Neuroimaging in normal pressure hydrocephalus

Damasceno, Benito Pereira

doi:10.1590/1980-57642015dn94000350

Cited by 59 publications

(36 citation statements)

References 39 publications

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“…brain atrophy, as in Alzheimer' s and Lewy body dementias); widening of the temporal horns not entirely explained by hippocampal atrophy; aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of the sulci and subarachnoid spaces over the high convexity and midline surface of the brain 5,6 . On the other hand, other imaging methods such as radionuclide cisternography, singlephoton emission computed tomography, positron emission tomography, and even diffusion tensor imaging or resting-state functional magnetic resonance imaging, though compatible with an NPH diagnosis, as yet do not improve the accuracy of identifying shunt-responsive patients.…”

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confidence: 99%

Normal pressure hydrocephalus and the predictive value of presurgical tests

Damasceno

2018

Arq. Neuro-Psiquiatr.

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ormal pressure hydrocephalus (NPH) is characterized by gait disturbance, progressive mental deterioration and urinary incontinence associated with enlargement of the ventricular system and normal cerebrospinal fluid (CSF) pressure, although episodes of increased CSF pressure do occur. In NPH, the excessive accumulation of CSF in the ventricular system is due to an impairment of CSF flow distally to the fourth ventricle ("communicating"). About 50% of NPH cases are "secondary" (due to meningitis, subarachnoid hemorrhage, trauma) while the other 50% are "idiopathic" (iNPH), usually occurring in the 7 th decade of life. Normal pressure hydrocephalus is a rare cause of dementia (less than 5% of all demented patients), with iNPH showing an annual incidence between 1.8/100,000 and 5.5/100,000 inhabitants, and prevalence ranging from 0.2% to 2.9% among individuals aged 65 years or older, based on surveys in northern Europe and Japan. Typical cases present with the triad of (1) gait disturbance as the first and most salient sign; followed by (2) an astheno-emotional syndrome characterized by difficulties in concentrating, increased irritability and fatigability, emotional instability, forgetfulness (more rarely, mild dementia), with psychomotor retardation, apathy, and sometimes a parkinsonian or depressive appearance; and, later on, (3) urinary urgency and/or incontinence. Gait disturbance is the cardinal sign in iNPH, typically a broad-based, short-step, slow magnetic gait with start hesitation and instability that is worst on turning, often with falls 1. It is not a genuine gait apraxia, since the patient can execute the walking movements without difficulty when lying down, despite freezing their gait when standing on their feet and trying to initiate walking 2. This gait impairment has been considered a gait ignition failure due to a frontal dysfunction or, more specifically, due to a frontal-basal ganglia disconnection, with uninhibited antigravity reflexes and co-contraction of agonists and antagonists during walking 3. Most of the iNPH syndrome is explained by a reduction of blood flow and metabolism in the frontal lobes, basal ganglia, medial thalamus, hippocampus, and anterior parts of periventricular white matter 4. In the typical patients, the diagnosis is almost straightforward and, after shunting, they are the most likely to improve, mainly in their gait disturbance. However, particularly in cases with atypical or incomplete clinical manifestations, there may be differential diagnostic difficulties, as the triad can be mimicked by other conditions such as Parkinson' s disease, progressive supranuclear palsy, and subcortical arteriosclerotic encephalopathy (Binswanger' s disease), which are much more common than NPH. In the elderly, other more common conditions may also explain the gait difficulties (arthrosis or arthritis, peripheral neuropathy, vestibular disease), urinary incontinence (prostate disease, chronic urinary tract infection), and mental deterioration (Alzheimer' s disease), particularly when the...

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Normal pressure hydrocephalus and the predictive value of presurgical tests

Damasceno

2018

Arq. Neuro-Psiquiatr.

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“…In the current study, MRI was selected instead of CT for its better spatial resolution and soft-tissue discrimination of intracranial structures. MRI proved a reliable measure quality in ventricular dilation and, for this reason, this technique is the commonly chosen method for the study of disorders of the cerebro-spinal uid, such as hydrocephalus, in both human (18) and animals (19).…”

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confidence: 99%

Morphometric Study of The Ventricular Indexes in Healthy Ovine Brain Using MRI

Trovatelli¹,

Spediacci²,

Castellano³

et al. 2020

Preprint

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BackgroundSheep (Ovis aries) have been largely used as animal models in a multitude of specialties in biomedical research. The similarity to human brain anatomy in terms of brain size, skull features, and gyrification index, gives to ovine as a large animal model a better translational value than small animal models in neuroscience. Despite this evidence and the availability of advanced imaging techniques, morphometric brain studies are lacking. We herein present the morphometric ovine brain indexes and anatomical measures developed by two observers in a double-blinded study and validated via an intra- and inter-observer analysis. ResultsFor this retrospective study, T1-weighted Magnetic Resonance Imaging (MRI) scans were performed at 1.5T on 15 sheep, under general anaesthesia. The animals were female Ovis aries, in the age of 18-24 months. Two observers assessed the scans, twice time each. The statistical analysis of intra-observer and inter-observer agreement was obtained via the Bland-Altman plot and Spearman rank correlation test.The results are as follows (mean±Standard deviation): Indexes: Bifrontal 0,338 ± 0,032 cm; Bicaudate 0,080 ± 0,012 cm; Evans’ 0,218 ± 0,035 cm; Ventricular 0,241 ± 0,039 cm; Huckman 1,693 ± 0,174 cm; Cella Media 0,096 ± 0,037 cm; Third ventricle ratio 0,040 ± 0,007 cm. Anatomical measures: Fourth ventricle length 0,295 ± 0,073 cm; Fourth ventricle width 0,344 ± 0,074 cm; Left lateral ventricle 4,175 ± 0,275 cm; Right lateral ventricle 4,182 ± 0,269 cm; Frontal horn length 1,795 ± 0,303 cm; Interventricular foramen left 1,794 ± 0,301cm; Interventricular foramen right 1,78 ± 0,317 cm.ConclusionsThe present study provides baseline values of linear indexes of the ventricles in the ovine models. The acquisition of these data contributes to filling the knowledge void on important anatomical and morphological features of the sheep brain.

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“…Neuroimaging exams must be requested, including CT or MRI scans, not only to verify the limbic structures but also to rule out other diseases, particularly vascular cognitive impairment. 34 Screening tests such as the mini-exam of the mental state, 35 clock-drawing test, verbal fluency and a questionnaire on instrumental and basic daily life activities, as well as the geriatric depression scale (GDS) questionnaire, must be applied. 36,37 neuropsychological testing…”

Section: Figurementioning

confidence: 99%

Mild cognitive impairment and progression to dementia of Alzheimer's disease

Steiner

Jacinto

Mayoral

et al. 2017

Rev. Assoc. Med. Bras.

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The increase in life expectancy in the Brazilian population raises questions about the preparation of the public health system in identifying elderly patients with signs of cognitive impairment. Currently, as a consequence of the long duration of preclinical phase of Alzheimer's disease, efforts of early detection have been emphasized. Clinical dementia presents an important impact on the individual's caregivers, family, society and economy. Identifying individuals who already have some cognitive impairment, despite remaining functional, as well as analyzing associated comorbidities, constitutes an opportunity to analyze possibilities for future interventions. Dementias are clinical conditions that impose a burden on the health system with its high costs, whereas the identification of individuals with cognitive impairment without dementia can aid patients and their families to plan the future and mitigate costs. This narrative revision can provide general practitioners with more information on the subject.

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Neuroimaging in normal pressure hydrocephalus

Cited by 59 publications

References 39 publications

Normal pressure hydrocephalus and the predictive value of presurgical tests

Normal pressure hydrocephalus and the predictive value of presurgical tests

Morphometric Study of The Ventricular Indexes in Healthy Ovine Brain Using MRI

Mild cognitive impairment and progression to dementia of Alzheimer's disease

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