Hydrocephalus due to ectasia of the basilar artery

https://doi.org/10.1016/0022-510X(69)90006-9Get rights and content

Abstract

Nine patients, aged 46–68 years, showed typical clinical features, usually characterized by three stages: (1) a latent stage with essential hypertension; (2) the appearance of disturbances of gait and balance, as well as bilateral pyramidal tract symptoms; the disturbance of gait was of the “spastic ataxia” or “apraxia of gait” type; (3) the appearance of progressive presenile dementia. Four patients had epilepsy.

Neuroradiological investigation showed, in every case, a characteristic deformation of the third ventricle, caused by elongation and ectasia of the basilar artery, and symmetrical dilatation of the lateral ventricles. Air did not pass up on to the convexity of the brain. RIHSA cisternography was performed in 6 cases, and disclosed a characteristic picture of delayed resorption of CSF over the convexity. The cerebral blood flow was determined in 7 cases; reduced values were noted in all of them.

It is concluded that, in these cases, the ectatic basilar artery had caused a functional form of obstructive hydrocephalus, in which the obstruction lay anterior to the aqueduct of Sylvius, and resulted from deformation of the third ventricle. Probably, the strong vascular pulsations can be transmitted to the ventricular system, and cause or contribute to the appearance of hydrocephalus.

A ventriculo-atrial shunt according to Pudenzet al. (1957) was made in 6 patients. Definite improvement was observed in 2 patients, moderate in 1, and slight improvement in another 1. In 2 cases, no improvement could be observed after operation. In 3 of the patients who improved, the cerebral blood flow was also determined post-operatively. In all 3 cases, the flow had increased, and this increase was correlated with the degree of clinical improvement. It is suggested that this forms the basis of the clinical improvement that can be achieved by a shunt operation.

References (27)

  • B.S. Epstein

    Pneumoencephalography and Cerebral Angiography

  • W.A. Evans

    Encephalographic ratio for estimating the size of ventricles

    Amer. J. Dis. Child.

    (1942)
  • F.A. Freyhan et al.

    Cerebral blood flow and metabolism in psychosis of senility

    J. nerv. ment. Dis.

    (1951)
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