A xenon-133 method was used to measure cerebral blood flow (CBF) before and after cerebrospinal fluid (CSF) removal in patients with normal pressure hydrocephalus (NPH). Preliminary results suggested that shunting should be performed on patients whose CBF increased after CSF removal. There was a significant increase in CBF in patients with NPH, which was confirmed by the favorable outcome of 88% of patients shunted. The majority of patients with senile and presenile dementia showed a decrease or no change in CBF after CSF removal. It is suggested that although changes in CBF and clinical symptoms of NPH may have the same cause, i.e., changes in the cerebral intraparenchymal pressure, there is no simple direct relation between these two events. The mechanism underlying the loss of autoregulation observed in NPH is also discussed. (Stroke 1987;18:1074-1080)

SUMMARY Regional cerebral blood flow (rCBF) was studied by the intravenous 133Xe method in 38 patients with systemic lupus erythematosus (SLE); 21 patients had neuropsychiatric manifestations (N+) and 17 did not (N-). Twelve of the N+ patients had had neuropsychiatric episodes less than one year before measurement of CBF ("recent" N+), while seven patients in this group had had episodes over a year before measurement ("old" N+). The results were compared with those obtained from a group of 27 age-matched normal healthy subjects. It was found that, in most of the N+ and N-patients, rCBF was evenly distributed bilaterally, but there was a "patchwork" of high/normal and low flow areas. This disturbance of rCBF distribution was significantly greater in "recent" N+ patients than in "old" N-patients, but was not a function of the potential evolution of systemic lupus erythematosus. It was also found that there was a reduction in the physiological high frontal rCBF in the "old" N+ patients. No correlation could be found between rCBF, the topography of the neuropsychological lesions, other neurological investigations or the glucocorticoid dosage and treatment schedules.Cerebral complications constitute the second most serious risk factor, after renal complications, in patients suffering from systemic lupus erythematosus

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