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P.149 Association between apolipoprotein E polymorphism and Alzheimer disease in Tehran, Iran
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Abstracts of the Hydrocephalus 2008 Congress / Clinical Neurology and Neurosurgery 110S (2008), S1–S41
erative mortality or morbidity. In the patient with shunt malfunction, the shunt was removed at the same procedure as endoscopic removal of the choroid plexus papilloma. In all three patients it was possible to achieve stabilization of the condition. Conclusions: These cases demonstrate that treatment of children with communicating (non-obstuctive) hypersecretory hydrocephalus and choroid plexus papilloma may be treated by minimally invasive surgery using endoscopy.
P.146 Early and late complications of endoscopic third ventriculostomy R. Lipina, M. Chlachula Department of Neurosurgery, University Hospital Ostrava, Czech Republic
and the mean tumor size was 3.9cm. In one patient an external ventricular drainage was inserted prior to tumor removal. The rest were treated by primary tumor removal. In 6 of them the H increased and 4 needed specific treatment. The incidence of CSF leaks in Group A was higher then in Group B (9.6% vs. 2.7%). However, in all cases it was managed successfully with lumbar drainage. The rate of other complications and neurological outcome was similar in both groups. Newly developed H had 6 patients: 4 were managed with ventricular drainage and 2 needed VP shunt. Conclusion: Complete tumor removal leads to alleviation of H in majority of cases. Although the rate of CSF leaks is higher in patients with H, it is not related to any additional morbidity. The neurological outcome is independent of the existence of H.
P.149 Association between apolipoprotein E polymorphism and Alzheimer disease in Tehran, Iran
P.147 Hydrocephalus with cerebrospinal fluid shunts during pregnancy: Report of two cases V. Vybíhal 1 , M. Sova 1 , P. Fadrus 1 , M. Smrèka 1 , M. Keøkovský 2 of Neurosurgery, 2 Department of Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Czech Republic
1 Department
Introduction: Women with cerebrospinal fluid shunts are now reaching reproductive age. They are making independent decisions in regard to planning their families. Two cases of pregnant women with cerebrospinal fluid shunts are presented. Cases/results: The first patient, a 27-year-old pregnant woman with a programmable shunt implanted 3 years ago was admitted with headache, double vision and severe Parinaud’s syndrome. She was in 27th gestation week. She underwent reprogramming of the valve so as the surgical revision without improving of the patient’s condition. Due to the further neurological worsening the shunt was externalized from the abdominal cavity for 4 weeks. Because of the immature lungs of the baby pre-term delivery was not felt optimal. Diprophos was administered to the mother to improve the baby’s lung maturation. A healthy child was delivered by cesarean section in 34th gestation week. The shunt was implanted back to the peritoneal cavity 3 weeks after the delivery. The patient’s symptoms had resolved and the CT scan was improved. The second patient, a 19-year-old pregnant woman received a programmable shunt at the age of 4 years. She has got epilepsy from childhood. Young woman gave birth to a healthy baby girl weighting 2500 grams. The child was delivered by cesarean section. No complications occurred. Conclusion: Cooperation of neurosurgeons, obstetricians and other specialists is always necessary to take care of shunted pregnant women. These women are able to gave birth to a healthy child but complications can occur during pregnancy and delivery.
P.148 Neurological outcome and morbidity rate after surgical treatment of patients with vestibular schwannoma and associated hydrocephalus V.M. Gerganov, A. Pirayesh, P.M. Klinge, A. Samii, M. Samii International Neuroscience Institute, Hannover, Germany Objective: The association of hydrocephalus (H) with vestibular schwannomas (VS) is a known phenomenon. Preferred management is primarily tumor removal and treatment of those who do not improve. Goal of our study was to determine if the complication rate and outcome of surgery are influenced by the existence of H. Methods: retrospective study of 350 patients operated by a single surgeon. All VS were removed completely via retrosigmoid approach. Those patients with radiological defined H regardless of symptomatology were included (Group A). The neurological outcome and complications rate in this group was compared to that in patients without H (Group B). Results: the incidence of H was 14%. The mean patient age was 46.2 years
A.A. Vaisiraygani, A. Vaisiraygani, H. Kharrazi, Z. Rahimi Department of Clinical Biochemistry, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran Epsilon 4 allele of apolipoprotein E(APOE-epsilon4) is a major risk factor for Alzheimer’s disease(AD). The association of APOE allele frequencies with AD remains unknown in developing countries.We examined the frequency of APOE alleles in 105 patients with AD and 129 cognitively normal subjects of similar age and sex (control group), in Tehran, Iran. The APOE-epsilon4 allele frequency was significantly higher in the AD subjects than in the control group(21% versus 6.2%, p<0.001). In addition, the OR for APOE-epsilon4 heterozygous and homozygous subjects were 3.2(p = 0.001) and 12.75(p = 0.01),respectively. The OR was not uniform across age groups. The AD subjects carrying one or two APOE-epsilon4 allele showed earlier age-at-onset(p < 0.001). These data suggest that the APOE-epsilon4 allele increase the risk for AD in Tehran population in a dose and age-dependent manner. Although the APOE-epsilon2 allele frequency was lower in the AD subjects than in the control group(0.95% versus 2.7%,p = 0.15), APOE-epsilon2 was not associated with the onset of AD in Tehran’s population. The OR for epsilon2 allele in AD subjects was 0.34 (p = 0.21). The genotype frequencies for epsilon3, epsilon4, and epsilon2 alleles in control subjects were 91.2, 6.1, and 2.7%, respectively. These values were similar to that reported for Turkish, Greece, Japanese, Spanish, and Moroccan populations, but they were significantly different from the reported values for the other ethnic populations. This observation emphasizes the importance of geographical location and ethnical background of the subjects in the study of APOE genotypes and their association with AD.
P.150 Association between apolipoprotein E polymorphism and serum lipid and apolipoprotein levels with Alzheimer’s disease H. Kharrazi, A. Vaisiraygani, Z. Rahimi, A.A. Vaisiraygani Department of Clinical Biochemistry, Medical School,Kermanshah University of Medical Sciences, Kermanshah, Iran We have recently demonstrated that apolipoprotein E (APOE)-epsilon4 allele is a risk factor for Alzheimer disease (AD). The current study is specifically aimed to examine whether APOE polymorphism in association with serum lipid-apolipoprotein level is a risk factor for AD. APOE polymorphism and plasma lipids, apoA1, apoB and lipoprotein (a) (Lp(a)) levels were determined in 94 AD patients and 111matched controls. Our study demonstrated a significant association between APOE polymorphism and the level of plasma lipids and apolipoprotein with AD in this population. The AD subjects had significantly lower apoA1 (p < 0.001) and HDL-C (p < 0.01) and higher apoB (p = 0.01) and LDL-C (p = 0.02) levels than that of the control group. The AD subjects carrying APOE- 4 allele had lower plasma apoA1 (t = 5.2, p < 0.002) and HDL-C level (t = 2.7, p = 0.01) but had higher plasma apoB (t = -5.4, p < 0.002), LDL-C (t = -4.6, p = 0.005) and total cholesterol (TC) (t = -2.7, p = 0.01) than that of the
Abstracts of the Hydrocephalus 2008 Congress / Clinical Neurology and Neurosurgery 110S (2008), S1–S41
erative mortality or morbidity. In the patient with shunt malfunction, the shunt was removed at the same procedure as endoscopic removal of the choroid plexus papilloma. In all three patients it was possible to achieve stabilization of the condition. Conclusions: These cases demonstrate that treatment of children with communicating (non-obstuctive) hypersecretory hydrocephalus and choroid plexus papilloma may be treated by minimally invasive surgery using endoscopy.
P.146 Early and late complications of endoscopic third ventriculostomy R. Lipina, M. Chlachula Department of Neurosurgery, University Hospital Ostrava, Czech Republic
and the mean tumor size was 3.9cm. In one patient an external ventricular drainage was inserted prior to tumor removal. The rest were treated by primary tumor removal. In 6 of them the H increased and 4 needed specific treatment. The incidence of CSF leaks in Group A was higher then in Group B (9.6% vs. 2.7%). However, in all cases it was managed successfully with lumbar drainage. The rate of other complications and neurological outcome was similar in both groups. Newly developed H had 6 patients: 4 were managed with ventricular drainage and 2 needed VP shunt. Conclusion: Complete tumor removal leads to alleviation of H in majority of cases. Although the rate of CSF leaks is higher in patients with H, it is not related to any additional morbidity. The neurological outcome is independent of the existence of H.
P.149 Association between apolipoprotein E polymorphism and Alzheimer disease in Tehran, Iran
P.147 Hydrocephalus with cerebrospinal fluid shunts during pregnancy: Report of two cases V. Vybíhal 1 , M. Sova 1 , P. Fadrus 1 , M. Smrèka 1 , M. Keøkovský 2 of Neurosurgery, 2 Department of Radiology, University Hospital Brno and Faculty of Medicine, Masaryk University Brno, Czech Republic
1 Department
Introduction: Women with cerebrospinal fluid shunts are now reaching reproductive age. They are making independent decisions in regard to planning their families. Two cases of pregnant women with cerebrospinal fluid shunts are presented. Cases/results: The first patient, a 27-year-old pregnant woman with a programmable shunt implanted 3 years ago was admitted with headache, double vision and severe Parinaud’s syndrome. She was in 27th gestation week. She underwent reprogramming of the valve so as the surgical revision without improving of the patient’s condition. Due to the further neurological worsening the shunt was externalized from the abdominal cavity for 4 weeks. Because of the immature lungs of the baby pre-term delivery was not felt optimal. Diprophos was administered to the mother to improve the baby’s lung maturation. A healthy child was delivered by cesarean section in 34th gestation week. The shunt was implanted back to the peritoneal cavity 3 weeks after the delivery. The patient’s symptoms had resolved and the CT scan was improved. The second patient, a 19-year-old pregnant woman received a programmable shunt at the age of 4 years. She has got epilepsy from childhood. Young woman gave birth to a healthy baby girl weighting 2500 grams. The child was delivered by cesarean section. No complications occurred. Conclusion: Cooperation of neurosurgeons, obstetricians and other specialists is always necessary to take care of shunted pregnant women. These women are able to gave birth to a healthy child but complications can occur during pregnancy and delivery.
P.148 Neurological outcome and morbidity rate after surgical treatment of patients with vestibular schwannoma and associated hydrocephalus V.M. Gerganov, A. Pirayesh, P.M. Klinge, A. Samii, M. Samii International Neuroscience Institute, Hannover, Germany Objective: The association of hydrocephalus (H) with vestibular schwannomas (VS) is a known phenomenon. Preferred management is primarily tumor removal and treatment of those who do not improve. Goal of our study was to determine if the complication rate and outcome of surgery are influenced by the existence of H. Methods: retrospective study of 350 patients operated by a single surgeon. All VS were removed completely via retrosigmoid approach. Those patients with radiological defined H regardless of symptomatology were included (Group A). The neurological outcome and complications rate in this group was compared to that in patients without H (Group B). Results: the incidence of H was 14%. The mean patient age was 46.2 years
A.A. Vaisiraygani, A. Vaisiraygani, H. Kharrazi, Z. Rahimi Department of Clinical Biochemistry, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran Epsilon 4 allele of apolipoprotein E(APOE-epsilon4) is a major risk factor for Alzheimer’s disease(AD). The association of APOE allele frequencies with AD remains unknown in developing countries.We examined the frequency of APOE alleles in 105 patients with AD and 129 cognitively normal subjects of similar age and sex (control group), in Tehran, Iran. The APOE-epsilon4 allele frequency was significantly higher in the AD subjects than in the control group(21% versus 6.2%, p<0.001). In addition, the OR for APOE-epsilon4 heterozygous and homozygous subjects were 3.2(p = 0.001) and 12.75(p = 0.01),respectively. The OR was not uniform across age groups. The AD subjects carrying one or two APOE-epsilon4 allele showed earlier age-at-onset(p < 0.001). These data suggest that the APOE-epsilon4 allele increase the risk for AD in Tehran population in a dose and age-dependent manner. Although the APOE-epsilon2 allele frequency was lower in the AD subjects than in the control group(0.95% versus 2.7%,p = 0.15), APOE-epsilon2 was not associated with the onset of AD in Tehran’s population. The OR for epsilon2 allele in AD subjects was 0.34 (p = 0.21). The genotype frequencies for epsilon3, epsilon4, and epsilon2 alleles in control subjects were 91.2, 6.1, and 2.7%, respectively. These values were similar to that reported for Turkish, Greece, Japanese, Spanish, and Moroccan populations, but they were significantly different from the reported values for the other ethnic populations. This observation emphasizes the importance of geographical location and ethnical background of the subjects in the study of APOE genotypes and their association with AD.
P.150 Association between apolipoprotein E polymorphism and serum lipid and apolipoprotein levels with Alzheimer’s disease H. Kharrazi, A. Vaisiraygani, Z. Rahimi, A.A. Vaisiraygani Department of Clinical Biochemistry, Medical School,Kermanshah University of Medical Sciences, Kermanshah, Iran We have recently demonstrated that apolipoprotein E (APOE)-epsilon4 allele is a risk factor for Alzheimer disease (AD). The current study is specifically aimed to examine whether APOE polymorphism in association with serum lipid-apolipoprotein level is a risk factor for AD. APOE polymorphism and plasma lipids, apoA1, apoB and lipoprotein (a) (Lp(a)) levels were determined in 94 AD patients and 111matched controls. Our study demonstrated a significant association between APOE polymorphism and the level of plasma lipids and apolipoprotein with AD in this population. The AD subjects had significantly lower apoA1 (p < 0.001) and HDL-C (p < 0.01) and higher apoB (p = 0.01) and LDL-C (p = 0.02) levels than that of the control group. The AD subjects carrying APOE- 4 allele had lower plasma apoA1 (t = 5.2, p < 0.002) and HDL-C level (t = 2.7, p = 0.01) but had higher plasma apoB (t = -5.4, p < 0.002), LDL-C (t = -4.6, p = 0.005) and total cholesterol (TC) (t = -2.7, p = 0.01) than that of the