Hydrocephalus And the Disorders of CSF Circulation
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- Опубликовано: 16 июл 2024
- 00:00 - Intro
00:35 - Objectives
01:23 - Case presentation
03:01 - Clinical features
05:45 - Diagnostic studies (imaging)
11:15 - Circulation of CSF
13:52 - Differential diagnosis: Non-communicating vs Communicating hydrocephalus
16:12 - Example disorders causing non-communicating hydrocephalus
22:18 - Bulk theory vs hydrodynamic theory
25:40 - Example disorders causing communicating hydrocephalus
30:58 - Long-term treatment of hydrocephalus
This video is intended for medical students in preclinical years and on clinical rotations to understand the clinical presentation, mechanisms and the disorders causing hydrocephalus.
Created by:
Igor Rybinnik MD
Produced and narrated by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Images adapted from, and redrawn whenever possible:
Netter F. Atlas of Human Anatomy, 6th ed. Philadelphia, Saunders, 2014.
Martin-Laez R, et al. Neurologia (English Edition), 2018;33(7):449
Netter FH. The Netter Collection of Medical Illustrations. 2nd ed. Saunders, 2013.
Kandel ER, et al. Principles of Neural Science 5th Edition. McGraw Hill, 2012.
Lee T, Mukundan S. Netter’s Correlative Imaging. Saunders, 2015.
Greitz D. Neurosurg Rev (2004) 27: 145-165
Terem I, et al. Magn Res in Med 2018;80(6):2549
Purulent meningitis gross pathology photo adapted from WikiDoc
Graff Radford NR, Jones DT. Continuum 2019;25(1):165-86
Kulkarni AV, et al. NEJM 2017;377(25):2456
Colloid cyst image courtesy of Weill Cornell Brain and Spine Center
Hydrocephalus video courtesy of Dr. M. M. Haque ( / @drmmhaque )
Ventriculostomy surgical demonstration video courtesy of Prof. Dr. med. Henry W. S. Schroeder, University Medicine Greifswald, Department of Neurosurgery ( • Ventriculostomy - Hydr... .
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, or Rutgers University as a whole.
Dr Rybinnik, I am the chief neuro resident at a Canadian University. I just wanted to say I absolutely love your videos and channel. I don’t think there is any other educational neurology content of this quality out there. Many thanks for making neurology appetizing. I don’t know it there’s anything you need help with, but I would be love to contribute to this amazing endeavour.
Cheers.
I join to collaborate in any way. I am a Functional Neurosurgeon and Radiosurgeon. Many congratulations Dr. Rubinnik
Thanks for the kind words. I always welcome help. If you have a particular topic you want to cover, I can help design a talk for it.
I am an IM resident from India. The level of quality in these videos is exceptional. Many thanks, Dr IR.
@@theneurophile I have one idea. AD/Dementia related videos. Early- and Late-Onset differences/demonstrations of MRIs... I give "cognoscopies" to my elderly friends, but they are really difficult for me too :( (I score around a bit above the average though)
@@Magnus_E Absolutely. One of our residents just graduated and joined our faculty in the neurocognitive division. She is working on a dementia video
Hi Dr Rybinnik, i'm Adrian Joshua Velaro, a med student from Indonesia, it's hard to understand hydrocephalus for me only based on journals and books especially nowadays the lecture is full online, boring and difficult to understand. I have to learn extra from others to get a full picture of things i need to learn, surfing on internet takes a lot of time, but after find your channel and this video, i think your teaching method is very very cool, i just need to watch it over and over to get a full picture and it's very helpful. I kinda hope you can also teach about others outside the neurology, maybe collaboration with other, but i know it's too much to ask. Anyway, i hope you always get healthy so you can keep produce videos like this. THANK YOU SO MUCH!
Dr Hassan HAMED, resident from Mauritania (Africa), thank you so much for this course.
Incredible video, Nobody teaches neurology like this. Really impressive
Definitely the best explanation I've heard regarding the neuroimaging of hydrocephalus.
Best medical school lessons ever! Enjoy watching them! Thanks!
I'm 4th year medical student in Egypt, that's very nice, thanks for your effort 👏❤️
I am a retired Neuro ICU nurse with an adult son with increased ICP due to aqueductal stenosis. This was an excellent review to help confirm treatment options. Thank you
I am glad this is helpful.
HIGH QUALITY AND HIGH YIELD. Its really satisfying to listen. Thank you so much for such a wonderful lecture. 3rd year medical student here.
Your videos are amazingly useful. Please don't stop producing them. Thank you!
I have to congratulate you. Your video is very didactic, I think you do a great job in spreading science and medicine. Keep doing it.
Excellent! You are the Best Ever, A BIG THANK YOU !!
We need more videos like this. this is the best lecture I ever saw
This video was an absolute joy to watch, thank you!
Hats off to you Dr Rybinik….your teaching and videos are really great and easy to digest. Gr8 job….
The Best Medical/Clinical Video I have ever found on Internet. Love and Thanks . I am a medical student & this was my first video of this channel. I have no words to thank you sir.
Congratulations. Excellent explanations and videos. Keep up the good work!
Good day, doc. I got diagnosed with NPH and underwent both the lumbar puncture + shunt placement; your video has enabled me to better understand the diagnosis. Thank you
I hope you are feeling better.
5:50 Dr Rybinnik joking about trying to keep me awake when i'm literally falling asleep xD thank you for the amazing education!!
I really love your videos Dr. Rybinnik
These videos are gold. Thank you so much!
I am a medical student in Turkey. You did an excellent lesson. You'r teaching is amazing and so much fun.
Hope you r doing good in turkey. May god bless you
@@MonaLisa-sv7cmI appreciate your concern. I am good. Only thing that we can do is making donation.
Wonderful lecture! Great work.
I love the way you explain everything! And make it easier too!!
I enjoy how interact with us through the screen, even when you cannot see us.
IT IS charming
I am watching all your videos! Thank youu so much!
Greets from México!
WOW ABSOLUTELY INCREDIBLE NEUROLOGY TEACHING WAY!!! THANKS A LOT!!!!!!!!!
excellent tutorials. Great teacher.
Simply awesome!!
Such a nice and excellent educational material,, congratulations from overseas!
I love so much your videos! Very helpful!
Excellent lecture. systematic and methodical. Accent wonderful.
Amazingly well made video
Thank you very much!
thank you so much, loved the video!
thank you so musch i with you to continue upload these series of videos i wish you the best
who is this guy😭😭😭😭😭 i love him omg
Great lecture..
Thanks alot for your great effort
amazing video!!
Wow!!! Thank you very very much!
Amazing videos
Incredible ❤❤❤
Damn you're videos are insane, congratulations, you're the best I've ever seen
Wow. I'm glad you liked it. We try.
Brilliant… just brilliant
Awesome video 😁
Wow best neuro presentation nice voice want more from u please
Thank you! My 16yo son was just diagnosed with chiari 1 with csf obstruction and hydrocephalus. I’m here to better understand what’s going on with him before our appointment with a neurosurgeon tomorrow. This was very helpful!
I’m sorry that your son has hydrocephalus. I wish him a speedy recovery. I am glad this video was helpful.
Thank you
Please do more videos , this was an incredible presentation!!!!
Thank you! I am working on more videos as we speak. Sorry for the slowness, but I am a full-time clinician, so I have to somehow get these done during free time.
I'm new to your channel, but it's quite interesting. Thanks 👍 please keep it up
thank you for your wonderful videos Doc! as a med student I really enjoy how detailed and specific you explain these advanced topics in plain language.
I have a question though...
what's a pseudotumor cerebri? and how is that different from hydrocephalus?
Pseudotumor cerebri (or idiopathic intracranial hypertension) is a disorder where intracranial pressure is increased, but there is no evidence imaging of hydrocephalus or obstruction. The proposed mechanism is increased pressure in the venous system (perhaps due to stenosis of the venous sinuses) makes CSF reabsorption less efficient, but not to the point to cause hydrocephalus.
Thanks a lot🙂
I've watched all the videos from Rutgers RWJMS neurology, they are really very visual and useful contents, perhaps the best teaching videos any of us can find in RUclips, please keep up the good work! Would be glad to see more contents in future, perhaps about ALS?
Thank you. Will try
thank you for making this videooo
i loved it.
Thanks
Dude, again, you are gold! Dont ever stop making these videos! Greetings
I was diagnosed last year age 47 with LOVA hydrocephalus. I had an ETV which failed. After making me dangerously ill and in HDU with sale wasting syndrome and acute kidney injury stage 2 I then had a VP shunt fitted.
I am sorry to hear that. I hope you are feeling better now.
Super
KOK LUCUU
Please please please upload more videos.. your videos are really very helpful..
Sorry, work has been busy. I’m working on a video which will hopefully be available soon.
I m preparing for my neurocritical boards . This channel are the best well illustrated concise videos on the topic . I really watched all them many times as I was driving , then sitting , then taking Notes . I really wonder if there are more vidoes coming , do u have dedicated website or blog . U guys are amazing.
Thank you! Currently, I am a team of 1. And I am a practicing clinician. So, it takes a while for me to make a video because I have to use my free time to do it. But yes, more videos are coming.
The doctor who teaches us told me that CSF drainage diversion of flow cannot be used in infection tuberculosis because in this case the patient does not have to stand for 8 months.
systolic is a beautiful word
Sir need more video.every week or month topic wise video needed
Working on it. Unfortunately, I am always busy with clinical work, and I make these videos on my own personal time.
As a 75 year old with a childhood head injury, hydrocephalus may be the diagnosis for me. Severe migraines for over 20 years that came and went, wobbly walk that is not now present, and urinary urgency. Misplacing words for a second or so. Walking almost everywhere since my husband died over 25 years ago. Strangely enough, altho no site have found indicates improvement over time, I feels that is the case with me.
Interesting. Thank you for sharing.
thankyou doctor..!
How could you made this animation, its so brilliant!
Thank you. It’s PowerPoint.
Hello Dr. Rybinnik, as always a stellar talk, thanks!
Could you shortly talk about the imaging differential between ex-vacuo and true NPH, as this, as you said, is supremely important in the prognosis.
Are there other Indices outside The Evans that would lead us to the diagnosis purely on imaging grounds?
Thanks!
Thank you for that question. Imaging is not likely to be the answer for NPH patients (imaging is too non-specific when trying to differentiate between NPH and ex-vacuo). Evan’s ratio simply identifies ventroculomegaly, and not the cause. Sure if a patient is elderly and has significant cortical atrophy, NPH is unlikely. But NPH is a physiological diagnosis. Patients need a lumbar puncture drawing off high volume of CSF to tell if they would respond to a shunt. Usually you would do a diligent neuro exam including MOCA and gait, and repeat the entire exam after LP looking for dramatic improvement in cognition or gait. If minimal or no improvement is noted, a patient won’t benefit from a shunt.
@@theneurophile Many, many thanks!
I had a VP Shunt put in when i was 16. Ill never forget the day i came home from making money mowing lawns and my mom left with my brothers to take them to the baseball tournament...
Withen a half hour my temp went high, my memory started to go away and went into a coma till i was taken to the ER from a meighbor
I’m sorry to hear that. I hope the shunt has helped you.
It's actually been doing good for the last 23 years I think
Wow. That’s incredible.
@@theneurophile thanks. But I've been getting some weird headaches lately and my short term memory has been getting terrible latly
I just wish that some of these doctors would stick around where I live because the last three or four years it seems like all the doctors are starting to go west from where I'm at.
awesome as always, thanks , but why didn't you continue explanation of other neurology topics?
Will do soon
👏🏾👏🏾👏🏾
tY!
11:31 CEREBROspinal fluid
23:00
😍😍😍
That understanding of CSF circulation based on nuclear medicine studies in the 1950s is well know to be grossly incomplete
Agreed. Modern conception of hydrocephalus still needs quite a bit of work.
I’m wondering if there’s a relationship between AVM and hydrocephalus in older adults. Do you have any materials that provide explanations of the two together? Thank youuuuu
Interesting question. AVMs can certainly cause dural venous sinus thrombosis which decreases CSF reabsorption and increases intracranial pressure. There is also some discussion regarding idiopathic intracranial hypertension possibly caused by chronic venous insufficiency in the brain. Those entities do not cause hydrocephalus per se, but the mechanism of increase intracranial pressure is roughly the same.
I had a severe. On communicating hydrocephalus not even found except for accident whe I was close to death after enduring about 3 years of pain new immense dizziness and new immense pain pressure in head. After years before having a person reading my imaging seen my horns were rather pointy like a devils- happens with obstruction to CSF NON COMMUNICATING HYDROCEPHALUS! Tried to get help for my neck years back always pushed away… I assume it’s chiari…. Chiropractor said I had that about 20 years ago.. Recent imaging the X-ray tech asked if I was full of cyst’s asked to feel my neck and was like wow….. it’s sad I get the wrong help.
I’m very sorry that you are experiencing difficulties. I hope you got the help you needed.
My Thesis is about Hydrocephalus and Folic acid role in preventing Hydrocephalus, any idea about how folic acid prevents Hydrocephalus from happening?
Thank you for the video.
That’s an interesting question. I am not sure, actually. I would be interested to find out. Good luck with your thesis.
@@theneurophile thank you 😊
PLASHET WARD LONDON
Does occupuncture for hydrocephalus usefull?
I don't believe that there are any studies showing efficacy of acupuncture in hydrocephalus.
I am a lifelong hydrocephalus patient..i will be 36 in September and have 6 brain shunt replacements so far in my life.
Thank you for sharing your story. I’m sorry that you are living with hydrocephalus. I hope the shunt is helping.
@@theneurophile thank you. For now I am stable and if I make it to July 1st I'll be 14 years surgery free.
Sir, can complications from open biopsy of supraclavicular lymph node also leads to Hydrocephalus? or chances are very rare?
That would be highly improbable. Hydrocephalus is caused by intracranial issues, not issues below the beck.
@@theneurophile But on the next day after Biopsy patient complaint difficulty in speaking. I thought this could be due to open biopsy of supraclavicular lymph node.
@@mygame4451 Vast majority of episodes of difficulty speaking are not caused by hydrocephalus. Hydrocephalus is relatively rare.
What disease causes enlarged frontel Horn lateral ventricles
Hydrocephalus can cause that, but so can brain atrophy.
Ok because I had well over a hundred Brain injuries in life and when I was in ICU they never did any testing I was very disoriented after I went to 7 doctors and never told me about this disdorder just pain pils
Just on correction for the sake of scientific accuracy. Transependymal flow theory has been abandoned, it is now thought to be ischaemic changes from pressure on periventricular vessels.
Agreed. But yes, and no. Some of it is reversible, which goes against ischemic changes. The "ischemic changes" is probably more applicable to NPH specifically. I was just trying to keep it simpler for the students.
Sir
Is hydrocephalus due to aqueductal obstruction cured in later life ?
Please answer sir
Sir said mine is cured
Is aqueduct of sylvius visible in ct scan
Significant numbers of aqueductal stenosis do not have any symptoms and don't require any surgery. That being said, if aqueductal stenosis causes symptoms/hydrocephalus, surgical interventions have reasonable success rates. Usually MRI is needed to diagnose aqueductal stenosis, and CT is not enough.
@@theneurophile sir
How can I send u my ct scan to show that is it aqueduct of sylvius or not
@@mattasowjanya9798 You should discuss this with your doctor. It is difficult to diagnose disorders without obtaining proper medical history and examining a person. A CT scan cannot give you the answer.
How we made diagnosis for low cfs
Do you mean low CSF pressure?
Plz sir reply fast we r living in a country where there is very less medical help available here they don't even have MRI machine they only have CT scan and patient is in very bad condition for almost 3 weeks cannot travel and there is no emergency service by air to take him out of country plz help he had same issue when he was 9 month old got operated and with shunt he passed 18years without any problem but now he was having seizures drs said he got infection gave antibiotics then they operated him 3 time in 3 weeks in last operation they removed shunt now he is again having pain in his back beneath the shoulder area and so intense pain that he is having seizures and he cannot even take liquid c food coz mostly he is under the influence of medicine and unconscious and when he awake he get seizures and immense pain Doctors even can't tell why he is having pain can u help and tell what is going on with him ..😥😥
Sorry for poor english
I am sorry to hear of your troubles. Unfortunately, it is impossible to offer any medical advise without reviewing the entire case (medical records, imaging). You doctors cannot offer an explanation, they should be able to send medical records to specialists who can advise you.
HUNTLEY CENTRE
I take vp shunt surgery before two years. Now i take married life??
I hope you feel better after VP shunt.
Hi I have questions but no one reply
What is your question?
@@theneurophile how I can connect you?
Also surgeon said nothing permanent damage so my memory and my emotions will connect with thoughts thn I can feel my all feelings .I am having some improvement but not fully it's been 8 months post surgery.
@@faisalbi1330 If you would like to see a physician at Rutgers Robert Wood Johnson medical school, please visit this page: umg.rwjms.rutgers.edu/departments/neurology/index.php
@@theneurophile thank you so much if I make appointment in my case they can help me ?
Watching.. my mom just died cause of hydrocephalus and doctors didn't do everything to treat my mom's sickness 😭
I am very sorry to hear that. My condolences.
I thought it was a tumor!
What was a tumor?
Incredible video, Nobody teaches neurology like this. Really impressive
Thank you
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