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Hydro/MS/cognition?

F. Frank LeFever flefever at ix.netcom.com
Sun Feb 21 11:44:52 EST 1999



    "Challenging", to say the least.  Have known a few patients with   
    hydrocephaly (usually in context of spina bifida) and a few MS     
    patients, but am far from expert re either.  Know something about  
    mild traumatic head injury.  Will insert a comment or two below.

    First: "probably" congenital?  when noticed?  when/how treated?

    F. LeFever (v. infra)


In <7aoops$o76 at nnrp3.farm.idt.net> "rob" <22rdunca19 at idt.net> writes: 
>
>
>After perusing this group a bit I have to say that you have some real
>loonies here.  The sad thing is... theyre dumb as well.   Oh well. 
LOL
>
>Now to my Q.  I have hydrocephalus.  (some may remember me from 
several
>months ago.)  I also have MS.  How frequently are white matter lesions
seen
>in hydro?  How can I or my neuro tell the difference? 

        My impression is that white matter lesions are seen and/or     
        inferred primarily in tracts adjacent to ventricles, but I     
        invite correction from someone who knows.  MS white matter     
        lesions might thereby be distinguished from them on basis of   
        location.

            (more, below)

 I have been to far to
>many neuros and have received way to many conflicting opinions.
>
>My last attack was in my pons.  Can high icp affect that area?  The LP
>pressure was high.  But after calling the neuros at Barrows neuro
inst. they
>said to never get another LP because of the possibility of coning. 
(DUH!)
>I also have the possibility of Arnold Chari malformation btw.  Arent I
a
>pretty picture?  It seems everything is on the cusp of being certain. 
Yet
>nothing is.
>
>A little background I guess.  I am/was perfectly normal.  From others
point
>of view I suppose.  Looks, brain, behavior, interests, IQ far above
normal,
>etc...  But in retrospect its far to easy to correlate things that may
be
>unrelated.  So I suppose some things may be attributable to the hydro,
but
>nothing extraordinary.
>
>Now, just how in the hell do I tell if I should have the third
>ventriculostomy?  My MRIs have shown little difference in ventricle
volume
>since the day of its discovery.  (coming on 3 yrs, it was discovered
purely
>by accident btw)  I can understand periventricular lesions... but a
lesion
>in the pons?
>
> If my hydro truly is stable, even with NO third aqueduct, I am
reluctant to
>go under the knife obviously.  For me this is a conundrum.  I have
suffered
>some cognitive deterioration, but still test well above norm on
neuropsych
>tests.   I have even had one very well respected neurosurgeon tell me
I have
>a tethered spinal cord and positioning can lead to a temp coning. 
ARGH!!!!
>
>I have learned that neuro-opinions are like as&%#@$, everyone has one.
 I am
>not about to roll the dice, nor make the mistake of choosing one over
the
>other based on stature,behavior,certitude, etc...  So I am left having
to
>make my own decisions.  And I am the least qualified since I am not
well
>versed in neurology.
>
>Here are the facts.
>I have moderate to sever longstanding hydrocephalus.  Probably
congenital
>aquaductal stenosis.
>No shunt.
>No prior headaches until car accident in march of 97.

            Details?  Head trauma? Loss of consciousness or no?
            EEG or MRI data?  SPECT??  Latency of headache development?
            Other sequelae of accident?

            I don't know of any hard data relating head trauma to MS   
            exacerbations or to exacerbation of preexisting            
            hydrocephaly, although effects of subarachnoid hemorrhage  
             might be relevant to latter.

            I have, however, presented some speculative ideas about    
            possible neuroimmune mediation of some mild head trauma    
            sequelae--including headaches, fatigue, variable problems  
            with attention and/or memory lapses.  Possible agents      
            include (but are not limited to) mast cells, which "should"
            proliferate in some brain regions after brain trauma (and  
            are known to after some kinds of trauma).  A role for      
             mast cells in demyelination of MS has been persuasively   
            argued (i.e. by MS researhers).

            (more below)

>3 exacerbations of (supposed) MS.
>few lesions.  3 in white matter, 1 in pons with a little bit into the
grey
>matter (very little), possibly one in spine (t-9)
>SEVERE fatigue.  not imagined, although I wish this was a question of
>sanity.  (much easier to fix, I guess the resident loons arent so bad
off
>eh? LOL)
>Basically I lost the right half of my body in my last attck and am
slowly
>recovering.
>I am on Interferon Beta 1A, famvir (because of hhv-6s possible role in
MS),
>amantadin for fatigue, etc...
>Male
>32
>superior athlete  (was)
>
>This is getting long and I am getting tired so Ill leave you with this
and
>pose more questions and add to the confusion at a later time.  Is
there a
>more appropriate ng to post this to?
>
>And BTW... the ignorance concernig animal cognition and empathy is
suprising
>me.  I had never expected it from what seems like educated people.
>
>Rob
>
>
            As you well know, various problems (including cognitive    
            problems, including fatigue, etc.) can increase or decrease
            during the course of MS.

            Variable (day to day, moment to moment) symptomatology is  
            characteristic of mild head trauma (postconcussion         
            syndrome) as well>

            Finally, is it possible that interferon itself accounts for
            some cognitive and/or vegetative (fatigue) symptoms?

            Sorry I can't be more "definitive"!

            F. Frank LeFever, Ph.D.
            New York Neuropsychology Group



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