increased cerebral blood flow in communicating hydro

[sharon k]

My 10yr old son was dx communicating hydro at 18mths after CT when complex partial seizures began. He has never been shunted as was considered mild/mod ventricular dilatation. Has had periods over the past 18 mths of severe headache-worst early a.m., vomiting, nausea, short term memory loss, occasional bowel & bladder incontinance-gets no warning, balance & co-ordination problems-handwriting badly effected, decline in psycho-ed testing, verbal IQ-110, Performance IQ-81,(2 yrs ago OK), History of pale optic discs & visual field loss, some visual loss, has no seizure activity. Sought second opinion, neurologist ordered cineMRI most significant finding increased cerebral blood flow of 1600mls/min, told that 1000mls/min is normal, the neurologist does not know what this means & has not been able to find out. His 1st thought was pseudo tumor but says you do not see large ventricles with that. Said he wished we had taken our son to someone. In a post on your forum dated 5/4/98 it states ventricles can be enlarged in PT. This is all very confusing. He is booked to have repeat MRI & 1st LP next monday. I have found some very minimal information through web search that states in progressive communicating hydro you do see increased cerebral blood flows & that it can be a cause of PT. We are thinking of getting a neurosurgical consult. We live in Australia & cineMRI has only been around for the past 12 mths so  the Drs aren't up on all the results is what we were told. Will appreciate any advice or information you can give to help us find the right treatment for our son. Thanks Sharon

[CCF-Neuro-M.D.-JT]

With the presence of known hydrocephalus-increased vent size, pseudotumor cerebri is not a likely candidate as a cause for your child's symptoms. Pseuotumor occurs in the absence of any intracranial problems and is usually associated with very small vents. What you may be thinking of is actual increase in pressure due to a CSF absorption problem, etc... rather than a pseudotumor. As he is having serious neurological problems (visual loss, cognitive changes, and headaches), it is imperative that he get further workup for the hydrocephalus (as you are doing) and consideration of the need for shunt placement. Depending on the clinical severity, he may need to be seen by a neurosurgeon sooner rather than later. What will be important is comparison of MRIs and head circumference measurements along a growth curve. In patients with hydrocephalus, increased blood flow as a compensatory measure to the increased CSF pressure is seen. This means the brain has to try harder to get enough blood/oxygen due to the pressures being exerted by the cerebrospinal fluid. Hope the testing went well yesterday and that you will have enough information so your child can be appropriately treated. Best of luck.

[sharon k]

Thankyou for your reply, it confirmed my thoughts from the research I have been doing. The latest tests show the increased blood flow is still the same, & the LP revealed pressure at 19cm. My 1st thought was if that is what it is while he is well,just nausea for past 3 weeks what is it when he is having headaches & vomiting all the time. Have been referred to top Australian NSG. Told secretary test results & given appt. next Tuesday. Neurologist blew all this off, Your reply helped convince Paediatrician of need for NSG consult, am eternally grateful for advice. Our sincere thanks,
                                  Sharon k