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What Causes Ventriculomegaly While Suffering From Hydrocephalus?
Question: 55yo family member with congenital hydrocephalus and a VP shunt since 1yo. Deteriorating slowly in cognitive and motor functioning over lifespan but in the past 12 months the decline has become quite rapid. He is now barley able to walk, sporadically incontinent, takes a long time to verbally respond and has had to resign from supermarket work of 17 years. Neurologist says it is stress, possible dementia. I have recently discovered by looking at CT reports that mild long standing ventriculomegaly was observed twice in 2009 by the radiology doctor - but no mention of it in following CT reports by other doctors. Could this be a possible cause of decline?
Brief Answer:
Symptoms are suggestive of dementia
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the symptoms of your family member. They are suggestive of dementia. However, further work up would be necessary to confirm the diagnosis. This would include detailed neuropsychological testing, MRI brain, blood tests (vitamin B12 level, thyroid profile), and EEG.
Ventriculomegaly is a CT/MRI finding seen in patients with hydrocephalus. So, that is not the cause of his symptoms.
I hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
XXXX, XXXXXXX
For DIRECT QUERY to me: XXXX
My blog: XXXX
Symptoms are suggestive of dementia
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the symptoms of your family member. They are suggestive of dementia. However, further work up would be necessary to confirm the diagnosis. This would include detailed neuropsychological testing, MRI brain, blood tests (vitamin B12 level, thyroid profile), and EEG.
Ventriculomegaly is a CT/MRI finding seen in patients with hydrocephalus. So, that is not the cause of his symptoms.
I hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
XXXX, XXXXXXX
For DIRECT QUERY to me: XXXX
My blog: XXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for reply.
I have uploaded CT scans from 2009 and the most recent from 2015.
May you please view and provide a follow up opinion?
Thank you very much
https://drive.google.com/folderview?id=0B3DVE5jkfNIUMXNhWFQ4T1d3d0E&usp=sharing
I have uploaded CT scans from 2009 and the most recent from 2015.
May you please view and provide a follow up opinion?
Thank you very much
https://drive.google.com/folderview?id=0B3DVE5jkfNIUMXNhWFQ4T1d3d0E&usp=sharing
Brief Answer:
Please upload the radiologist's report
Detailed Answer:
Thank you for getting back.
I would request you to upload the radiologist's report of the two CT scans in pdf format.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Please upload the radiologist's report
Detailed Answer:
Thank you for getting back.
I would request you to upload the radiologist's report of the two CT scans in pdf format.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the response.
I have uploaded the reports in PDF.
https://drive.google.com/folderview?id=0B3DVE5jkfNIUMXNhWFQ4T1d3d0E&usp=sharing
I have uploaded the reports in PDF.
https://drive.google.com/folderview?id=0B3DVE5jkfNIUMXNhWFQ4T1d3d0E&usp=sharing
Brief Answer:
The CT reports do not show any significant abnormality.
Detailed Answer:
Thank you for getting back and uploading the CT reports.
I have gone through the reports. The reports do not show any significant abnormality , which could explain the patient's current symptoms.
As suggested, further work would be necessary to determine the cause of his current symptoms suggestive of dementia.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
The CT reports do not show any significant abnormality.
Detailed Answer:
Thank you for getting back and uploading the CT reports.
I have gone through the reports. The reports do not show any significant abnormality , which could explain the patient's current symptoms.
As suggested, further work would be necessary to determine the cause of his current symptoms suggestive of dementia.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello thank you for the reply.
If he has had a shunt since childhood shouldn't it prevent ventriculomegaly?
I have updated the CT scans I uploaded earlier in a different format, are there any changes in the current one from the one back in 2009?
https://drive.google.com/folderview?id=0B3DVE5jkfNIUMXNhWFQ4T1d3d0E&usp=sharing
If he has had a shunt since childhood shouldn't it prevent ventriculomegaly?
I have updated the CT scans I uploaded earlier in a different format, are there any changes in the current one from the one back in 2009?
https://drive.google.com/folderview?id=0B3DVE5jkfNIUMXNhWFQ4T1d3d0E&usp=sharing
Brief Answer:
Mild ventriculomegaly would persist.
Detailed Answer:
Thank you for getting back.
Shunt placement prevents an increase in the size of ventricles, and most of ventriculomegaly also disappears. However, mild degree of ventriculomegaly often persists despite shunt placement; but this is not of any clinical consequence.
There are no significant changes between the two CT scans.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Mild ventriculomegaly would persist.
Detailed Answer:
Thank you for getting back.
Shunt placement prevents an increase in the size of ventricles, and most of ventriculomegaly also disappears. However, mild degree of ventriculomegaly often persists despite shunt placement; but this is not of any clinical consequence.
There are no significant changes between the two CT scans.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Ok thanks.
One last thing, I noticed a cyst in the CT.
Could this be obstructing or causing anything to do with the decline?
One last thing, I noticed a cyst in the CT.
Could this be obstructing or causing anything to do with the decline?
Brief Answer:
No
Detailed Answer:
Thank you for getting back.
Cyst is not related to obstruction of CSF flow or decline in cognition.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
No
Detailed Answer:
Thank you for getting back.
Cyst is not related to obstruction of CSF flow or decline in cognition.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply. It is very much appreciated.
I understand dementia is a very likely possibility and can accept it. However, our main concern is not the decline in cognitive function but more so the gait. He went from riding a bike and working 4AM-11AM every morning to now barley able to walk.
He is also sometimes very hard to wake, it is as if he is in a coma. He gets slightly better some days while others he significantly goes downhill.
We recently saw a reputable neurosurgeon who advised that his shunt is likely not functioning and he is dependant without it. Does this mean he possibly had no hydrocephalus to begin with as a child (maybe misdiagnosed due to to agenesis of the corpus callosum) ?? - the shunt was placed in 1963.
If this is the case, could the ventriculomegaly be a newly acquired type of untreated hydrocephalus? NPH??
Or, if the shunt is functioning is there any evidence on CT of over drainage?
Sorry for so many questions - I just want to get a full understanding.
Again thank you very much
I understand dementia is a very likely possibility and can accept it. However, our main concern is not the decline in cognitive function but more so the gait. He went from riding a bike and working 4AM-11AM every morning to now barley able to walk.
He is also sometimes very hard to wake, it is as if he is in a coma. He gets slightly better some days while others he significantly goes downhill.
We recently saw a reputable neurosurgeon who advised that his shunt is likely not functioning and he is dependant without it. Does this mean he possibly had no hydrocephalus to begin with as a child (maybe misdiagnosed due to to agenesis of the corpus callosum) ?? - the shunt was placed in 1963.
If this is the case, could the ventriculomegaly be a newly acquired type of untreated hydrocephalus? NPH??
Or, if the shunt is functioning is there any evidence on CT of over drainage?
Sorry for so many questions - I just want to get a full understanding.
Again thank you very much
Brief Answer:
Shunt functional status needs to be confirmed.
Detailed Answer:
Thank you for getting back.
We need to ascertain whether the shunt is functioning or not. This can be done by the neurosurgeon's examination of the shunt tube. CT scan would not help, unless the hydrocephalus gets worse. MRI brain may help to find, if the CSF is under pressure or not (by a finding called as periventricular seepage, which indicated that CSF is under high pressure). If the shunt is not functioning, then, it should be removed and new shunt tube placed, especially if the CSF is under high pressure.
Gait disturbances and consciousness level can get altered in dementia too, however, we first need to make sure the CSF in ventricles are not under high pressure.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Shunt functional status needs to be confirmed.
Detailed Answer:
Thank you for getting back.
We need to ascertain whether the shunt is functioning or not. This can be done by the neurosurgeon's examination of the shunt tube. CT scan would not help, unless the hydrocephalus gets worse. MRI brain may help to find, if the CSF is under pressure or not (by a finding called as periventricular seepage, which indicated that CSF is under high pressure). If the shunt is not functioning, then, it should be removed and new shunt tube placed, especially if the CSF is under high pressure.
Gait disturbances and consciousness level can get altered in dementia too, however, we first need to make sure the CSF in ventricles are not under high pressure.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks for the reply.
Could you please read this post
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=224507
and provide over all opinion and answer to my last reply
Could you please read this post
http://www.healthcaremagic.com/AskDoctorInboxServlet?page=viewQuery&queryId=224507
and provide over all opinion and answer to my last reply
Brief Answer:
The opinion would be along similar lines
Detailed Answer:
Thank you for getting back and providing the link.
I went through the detailed responses provided by Dr Bhardwaj, a Neurosurgeon. As he explained, we need to first check whether the shunt is functioning or not. If it is not functioning, it needs to be changed.
If the shunt tube is functioning, then, work up should be done to look for other causes of dementia.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
The opinion would be along similar lines
Detailed Answer:
Thank you for getting back and providing the link.
I went through the detailed responses provided by Dr Bhardwaj, a Neurosurgeon. As he explained, we need to first check whether the shunt is functioning or not. If it is not functioning, it needs to be changed.
If the shunt tube is functioning, then, work up should be done to look for other causes of dementia.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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