Predictive assessment of shunt effectiveness in patients with idiopathic normal pressure hydrocephalus by determining regional cerebral blood flow on 3D stereotactic surface projections

Murakami, Motonobu; Hirata, Yoshihumi; Kuratsu, Jun Ichi

doi:10.1007/s00701-007-1259-1

Cited by 29 publications

(35 citation statements)

References 23 publications

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“…This finding is consistent with the cognitive features of subcortical dementia, which arises from disruption of the frontal-subcortical circuits [23,24,25]. Previous neuroimaging studies have reported that frontal cortical grey matter volume is preserved, but frontal regional cerebral blood flow (rCBF) is decreased in iNPH patients [26,27,28,29]. These findings support the view that frontal lobe-like cognitive dysfunction in iNPH is associated with subcortical white matter damage but not frontal lobe damage itself.…”

Section: Discussionsupporting

confidence: 81%

Cognitive Profile of Idiopathic Normal Pressure Hydrocephalus

Saitô

Nishio

Kanno

et al. 2011

Dement Geriatr Cogn Disord Extra

102

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Background/Aims: Frontal lobe dysfunction is believed to be a primary cognitive symptom in idiopathic normal pressure hydrocephalus (iNPH); however, the neuropsychology of this disorder remains to be fully investigated. The objective of this study was to delineate a comprehensive profile of cognitive dysfunction in iNPH and evaluate the effects of cerebrospinal fluid (CSF) shunt surgery on cognitive dysfunction. Methods: A total of 32 iNPH patients underwent neuropsychological testing of memory, attention, language, executive function, and visuoperceptual and visuospatial abilities. Of these 32 patients, 26 were reevaluated approximately 1 year following CSF shunt surgery. The same battery of tests was performed on 32 patients with Alzheimer’s disease (AD) and 30 healthy elderly controls. Results: The iNPH patients displayed baseline deficits in attention, executive function, memory, and visuoperceptual and visuospatial functions. Impairments of attention, executive function, and visuoperceptual and visuospatial abilities in iNPH patients were more severe than in those with AD, whereas the degree of memory impairment was comparable to that in AD patients. A significant improvement in executive function was observed following shunt surgery. Conclusion: Patients with iNPH are impaired in various aspects of cognition involving both ‘frontal’ executive functions and ‘posterior cortical’ functions. Shunt treatment can ameliorate executive dysfunction.

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Section: Discussionsupporting

confidence: 81%

Cognitive Profile of Idiopathic Normal Pressure Hydrocephalus

Saitô

Nishio

Kanno

et al. 2011

Dement Geriatr Cogn Disord Extra

102

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“…Although our study was performed on iNPH brains, and was a CBF study, not a glucose metabolism study, the same phenomenon may be seen in the brains of patients with motor dysfunction. Murakami et al [19] reported that shunt responders manifested significantly lower CBF in the basal frontal lobes and cingulate gyrus in a comparison of 14 shunt responders with 10 shunt nonresponders, although our study did not show such differences in a large sample study, except for a decreased CBF in the right medial basal frontal region in the favorable outcome group compared with the unfavorable group. Klinge et al [20,21] reported significantly reduced CBF in the frontobasal cortex in responders compared with nonresponders.…”

Section: Discussioncontrasting

confidence: 52%

A Multicenter Brain Perfusion SPECT Study Evaluating Idiopathic Normal-Pressure Hydrocephalus on Neurological Improvement

Ishii

Hashimoto

Hayashida

et al. 2011

Dement Geriatr Cogn Disord

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Purpose: This study was designed to investigate the specific cerebral blood flow (CBF) pattern in patients with idiopathic normal-pressure hydrocephalus (iNPH) and a predictive value for shunt responsiveness in a multicenter study (Study of Idiopathic Normal-Pressure Hydrocephalus on Neurological Improvement: SINPHONI). Methods: Eighty-four iNPH patients underwent shunt operations using MRI selection criteria from the SINPHONI and were subjected to CBF single photon emission computed tomography (SPECT). The perfusion patterns on SPECT were classified: anterior-dominant CBF reduction type (A type), posterior-dominant CBF reduction type (P type), and mixed or diffuse CBF reduction type (M type). The predictive value of the CBF pattern for favorable shunt outcome was evaluated. Results: Favorable outcomes were obtained in 76% (64/84) of patients, and shunt responsiveness was achieved in 85% (71/84) of patients. Areas of severely reduced relative CBF were demonstrated around the corpus callosum and in the sylvian fissure area, which included the effects of dilatations of the ventricles and sylvian fissures and relatively increased perfusion in the medial and lateral frontal, parietal, and occipital areas at high convexity. Forty-nine (58%) cases were A type, 25 (30%) cases were M type, and 10 (12%) cases were P type. A, M, and P type cases exhibited 83, 84, and 90% positive predictive values for shunt responsiveness, respectively. Mean modified Rankin scale and Mini-Mental State Examination scores of the A type group were significantly better than those of other groups. Conclusion: The iNPH patients showed various patterns of CBF reduction, but there was no significant difference in the predictive value among the three patterns, though CBF reduction patterns may suggest a severe condition of iNPH.

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“…On the other hand, the mean z-score for the precentral gyrus was significantly lower in the FOG group than in the non-FOG group, possibly because rCBF in the precentral gyrus increased to compensate for ACC dysfunction in the FOG group. The rCBF reduction in the ACC is also reportedly observed in PSP [35] and INPH [36]. Although the association between the FOG and the ACC was not examined in earlier reports, it is noteworthy that rCBF reduction in the ACC is common in diseases characterized by FOG.…”

Section: I-imp Spect In Pd Patients With and Without Fog Matched For mentioning

confidence: 64%

Regional Cerebral Blood Flow Patterns in Patients With Freezing of Gait Due to Lacunar Infarction: SPECT Study Using Three-Dimensional Stereotactic Surface Projections

Terashi

Ishimura

Utsumi

2012

International Journal of Neuroscience

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Predictive assessment of shunt effectiveness in patients with idiopathic normal pressure hydrocephalus by determining regional cerebral blood flow on 3D stereotactic surface projections

Abstract: The preoperative measurement of rCBF by 3D-SSP SPECT may help to identify iNHP patients expected to exhibit a good response to shunt operations.

Cited by 29 publications

References 23 publications

Cognitive Profile of Idiopathic Normal Pressure Hydrocephalus

Cognitive Profile of Idiopathic Normal Pressure Hydrocephalus

A Multicenter Brain Perfusion SPECT Study Evaluating Idiopathic Normal-Pressure Hydrocephalus on Neurological Improvement

Regional Cerebral Blood Flow Patterns in Patients With Freezing of Gait Due to Lacunar Infarction: SPECT Study Using Three-Dimensional Stereotactic Surface Projections

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