Normal Pressure Hydrocephalus

Akai, K; Uchigasaki, Shinya; Tanaka, U; Komatsu, Akio

doi:10.1111/j.1440-1827.1987.tb03137.x

Cited by 19 publications

(8 citation statements)

References 20 publications

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“…There is some, albeit limited, neuropathological evidence to support these interpretations [ 6 , 72 ]. The impact of proximity to the ventricle may be a reflection of greater tissue distortion not only on adjacent axons but also on periventricular vasculature, leading to increase in local cerebrovascular resistance and ischaemia, with resultant watershed infarction and impairment of regional cerebrovascular autoregulation [ 73 – 75 ]. The anterior thalamic radiation demonstrated moderate increase in fluid, i.e.…”

Section: Discussionmentioning

confidence: 99%

Diffusion tensor imaging profiles reveal specific neural tract distortion in normal pressure hydrocephalus

et al. 2017

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BackgroundThe pathogenesis of normal pressure hydrocephalus (NPH) remains unclear which limits both early diagnosis and prognostication. The responsiveness to intervention of differing, complex and concurrent injury patterns on imaging have not been well-characterized. We used diffusion tensor imaging (DTI) to explore the topography and reversibility of white matter injury in NPH pre- and early after shunting.MethodsTwenty-five participants (sixteen NPH patients and nine healthy controls) underwent DTI, pre-operatively and at two weeks post-intervention in patients. We interrogated 40 datasets to generate a full panel of DTI measures and corroborated findings with plots of isotropy (p) vs. anisotropy (q).ResultsConcurrent examination of DTI measures revealed distinct profiles for NPH patients vs. controls. PQ plots demonstrated that patterns of injury occupied discrete white matter districts. DTI profiles for different white matter tracts showed changes consistent with i) predominant transependymal diffusion with stretch/ compression, ii) oedema with or without stretch/ compression and iii) predominant stretch/ compression. Findings were specific to individual tracts and dependent upon their proximity to the ventricles. At two weeks post-intervention, there was a 6·7% drop in axial diffusivity (p = 0·022) in the posterior limb of the internal capsule, compatible with improvement in stretch/ compression, that preceded any discernible changes in clinical outcome. On PQ plots, the trajectories of the posterior limb of the internal capsule and inferior longitudinal fasciculus suggested attempted ‘round trips’. i.e. return to normality.ConclusionDTI profiling with p:q correlation may offer a non-invasive biomarker of the characteristics of potentially reversible white matter injury.

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Section: Discussionmentioning

confidence: 99%

Diffusion tensor imaging profiles reveal specific neural tract distortion in normal pressure hydrocephalus

et al. 2017

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“…Neuropathological studies of the brain of hydrocephalic patients show signs of cerebrovascular disease such as sclerosis of the arterioli [21-23]. Hypertension and sometimes other vascular risk factors and a previous history of cerebrovascular incidents are often found in INPH patients [24-27].…”

Section: Reviewmentioning

confidence: 99%

Influence of comorbidities in idiopathic normal pressure hydrocephalus — research and clinical care. A report of the ISHCSF task force on comorbidities in INPH

Malm

Graff‐Radford

Ishikawa

et al. 2013

Fluids Barriers CNS

177

155

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Idiopathic normal pressure hydrocephalus (INPH) is a syndrome of ventriculomegaly, gait impairment, cognitive decline and incontinence that occurs in an elderly population prone to many types of comorbidities. Identification of the comorbidities is thus an important part of the clinical management of INPH patients. In 2011, a task force was appointed by the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders (ISHCSF) with the objective to compile an evidence-based expert analysis of what we know and what we need to know regarding comorbidities in INPH. This article is the final report of the task force. The expert panel conducted a comprehensive review of the literature. After weighing the evidence, the various proposals were discussed and the final document was approved by all the task force members and represents a consensus of expert opinions. Recommendations regarding the following topics are given: I. Musculoskeletal conditions; II. Urinary problems; III. Vascular disease including risk factors, Binswanger disease, and white matter hyperintensities; IV. Mild cognitive impairment and Alzheimer disease including biopsies; V. Other dementias (frontotemporal dementia, Lewy body, Parkinson); VI. Psychiatric and behavioral disorders; VII. Brain imaging; VIII. How to investigate and quantify. The task force concluded that comorbidity can be an important predictor of prognosis and post-operative outcome in INPH. Reported differences in outcomes among various INPH cohorts may be partly explained by variation in the rate and types of comorbidities at different hydrocephalus centers. Identification of comorbidities should thus be a central part of the clinical management of INPH where a detailed history, physical examination, and targeted investigations are the basis for diagnosis and grading. Future INPH research should focus on the contribution of comorbidity to overall morbidity, mortality and long-term outcomes.

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“…1 Normal pressure hydrocephalus (NPH) is described as a neurological condition which is usually seen in elderly patients, mostly in those with age more than 60 years. [2][3][4] The literature reports a classic triad of symptoms for NPH known as the Hakim triad. 6 It is triad of gait apraxia, dementia and incontinence.…”

Section: Introductionmentioning

confidence: 99%

A study of VP shunt in management of hydrocephalus

Pal

Dubey

2017

Int Surg J

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Background: Hydrocephalus a neurological disorder common in both children and adults. VP shunt placement is considered the mainstay of management. The aim was to study complications of VP Shunt and factors influencing shunt malfunction and prognosis.Methods: This study was conducted in the Department of Surgery, Gandhi Medical College Bhopal, Madhya Pradesh, India between January 2013 to August 2016 and included all patients of hydrocephalus who underwent VP shunt surgery. We performed a retrospective and prospective data review which was subjected to statistical analysis, frequency determination, determination of mean and standard deviation, Pearson’s Chi-square test for studying associations between variables.Results: A total of 198 patients were studied. The predominant etiologies being congenital hydrocephalus, aqueduct stenosis, spina bifida/MMC, intracranial space occupying lesions and tuberculous meningitis. The incidence of overall shunt complications was 28.8%, incidence of shunt revision was 21.2%, shunt blockade 7.6%), shunt migration 5.05%, shunt infection 4.5%, and shunt malfunction due to other causes 8.6%. The mortality rate was 20.2%. Factors associated with increased shunt complications included infective etiology of the hydrocephalus and CSF culture positivity in preoperative period.Conclusions: Infective and traumatic causes of hydrocephalus are more likely to be associated with complications like infection and obstruction. Shunt migration is seen in paediatric patients.

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Normal Pressure Hydrocephalus

Cited by 19 publications

References 20 publications

Diffusion tensor imaging profiles reveal specific neural tract distortion in normal pressure hydrocephalus

Diffusion tensor imaging profiles reveal specific neural tract distortion in normal pressure hydrocephalus

Influence of comorbidities in idiopathic normal pressure hydrocephalus — research and clinical care. A report of the ISHCSF task force on comorbidities in INPH

A study of VP shunt in management of hydrocephalus

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