Idiopathic normal-pressure hydrocephalus, cortical thinning, and the cerebrospinal fluid tap test

Kang, Kyunghun; Yoon, Uicheul; Lee, Jongmin; Lee, Ho‐Won

doi:10.1016/j.jns.2013.07.014

Cited by 25 publications

(26 citation statements)

References 53 publications

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“…In a recent study, Moore et al [33] found that a combination of cortical thickness and ventricular volume distinguished five NPH patients from five AD and five Parkinson disease patients. Kang et al [34] found greater cortical thinning in AD when compared to NPH patients with positive response to CSF tap. Our results are in overall agreement with these studies in the lower GM volume in AD compared with NPH.…”

Section: Discussionmentioning

confidence: 96%

Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation

et al. 2014

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Evidence suggests that normal pressure hydrocephalus (NPH) is underdiagnosed in day to day radiologic practice, and differentiating NPH from cerebral atrophy due to other neurodegenerative diseases and normal aging remains a challenge. To better characterize NPH, we test the hypothesis that a prediction model based on automated MRI brain tissue segmentation can help differentiate shunt-responsive NPH patients from cerebral atrophy due to Alzheimer disease (AD) and normal aging. Brain segmentation into gray and white matter (GM, WM), and intracranial cerebrospinal fluid was derived from pre-shunt T1-weighted MRI of 15 shunt-responsive NPH patients (9 men, 72.6 ± 8.0 years-old), 17 AD patients (10 men, 72.1 ± 11.0 years-old) chosen as a representative of cerebral atrophy in this age group; and 18 matched healthy elderly controls (HC, 7 men, 69.7 ± 7.0 years old). A multinomial prediction model was generated based on brain tissue volume distributions. GM decrease of 33% relative to HC characterized AD (P < 0.005). High preoperative ventricular and near normal GM volumes characterized NPH. A multinomial regression model based on gender, GM and ventricular volume had 96.3% accuracy differentiating NPH from AD and HC. In conclusion, automated MRI brain tissue segmentation differentiates shunt-responsive NPH with high accuracy from atrophy due to AD and normal aging. This method may improve diagnosis of NPH and improve our ability to distinguish normal from pathologic aging.

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Section: Discussionmentioning

confidence: 96%

Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation

et al. 2014

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“…The most typical morphological characteristics of CSF distribution in iNPH were narrow sulci at the high convexity due to z-axial expansion of the lateral ventricles and enlargement of the basal cistern and Sylvian fissure7891011. Subsequently, many MRI volumetric analyses proposed several parameters specific to iNPH910121314. Nevertheless, little information is available on the CSF distribution in sNPH.…”

mentioning

confidence: 99%

Choroidal fissure acts as an overflow device in cerebrospinal fluid drainage: morphological comparison between idiopathic and secondary normal-pressure hydrocephalus

Yamada

Ishikawa

Iwamuro

et al. 2016

Sci Rep

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To clarify the pathogenesis of two different types of adult-onset normal-pressure hydrocephalus (NPH), we investigated cerebrospinal fluid distribution on the high-field three-dimensional MRI. The subarachnoid spaces in secondary NPH were smaller than those in the controls, whereas those in idiopathic NPH were of similar size to the controls. In idiopathic NPH, however, the basal cistern and Sylvian fissure were enlarged in concurrence with ventricular enlargement towards the z-direction, but the convexity subarachnoid space was severely diminished. In this article, we provide evidence that the key cause of the disproportionate cerebrospinal fluid distribution in idiopathic NPH is the compensatory direct CSF communication between the inferior horn of the lateral ventricles and the ambient cistern at the choroidal fissure. In contrast, all parts of the subarachnoid spaces were equally and severely decreased in secondary NPH. Blockage of CSF drainage from the subarachnoid spaces could cause the omnidirectional ventricular enlargement in secondary NPH.

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“…Further analyses were conducted by the eLORETA-KEY software package. We performed CSD analysis in the delta (2-4 Hz), theta (4-8 Hz), alpha (8-13 Hz), beta (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), and gamma (30-60 Hz) frequency bands.…”

Section: Twentymentioning

confidence: 99%

“…[9][10][11][12][13][14][15] However, white matter injuries resulted in structural cortical abnormalities, such as cortical thinning, in patients with iNPH. 16 Quantitative electroencephalogram (EEG) provides computerized imaging and statistical procedures to detect abnormal patterns in specific pathological conditions and normative features in several disorders. 17 The exact low-resolution brain electromagnetic tomography (eLORETA) method is a discrete, 3-D distributed, linear, weighted minimum norm inverse solution devised by Pascual-Marqui.…”

Section: Introductionmentioning

confidence: 99%

Association of cerebrospinal fluid tap‐related oscillatory activity and shunt outcome in idiopathic normal‐pressure hydrocephalus

et al. 2015

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Background: Idiopathic normal-pressure hydrocephalus (iNPH) is a neuropsychiatric syndrome characterized by the clinical triad of gait disturbance, urinary dysfunction, and cognitive impairment. The aim of the present study was to find specific EEG patterns associated with shunt response in iNPH. Methods: Twenty five iNPH patients (10 shunt responders and 15 nonresponders) were enrolled in this study. We performed current source density (CSD) analysis in several frequency bands (delta: 2-4Hz, theta: 4-8Hz, alpha: 8-13Hz, beta: 13-30Hz, gamma: 30-60Hz) using exact Low Resolution Brain Electromagnetic Tomography (eLORETA). CSD distribution was compared between shunt responders and non-responders for each frequency band before and after CSF tap test. Results: Shunt responders showed increased gamma CSD in the left temporal cortex before CSF tapping relative to non-responders. However, after CSF tapping, shunt response was associated with significantly higher CSDs in several frequency bands, specifically theta, alpha, beta and gamma, involving mainly the frontal and temporal areas. Using eLORETA analysis, we were able to identify cortical oscillatory activity before and after CSF tap test related to clinical recovery due to shunt operation in iNPH. Conclusion: Our findings support and extend the results of previous studies examining the effects of CSF tap test and shunt operation in patients with iNPH, possibly indicating electrophysiological features of shunt response in this disease. These findings warrant future studies to use EEG for prediction of shunt response in iNPH.

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Idiopathic normal-pressure hydrocephalus, cortical thinning, and the cerebrospinal fluid tap test

Cited by 25 publications

References 53 publications

Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation

Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation

Choroidal fissure acts as an overflow device in cerebrospinal fluid drainage: morphological comparison between idiopathic and secondary normal-pressure hydrocephalus

Association of cerebrospinal fluid tap‐related oscillatory activity and shunt outcome in idiopathic normal‐pressure hydrocephalus

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