Regional cerebral blood flow, white matter abnormalities, and cerebrospinal fluid hydrodynamics in patients with idiopathic adult hydrocephalus syndrome.

Kristensen, Bo; Malm, Jan; Fagerland, Morten Wang; Hietala, Sven‐Ola; Johansson, Boo; Ekstedt, Jan; Karlsson, Thomas

doi:10.1136/jnnp.60.3.282

Cited by 124 publications

(78 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The literature suggests that when low blood flow does occur in NPH, it is probably fixed (due to atrophy or Alzheimer disease) because the blood flow does not appear to increase following shunt insertion. 12,31 Despite this finding, a previous MR imaging study has shown a 28% (49 mL/min in this cohort) increase in blood returning from the sagittal sinus but no change in straight sinus following shunt insertion. 6 A review of the arterial inflow data from this original study did not show a significant change in inflow following shunt surgery (unpublished data, Bateman 2000), and this indicates that the 49 mL/ min increase had to come from somewhere other than extra inflow.…”

Section: Venous Pressure Elevation In Nph?contrasting

confidence: 39%

The Pathophysiology of Idiopathic Normal Pressure Hydrocephalus: Cerebral Ischemia or Altered Venous Hemodynamics?

Bateman¹

2007

AJNR Am J Neuroradiol

154

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE:Many theories of normal pressure hydrocephalus (NPH) stress the importance of ischemia in the deep white matter. Alternate theories stress a reduction in superficial venous compliance and changes in pulse-wave propagation. An overlap in the cerebral blood flow volumes measured between NPH and controls suggests that ischemia may not be a prerequisite for this condition. This study sought to compare blood flow and compliance measures in a cohort of patients with NPH selected for having arterial inflows above the normal range to see if deep brain ischemia or superficial hemodynamic changes contribute to the pathophysiology of NPH.

show abstract

Section: Venous Pressure Elevation In Nph?contrasting

confidence: 39%

The Pathophysiology of Idiopathic Normal Pressure Hydrocephalus: Cerebral Ischemia or Altered Venous Hemodynamics?

Bateman¹

2007

AJNR Am J Neuroradiol

154

View full text Add to dashboard Cite

show abstract

“…9). Earlier studies on ischemic sites in iNPH before surgery 16,17,19,20,22,24,[26][27][28][29][30][31][32]34) have reported various patterns of these two pathophysiological conditions according to the disease stage of iNPH. While one group reports only reductions in hypoperfusion, 34) most authors agree that the CBF improves after surgery in shunt-effective cases, in light of the compensatory increase of the blood flow at normoperfusion sites in non-improved hypoperfusion cases after surgery.…”

Section: Discussionmentioning

confidence: 99%

Pathophysiology of Cerebral Circulatory Disorders in Idiopathic Normal Pressure Hydrocephalus

Takeuchi

Goto

Izaki

et al. 2007

Neurol. Med. Chir.(Tokyo)

View full text Add to dashboard Cite

This study was conducted to elucidate the pathologic conditions of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus (iNPH). Among 44 possible iNPH patients, 40 patients underwent shunt surgery based on diagnostic flow charts plotted by the Southern Tohoku method and were evaluated to be shunt-effective at the end of the first post-surgical month. The cerebral blood flow (CBF) was measured by N-isopropyl-( 123 I)-P-iodo-amphetamine single photon emission computed tomography (mean, mCBF; cortical region, cCBF; thalamus-basal ganglia region, tbCBF on autoradiography [ARG] method) and the perfusion patterns of the cerebral cortex were measured based on threedimensional stereotactic surface projection (3D-SSP) Z-score images, before and 1 month after the surgery in all 40 subjects. The mCBF rose significantly from 32.1 ± 2.74 ml/100 g/min before surgery to 39.8 ± 3.02 ml/100 g/min after surgery (p º 0.03). Investigation of the change of CBF revealed reductions in the cCBF (3 cases), tbCBF (9 cases), and cCBF ＋ tbCBF (28 cases), with the reduced-cCBF group totaling 31 cases and the reduced-tbCBF group totaling 37 cases. Investigation of cerebral cortex hypoperfusion by 3D-SSP Z-score revealed 31 cases with hypoperfusion (frontal lobe type [19 cases], occipitotemporal lobe type [5 cases], mixed type [7 cases]) and nine cases with cortical normoperfusion (N). The pattern of reduction of the cortical blood flow on ARG method was favorably correlated with the pattern of hypoperfusion of the cerebral cortex on 3D-SSP Z-score images before surgery. A reduction of blood flow was found in the thalamus-basal ganglia region of all N type cases. The blood flow improved in 19 of 31 (61.3%) cases of the reduced-cCBF group and in 32 of 37 (86.5%) cases of the reducedtbCBF group. All of the cases without detectable improvement exhibited increased blood flow in nonreduction areas. Investigation of the hypoperfusion patterns of the cerebral cortex on 3D-SSP Z-score images, revealed a reduction or disappearance of the hypoperfusion site in 19 of 31 (61.3%) cases, either no-change or a shift of the hypoperfusion site in 12 of 31 (38.7%) cases, and a correlation between the pattern of cortical blood flow reduction on ARG method and the pattern of cerebral cortex hypoperfusion on 3D-SSP Z-score images after surgery. Cerebral circulatory disorders in iNPH manifest as either of two pathophysiological conditions: the``circulatory disorder of the cerebral cortical region'' and thè`c irculatory disorder of the thalamus-basal ganglia region.'' Various patterns develop according to the disease stage.

show abstract

“…Increase in CBF after CSF removal has been reported in some of these studies, but the results have not been uniform. [8][9][10][11][12][13][14] In a recent study, we showed that clinical improvement after a CSF TT is measurable during the first 24 hours after the drainage. 15 The time window for the hypothesized increase in CBF after a CSF TT is, however, unknown.…”

Section: Introductionmentioning

confidence: 99%

Idiopathic Normal Pressure Hydrocephalus: Cerebral Perfusion Measured with pCASL before and Repeatedly after CSF Removal

Virhammar

Laurell

Ahlgren

et al. 2014

J Cereb Blood Flow Metab

View full text Add to dashboard Cite

Pseudo-continuous arterial spin labeling (pCASL) measurements were performed in 20 patients with idiopathic normal pressure hydrocephalus (iNPH) to investigate whether cerebral blood flow (CBF) increases during the first 24 hours after a cerebrospinal fluid tap test (CSF TT). Five pCASL magnetic resonance imaging (MRI) scans were performed. Two scans were performed before removal of 40 mL CSF, and the other three at 30 minutes, 4 hours, and 24 hours, respectively after the CSF TT. Thirteen different regions of interest (ROIs) were manually drawn on coregistered MR images. In patients with increased CBF in lateral and frontal white matter after the CSF TT, gait function improved more than it did in patients with decreased CBF in these regions. However, in the whole sample, there was no significant increase in CBF after CSF removal compared with baseline investigations. The repeatability of CBF measurements at baseline was high, with intraclass correlation coefficients of 0.60 to 0.90 for different ROIs, but the median regional variability was in the range of 5% to 17%. Our results indicate that CBF in white matter close to the lateral ventricles plays a role in the reversibility of symptoms after CSF removal in patients with iNPH.

show abstract

Regional cerebral blood flow, white matter abnormalities, and cerebrospinal fluid hydrodynamics in patients with idiopathic adult hydrocephalus syndrome.

Cited by 124 publications

References 40 publications

The Pathophysiology of Idiopathic Normal Pressure Hydrocephalus: Cerebral Ischemia or Altered Venous Hemodynamics?

The Pathophysiology of Idiopathic Normal Pressure Hydrocephalus: Cerebral Ischemia or Altered Venous Hemodynamics?

Pathophysiology of Cerebral Circulatory Disorders in Idiopathic Normal Pressure Hydrocephalus

Idiopathic Normal Pressure Hydrocephalus: Cerebral Perfusion Measured with pCASL before and Repeatedly after CSF Removal

Contact Info

Product

Resources

About