aid in outpatient ICU diagnosis
application and context
hydrocephalus is a disease caused by the abnormal accumulation of cerebrospinal fluid in the brain in one or more ventricular sinuses, causing changes in brain compliance and clinical manifestations such as headaches (intensified when the person is lying down and improved when sitting or standing), mental confusion, and losses of memory and balance. It can affect adults and children and differential diagnosis is often difficult and time-consuming, as imaging tests may be non-specific.
In adults, hydrocephalus may occur due to other diseases, such as strokes, brain tumors, trauma, and intracranial hemorrhages. In children, growth entails the need for periodic surgeries to replace ventriculoperitoneal shunts.
how brain4care contributes to the diagnosis of hydrocephalus
brain4care’s non-invasive monitoring can determine whether there are changes in brain compliance in real time, requiring no contrast or preparation, and assessments can be performed at various stages throughout the patient’s journey.
The examination is performed with the patient lying down and while sitting: if there is an improvement in brain compliance while sitting, we have a positive indicator for disturbances in cerebrospinal fluid circulation (potentially associated with hydrocephalus), because in this position there is a higher incidence of severity, resulting in greater drainage of cerebrospinal fluid and improvement of brain compliance.
main benefits and impacts
- Monitoring can be performed in minutes, in various care settings, without causing pain or entailing risks to the patient
- Ability to determine changes in brain compliance related to early stages of hydrocephalus and in cases where imaging tests are non-specific
- Increases safety in prescribing invasive procedures, pointing out when they are actually needed
- Reduces the repetition of invasive procedures and exposure to radioactive agents in the diagnostic survey
related scientific article
Analysis of a Minimally Invasive Intracranial Pressure Signals During Infusion at the Subarachnoid Spinal Space of Pigs.
Acta Neurochirurgica Supplement, 2018
G. Frigieri, R.A.P. Andrade, C.C. Wang, D. Spavieri Jr., L. Lopes, R. Brunelli, D.A. Cardim, R.M.M. Verzola, and S. Mascarenhas.
Noninvasive intracranial pressure monitoring for HIV-associated cryptococcal meningitis.
case 1 – hydrocephaly in an adult
aid in ICU diagnosis
Adult, female, 65 years old, with diagnosis of HSA (Subarachnoid Hemorrhage), Fisher III classification. Aware, responding to stimuli, oriented in time and space, she presents intense headache at the base of the skull, with worsening in decubitus inferior to 30°.
The monitoring of NIICP (non-invasive intracranial pressure) was requested by the physician to assist in the diagnosis of hydrocephaly and intracranial hypertension.
Two monitoring sessions were performed on 12/12/18 and 12/13/18, both with changes in the decubitus position: the first 5 minutes in the horizontal dorsal decubitus position and then 5 minutes in the elevated decubitus position at 45°.
findings and medical conduct
Horizontal dorsal decubitus. Change in brain compliance (P2/P1 ratio = 1,210)
Elevated dorsal decubitus at 45°. Change in brain compliance, but with an improvement in the P2/P1 ratio (P2/P1 ratio = 0.849)
Performing lumbar puncture for CSF drainage
After lumbar puncture, the patient presents improved symptoms (headache). Horizontal dorsal decubitus. Compliance change, but with an improvement in the P2/P1 ratio (P2/P1 ratio = 1.030)
Elevated dorsal decubitus at 45°. Compliance change maintained, but P2> P1 ratio improved in relation to the dorsal decubitus position
horizontal (P2/P1 ratio = 0.965)
Due to the significant improvement in the clinical symptoms, it was decided to wait another 24 hours for reevaluation and for the discharge from the semi-intensive care unit
Patient with clinical improvement and rapid diagnosis
case 2 – pediatric hydrocephalus
aid in outpatient diagnosis
Girl, age 8, born prematurely at 32 weeks, GI, Apgar 4/8, with previous diagnoses of: grade III intracranial hemorrhage in the left ventricle and grade II in the right ventricle at 18 days of life, third ventriculostomy at the 28th day of life, placement of ventriculoperitoneal shunt (VPS) without gauging in the right ventricle at 60 days of life and change of this shunt at age 3 for a gauged valve.
New change of VPS at age 4 by a programmable siphon model, gauged at 16mmHg.
Entered the emergency room with severe headache; an eye fundus evaluation was performed and the results were normal.
Non-invasive intracranial pressure monitoring was requested for diagnostic assistance.
findings and medical conduct
Change in brain compliance with P2> P1 (P2/P1 ratio = 0.999)
A new imaging examination (computed tomography) was performed and showed hydrocephalus, and another ventriculoperitoneal shunt (VPS) was placed in the left ventricle
Performed in the postoperative period after the placement of the ventriculoperitoneal shunt (VPS).
No changes in brain compliance with P1> P2 (P2/P1 ratio = 0.586)
Clinical evaluation with improvement of signs and symptoms, opting for hospital discharge and outpatient follow-up.
Rapid and effective diagnosis, with economy of resources and gain of quality of life for the patient and her relatives.