Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence without causative disorders, as well as dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure and no secondary cause [1][2][3] . It is a differential diagnosis for most of the dementia syndromes and occurs mainly in elderly populations 4 .The known incidence is approximately 6 per 100,000 and it has a prevalence of 22 per 100,000 for suspected iNPH.There are associations with hypertension, cerebrovascular and Alzheimer diseases [1][2][3] .The clinical evolution of iNPH is not clear 5 . Without surgery, most iNPH patients present early clinical deterioration. A small number of patients might improve without shunting; however, the extent of improvement is not clear 3 .Ventricular CSF shunting is the main treatment in the management of iNPH and its results in reducing the caregiver's burden when caring for iNPH patients are well-established 6 . ABSTRACTIdiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata ® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/ worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata ® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH.Key words: hydrocephalus, normal pressure, cerebrospinal fluid shunts, treatment. RESUMOA hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata ® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatad...
Object. Craniovertebral junction malformation (CVJM) or Chiari malformation in adults, with or without syringomyelia and basilar invagination, produces neuronal dysfunction of the brainstem, cerebellum, cranial nerves, and upper spinal cord. The respiratory center and some of its afferent and efferent components can be altered in these diseases. The authors studied patients with and without CVJM to determine whether this physical feature contributed to sleep disturbances. Methods. Respiratory manifestations during sleep were studied prospectively, by using whole-night polysomnography, in 32 symptomatic patients (CVJM group) and 16 healthy volunteers (control group). Patients with CVJM presented with more sleep disturbances (reports of snoring and apnea) than those in the control group. The apnea/hypopnea index values were higher in patients with CVJMs than in the control group (13 ± 15 compared with 3 ± 6; p = 0.007) and the rate of central sleep apneas was higher in the CVJM than in the control group (22 ± 30 compared with 4 ± 8%; p = 0.009). The apnea/hypopnea index was highest in the subgroup with basilar invagination than in the other subgroups. The central apneic episodes were more frequent in the patients with basilar invagination (35 ± 40%; p = 0.001) and in those with syringomyelia (17.6 ± 24.6%; p = 0.003) than in the control group (4 ± 8%). Patients with symptomatic CVJM, especially those with basilar invagination, presented with more sleep respiratory compromise than did those in the control group. Conclusions. The incidence of sleep apnea/hypopnea syndrome is significantly higher in patients with CVJM.
Patients with craniocervical disorders (CCD) show a wide variety of symptoms and signs suggesting cerebellar and/or high cervical lesion. The anatomic localization of respiratory centers and their possible injury may explain the presence of respiratory disturbances in these diseases. The aim of this preliminary study was to evaluate the polysomnographic findings in a group of patients with CCD, most of them with Arnold-Chiari malformation type I, since sleep apnea has been referred to in isolated cases in the literature. Eleven patients (seven females and four males) with CCD diagnosed by magnetic resonance imaging referred from the neurosurgery unit were submitted to clinical history, physical examination with sleep questionnaires, and scored on the Epworth Sleepiness Scale. Full night polysomnography was performed in an Oxford SAC system where EEG, electro-oculography, electrocardiography, chin and leg electromyography, chest and abdominal efforts, airflow, and oximetry were recorded continuously. Nine patients presented with Arnold-Chiari type I malformation, of whom six showed associated syringomyelia. The other two had basilar invagination. Ninety percent of these patients complained of sleep problems (snoring, choking, and witnessed apneas) and 72% presented hypersomnolence (ESS >9). The polysomnographic findings showed sleep fragmentation in 81% of the patients and a reduction of rapid eye movement sleep in 63%. The apnea/hypopnea index was above 5 in 72%, with a predominance of central apnea. Patients with craniocervical disorders present a higher probability of displaying sleep respiratory disturbances. Their sleep complaints should be assessed and patients should be submitted to an overnight sleep recording in order to identify sleep apnea.
Decompressive surgery in patients with craniovertebral junction malformations resulted in decreased respiratory events during sleep, lowered sleep fragmentation, and enhanced the sleep apnea index in a significant number of patients. The effect was more pronounced in patients with central apnea.
Normal pressure hydrocephalus (NPH) is characterized by gait disturbance, dementia and/or urinary incontinence associated with dilation of ventricular system with normal opening cerebrospinal fluid pressure. Wide scientifical evidence confirms association between NPH and psychiatric symptoms. We selected 35 patients with idiopathic normal pressure hydrocephalus from January 2010 to January 2012 in a Brazilian tertiary hospital and performed a formal psychiatric evaluation to identify psychiatric disorders. Psychiatric disorders were present in 71% of these patients, especially anxiety, depression and psychotic syndromes. NPH patients may develop symptoms with frontal dominance, such as personality changes, anxiety, depression, psychotic syndromes, obsessive compulsive disorder, Othello syndrome; shoplifting and mania. Unusual appearances of NPH symptoms may hinder early diagnosis and consequently proper treatment.Keywords: normal pressure hydrocephalus, psychiatry, symptoms. RESUMO A hidrocefalia de pressão normal (HPN) é caracterizada por distúrbios da marcha, demência e/ou incontinência urinária associada com dilatação do sistema ventricular e pressão de abertura do líquido cefalorraquidiano normal. Evidências científicas confirmam associação entre HPN e sintomas psiquiátricos. Foram selecionados 35 pacientes com hidrocefalia de pressão normal idiopática, de janeiro de 2010 a janeiro de 2012 em um hospital terciário brasileiro e realizada uma avaliação psiquiátrica formal para identificar transtornos psiquiátricos. Transtornos psiquiátricos foram detectados em 71% dos pacientes, principalmente depressão, ansiedade e síndromes psicóticas. Pacientes com HPN podem desenvolver sintomas com predomínio frontal, tais como mudanças de personalidade, ansiedade, depressão, síndromes psicóticas, transtorno obsessivo compulsivo, síndrome de Otelo, furtos e mania. Sintomas incomuns de HPN podem dificultar o diagnóstico precoce e o tratamento adequado.Palavras-chave: hidrocefalia de pressão normal, sintomas, psiquiatria.Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, dementia and urinary incontinence plus dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure 1,2,3,4,5,6 . Dilated ventricles theoretically impair perfusion in ventricular walls, generating hypoperfusional states especially in frontal lobes, basal ganglia and thalamus, thus resulting classic symptomatology 7 . NPH can present in two forms: primary (also known as idiopathic), when there are no causative disorders and secondary, where other disorders such as trauma, infection and hemorrhage are putative causes for hydrocephalus 1,2,3,4,5,6 . Idiopathic NPH (INPH) is associated with communicating hydrocephalus (as demonstrated by brain CT or MRI) and CSF pressure within normal range (7-24 cm H2O) 1,2,3,4,5,6 . With improvements in quality of life and subsequent increase in life expectancy, it is expected that a greater number of elderly individuals will suffe...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.