Dr Rybinnik, I am the chief neuro resident at a Canadian University. I just wanted to say I absolutely love your videos and channel. I don’t think there is any other educational neurology content of this quality out there. Many thanks for making neurology appetizing. I don’t know it there’s anything you need help with, but I would be love to contribute to this amazing endeavour. Cheers.
@@theneurophile I have one idea. AD/Dementia related videos. Early- and Late-Onset differences/demonstrations of MRIs... I give "cognoscopies" to my elderly friends, but they are really difficult for me too :( (I score around a bit above the average though)
I am a retired Neuro ICU nurse with an adult son with increased ICP due to aqueductal stenosis. This was an excellent review to help confirm treatment options. Thank you
Good day, doc. I got diagnosed with NPH and underwent both the lumbar puncture + shunt placement; your video has enabled me to better understand the diagnosis. Thank you
I've watched all the videos from Rutgers RWJMS neurology, they are really very visual and useful contents, perhaps the best teaching videos any of us can find in RU-vid, please keep up the good work! Would be glad to see more contents in future, perhaps about ALS?
Thank you! My 16yo son was just diagnosed with chiari 1 with csf obstruction and hydrocephalus. I’m here to better understand what’s going on with him before our appointment with a neurosurgeon tomorrow. This was very helpful!
Hi Dr Rybinnik, i'm Adrian Joshua Velaro, a med student from Indonesia, it's hard to understand hydrocephalus for me only based on journals and books especially nowadays the lecture is full online, boring and difficult to understand. I have to learn extra from others to get a full picture of things i need to learn, surfing on internet takes a lot of time, but after find your channel and this video, i think your teaching method is very very cool, i just need to watch it over and over to get a full picture and it's very helpful. I kinda hope you can also teach about others outside the neurology, maybe collaboration with other, but i know it's too much to ask. Anyway, i hope you always get healthy so you can keep produce videos like this. THANK YOU SO MUCH!
thank you for your wonderful videos Doc! as a med student I really enjoy how detailed and specific you explain these advanced topics in plain language. I have a question though... what's a pseudotumor cerebri? and how is that different from hydrocephalus?
Pseudotumor cerebri (or idiopathic intracranial hypertension) is a disorder where intracranial pressure is increased, but there is no evidence imaging of hydrocephalus or obstruction. The proposed mechanism is increased pressure in the venous system (perhaps due to stenosis of the venous sinuses) makes CSF reabsorption less efficient, but not to the point to cause hydrocephalus.
I m preparing for my neurocritical boards . This channel are the best well illustrated concise videos on the topic . I really watched all them many times as I was driving , then sitting , then taking Notes . I really wonder if there are more vidoes coming , do u have dedicated website or blog . U guys are amazing.
Thank you! Currently, I am a team of 1. And I am a practicing clinician. So, it takes a while for me to make a video because I have to use my free time to do it. But yes, more videos are coming.
I was diagnosed last year age 47 with LOVA hydrocephalus. I had an ETV which failed. After making me dangerously ill and in HDU with sale wasting syndrome and acute kidney injury stage 2 I then had a VP shunt fitted.
I love the way you explain everything! And make it easier too!! I enjoy how interact with us through the screen, even when you cannot see us. IT IS charming I am watching all your videos! Thank youu so much! Greets from México!
I had a VP Shunt put in when i was 16. Ill never forget the day i came home from making money mowing lawns and my mom left with my brothers to take them to the baseball tournament... Withen a half hour my temp went high, my memory started to go away and went into a coma till i was taken to the ER from a meighbor
I just wish that some of these doctors would stick around where I live because the last three or four years it seems like all the doctors are starting to go west from where I'm at.
The Best Medical/Clinical Video I have ever found on Internet. Love and Thanks . I am a medical student & this was my first video of this channel. I have no words to thank you sir.
My Thesis is about Hydrocephalus and Folic acid role in preventing Hydrocephalus, any idea about how folic acid prevents Hydrocephalus from happening? Thank you for the video.
The doctor who teaches us told me that CSF drainage diversion of flow cannot be used in infection tuberculosis because in this case the patient does not have to stand for 8 months.
Just on correction for the sake of scientific accuracy. Transependymal flow theory has been abandoned, it is now thought to be ischaemic changes from pressure on periventricular vessels.
Agreed. But yes, and no. Some of it is reversible, which goes against ischemic changes. The "ischemic changes" is probably more applicable to NPH specifically. I was just trying to keep it simpler for the students.
I had a severe. On communicating hydrocephalus not even found except for accident whe I was close to death after enduring about 3 years of pain new immense dizziness and new immense pain pressure in head. After years before having a person reading my imaging seen my horns were rather pointy like a devils- happens with obstruction to CSF NON COMMUNICATING HYDROCEPHALUS! Tried to get help for my neck years back always pushed away… I assume it’s chiari…. Chiropractor said I had that about 20 years ago.. Recent imaging the X-ray tech asked if I was full of cyst’s asked to feel my neck and was like wow….. it’s sad I get the wrong help.
Hello Dr. Rybinnik, as always a stellar talk, thanks! Could you shortly talk about the imaging differential between ex-vacuo and true NPH, as this, as you said, is supremely important in the prognosis. Are there other Indices outside The Evans that would lead us to the diagnosis purely on imaging grounds? Thanks!
Thank you for that question. Imaging is not likely to be the answer for NPH patients (imaging is too non-specific when trying to differentiate between NPH and ex-vacuo). Evan’s ratio simply identifies ventroculomegaly, and not the cause. Sure if a patient is elderly and has significant cortical atrophy, NPH is unlikely. But NPH is a physiological diagnosis. Patients need a lumbar puncture drawing off high volume of CSF to tell if they would respond to a shunt. Usually you would do a diligent neuro exam including MOCA and gait, and repeat the entire exam after LP looking for dramatic improvement in cognition or gait. If minimal or no improvement is noted, a patient won’t benefit from a shunt.
@@theneurophile But on the next day after Biopsy patient complaint difficulty in speaking. I thought this could be due to open biopsy of supraclavicular lymph node.
As a 75 year old with a childhood head injury, hydrocephalus may be the diagnosis for me. Severe migraines for over 20 years that came and went, wobbly walk that is not now present, and urinary urgency. Misplacing words for a second or so. Walking almost everywhere since my husband died over 25 years ago. Strangely enough, altho no site have found indicates improvement over time, I feels that is the case with me.
Plz sir reply fast we r living in a country where there is very less medical help available here they don't even have MRI machine they only have CT scan and patient is in very bad condition for almost 3 weeks cannot travel and there is no emergency service by air to take him out of country plz help he had same issue when he was 9 month old got operated and with shunt he passed 18years without any problem but now he was having seizures drs said he got infection gave antibiotics then they operated him 3 time in 3 weeks in last operation they removed shunt now he is again having pain in his back beneath the shoulder area and so intense pain that he is having seizures and he cannot even take liquid c food coz mostly he is under the influence of medicine and unconscious and when he awake he get seizures and immense pain Doctors even can't tell why he is having pain can u help and tell what is going on with him ..😥😥 Sorry for poor english
I am sorry to hear of your troubles. Unfortunately, it is impossible to offer any medical advise without reviewing the entire case (medical records, imaging). You doctors cannot offer an explanation, they should be able to send medical records to specialists who can advise you.
Ok because I had well over a hundred Brain injuries in life and when I was in ICU they never did any testing I was very disoriented after I went to 7 doctors and never told me about this disdorder just pain pils
I’m wondering if there’s a relationship between AVM and hydrocephalus in older adults. Do you have any materials that provide explanations of the two together? Thank youuuuu
Interesting question. AVMs can certainly cause dural venous sinus thrombosis which decreases CSF reabsorption and increases intracranial pressure. There is also some discussion regarding idiopathic intracranial hypertension possibly caused by chronic venous insufficiency in the brain. Those entities do not cause hydrocephalus per se, but the mechanism of increase intracranial pressure is roughly the same.
Thank you! I am working on more videos as we speak. Sorry for the slowness, but I am a full-time clinician, so I have to somehow get these done during free time.
Sir Is hydrocephalus due to aqueductal obstruction cured in later life ? Please answer sir Sir said mine is cured Is aqueduct of sylvius visible in ct scan
Significant numbers of aqueductal stenosis do not have any symptoms and don't require any surgery. That being said, if aqueductal stenosis causes symptoms/hydrocephalus, surgical interventions have reasonable success rates. Usually MRI is needed to diagnose aqueductal stenosis, and CT is not enough.
@@mattasowjanya9798 You should discuss this with your doctor. It is difficult to diagnose disorders without obtaining proper medical history and examining a person. A CT scan cannot give you the answer.
Also surgeon said nothing permanent damage so my memory and my emotions will connect with thoughts thn I can feel my all feelings .I am having some improvement but not fully it's been 8 months post surgery.
@@faisalbi1330 If you would like to see a physician at Rutgers Robert Wood Johnson medical school, please visit this page: umg.rwjms.rutgers.edu/departments/neurology/index.php