients with an early stage NPH (without cerebral atrophy) a short course of disease (< 1 year), a just slight distinct of dementia and an implanted Miethke-Dual-Switch valve were significant predictors for a positive postoperative outcome. The outflow resistance measured in the intrathecal infusion test showed only a minimal relevance for the outcome. Those 75 patients with a late state NPH (with cerebral atrophy) had a better outcome when dementia was not present, the outflow resistance was above 20 mm Hg*min/ml, the CSF tap-test was positive and a Miethke-Dual-Switch valve was implanted.
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PMID:[Predictors of outcome in patients with normal pressure hydrocephalus]. 1511 17

Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by gait disturbance, dementia, and/or urinary incontinence without causative disorders, and ventricular enlargement due to disturbance of the cerebrospinal fluid (SF) circulation. The number of patients with iNPH will increase with the aging of the population in Japan. However, iNPH is often difficult to differentiate from other senile disorders such as lumbar canal stenosis, parkinsonism, and so on. Clinical guidelines for iNPH are required to improve understanding and provide for patients' quality of life and social care. These guidelines propose three levels of iNPH: possible, probable, and definite. Possible iNPH includes one or more of the classical triad and ventricular dilation in middle aged and elderly patients with closing of the CSF space at high convexity on magnetic resonance imaging. Probable iNPH shows improvement of the symptoms after CSF removal in patients with possible iNPH. Definite iNPH shows clinical improvement after CSF shunt operation. The CSF tap test is a major diagnostic measure because of the simplicity and less invasiveness. Use of the programmable valve is recommended to decrease CSF overdrainage. These guidelines are helpful for the diagnosis and treatment of iNPH.
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PMID:Clinical guidelines for idiopathic normal pressure hydrocephalus. 1518 67

Normal pressure hydrocephalus (NPH) or, more precisely, chronic adult hydrocephalus, is a complex condition. Even if the basic mechanism is found in an impediment to CSF absorption, the underlying pathology is heterogeneous. In secondary NPH, the disruption of normal CSF pathways, following meningitis or sub-arachnoid haemorrhage, is responsible for ventricular dilatation. However, in about half of the cases, the etiology remains obscure. NPH is more frequently found in elderly people, probably in relation with the increased incidence of cerebrovascular disease. The diagnosis of NPH is based upon a triad of clinical symptoms. The main symptom is gait disturbances, followed by urinary incontinence and various degree of cognitive changes. The latter two symptoms are not prerequisites for the diagnosis. Radiological ventricular dilatation without cortical sulcal enlargement is a key factor, as well as substantial clinical improvement after CSF withdrawal (CSF tap test). Other CSF dynamic studies and various imaging investigations have been proposed to improve diagnostic accuracy, but no simple test can predict the results of CSF drainage. The current treatment is ventriculo-peritonial shunting, ideally using an adjustable valve. Results are directly dependent upon the accuracy of the preoperative diagnosis. Post-surgical complications may be observed in about 10% of cases.
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PMID:["Normal pressure" hydrocephalus]. 1581 26

Myelocystoceles are rare lesions. Rarer still are thoracic myelocystoceles. Two patients with thoracic myelocystoceles are being reported. The first patient presented with swelling in the thoracic region with paraplegia and incontinence. MR with MR myelography revealed the malformation to be a thoracic myelocystocele. The second patient presented with a midline cutaneous mass lesion without neurological deficit. MRI revealed a Type I split cord malformation, a CSF containing sac in the thoracic region that communicated through a stalk-like structure to the hydromyelic hemicord. Surgery in both these patients did not produce any change in the neurological status. The importance of recognizing thoracic myelocystoceles, their clinical presentation, embryology, value of MR myelography in the diagnosis and role of surgery are discussed. The differences between terminal myelocystoceles and thoracic myelocystoceles are also highlighted.
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PMID:Thoracic myelocystoceles--two variants. 1646 60

Normal pressure hydrocephalus (NPH) is an adult syndrome characterised by a combination of gait disturbance, varying degrees of cognitive decline, urinary incontinence, ventricular enlargement and normal mean intracranial pressure. Since this syndrome was first described, its pathophysiology has been a matter of great debate, although it is now considered that NPH could be divided into two groups: cases with unknown etiology (idiopathic normal pressure hydrocephalus, or INPH) and those which develop from several known causes (such as trauma, meningitis or subarachnoid haemorrhage). The pathophysiology of INPH is still unclear and a matter of debate. In this manuscript, the current pathophysiological conditions of INPH are analysed and the authors put forward the theory that the disease is a dynamic syndrome which occurs in patients who have suffered a significant loss of spinal compliance over time. Consequently, intracranial pressure increases more during systole in INPH patients because it cannot be compensated for by the escape of CSF into the spinal canal as effectively, due to the reduced volume or lack of distension of the spinal canal. This leads to an increase in ventricular size and causes cumulative brain damage over a long period of time and accounts for the slow, progressive nature of NPH. The loss of spinal compliance with age is fundamental to the proposed theory which provides a theoretical justification for studying the spinal canal in INPH and investigating the relationship between the progressive narrowing of the spinal canal and the compensating ability of the craniospinal system.
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PMID:Idiopathic normal pressure hydrocephalus: theoretical concept of a spinal etiology. 1652 6

From 1982 until 2000 we examined 200 patients diagnosed with normal-pressure hydrocephalus (NPH) in a prospective study. From the patients who were surgically treated by a shunt implantation we could re-examine 155 (78%) at a mean time interval of 7 months after the operation. NPH differed in severity according to the results of the intrathecal infusion test in an early state NPH (without brain atrophy) and late state NPH (with brain atrophy). In our study, we focused on the possible predictors: patient age; length of disease; clinical signs including gait ataxia, dementia, and bladder incontinence; idiopathic vs. secondary origin; implanted valve type and the resistance of the valve to cerebrospinal fluid outflow. In 80 patients without cerebral atrophy and a short course of disease (< 1 year), a slight amount of dementia and an implanted Miethke Dualswitch-Valve were significant predictors for a positive postoperative outcome. The outflow resistance measured in the intrathecal infusion test showed only minimal relevance for outcome. Seventy-five patients with cerebral atrophy had a better outcome when dementia was not present, outflow resistance was above 20 mmHg/mL/min, the CSF tap-test was positive, and a Miethke Dualswitch-Valve was implanted.
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PMID:Predictors of outcome in patients with normal-pressure hydrocephalus. 1667 84

Apart from the classic triad of hypokinetic gait disorder, cognitive dysfunction and urinary incontinence, the clinical spectrum of normal pressure hydrocephalus has been found to affect the upper limbs. It is unclear if the motor deficit of hand and arm movements improves with CSF evacuation. The present study was designed to quantitatively assess the effect of CSF evacuation on the hypokinesia of grasping movements in normal pressure hydrocephalus. Eight subjects with normal pressure hydrocephalus grasped to lift an instrumented object prior to and following evacuation of 40 ml CSF. The build-up of fingertip forces and the kinematics of the lifting movement were slower for patients compared with healthy controls. Patients also generated excessive grasping forces when lifting and holding the object stationary prior to and following CSF evacuation. CSF evacuation significantly improved the gait disorder, the cognitive impairment and the urinary incontinence in normal pressure hydrocephalus. CSF evacuation accelerated the lifting movement and reduced the grip force overshoot. These data suggest that the measurement of grasping forces may provide an additional test to quantify the clinical response to CSF tapping in normal pressure hydrocephalus.
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PMID:CSF drainage ameliorates the motor deficit in normal pressure hydrocephalus: evidence from the analysis of grasping movements. 1676 41

Neurological manifestations in Paget's disease are rare. Hydrocephalus is infrequent, its etiology in Paget's disease being multi-factorial. Surgical and anesthetic procedures may be challenging, requiring special precautions. We describe one such case and discuss these peculiarities. An elderly lady, diagnosed to have Paget's disease presented with features of recent onset dementia, gait disturbances with urinary incontinence. Hydrocephalus secondary to posterior fossa crowding was present. A ventriculo-peritoneal shunt was inserted. Endotracheal intubation proved to be difficult. Modification of the surgical technique was required to ensure a safe procedure. She improved immediately following CSF diversion. Timely CSF diversion yields good results. Certain precautions during anesthesia and surgery can ensure a safe and uneventful peri-operative period.
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PMID:Hydrocephalus in Paget's disease. 1708 74

We studied retrospectively the effectiveness of the repeated lumbar CSF tap test (RTT), lumbar external CSF drainage (LED) and radioisotope cisternography (RIC) in predicting the outcome of shunt surgery, as well as the diagnostic and prognostic value of periventricular hyperintensity (PVH) and of the classic clinical triad in normal pressure hydrocephalus. Two hundred and seventy patients were referred to the Departments of Neurosurgery, in Nancy, France and in Istanbul, Turkey. The decision to perform surgery was based on the clinical presentation (all patients had at least two symptoms of the classic clinical triad), neuroimaging examinations and the results of the RTT (taps were performed on three consecutive days and at each tap a minimum of 30 to 40 cc of CSF was removed), the LED (drainage was performed for 3 days and the volume of CSF drained daily was a minimum of 150 to 250 cc) or the RIC. After all shunt procedures, postoperative assessments verified improvements in 88% of the RTT group, 91% of the LED group and 66% of the RIC group. Gait disturbance had improved in 90% at the end of the second and twelfth month follow-up. Cognitive dysfunction had improved in 79% at the second and in 77% at the twelfth month follow-up. Urinary incontinence had improved in 66% at the second and in 62% at the twelfth month follow-up. From the surgical point of view, the greatest difficulty is not to make the diagnosis, but rather to identify the appropriate patients to operate on. The decision to perform shunt surgery should be based on strict clinical findings associated with CT and MRI criteria and especially with positive RTT or LED test results.
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PMID:Predicting the outcome of shunt surgery in normal pressure hydrocephalus. 1864 Aug 40

Spinal cord injured patients with a suprasacral lesion usually develop a spastic bladder. The neurogenic detrusor overactivity (NDO) and the overactive external sphincter cause incontinence and threaten these patients with recurrent urinary tract infections (UTI), renal failure and autonomic dysreflexia. All of these severe disturbances may be well managed by sacral deafferentation (SDAF) and implantation of a sacral anterior root stimulator (SARS). Since September 1986 to December 2002, 464 paraplegic patients (220 females, 244 males) received a SDAF-SARS. The SDAF was done intradurally in almost all cases, which means that we used a single operation field to do a two-stages procedure (SDAF and SARS). The results include data on 440 patients with a mean follow-up of 8.6 years (18 months to 18 years) until December 2004. The complete deafferentation was successful in 95.2%. Of these patients, 420 paraplegics use the SARS for voiding, (frequency 4.7 per day) and 401 for defecation (frequency 4.7 per week). Continence was achieved in 364 patients (83%). UTIs decreased from 6.3 per year preoperatively to 1.2 per year postoperatively. Kidney function remained stable. Early complications were 6 CSF leaks and 5 implant infections. Late compli cations included receiver or cable failures and required surgical repair in 44 patients. A step-by-step program for trouble-shooting distinguishes implant failure from myogenic or neurogenic failure. SDAF is able to restore the reservoir function of urinary bladder and makes the patient achieve continence. Autonomic dysreflexia disappeared in most cases. By accurate adjustment of stimulation parameters, it is possible for the patient to have a low resistance micturition. The microsurgical technique requires intensive education. In addition, the therapist should be able to manage late complications.
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PMID:Surgical therapy of neurogenic detrusor overactivity (hyperreflexia) in paraplegic patients by sacral deafferentation and implant driven micturition by sacral anterior root stimulation: methods, indications, results, complications, and future prospects. 1769 94


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