Quantitative SPECT cisternography in normal pressure hydrocephalus

Larsson, Anders; Ärlig, Åsa; Bergh, A C; Bilting, M.; Jacobsson, Lars; Stephensen, Hannes; Wikkelsø, Carsten

doi:10.1111/j.1600-0404.1994.tb02704.x

Cited by 29 publications

(9 citation statements)

References 30 publications

(11 reference statements)

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“…However, clear evidence for this clearance is still lacking. In iNPH the CSF flow above the convexities is reduced and redirected into the ventricles and iNPH patients often present with a disproportionately enlarged subarachnoid-space [ 28 , 29 ]. These findings could hypothetically be in accordance with a disturbance of CSF/ISF exchange as the dilated paravascular spaces could impair CSF/ISF exchange.…”

Section: Discussionmentioning

confidence: 99%

Amyloid mis-metabolism in idiopathic normal pressure hydrocephalus

Jeppsson

Hölttä

Zetterberg

et al. 2016

Fluids Barriers CNS

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BackgroundPatients with idiopathic normal pressure hydrocephalus (iNPH) have reduced cerebrospinal fluid (CSF) concentrations of amyloid-β (Aβ) and α- and β-cleaved soluble forms of amyloid precursor protein (sAPPα and sAPPβ). The aims of this study were to examine if changes could also be seen in the CSF for secreted metabolites of APP-like protein 1 (APLP1) and to explore the prognostic value of amyloid-related CSF biomarkers, as well as markers of neuronal injury and astroglial activation, as regards to clinical outcome after shunt surgery.MethodsTwenty patients diagnosed with iNPH, 10 improved and 10 unchanged by shunt surgery, and 20 neurologically healthy controls were included. All patients were examined clinically prior to surgery and at 6-month follow-up after surgery using the iNPH scale. Lumbar puncture was performed pre-operatively. CSF samples were analyzed for neurofilament light (NFL), Aβ isoforms Aβ38, Aβ40 and Aβ42, sAPPα, sAPPβ, APLP1 β-derived peptides APL1β25, APL1β 27 and APL1β 28 and YKL40 by immunochemical methods.ResultsThe concentrations of all soluble forms of APP, all Aβ isoforms and APL1β28 were lower, whilst APL1β25 and APL1β27 were higher in the CSF of iNPH patients compared to controls. There was no difference in biomarker concentrations between patients who improved after surgery and those who remained unchanged.ConclusionsThe reduced CSF concentrations of Aβ38, Aβ40, Aβ42, sAPPα and sAPPβ suggest that APP expression could be downregulated in iNPH. In contrast, APLP1 concentration in the CSF seems relatively unchanged. The increase of APL1β25 and APL1β27 in combination with a slight decreased APL1β28 could be caused by more available γ-secretase due to reduced availability of its primary substrate, APP. The data did not support the use of these markers as indicators of shunt responsiveness.

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Section: Discussionmentioning

confidence: 99%

Amyloid mis-metabolism in idiopathic normal pressure hydrocephalus

Jeppsson

Hölttä

Zetterberg

et al. 2016

Fluids Barriers CNS

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“…In patients over 70 years of age, shunted previously or after meningitis, reduction of the size of the ventricular system should not be expected [ 40 , 41 ]. More reliable information on the patency of the ventriculostomy may be provided by phase-contrast cine MRI or isotope cisternography [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic third ventriculostomy - effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults.

Stachura

Grzywna

Kwinta

et al. 2014

Videosurgery and Other Miniinvasive Techniques

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IntroductionAfter a time of domination of shunt placement, endoscopic third ventriculostomy (ETV) has been increasingly applied in treatment of obstructive hydrocephalus.AimTo assess the effectiveness of ETV in treatment of adults with three-ventricle hydrocephalus of different etiology.Material and methodsNinety-six patients with obstructive hydrocephalus were studied: 24 with primary aqueductal stenosis, 61 with brain tumor, and 2 with basilar tip aneurysm. In 9 patients the etiology of hydrocephalus remained undetermined. The assessment of treatment results was based on clinical and radiological criteria.ResultsClinical improvement was observed in 74 (77.1%) patients, and radiological improvement in 52 (54.2%). One patient died. Follow-up of 24 patients with primary aqueductal stenosis has shown that in 20 (83.3%) of them clinical improvement has been stable, and in 14 (58.3%) radiological improvement has been observed. Two patients required shunt placement due to hydrocephalus recurrence 12–24 months after the ETV procedure. Among 9 patients with undefined hydrocephalus, 3 required shunt placement within 6 months after ETV (2 shunted previously). Endoscopic third ventriculostomy treatment in a patient with hydrocephalus caused by basilar tip aneurysm succeeded. The assessment of ETV effectiveness in oncological patients has been indirect in view of the underlying disease.ConclusionsThe best results of ETV treatment have been demonstrated for patients with primary aqueductal stenosis. Ventricle size cannot determine the effectiveness of treatment as an individual requirement. Endoscopic third ventriculostomy is effective in previously shunted patients although the prediction of outcome should be cautious. Endoscopic third ventriculostomy enables preparation for further therapy and is palliative treatment in oncological patients with secondary hydrocephalus.

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“…56,116) They are mainly derived from studies of sNPH, although its diagnostic significance is of some doubt even in sNPH. 125) A study of iNPH reported improvement of symptoms in 55% of all cases with normal findings on RI cisternography.…”

Section: Cisternographymentioning

confidence: 99%

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

Ishikawa

Hashimoto

Kuwana

et al. 2008

Neurol. Med. Chir.(Tokyo)

198

184

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With the rapid aging of Japanese society, medical care of the elderly has become an important social issue. Among various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, normal pressure hydrocephalus (NPH), especially of idiopathic type (iNPH), is becoming noteworthy. The Guidelines for management of iNPH in Japan are created in compliance with the evidence-based medicine methods and published in 2004. This English version is made to show the diagnosis and treatment of iNPH with reference to the socio-medical background in Japan and to promote the international research on iNPH. They propose three diagnostic levels; possible, probable, and definite. They indicate the diagnostic importance of high convexity tightness and dilated sylvian fissure with mild to moderate ventriculomegaly on coronal magnetic resonance imaging. The cerebrospinal fluid tap test is regarded as an important diagnostic test because of its simplicity to perform and high predictability of the shunt efficacy. The use of programmable valves at shunt surgeries is recommended. Flowcharts for diagnosis, preoperative assessment, and prevention for complications of shunt surgery are made to promote a wide use of them.

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Quantitative SPECT cisternography in normal pressure hydrocephalus

Cited by 29 publications

References 30 publications

Amyloid mis-metabolism in idiopathic normal pressure hydrocephalus

Amyloid mis-metabolism in idiopathic normal pressure hydrocephalus

Endoscopic third ventriculostomy - effectiveness of the procedure for obstructive hydrocephalus with different etiology in adults.

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

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