Cerebrospinal Fluid Pressure Studies in Normal Pressure Hydrocephalus and Cerebral Atrophy

Rocco, Concezio Di; Maira, Giulio; Gf, Rossi; Vignati, Andrea

doi:10.1159/000114734

Cited by 51 publications

(16 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…High and/or low amplitude beta waves, abnormalities in pulse amplitude and plateau or plateau-like fluctuations especially during overnight recording and REM sleep have been widely reported in the NPHS 6-9' 13,15,27,38,40,42,43,49,52,59 Additionally, some studies have reported high mean ICP similar to that found in hypertensive hydrocephalus in patients with this syndrome 3~' 38, 42. We have used the mean ICP to classify patients into active and compensated hydrocephalus.…”

Section: Discussionmentioning

confidence: 93%

Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called ?Normal pressure hydrocephalus? syndrome

et al. 1991

View full text Add to dashboard Cite

Fifty-four shunt-responsive patients were selected from a prospective protocol directed to study patients with suspected normal pressure hydrocephalus (NPH). Patients with gait disturbances, dementia, non-responsive L-Dopa Parkinsonism, urinary or faecal incontinence and an Evans ratio greater or equal to 0.30 on the CT scan were included in the study. As a part of their work-up all patients underwent intracranial pressure monitoring and hydrodynamic studies using Marmarou's bolus test. According to mean intracranial pressure (ICP) and the percentage of high amplitude B-waves, patients were subdivided in the following categories: 1) Active hydrocephalus (mean ICP above 15 mmHg), which is in fact no tone normal pressure hydrocephalus; 2) Compensated unstable hydrocephalus, when mean ICP was below 15 mmHg and B-waves were present in more than 25% of the total recording time and 3) Compensated stable hydrocephalus when ICP was lower or equal to 15 mmHg and beta waves were present in less than 25% of the total recording time. The majority of the patients in this study (70%) presented continuous high or intermittently raised ICP (active or unstable compensated hydrocephalus group). Mean resistance to outflow of CSF (Rout) was 38.8 mm Hg/ml/min in active hydrocephalus and 23.5 mm Hg/ml/min in the compensated group (Students t-test, p less than 0.05). Higher resistance to outflow was found in patients with obliterated cortical sulci and obliterated Sylvian cisterns in the CT scan. No statistically significant correlation was found when plotting the percentage of beta waves against pressure volume index (PVI), compliance or Rout. An exponential correlation was found when plotting beta waves against the sum of conductance to outflow and compliance calculated by PVI method (r = 0.79). Patients with the so-called normal pressure hydrocephalus syndrome have different ICP and CSF dynamic profiles. Additional studies taking into consideration these differences are necessary before defining the sensitivity, specificity and predictive value of ICP monitoring and CSF studies in selecting appropriate candidates for shunting.

show abstract

Section: Discussionmentioning

confidence: 93%

Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called ?Normal pressure hydrocephalus? syndrome

et al. 1991

View full text Add to dashboard Cite

show abstract

“…As a result, less blood can be shifted extracranially to accommodate the injected volume. The same mechanism explains the increase in CSF pulse pressure in adult hydrocephalus (Di Rocco et al, 1976;Foltz and Aine, 1981). Here it is the patient's heart that injects a relatively fixed volume of blood intracranially with each cardiac systole.…”

Section: Cerebral Content Of Interstitial Fluidmentioning

confidence: 90%

The Pathogenesis of Normal Pressure Hydrocephalus: A Theoretical Analysis

Levine

1999

Bulletin of Mathematical Biology

View full text Add to dashboard Cite

Hydrocephalus is an abnormal accumulation of cerebrospinal fluid (CSF) in the cerebral ventricles, usually caused by impaired absorption of the fluid into the bloodstream. Despite obstructed absorption and continued secretion of CSF into the ventricles at a near normal rate, the ventricular CSF pressure (VCSFP) is often normal. We attempt to understand how hydrocephalus can exist with normal VCSFP by exploring the role of the brain parenchyma in absorbing CSF in hydrocephalus. We test three theories: (1) the ventricular wall is impermeable to CSF; (2) ventricular CSF seeps into the parenchyma, from which it is efficiently absorbed; and (3) ventricular CSF seeps into the parenchyma but is absorbed inefficiently. We model the brain as a thick spherical shell consisting of a porous, elastic, solid matrix, containing interstitial fluid and blood. We modify the equations of poroelasticity, which describe flow of fluid through porous solids, to allow for parenchymal absorption. For each of the three theories we calculate the steady state changes in VCSFP and in parenchymal fluid pressure caused by an incremental defect in CSF absorption. We also calculate the-steady state changes in fluid content, tissue volume, tissue displacement, and stresses caused by a small increment of VCSFP. We conclude that only the second theory-seepage of CSF with efficient parenchymal absorption-accounts for the clinical features of normal pressure hydrocephalus. These features include sustained ventricular dilatation despite normal VCSFP, increased periventricular fluid content, and localized periventricular white matter damage.

show abstract

“…The apparently high diagnostic significance of the ICP recording appears interesting s, 12,35,36,54,55 However, the limitation of this examination to a few patients only requires further study.…”

Section: Discussionmentioning

confidence: 99%

Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of surgical treatment

Belloni¹,

Rocco

Focacci

et al. 1976

Acta neurochir

Self Cite

View full text Add to dashboard Cite

Twenty two of fifty five patients initially suspected of suffering from normotensive hydrocephalus were surgically treated (CSF ventriculoatrial shunt). The results of surgery were related to the findings of the different diagnostic examinations (pneumoencephalography, isotope cisternography, transfer fron CSF to blood of isotope labelled serum albumin, constant infusion manometric test, long lasting intraventricular pressure recording). 1.Pneumoencephalography, intraventricular pressure recording, and, above all, isotope cisternography provided the most reliable data for diagnosis and surgical prognosis. 2. The combined use of pneumoencephalography and isotope cisternography was sufficient for a correct diagnosis and surgical prognosis in about 50% of the patients examined. 3. When the diagnostic information given by the combined results of the two above examinations was not sufficient, intraventricular pressure recording proved to be the most useful examination to supplement it. 4. The relation of the results of the study of transfer of istope labelled serum albumin from CSF to blood and of the constant infusion manometric test to the surgical outcome was uncertain.

show abstract

Cerebrospinal Fluid Pressure Studies in Normal Pressure Hydrocephalus and Cerebral Atrophy

Cited by 51 publications

References 17 publications

Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called ?Normal pressure hydrocephalus? syndrome

Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called ?Normal pressure hydrocephalus? syndrome

The Pathogenesis of Normal Pressure Hydrocephalus: A Theoretical Analysis

Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of surgical treatment

Contact Info

Product

Resources

About