High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

Narita, Wataru; Nishio, Yoshiyuki; Baba, Toru; Iizuka, Osamu; Ishihara, T.; Matsuda, Minoru; Iwasaki, Masaki; Tominaga, Teiji; Mori, Etsuro

doi:10.3174/ajnr.a4838

Cited by 68 publications

(102 citation statements)

References 39 publications

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“…Thus, the presence of high convexity tightness is suggested to be a highly predictive feature of DESH. Previous reports also suggested the importance of high convexity tightness as the most predictive feature of the three components of DESH, for surgical outcomes in terms of Mini-Mental State Examination score, gait disturbance, and the total scoring [19]. Another study also reported that high convexity tightness combined with ventriculomegaly was a predictor for shunt effectiveness in patients with suspected iNPH [27].…”

Section: Discussionmentioning

confidence: 88%

“…In other words, most of the subjects with high convexity tightness also presented with Sylvian dilatation as well as ventriculomegaly. In addition, although both Sylvian dilatation and ventriculomegaly are morphologic features of hydrocephalus, these are also observed in brain atrophy [19]. Thus, the presence of high convexity tightness is suggested to be a highly predictive feature of DESH.…”

Section: Discussionmentioning

confidence: 99%

“…An Evans' index of > 0.3 was defined as ventriculomegaly [18]. Tightness of subarachnoid spaces in the high convexity/midline surface (high convexity tightness) and dilatation of Sylvian fissure were evaluated in accordance with the previous description of MRI neuroimaging features in iNPH [19]. High convexity tightness combined with Sylvian dilatation accompanied by ventriculomegaly was defined as DESH [5] ( Fig.…”

Section: Assessment Of Deshmentioning

confidence: 99%

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The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

Akiba

Gyanwali

Villaraza

et al. 2020

Journal of the Neurological Sciences

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Introduction: Disproportionately Enlarged Subarachnoid space Hydrocephalus (DESH) is considered as an important imaging feature of idiopathic normal pressure hydrocephalus (iNPH). Method: Subjects aged 60 and over in a memory clinic and a community-based cohort were assessed for the presence of ventriculomegaly, Sylvian dilatation, and high convexity tightness by neuroimaging, and a clinical triad of iNPH symptoms, i.e. cognitive, gait and urinary symptoms. Results: In the memory clinic-based study (548 subjects), the prevalence of DESH was 1.1% and increased with age. The clinical triad was significantly more frequent in subjects with DESH (50%) compared to those with normal images (none), Sylvian dilatation (7%), and ventriculomegaly (12%). Gait disturbance was also significantly more frequent in DESH (83%) compared to those with normal images (2%), Sylvian dilatation (14%), and ventriculomegaly (26%). In the community-based cohort (946 subjects), the prevalence of DESH was 1.0% and increased with age. The clinical triad (11%) was significantly more common in subjects with DESH compared to those with normal images (none), Sylvian dilatation (2%), and ventriculomegaly (7%). Gait disturbance was also significantly more common in DESH (33%) compared to those with normal images (1%), Sylvian dilatation (4%), and ventriculomegaly (10%). Conclusion: The reported prevalence of DESH was approximately 1%, and increased with age. DESH and high convexity tightness were specifically associated with the clinical triad of iNPH. Of the triad, gait disturbance was associated to DESH and high convexity tightness. 1. Introduction With rapidly aging societies globally, the medical care of the elderly has become an important social issue. As aging is the strongest risk factor for dementia, the burden of dementia is increasing worldwide, and has major impact on quality of life as well as the economy [1,2]. Idiopathic normal pressure hydrocephalus (iNPH) is a neurodegenerative disease of the elderly, marked by triad of symptoms:

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Assessment Of Deshmentioning

confidence: 99%

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The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

Akiba

Gyanwali

Villaraza

et al. 2020

Journal of the Neurological Sciences

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“…Thus, the treatment of NPH relies partly on accurate neuroimaging diagnosis and characterization. 10,11 Kitagaki et al 9 demonstrated that the Sylvian fissure CSF volume and ventricular volume were greater in patients with iNPH compared with other dementias (ie, Alzheimer disease). Patients with iNPH also had decreased CSF in the superior convexity and medial subarachnoid spaces.…”

Section: Discussionmentioning

confidence: 99%

Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus?

Ahmed¹,

Luciano²,

Moghekar³

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:The DESH (disproportionately enlarged subarachnoid-space hydrocephalus) pattern of "tight highconvexity and medial subarachnoid spaces, and enlarged Sylvian fissures with ventriculomegaly" is used to determine which patients undergo an operation for adult hydrocephalus at many centers. Our aim was to review adult hydrocephalus cases when DESH has not been a criterion for an operation to determine the prevalence of DESH among the cohort and compare the surgical outcomes in the presence or absence of DESH. MATERIALS AND METHODS:A retrospective cohort study was conducted at a single institution (Johns Hopkins Hospital) to include patients surgically treated for adult hydrocephalus between 2003 and 2014 drawn from a data base of patients who had undergone standardized hydrocephalus protocol MR imaging. Preoperative imaging was reviewed by 2 blinded neuroradiologists to characterize the presence of DESH. Preoperative and postoperative clinical symptomatology was recorded. Frequencies were compared using the Fisher exact test, and nonparametric means were compared using the Mann-Whitney U Test. RESULTS:One hundred thirty-three subjects were identified and included (96 DESH absent, 37 DESH present). Shunting led to significant improvement in gait and urinary and cognitive symptoms for the overall cohort and for patients with and without DESH (P Ͻ .05). The Fisher exact test did not demonstrate any significant differences in either gait or urinary or cognitive symptom improvement between patients with or without DESH (P Ͼ .05). CONCLUSIONS:The current study demonstrated symptom improvement in patients with adult hydrocephalus following shunting, with no significant differences between subjects with and without DESH. Thus, shunt insertion for patients with adult hydrocephalus should not rely solely on the presence of preoperative DESH findings. ABBREVIATIONS: DESHϭ disproportionately enlarged subarachnoid-space hydrocephalus; iNPH ϭ idiopathic normal pressure hydrocephalus; MMSE ϭ Mini-Mental State Examination; NPH ϭ normal pressure hydrocephalus; TUG ϭ Timed Up and Go test A dult hydrocephalus, the communicating form known as nor-

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“…However, morphological signs of iNPH and their relation to symptoms have rarely been described in the general population [8]. Most previous studies have described morphological changes of iNPH on computed tomography (CT) or magnetic resonance imaging (MRI) in patients selected for shunt surgery, with the focus on predicting shunt response [9][10][11][12][13][14].…”

Section: Introductionmentioning

confidence: 99%

The idiopathic normal‐pressure hydrocephalus Radscale: a radiological scale for structured evaluation

Kockum

Lilja-Lund

Larsson

et al. 2018

Euro J of Neurology

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High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus

Cited by 68 publications

References 39 publications

The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

The prevalence and clinical associations of disproportionately enlarged subarachnoid space hydrocephalus (DESH), an imaging feature of idiopathic normal pressure hydrocephalus in community and memory clinic based Singaporean cohorts

Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus?

The idiopathic normal‐pressure hydrocephalus Radscale: a radiological scale for structured evaluation

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