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In some patients with congenital or acquired hydrocephalus, a low-density area is seen around the lateral ventricle on computerized tomography. Above all, in patients with normal-pressure hydrocephalus following subarachnoid hemorrhage, there appears a specific low-density area which is fan-shaped and irregular and which extends from the bilateral anterior horns to the frontal pole. This disappears or decreases with a VP shunt. Improvement of clinical symptoms is proportional to the degree of disappearance of the low-density area. The essential part of the occurrence of symptoms in patients with normal-pressure hydrocephalus depends upon a low-density area on CT.

Serial lumbar puncture (LP) as a method of treating hydrocephalus was evaluated in ten infants of birthweights ≤ 1500 grams, who had a cerebral intraventricular hemorrhage(CVH) and ventricular dilatation identified by computed tomography (CT).Each of the infants had an initial CT scan within the first ten days of life. Follow-up CT scans were done at weekly intervals. If progressive ventricular dilatation was observed, daily LP was attempted. Ventricular size remained stable or decreased throughout the tapping period and remained so after the cessation of tapping in eight of the ten infants. Follow-up CT scans at six months of age on eight of the ten infants showed no increase in ventricular size and an increase in the thickness of the cerebral mantle. The two infants from whom cerebrospinal fluid could not be obtained had progressive ventricular dilatation and required the placement of a ventriculo-peritoneal shunt. This approach to early intervention of progressive ventricular dilatation secondary to CVH by means of serial LP may arrest the development of hydrocephalus and eliminate the need for a shunt.

26/31(84%) surviving NICU infants with birthweights ≤950 g.born 4/74-1/77 were evaluated by an interdisciplinary team including pediatricians(2), psychologist, audiologist, optometrist, developmentalist, social worker, nutritionist and R.N. The study began in 1/76 with evaluations performed at ages 6, 12, 18, 24 and 36 mos. Mean age at last evaluation was 18 mos.(range 6-38 mos.). Population characteristics included mean birth weight 889 g.(range 650-940 g.); mean gestational age 28.4 wks.(range 24-33 wks., 7/26 small for gestational age); male:female 10:16; inborn:outborn 5:21; and Black:White:Other 13:12:1. Results were corrected for gestational age. Significant major morbidity was found in 9/26(34.6%)including stage V retrolental fibroplasia (RLF)(1); developmental delay (7 with DQ≥70); cerebral palsy(6); acquired hydrocephalus(2); extreme failure to thrive (FTT)(3). 6/9(67%) affected infants had multiple major handicaps. 11/17 infants without major handicaps had one or more minor disabilities including stage II RLF(1); recurrent lower respiratory disease(4); serous otitis media(11); mild conductive hearing loss(8); mild FTT(2); visual disorders(4) arrested hydrocephalus(3) and scoliosis(1). Although longitudinal followup may alter some of the results reported, it appears that survival without major morbidity is occurring in 65% of surviving infants with birthweights ≥950 g.