A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus

Chang, Chia‐Cheng; Asada, Hiroyuki; Mimura, Toshiro; Suzuki, Shinichi

doi:10.3171/2008.10.17676

Cited by 44 publications

(42 citation statements)

References 28 publications

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“…One Class I study of 162 patients (with limited generalizability because patients were selected for surgery on the basis of a TT and CT cisternography with Table 1 Normal pressure hydrocephalus score used by a number of authors to quantify patients' limitations iodinated contrast) 24 found that SPECT cerebral blood flow (CBF) in responders was no different from CBF in controls or nonresponders. The study also found that CBF reactivity to acetazolamide was significantly impaired in responders compared with controls (p , 0.0025) and nonresponders (p , 0.005).…”

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confidence: 99%

Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response

et al. 2015

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Objective: We evaluated evidence for utility of shunting in idiopathic normal pressure hydrocephalus (iNPH) and for predictors of shunting effectiveness. Methods:We identified and classified relevant published studies according to 2004 and 2011 American Academy of Neurology methodology.Results: Of 21 articles, we identified 3 Class I articles.Conclusions: Shunting is possibly effective in iNPH (96% chance subjective improvement, 83% chance improvement on timed walk test at 6 months) (3 Class III). Serious adverse event risk was 11% (1 Class III). Predictors of success included elevated R o (1 Class I, multiple Class II), impaired cerebral blood flow reactivity to acetazolamide (by SPECT) (1 Class I), and positive response to either external lumbar drainage (1 Class III) or repeated lumbar punctures. Age may not be a prognostic factor (1 Class II). Data are insufficient to judge efficacy of radionuclide cisternography or aqueductal flow measurement by MRI.Recommendations: Clinicians may choose to offer shunting for subjective iNPH symptoms and gait (Level C). Because of significant adverse event risk, risks and benefits should be carefully weighed (Level B). Clinicians should inform patients with iNPH with elevated R o and their families that they have an increased chance of responding to shunting compared with those without such elevation (Level B). Clinicians may counsel patients with iNPH and their families that (1) positive response to external lumbar drainage or to repeated lumbar punctures increases the chance of response to shunting, and (2) increasing age does not decrease the chance of shunting being successful (both Level C). Neurology ® 2015;85:2063-2071 GLOSSARY AAN 5 American Academy of Neurology; AD 5 Alzheimer disease; AE 5 adverse event; CBF 5 cerebral blood flow; CI 5 confidence interval; CIBIC-Plus 5 Clinician Interview-Based Impression of Change, plus carer interview; CMI 5 comorbidity index; CSF-IT 5 CSF infusion test; ELD 5 external lumbar drainage; GRADE 5 Grading of Recommendations Assessment, Development and Evaluation; ICP 5 intracranial pressure; iNPH 5 idiopathic normal pressure hydrocephalus; LP 5 lumbar puncture; NPH 5 normal pressure hydrocephalus; TT 5 tap test.In 1965, Hakim and Adams 1 first described normal pressure hydrocephalus (NPH) as a condition characterized by the clinical triad of gait disturbance, urinary incontinence, and memory impairment; the presence of normal CSF pressure on lumbar puncture (LP); the radiologic finding of enlarged cerebral ventricles; and improvement after ventricular shunting. One of the few available epidemiologic studies estimates the incidence in a Norwegian population to be 5.5/100,000.2 The condition has been emphasized as a potentially reversible cause of dementia and impaired gait. The NPH syndrome Hakim and Adams 1 described is now separated into idiopathic NPH (iNPH) and secondary NPH, 3 with the latter typically arising from conditions such as subarachnoid hemorrhage or infectious meningitis. Ventricular shunting is considered ...

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Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response

et al. 2015

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“…Thus, one of our objectives was to identify a preoperative CBF estimate of prognostic value. Although several studies have not been able to find any relationship between pretreatment CBF and outcome after shunt insertion (33,34), other groups have reported different and sometimes contradictory correlations (35)(36)(37)(38). Some studies (36,38) found that patients with higher global or hemispheric preoperative CBF showed the most consistent clinical improvement after shunt therapy.…”

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confidence: 99%

Cerebral perfusion measured by dynamic susceptibility contrast MRI is reduced in patients with idiopathic normal pressure hydrocephalus

Ziegelitz

Starck

Kristiansen

et al. 2013

J. Magn. Reson. Imaging

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“…However, should a globally uniform CVR deficit be the hypothesis, as is the case in hydrocephalus (Chang et al, 2009b), the calibration issue may become more relevant. The fact that the slopes associating our resting-state CVR with standard CVR values are not uniform (Table 2) may present a challenge, raising questions such as "is this calibrationfactor variability large enough to prevent the detection of patient-control differences in CVR?".…”

Section: Practical Considerations and Limitationsmentioning

confidence: 99%

Quantitative mapping of cerebrovascular reactivity using resting-state BOLD fMRI: Validation in healthy adults

2016

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In conventional neuroimaging, cerebrovascular reactivity (CVR) is quantified primarily using the blood-oxygenation level-dependent (BOLD) functional MRI (fMRI) signal, specifically, as the BOLD response to intravascular carbon dioxide (CO 2 ) modulations, in units of [%ΔBOLD/ mmHg]. While this method has achieved wide appeal and clinical translation, the tolerability of CO 2 -related tasks amongst patients and the elderly remains a challenge in more routine and largescale applications. In this work, we propose an improved method to quantify CVR by exploiting intrinsic fluctuations in CO 2 and corresponding changes in the resting-state BOLD signal (rsqCVR). Our rs-qCVR approach requires simultaneous monitoring of PETCO 2 , cardiac pulsation and respiratory volume. In 16 healthy adults, we compare our quantitative CVR estimation technique to the prospective CO 2 -targeting based CVR quantification approach (qCVR, the "standard"). We also compare our rs-CVR to non-quantitative alternatives including the restingstate fluctuation amplitude (RSFA), amplitude of low-frequency fluctuation (ALFF) and globalsignal regression. When all subjects were pooled, only RSFA and ALFF were significantly associated with qCVR. However, for characterizing regional CVR variations within each subject, only the PETCO 2 -based rs-qCVR measure is strongly associated with standard qCVR in 100% of the subjects (p<=0.1). In contrast, for the more qualitative CVR measures, significant withinsubject association with qCVR was only achieved in 50-70% of the subjects. Our work establishes the feasibility of extracting quantitative CVR maps using rs-fMRI, opening the possibility of mapping functional connectivity and qCVR simultaneously.

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A prospective study of cerebral blood flow and cerebrovascular reactivity to acetazolamide in 162 patients with idiopathic normal-pressure hydrocephalus

Abstract: Both CBF and CVR decrease with the development of NPH, suggesting that hemodynamic ischemia may be responsible for manifestation of the symptoms. Impaired CVR and reduced CBF with the development of symptoms can be proposed as diagnostic criteria for idiopathic NPH.

Cited by 44 publications

References 28 publications

Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response

Practice guideline: Idiopathic normal pressure hydrocephalus: Response to shunting and predictors of response

Cerebral perfusion measured by dynamic susceptibility contrast MRI is reduced in patients with idiopathic normal pressure hydrocephalus

Quantitative mapping of cerebrovascular reactivity using resting-state BOLD fMRI: Validation in healthy adults

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