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Biomedical subjects

R A Minns

Publications and source records attributed to R A Minns.

At least 19 recordsLinked to original sources
PubMed1992

Cerebrovascular resistive index assessed by duplex Doppler sonography and its relationship to intracranial pressure in infantile hydrocephalus.

Duplex Doppler sonography and direct intracranial pressure (ICP) measurement were performed on 18 patients with infantile hydrocephalus. ICP was measured through a frontal reservoir or ventricular tap using a nondisplacement pressure transducer. The Pourcelot Resistive Index, RI = (peak systolic-end diastolic)/peak systolic velocity was obtained from pulsed-wave Doppler measurements of blood flow velocity in the anterior (ACA) and/or the middle cerebral (MCA) arteries. There was a statistically significant positive correlation between ICP and RIs in the MCA and ACA. Paired RI measurements in 7 patients with raised ICP decreased significantly from a mean of 0.90 pre-tap to 0.75 post-tap. Our results suggest that the RI provides a reliable measure of cerebrovascular resistance in hydrocephalus. Duplex Doppler ultrasonography thus is a useful noninvasive means of monitoring cerebrohaemodynamic change with simultaneous imaging of ventricular size in infantile hydrocephalus.

Blood Flow Velocity↗
PubMed1992

Cerebral blood-flow velocity and intermittent intracranial pressure elevation during sleep in hydrocephalic children.

The clinical importance of intermittent intracranial pressure (ICP) elevations during sleep in hydrocephalic children is unclear. Eight studies of continuous ICP monitoring with simultaneous cerebral blood-flow velocity (CBFV) measurements were recorded during sleep in seven hydrocephalic children aged between one and 10 years. ICP was measured directly through a frontal reservoir. There were two main patterns of CBFV change in response to raised ICP: a progressive decrease in mean flow velocity and increase in resistance index, suggesting impaired haemodynamic compensation to ICP elevation due to reduced circulatory reserve in patients with limited intracranial compliance; and an increase in mean flow velocity with raised ICP, suggesting that appropriate haemodynamic compensation with increased blood-flow can occur to maintain adequate cerebral perfusion in those with sufficient circulatory reserve. Simultaneous CBFV and ICP measurements may help to identify those with reduced circulatory reserve who are at greater risk of ischaemic insult from episodic increases in ICP.

Blood Flow Velocity↗
PubMed1991

Cerebral blood flow velocity changes after ventricular taps and ventriculoperitoneal shunting.

Transcranial Doppler ultrasonography (TCD) was performed on 14 patients with hydrocephalus (age range 1 day to 12 years old) before and after ventriculoperitoneal shunting. TCD was also performed with simultaneous intracranial pressure (ICP) measurements during ventricular taps through a reservoir in 7 patients. Measurements of the resistance index (RI) = (S-D)/S, peak systolic (S), enddiastolic (D) and time-averaged mean flow velocities were made. After ventricular taps and ventriculoperitoneal shunting there was a significant decrease in RI in all patients. This was due to a greater increase in D compared to S, which suggests a decreased distal cerebrovascular resistance. There was a significant correlation between RI and ICP in the older infants and children and in individual neonates. Successful cerebrospinal fluid diversion reduces ICP and cerebrovascular resistance, thus improving cerebral perfusion. The RI is a reliable index for serial monitoring of cerebrohaemodynamic change in patients with hydrocephalus.

Blood Flow Velocity↗
PubMed1991

Transcranial Doppler (TCD) ultrasound as a noninvasive means of monitoring cerebrohaemodynamic change in hydrocephalus.

Cerebral blood flow velocity (CBFV) measurements by Transcranial Doppler (TCD) ultrasound were performed on 27 patients with hydrocephalus (Group I: neonates, Group II: children). Simultaneous measurements of direct ICP and CBFV were performed during ventricular taps in 16 patients. There was a significant correlation between ICP and Resistance Index (RI = peak systolic-end distolic/peak systolic velocity) overall in Group II patients (p less than 0.02) and in individual neonatal patients (p less than 0.001). After ventricular taps and ventriculo-peritoneal shunting (17 patients) there was a consistent significant decrease in RI due to increased end diastolic velocity in all patients (p less than 0.001). This suggests the RI is a reliable index of cerebrovascular resistance for serial monitoring in individual patients. There was an exponential pattern of decay in RI with CSF volume depletion (volume-flow velocity response) in 50/56 taps which allows calculation of a volume-buffering reserve before perfusion change occurred. Simultaneous ICP/CBFV monitoring during sleep may help to identify patients who are unable to compensate haemodynamically during episodic increase in ICP and are a greater risk of ischaemic insult. TCD is a useful noninvasive technique of monitoring cerebrohaemodynamic change for initial assessment and further management of children with hydrocephalus.

Adolescent↗
PubMed1989

Neuro-developmental study of profoundly mentally handicapped children in hospital care.

Swedish estimates of the need for long-term intensive health care provision for profoundly mentally handicapped children were compared with an Edinburgh survey, and the neurodevelopment and health characteristics of Edinburgh children with profound mental handicap who required prolonged admission are described. The extent of their disabilities indicates the complexity of the task of designing alternatives to their present hospital provision which will adequately meet their health needs.

Abnormalities, Multiple↗
PubMed1989

Symptoms and signs of progressive hydrocephalus.

The clinical features of 107 cases of children with hydrocephalus and measured raised intraventricular pressure were analysed retrospectively. Fifty one children had recently been diagnosed as having hydrocephalus, and the remainder had had shunts injected to direct the cerebrospinal fluid. The most common symptoms in the group were vomiting, behavioural changes, drowsiness, and headaches. The most common clinical signs were inappropriately increasing occipitofrontal head circumferences, tense anterior fontanelles, splayed sutures, and distension of the scalp veins. Half the infantile cases of hydrocephalus were without symptoms, and a quarter of the cases with cerebrospinal fluid shunts and measured raised intraventricular pressure were without signs. There were no fewer than 33 different clinical signs including several unusual ones, such as macular rash and sweating. We believe that the presentation of hydrocephalus with raised intraventricular pressure is sufficiently variable, unusual, or even absent to justify the direct measurement of intracranial pressure.

Cerebrospinal Fluid Shunts↗
PubMed1989

Cerebrospinal fluid pressure in pyogenic meningitis.

The pressure of cerebrospinal fluid taken at lumbar puncture was recorded objectively by strain gauge pressure measurement in 35 infants and children with pyogenic meningitis. Raised pressures were found in 33 children. The median pressure was 15 mm Hg (range 4-70 mm Hg) in all age groups. The pressure level varied throughout the infection, but a higher median pressure (19 mm Hg) was found when this was measured on the day of admission. The clinical features of the meningitis in these patients suggest that many of the presenting symptoms and signs are those of pressure. These results show that high pressure is frequently present in childhood meningitis, not just in those who die from cones or who have radiological evidence of hydrocephalus. We conclude that raised cerebrospinal fluid pressure is a frequent accompaniment of childhood meningitis and may need treatment in its own right and is therefore one further important factor influencing the course and outcome of childhood meningitis.

Adolescent↗
PubMed1988

The use of CSF pressure recordings in acute purulent meningitis.

Non-fluid displacing pressure transducers can be applied to a spinal needle at LP and direct CSF pressure recordings obtained routinely. The method is particularly applicable to children with suspected meningitis and is both a safer and a more accurate estimate of CSF pressure. Children with acute purulent meningitis frequently have raised intracranial pressure on presentation and Mannitol infusion during the LP recording is useful in returning the pressure to normal.

Brain Edema↗
PubMed1988

Epilepsy precipitated by bathing.

A case of epilepsy precipitated by bathing is described and previously reported cases are reviewed. The prognosis for this rare form of reflex epilepsy seems to be good, in that the seizures resolve with age and neurodevelopment remains normal.

Baths↗
PubMed1988

Role of a separate subcutaneous cerebro-spinal fluid reservoir in the management of hydrocephalus.

A retrospective survey has been carried out on 56 children with shunted hydrocephalus either with a primary idiopathic cause or as a result of a low spina bifida complex. In all 56 children, a separate reservoir has been inserted at some stage in the management of their hydrocephalus. There was no mortality. Morbidity was not increased from CSF infection or shunt blockage. There was less chance of the initial shunt blocking and there was a lesser incidence of visual and schooling handicap. Double cortical puncture did not result in an increased incidence of hemiplegia or epilepsy. We conclude that a separate reservoir greatly eases the management of these children and does not cause significant increased morbidity.

Adolescent↗
PubMed1987

Specific enlargement of the fourth ventricle after ventriculo-peritoneal shunt for post-haemorrhagic hydrocephalus.

Disproportionate enlargement or isolation of the fourth ventricle are rare complications of ventriculo-peritoneal shunt for post-haemorrhagic hydrocephalus. Obvious features such as ataxia may indicate raised intracranial pressure in the posterior fossa. The child may, however, present with less specific signs of vomiting, anorexia, and lethargy and these symptoms may be misinterpreted as secondary to dilation of the lateral ventricular system due to malfunction of the ventriculo-peritoneal shunt. Two children with disproportionate enlargement of the fourth ventricle and two children with isolation of the fourth ventricle are described to illustrate the wide variations in clinical presentation. These rare complications can be diagnosed by real time ultrasound examination of the brain or computed tomography of the head. They should be considered in the differential diagnosis of a child who deteriorates after lateral ventriculo-peritoneal shunting for post-haemorrhagic hydrocephalus, and dealt with specifically to avoid the risk of upward herniation of the enlarged fourth ventricle.

Cerebral Hemorrhage↗
PubMed1987

CSF production rate: "real time" estimation.

CSF production rate has been measured by a drip detector method in 5 cases of childhood hydrocephalus undergoing closed ventricular drainage. The rate of production of CSF with this "real time" estimation is shown not to be constant but to be discontinuous and may vary by a factor of 10 over a one hour period, although the average rate of CSF production remains within previously established normal limits.

Cerebrospinal Fluid↗
PubMed1986

Sedimentation cytomorphology of the CSF in ventriculitis.

The cytological technique of cytocentrifugation and millipore filter collection of cells allows accurate identification of cells in the CSF. This study reports the changing CSF cell-populations during 26 episodes of ventriculitis in children with shunts to control hjydrocephalus. There was a significant discordance between lymphocytes and macrophages in the CSF. Neurosurgery led to a 20 per cent increase in neutrophils on the first postoperative day, with a progressive decline to a mean of 10 cells on the fourth postoperative day. There was a small decrease in lymphocytes on the first postoperative day, followed by an increase on the second day. Macrophages were reduced by 12 per cent on the first postoperative day and then steadily increased from the second to the fourth day. A mean number of two peaks (of all cells) occurred during the treatment for ventriculitis: there was a greater number of of neutrophils in the first peak, with less lymphocytes and macrophages than in the second peak. This study supports the advantages of this technique in the diagnosis and management of ventriculitis.

Adolescent↗
PubMed1985

Congenital rupture of a neuropathic bladder: report of a case.

A case of intra-uterine rupture of a neurogenic bladder in a female child with spina bifida is reported, together with the unusual histological appearances of detrusor-muscle atrophy at the site of rupture. The literature on ruptured bladder in the neonatal period is reviewed.

Adolescent↗