A Simplified Callosal Angle Measure Best Differentiates Idiopathic-Normal Pressure Hydrocephalus from Neurodegenerative Dementia

Cagnin, Annachiara; Simioni, Mariachiara; Tagliapietra, Matteo; Citton, Valentina; Pompanin, Sara; Puppa, Alessandro Della; Ermani, Mario; Manara, Renzo

doi:10.3233/jad-150107

Cited by 26 publications

(24 citation statements)

References 22 publications

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“…DESH is a reliable marker of diagnosis [47,48] and shunt responsiveness [49]. In addition, several reports also indicate the usefulness of the callosal angle for diagnostic [50,51] and shunt responsiveness [52][53][54]. We think that using DESH findings in addition to the Evans' index for making a diagnosis of iNPH in SZ patients is better than using the Evans' index only.…”

Section: Discussionmentioning

confidence: 96%

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

et al. 2020

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Background: We recently reported that older patients with schizophrenia (SZ) show possible idiopathic normal pressure hydrocephalus (iNPH) more frequently than the general population. In this study, we estimated the prevalence of iNPH in a larger number of older SZ patients and explored useful examination values for diagnosis in the SZ population. Methods: We enrolled older inpatients with SZ (n = 39, mean age = 68.6 ± 7.7 years) from several psychiatric hospitals in Ehime, Japan and acquired brain imaging data using computed tomography. We evaluated three iNPH symptoms (dementia, gait disturbance, and urinary incontinence). In addition, we combined these data with our previous data to elucidate the relationship between iNPH and characteristics of SZ symptoms. Results: In total, five (12.8%) patients were diagnosed with possible iNPH. Evans' index for patients with iNPH was significantly higher than for those without iNPH (p = 0.002). The number of disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings was significantly higher in patients with iNPH than in those without iNPH (p < 0.001). Using combined data, Drug-Induced Extra-pyramidal Symptoms Scale (DIEPSS) subscales of gait and bradykinesia showed an increasing trend in the SZ with iNPH group. Conclusions: We reconfirmed that older inpatients with SZ experienced possible iNPH more frequently than the general population. We should pay attention to the DIEPSS subscales of gait and bradykinesia and DESH findings in addition to the three main symptoms of iNPH and Evans' index so as to not miss SZ patients with iNPH.

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Section: Discussionmentioning

confidence: 96%

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

et al. 2020

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“…A previous NPH study showed that a small callosal angle on preoperative MRI was a signi cant predictor of a positive shunt outcome [13]. Another study showed a signi cantly decreased mean callosal angle in patients with NPH (109 ± 9) compared with patients with Alzheimer's disease (AD) (135.4 ± 11.3) or dementia with Lewy bodies (DLB) (136.9 ± 8.2) [20]. The mean callosal angle (113 ± 26.4°) in our elderly patients (Group C) (Table 3), which might be close to that in NPH, was smaller than that reported in AD and DLB cases [20].…”

Section: Discussionmentioning

confidence: 99%

“…Another study showed a signi cantly decreased mean callosal angle in patients with NPH (109 ± 9) compared with patients with Alzheimer's disease (AD) (135.4 ± 11.3) or dementia with Lewy bodies (DLB) (136.9 ± 8.2) [20]. The mean callosal angle (113 ± 26.4°) in our elderly patients (Group C) (Table 3), which might be close to that in NPH, was smaller than that reported in AD and DLB cases [20]. These results suggest that the morphologic changes accompanied by ventriculomegaly in DM1 patients are similar to those in patients with NPH.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Ventriculomegaly in Myotonic Dystrophy Type 1: Normal Pressure Hydrocephalus-like Appearances on Magnetic Resonance Imaging

Iida

Seino

Nagahata

et al. 2021

Preprint

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Background: Cerebral ventriculomegaly is an abnormal feature characteristic of myotonic dystrophy type 1 (DM1). This retrospective study investigated the morphologic changes accompanied by ventriculomegaly in DM1 on brain MRI.Methods: One hundred and twelve adult patients with DM1 and 50 sex- and age-matched controls were assessed. The imaging characteristics for evaluations included the z-Evans Index (ventriculomegaly), callosal angle (CA), enlarged perivascular spaces in the centrum semiovale (CS-EPVS), temporo-polar white matter lesion (WML) on 3D fluid-attenuated inversion recovery (FLAIR), disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and pathological brain atrophy. The “z-Evans Index” was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. To determine the imaging characteristics and genetic information (CTG repeat numbers) that were associated with the z-Evans Index, we used multivariate logistic regression analyses.Results: The z-Evans Index was significantly larger in the patients than in the controls (0.30±0.05 vs. 0.24 ± 0.02; p < 0.01). The multivariate logistic regression analyses showed that the z-Evans Index was independently associated with the patient age (p <0.05), CA (p < 0.01), Sylvian fissure dilation (p < 0.01), and pathological brain atrophy (p < 0.01) but not with CTG repeat numbers, CS-EPVS, or temporo-polar WML. Of the 34 patients older than 49 years, 7 (20.6%) were considered to have DESH.Conclusions: Our MRI study revealed a normal pressure hydrocephalus (NPH)-like appearance as a morphologic finding accompanied by ventriculomegaly in DM1 that tends to occur in elderly patients.

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“…CA greater than 90º suggests brain atrophy, 5 as occurs in degenerative diseases such as Alzheimer's and Lewy body dementia. 23 In a recent study, shunt-responders had a significantly smaller mean preoperative CA compared with non-responders (59% versus 68%), with a cut-off value of 63% providing the best prognostic accuracy. 24 Another consistent finding in NPH, best recognized with mid-sagittal MRI, is callosal upward elevation, stretching and thinning, usually showing total or partial recovery after shunting.…”

Section: Neuroimaging and Complementary Prognostic Testsmentioning

confidence: 93%

Neuroimaging in normal pressure hydrocephalus

Damasceno

2015

Dement. neuropsychol.

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Normal pressure hydrocephalus (NPH) is a syndrome characterized by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation (triad) may be atypical or incomplete, or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, such as CSF tap-tests and computed tomography (CT) or magnetic resonance imaging (MRI). The CSF tap-test, especially the 3 to 5 days continuous external lumbar drainage of at least 150 ml/day, is the only procedure that simulates the effect of definitive shunt surgery, with high sensitivity (50-100%) and high positive predictive value (80-100%). According to international guidelines, the following are CT or MRI signs decisive for NPH diagnosis and selection of shunt-responsive patients: ventricular enlargement disproportionate to cerebral atrophy (Evans index >0.3), and associated ballooning of frontal horns; periventricular hyperintensities; corpus callosum thinning and elevation, with callosal angle between 40º and 90º; widening of temporal horns not fully explained by hippocampal atrophy; and aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of sulci and subarachnoid spaces over the high convexity and midline surface of the brain. On the other hand, other imaging methods such as radionuclide cisternography, SPECT, PET, and also DTI or resting-state functional MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases.

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A Simplified Callosal Angle Measure Best Differentiates Idiopathic-Normal Pressure Hydrocephalus from Neurodegenerative Dementia

Abstract: This simplified callosal angle measure represents an accurate, reproducible, and easy marker of iNPH.

Cited by 26 publications

References 22 publications

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

Prevalence of possible idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia: a replication study

Cerebral Ventriculomegaly in Myotonic Dystrophy Type 1: Normal Pressure Hydrocephalus-like Appearances on Magnetic Resonance Imaging

Neuroimaging in normal pressure hydrocephalus

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