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Chiyoda H, Kobayashi S, Yokoi K, Iwata O, Katano H. Acquired hydrocephalus following hypoxic ischemic encephalopathy without intraventricular hemorrhage: A case report. J Neonatal Perinatal Med 2023; 16:569-571. [PMID: 37718855 DOI: 10.3233/npm-210950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
The most common cause of acquired hydrocephalus in infants is hemorrhage, most often as a consequence of prematurity. Other important causes include neoplasm and infection, usually bacterial meningitis. Hypoxic ischemic encephalopathy (HIE) in term infants usually results in secondary microcephaly. We report an infant with severe HIE at birth treated by therapeutic hypothermia who developed progressive acquired hydrocephalus over 2 months, although no cause of the hydrocephalus was identified. Although hydrocephalus, even intraventricular hemorrhage, is uncommon in term infants with HIE, careful follow-up of the head circumference is important, even if no findings indicating possible causes of hydrocephalus, such as hemorrhage, are detected on ultrasound or magnetic resonance imaging.
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Affiliation(s)
- H Chiyoda
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - S Kobayashi
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - K Yokoi
- Department of Pediatrics, Nagoya City University West Medical Center, Nagoya, Japan
| | - O Iwata
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - H Katano
- Department of Neurosurgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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2
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Lubinsky M. Hypothesis: By-products of vascular disruption carried in the CSF affect prenatal brain development. Birth Defects Res 2022; 114:847-854. [PMID: 35775635 DOI: 10.1002/bdr2.2064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/31/2022] [Accepted: 06/12/2022] [Indexed: 01/24/2023]
Abstract
Prenatal CNS disruptions can be associated with physically separate findings. Examples include cognitive issues in septo-optic dysplasia and sporadic and WNT1-related unilateral cerebellar hypoplasia, and physical findings such as thinning of the corpus callosum, ventriculomegaly, hippocampal abnormalities, olfactory tract and bulb hypoplasia, and distant cortical dysplasias with schizencephaly. Similar effects to toxicities with intraventricular hemorrhage in prematurity could occur earlier in development. CSF transportation of disruption by-products would provide access to vulnerable areas through inflammatory effects on blood-brain barrier permeability. Outcomes are influenced by location and volume of byproducts in the CSF, timing, transport, and inflammatory responses. A particular association of vermis disruption with cognitive issues may be related to CSF flow distortions that avoid toxin dilutions in the third ventricle. Symmetrical contralateral cortical dysplasia with schizencephaly may reflect immunovascular field-related vulnerabilities seen in situations such as vitiligo.
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3
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Abstract
Reparative inflammation is an important protective response that eliminates foreign organisms, damaged cells, and physical irritants. However, inappropriately triggered or sustained inflammation can respectively initiate, propagate, or prolong disease. Post-hemorrhagic (PHH) and post-infectious hydrocephalus (PIH) are the most common forms of hydrocephalus worldwide. They are treated using neurosurgical cerebrospinal fluid (CSF) diversion techniques with high complication and failure rates. Despite their distinct etiologies, clinical studies in human patients have shown PHH and PIH share similar CSF cytokine and immune cell profiles. Here, in light of recent work in model systems, we discuss the concept of "inflammatory hydrocephalus" to emphasize potential shared mechanisms and potential therapeutic vulnerabilities of these disorders. We propose that this change of emphasis could shift our thinking of PHH and PIH from a framework of life-long neurosurgical disorders to that of preventable conditions amenable to immunomodulation.
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4
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Karimy JK, Reeves BC, Damisah E, Duy PQ, Antwi P, David W, Wang K, Schiff SJ, Limbrick DD, Alper SL, Warf BC, Nedergaard M, Simard JM, Kahle KT. Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets. Nat Rev Neurol 2020; 16:285-296. [PMID: 32152460 DOI: 10.1038/s41582-020-0321-y] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/11/2022]
Abstract
Hydrocephalus is the most common neurosurgical disorder worldwide and is characterized by enlargement of the cerebrospinal fluid (CSF)-filled brain ventricles resulting from failed CSF homeostasis. Since the 1840s, physicians have observed inflammation in the brain and the CSF spaces in both posthaemorrhagic hydrocephalus (PHH) and postinfectious hydrocephalus (PIH). Reparative inflammation is an important protective response that eliminates foreign organisms, damaged cells and physical irritants; however, inappropriately triggered or sustained inflammation can respectively initiate or propagate disease. Recent data have begun to uncover the molecular mechanisms by which inflammation - driven by Toll-like receptor 4-regulated cytokines, immune cells and signalling pathways - contributes to the pathogenesis of hydrocephalus. We propose that therapeutic approaches that target inflammatory mediators in both PHH and PIH could address the multiple drivers of disease, including choroid plexus CSF hypersecretion, ependymal denudation, and damage and scarring of intraventricular and parenchymal (glia-lymphatic) CSF pathways. Here, we review the evidence for a prominent role of inflammation in the pathogenic mechanism of PHH and PIH and highlight promising targets for therapeutic intervention. Focusing research efforts on inflammation could shift our view of hydrocephalus from that of a lifelong neurosurgical disorder to that of a preventable neuroinflammatory condition.
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Affiliation(s)
- Jason K Karimy
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Eyiyemisi Damisah
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Phan Q Duy
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Prince Antwi
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Wyatt David
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Kevin Wang
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT, USA
| | - Steven J Schiff
- Departments of Neurosurgery, Engineering Science & Mechanics, and Physics; Center for Neural Engineering, The Pennsylvania State University, University Park, PA, USA
| | - David D Limbrick
- Departments of Neurosurgery and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Seth L Alper
- Division of Nephrology and Vascular Biology Research Center, Beth Israel Deaconess Medical Center, Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Maiken Nedergaard
- Center for Translational Neuromedicine, University of Rochester Medical Center, Rochester, NY, USA.,Center for Translational Neuromedicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Marc Simard
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Kristopher T Kahle
- Departments of Neurosurgery, Pediatrics, and Cellular & Molecular Physiology and Yale-Rockefeller NIH Centers for Mendelian Genomics, Yale School of Medicine, New Haven, CT, USA.
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5
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Zhang L, Hussain Z, Ren Z. Recent Advances in Rational Diagnosis and Treatment of Normal Pressure Hydrocephalus: A Critical Appraisal on Novel Diagnostic, Therapy Monitoring and Treatment Modalities. Curr Drug Targets 2019; 20:1041-1057. [PMID: 30767741 DOI: 10.2174/1389450120666190214121342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/02/2019] [Accepted: 02/06/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH. OBJECTIVE The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised. RESULTS Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications. CONCLUSION Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.
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Affiliation(s)
- Lei Zhang
- Department of Radiology, Baoji Center Hospital, Baoji, Shaanxi, China
| | - Zahid Hussain
- Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Selangor, Puncak Alam Campus, Bandar Puncak Alam 42300, Selangor, Malaysia
| | - Zhuanqin Ren
- Department of Radiology, Baoji Center Hospital, No. 8 Jiang Tan Road, Baoji 721008, Shaanxi, China
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Darouich S, Boutaud L, Bessières B, Bonnière M, Martinovic J, Mechler C, Alby C, Bernard JP, Roth P, Ville Y, Malan V, Vekemans M, Attié-Bitach T, Encha-Razavi F. Fetal Cerebral Ventricular Dilatation: Etiopathogenic Study of 130 Observations. Birth Defects Res 2017; 109:1586-1595. [DOI: 10.1002/bdr2.1093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 06/18/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Sihem Darouich
- Unité de Foetopathologie, Hôpital Universitaire Habib Bougatfa, Faculté de Médecine de Tunis; Université Tunis El Manar; Tunis Tunisie
| | - Lucile Boutaud
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
- INSERM U-1163, Institut Imagine; Hôpital Necker-Enfants Malades, APHP; Paris France
- Université Paris Descartes; Paris France
| | - Bettina Bessières
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Maryse Bonnière
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Jelena Martinovic
- Unité de Pathologie Fœtale; Hôpital Antoine Béclère, APHP; Paris France
| | - Charlotte Mechler
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Caroline Alby
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
- INSERM U-1163, Institut Imagine; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Jean-Pierre Bernard
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Philippe Roth
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Yves Ville
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades, APHP; Paris France
| | - Valerie Malan
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
- INSERM U-1163, Institut Imagine; Hôpital Necker-Enfants Malades, APHP; Paris France
- Université Paris Descartes; Paris France
| | - Michel Vekemans
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
- INSERM U-1163, Institut Imagine; Hôpital Necker-Enfants Malades, APHP; Paris France
- Université Paris Descartes; Paris France
| | - Tania Attié-Bitach
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
- INSERM U-1163, Institut Imagine; Hôpital Necker-Enfants Malades, APHP; Paris France
- Université Paris Descartes; Paris France
| | - Férechté Encha-Razavi
- Service d'Histologie-Embryologie-Cytogénétique; Hôpital Necker-Enfants Malades, APHP; Paris France
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Abstract
Studies of syndromic hydrocephalus have led to the identification of >100 causative genes. Even though this work has illuminated numerous pathways associated with hydrocephalus, it has also highlighted the fact that the genetics underlying this phenotype are more complex than anticipated originally. Mendelian forms of hydrocephalus account for a small fraction of the genetic burden, with clear evidence of background-dependent effects of alleles on penetrance and expressivity of driver mutations in key developmental and homeostatic pathways. Here, we synthesize the currently implicated genes and inheritance paradigms underlying hydrocephalus, grouping causal loci into functional modules that affect discrete, albeit partially overlapping, cellular processes. These in turn have the potential to both inform pathomechanism and assist in the rational molecular classification of a clinically heterogeneous phenotype. Finally, we discuss conceptual methods that can lead to enhanced gene identification and dissection of disease basis, knowledge that will potentially form a foundation for the design of future therapeutics.
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Affiliation(s)
- Maria Kousi
- Center for Human Disease Modeling, Duke University School of Medicine, Durham, North Carolina 27701;
| | - Nicholas Katsanis
- Center for Human Disease Modeling, Duke University School of Medicine, Durham, North Carolina 27701;
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8
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Tully HM, Ishak GE, Rue TC, Dempsey JC, Browd SR, Millen KJ, Doherty D, Dobyns WB. Two Hundred Thirty-Six Children With Developmental Hydrocephalus: Causes and Clinical Consequences. J Child Neurol 2016; 31:309-20. [PMID: 26184484 PMCID: PMC4990005 DOI: 10.1177/0883073815592222] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/23/2015] [Indexed: 11/15/2022]
Abstract
Few systematic assessments of developmental forms of hydrocephalus exist. We reviewed magnetic resonance images (MRIs) and clinical records of patients with infancy-onset hydrocephalus. Among 411 infants, 236 had hydrocephalus with no recognizable extrinsic cause. These children were assigned to 1 of 5 subtypes and compared on the basis of clinical characteristics and developmental and surgical outcomes. At an average age of 5.3 years, 72% of children were walking independently and 87% could eat by mouth; in addition, 18% had epilepsy. Distinct patterns of associated malformations and syndromes were observed within each subtype. On average, children with aqueductal obstruction, cysts, and encephaloceles had worse clinical outcomes than those with other forms of developmental hydrocephalus. Overall, 53% of surgically treated patients experienced at least 1 shunt failure, but hydrocephalus associated with posterior fossa crowding required fewer shunt revisions. We conclude that each subtype of developmental hydrocephalus is associated with distinct clinical characteristics, syndromology, and outcomes, suggesting differences in underlying mechanisms.
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Affiliation(s)
- Hannah M Tully
- Department of Neurology, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Gisele E Ishak
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Tessa C Rue
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Samuel R Browd
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathleen J Millen
- Department of Pediatrics, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Dan Doherty
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - William B Dobyns
- Department of Neurology, University of Washington, Seattle, WA, USA Department of Pediatrics, University of Washington, Seattle, WA, USA Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
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9
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Del Bigio MR, Di Curzio DL. Nonsurgical therapy for hydrocephalus: a comprehensive and critical review. Fluids Barriers CNS 2016; 13:3. [PMID: 26846184 PMCID: PMC4743412 DOI: 10.1186/s12987-016-0025-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/15/2016] [Indexed: 12/13/2022] Open
Abstract
Pharmacological interventions have been tested experimentally and clinically to prevent hydrocephalus and avoid the need for shunting beginning in the 1950s. Clinical trials of varied quality have not demonstrated lasting and convincing protective effects through manipulation of cerebrospinal fluid production, diuresis, blood clot fibrinolysis, or manipulation of fibrosis in the subarachnoid compartment, although there remains some promise in the latter areas. Acetazolamide bolus seems to be useful for predicting shunt response in adults with hydrocephalus. Neuroprotection in the situation of established hydrocephalus has been tested experimentally beginning more recently. Therapies designed to modify blood flow or pulsation, reduce inflammation, reduce oxidative damage, or protect neurons are so far of limited success; more experimental work is needed in these areas. As has been recommended for preclinical studies in stroke and brain trauma, stringent conditions should be met for preclinical studies in hydrocephalus.
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Affiliation(s)
- Marc R Del Bigio
- Department of Pathology, University of Manitoba; Children's Hospital Research Institute of Manitoba, Diagnostic Services Manitoba, 401 Brodie Centre, 715 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
| | - Domenico L Di Curzio
- Department of Human Anatomy and Cell Science, University of Manitoba, Winnipeg, Canada.
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Guibaud L, Lacalm A. Etiological diagnostic tools to elucidate 'isolated' ventriculomegaly. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 46:1-11. [PMID: 25296846 DOI: 10.1002/uog.14687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/08/2014] [Accepted: 09/24/2014] [Indexed: 06/04/2023]
Affiliation(s)
- L Guibaud
- Département d'Imagerie Pédiatrique et Fœtale, Centre Pluridisciplinaire de Diagnostic Prénatal, Hopital Femme Mère Enfant, Lyon-Bron, France
| | - A Lacalm
- Département d'Imagerie Pédiatrique et Fœtale, Centre Pluridisciplinaire de Diagnostic Prénatal, Hopital Femme Mère Enfant, Lyon-Bron, France
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11
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Tully HM, Dobyns WB. Infantile hydrocephalus: a review of epidemiology, classification and causes. Eur J Med Genet 2014; 57:359-68. [PMID: 24932902 PMCID: PMC4334358 DOI: 10.1016/j.ejmg.2014.06.002] [Citation(s) in RCA: 194] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/02/2014] [Indexed: 12/19/2022]
Abstract
Hydrocephalus is a common but complex condition caused by physical or functional obstruction of CSF flow that leads to progressive ventricular dilatation. Though hydrocephalus was recently estimated to affect 1.1 in 1000 infants, there have been few systematic assessments of the causes of hydrocephalus in this age group, which makes it a challenging condition to approach as a scientist or as a clinician. Here, we review contemporary literature on the epidemiology, classification and pathogenesis of infantile hydrocephalus. We describe the major environmental and genetic causes of hydrocephalus, with the goal of providing a framework to assess infants with hydrocephalus and guide future research.
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Affiliation(s)
- Hannah M Tully
- Department of Neurology, University of Washington, Seattle, WA, USA; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA.
| | - William B Dobyns
- Department of Pediatrics, Division of Genetic Medicine, University of Washington, Seattle, WA, USA; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
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