Does CSF Outflow Resistance Predict the Response to Shunting in Patients with Normal Pressure Hydrocephalus?

Boon, Agnita J.W.; Tans, J. T. J.; Delwel, Ernst J.; Egeler-Peerdeman, Saskia M.; Hanlo, Patrick W.; Wurzer, J. A. L.; Avezaat, C. J. J.; Jong, D. A. de; Gooskens, R. H. J. M.; Hermans, J.

doi:10.1007/978-3-7091-6475-4_96

Cited by 25 publications

(26 citation statements)

References 10 publications

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“…Given the apparent benignancy, none of these children ever get a saline infusion test (requiring a lumbar puncture), which would continue to demonstrate decreased CSF resorption. Only 60 to 80 years later, when they are being evaluated for a gait disturbance, dementia, and possible NPH, will they have a saline infusion test, showing decreased CSF resorption (23,24). That histologic analysis of the meninges in NPH fails to show evidence of SAH or meningitis (25) is supportive of this theory.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic normal pressure hydrocephalus may be a “Two Hit” disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood

Bradley

Bahl

Alksne

2006

Magnetic Resonance Imaging

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Purpose: To determine if normal pressure hydrocephalus (NPH) could result from decreased resorption of cerebrospinal fluid (CSF) by the arachnoidal villi, leading to benign external hydrocephalus [BEH] in infancy, followed by deep white matter ischemia (DWMI) in late adulthood (the more hydrophilic environment increasing resistance to CSF flow through the extracellular space (ECS) of the brain). Materials and Methods:CSF outflow via the fourth ventricle and the ECS of the brain was mathematically modeled using a parallel electrical circuit analog. The apparent diffusion coefficient (ADC) was measured as a surrogate of the amount of water in the ECS in normals, patients with symptomatic NPH, and patients with dilated ventricles without symptoms of NPH ("pre-NPH"). Results:The electrical circuit model demonstrates increasing ventricular volume with increasing resistance to flow through the ECS of the brain. ADC measurements performed in the centrum semiovale are significantly higher in patients with NPH and "pre-NPH" than in age-matched controls (P Ͻ 0.05), controlling for the same degree of DWMI indicating increased fluid in the ECS of the brain. Conclusion:The electrical circuit analog and finding of increased periventricular ADC support the theory that NPH is a "two hit" disease.

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Section: Discussionmentioning

confidence: 99%

Idiopathic normal pressure hydrocephalus may be a “Two Hit” disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood

Bradley

Bahl

Alksne

2006

Magnetic Resonance Imaging

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“…On the contrary R out calculations may increase the risk of deselecting patients who would benefit from a shunting procedure. Thus at an R out cut off level of 18 mmHg/ml/min, as suggested by Boon et al (9), 16 of the 43 patients with post-surgical improvement and, at 14 mmHg/ml/min eight patients had not been selected for shunt surgery. Using a P pl cut off level of 22 mmHg only five patients of the 43 improved patients had been missed.…”

Section: R Outmentioning

confidence: 97%

“…Ekstedt (5,8) meticulously measured the CSF outflow conductance using a constant pressure infusion test (5) and Borgesen (1) reported that conductance to outflow below 0.008 ml/min/mmHg could predict a good outcome of surgery. By analogy, in a recent study, Boon et al (9) measuring the CSF outflow resistance (R out ), i.e. the reciprocal of outflow conductance, reported that R out ‡ 18 mmHg resulted in the best likelihood ratio with improvement rates above 90% as measured with objective clinical evaluations.…”

Section: Lumbar Infusion Test In Normal Pressure Hydrocephalusmentioning

confidence: 99%