The Diagnosis And Treatment Of Hydrocephalus In Third-Grade Class-Hospital:A Single-Center Retrospective Analysis

Objectives: 1.The distribution of hydrocephalus in the Second Affiliated Hospital to Chongqing Medical University and the characteristics of etiology in different age groups;2.The clinical characteristics 、diagnosis and treatment of Normal Pressure Hydrocephalus in the Second Affiliated Hospital to Chongqing Medical University.Methods: The clinical data of in-patients diagnosed with hydrocephalus were analyzed,which from January 2001 to December 2018 in the medical record system of Neurology and Neurosurgery of the Second Affiliated Hospital to Chongqing Medical University.Results: 1.there are 349 cases,176 males and 173 females,of which the following types of hydrocephalus were: 130 cases of obstructive hydrocephalus(37.25%),115 cases of unexplained hydrocephalus(32.95%),59 cases of communicating hydrocephalus(16.91%),28 cases with clear NPH(8.02%),6 cases with acute hydrocephalus(1.71%),and 9 cases with hydrocephalus after trauma(2.58%).1 case of Congenital hydrocephalus(0.29%),1 case with high intracranial pressure hydrocephalus(0.29%).According to the analysis of age groups <40 years old,40-80 years old and >80 years old,82 cases(23.49%)of hydrocephalus cases less than 40 years old were the highest(42.68%)due to occupation,followed by trauma(28.05%),followed by vascular malformations(10.98%),unexplained(10.98%),and at least the hydrocephalus caused by infection(7.31%).There were 243 cases of hydrocephalus in the 40-80 age group,of which the highest proportion of hydrocephalus caused by hemorrhage(58.02%),followed by occupying lesion(19.75%),followed by unexplained reasons(14.82%),trauma(4.94%),the proportion of infection was the least(2.47%).There were 24 cases of hydrocephalus in the 80-year-old age group.The cause of hydrocephalus was mostly unclear(54.17%),followed by bleeding(25.00%)and the occupying lesion(20.83%).2.Analysis of 349 cases of hydrocephalus clinical data found that only 28 cases were diagnosed as NPH,23 cases from neurology,5 cases from neurosurgery,the diagnosis rate was only8.6%,according to the diagnostic criteria of 2016 China Normal Pressure Hydrocephalus diagnosis and treatment expert consensus on hydrocephalus,found that 3 of them were misdiagnosed,the misdiagnosis rate was 0.99%.and the clinical data of patients not diagnosed with NPH were analyzed,22 cases were considered suspicious NPH,the missed diagnosis rate was 46.81%.Analysis of 25 cases with diagnosed as NPH(3 misdiagnosed cases were excluded)and 22 cases of suspected NPH were found in clinical data: 25 cases(53.19%)of which have clear cognitive dysfunction,gait disorder,and urinary tract symptoms.There were 12 cases(25.53%)of cognitive impairment combined with gait disorder,5 cases(10.64%)of cognitive impairment combined with urinary incontinence,3 cases(6.38%)of cognitive impairment,and 2 cases(4.26%)of urinary incontinence.Among them,there were 13 cases(27.66%)with cognitive impairment as the main complaint,10cases(21.28%)with gait disorder,2 cases(4.26%)with urinary incontinence,and 22 cases(46.80%)for other reasons,Such as headache,dizziness,and the history of the disease found that there are cognitive impairment,gait disorder or urinary tract symptoms.Among them,14 cases were successfully tested for cerebrospinal fluid release,9 cases showed improvement in symptoms after cerebrospinal fluid release test,and 3 cases showed no improvement,One case of cerebrospinal fluid release test showed no improvement in symptoms after lumbar drainage,Symptoms improved after routine ventriculo-peritoneal shunt,and the improvement of urinary incontinence symptoms was the most obvious.There were 6 cases without cerebrospinal fluid release test,but the symptoms were significantly improved after ventriculo-peritoneal shunt,and 1 case had no cerebrospinal fluid release test,but the symptoms improved after drainage from the lumbar pool.Conclusion: Firstly,the etiology of hydrocephalus is different in different age groups.It is caused by occupation in youth and adolescents.In middle aged and quinquagenarian,it leads to more after hemorrhage.In the old age,the cause of most hydrocephalus is unclear,and with the increase of age,the proportion of hydrocephalus caused by unknown causes is getting heavier and heavier.Secondly,our hospital still lacks understanding of NPH,and the rate of missed diagnosis is relatively high.It is necessary to further strengthen the understanding of NPH in order to improve the diagnosis and treatment rate of NPH.In addition,cerebrospinal fluid release test is a very effective method to assist in the diagnosis of NPH.Ventricular-peritoneal shunt is a very effective treatment for improving NPH-related symptoms.