Screening for idiopathic normal pressure hydrocephalus in the elderly after falls

Oike, Ryo; Inoue, Yasuaki; Matsuzawa, Kazuhito; Sorimachi, Takatoshi

doi:10.1016/j.clineuro.2021.106635

Cited by 9 publications

(5 citation statements)

References 38 publications

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“…The prevalence of possible iNPH has been reported to be 1.4%-3.7% in the general population aged 65 years or older (7) , (8) . Moreover, a recent study reported that 18.7% of patients aged 60-89 years who presented after a fall had possible iNPH, 12.3% had probable iNPH, and 10.6% had definite iNPH (9) . Furthermore, it has been reported that 7.7% of patients with hip fracture had possible iNPH, and a relationship between hip fractures and iNPH-related falls has been suggested previously (4) .…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Vertebral Compression Fracture in a Patient with Idiopathic Normal Pressure Hydrocephalus

2023

JMA J

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Idiopathic normal pressure hydrocephalus (iNPH) with gait disturbance can be effectively treated with a cerebrospinal fluid shunt. Furthermore, balloon kyphoplasty (BKP) is a successful minimally invasive treatment for osteoporotic vertebral compression fractures (VCFs). This case report presents the surgical management of an elderly patient with iNPH who presented after a VCF due to a fall. A 77-year-old woman who had been experiencing progressive gait disturbance for five years reported experiencing back pain one month after a fall. Imaging revealed a recent L1 VCF that did not compromise the spinal canal. Furthermore, the Mini-Mental State Examination results and the timed up-and-go test were 20 points and 17.96 seconds, respectively. Magnetic resonance imaging revealed ventriculomegaly with an Evans’ index of 0.35. Her symptoms improved temporarily after a tap test, and she was diagnosed with probable iNPH. BKP was performed for VCFs, followed by the lumboperitoneal (LP) shunt placement for iNPH one month later. Following the operation, her symptoms improved without complications. After one month of performing BKP, an LP shunt would be placed to prevent shunt complications, such as infection and catheter-related neurological symptoms. Screening for iNPH in the elderly who present after VCFs due to a fall may identify iNPH patients who may benefit more from surgical treatments.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Vertebral Compression Fracture in a Patient with Idiopathic Normal Pressure Hydrocephalus

2023

JMA J

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“…reported that 18.7% of patients aged 60–89 years who presented after a fall had possible iNPH, 12.3% had probable iNPH, and 10.6% had definite iNPH. [ 12 ] Natori et al . reported that 7.7% of patients with hip fractures had possible iNPH, suggesting an association between hip fractures and iNPH-related falls.…”

Section: Discussionmentioning

confidence: 99%

“…[2,14] In addition, Oike et al reported that 18.7% of patients aged 60-89 years who presented after a fall had possible iNPH, 12.3% had probable iNPH, and 10.6% had definite iNPH. [12] Natori et al reported that 7.7% of patients with hip fractures had possible iNPH, suggesting an association between hip fractures and iNPH-related falls. [10] is study found that of the 51 patients with VCFs over the age of 60 years, 18 (35.3%) had possible iNPH, one (2.0%) had probable iNPH, and one (2.0%) had definite iNPH.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of idiopathic normal pressure hydrocephalus in patients with vertebral compression fractures

Tanaka,

Iwashita,

Liu

et al. 2023

Surgical Neurology International

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Background: Patients with idiopathic normal pressure hydrocephalus (iNPH) may be more prone to all fracture types due to falls. Vertebral compression fractures (VCFs) are a global burden that temporarily or permanently affects millions of elderly people. This study aimed to investigate the prevalence of iNPH in patients with VCFs. Methods: We retrospectively reviewed 128 patients aged 60–102 years who underwent balloon kyphoplasty (BKP) for VCFs between November 1, 2017, and March 31, 2020. We also assessed the presence of the iNPH triad (i.e., gait disturbance, cognitive impairment, and urinary incontinence). Patients with Evans’ index (EI) >0.3 and the iNPH triad were defined as having possible iNPH, those with clinical improvement after a cerebrospinal fluid tap test were defined as having probable iNPH, and those with clinical improvement after a shunt surgery were defined as having definite iNPH. Results: Of the 128 patients, seven were excluded due to a history of intracranial disease that could cause ventricular enlargement or gait disturbance. Another 70 patients who did not undergo head computed tomography or magnetic resonance imaging one year before or after BKP were excluded from the study. Finally, 51 patients with a mean age of 78.9 years were enrolled. The mean EI value of these 51 patients was 0.28, with 18 patients showing EI >0.3. Moreover, 18 had possible iNPH, one had probable iNPH, and one had definite iNPH. Conclusion: Screening for iNPH in elderly patients with VCFs can allow early diagnosis of iNPH and benefit them more from surgical treatment.

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“…Moreover, CT scans are routinely used in the clinical assessments of traumatic brain injury and other neurodegenerative disorders. The frequent use of CT offers the opportunity to detect incidental morphological changes related to iNPH, potentially enabling earlier diagnosis and subsequent treatment of the condition 25 . Despite these advantages, current radiological assessments of CT still largely depend on subjective visual rating methods that are time-consuming, labor-intensive, require significant expertise, and are highly susceptible to variability in inter-rater reliability 1,2 .…”

Section: Introductionmentioning

confidence: 99%

Assessing CT-based Volumetric Analysis via Transfer Learning with MRI and Manual Labels for Idiopathic Normal Pressure Hydrocephalus

Srikrishna,

Seo,

Zettergren

et al. 2024

Preprint

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BackgroundBrain computed tomography (CT) is an accessible and commonly utilized technique for assessing brain structure. In cases of idiopathic normal pressure hydrocephalus (iNPH), the presence of ventriculomegaly is often neuroradiologically evaluated by visual rating and manually measuring each image. Previously, we have developed and tested a deep-learning-model that utilizes transfer learning from magnetic resonance imaging (MRI) for CT-based intracranial tissue segmentation. Accordingly, herein we aimed to enhance the segmentation of ventricular cerebrospinal fluid (VCSF) in brain CT scans and assess the performance of automated brain CT volumetrics in iNPH patient diagnostics.MethodsThe development of the model used a two-stage approach. Initially, a 2D U-Net model was trained to predict VCSF segmentations from CT scans, using paired MR-VCSF labels from healthy controls. This model was subsequently refined by incorporating manually segmented lateral CT-VCSF labels from iNPH patients, building on the features learned from the initial U-Net model. The training dataset included 734 CT datasets from healthy controls paired with T1-weighted MRI scans from the Gothenburg H70 Birth Cohort Studies and 62 CT scans from iNPH patients at Uppsala University Hospital. To validate the model’s performance across diverse patient populations, external clinical images including scans of 11 iNPH patients from the Universitätsmedizin Rostock, Germany, and 30 iNPH patients from the University of Alabama at Birmingham, United States were used. Further, we obtained three CT-based volumetric measures (CTVMs) related to iNPH.ResultsOur analyses demonstrated strong volumetric correlations (ρ=0.91, p<0.001) between automatically and manually derived CT-VCSF measurements in iNPH patients. The CTVMs exhibited high accuracy in differentiating iNPH patients from controls in external clinical datasets with an AUC of 0.97 and in the Uppsala University Hospital datasets with an AUC of 0.99.DiscussionCTVMs derived through deep learning, show potential for assessing and quantifying morphological features in hydrocephalus. Critically, these measures performed comparably to gold-standard neuroradiology assessments in distinguishing iNPH from healthy controls, even in the presence of intraventricular shunt catheters. Accordingly, such an approach may serve to improve the radiological evaluation of iNPH diagnosis/monitoring (i.e., treatment responses). Since CT is much more widely available than MRI, our results have considerable clinical impact.

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Screening for idiopathic normal pressure hydrocephalus in the elderly after falls

Cited by 9 publications

References 38 publications

Surgical Treatment of Vertebral Compression Fracture in a Patient with Idiopathic Normal Pressure Hydrocephalus

Surgical Treatment of Vertebral Compression Fracture in a Patient with Idiopathic Normal Pressure Hydrocephalus

Prevalence of idiopathic normal pressure hydrocephalus in patients with vertebral compression fractures

Assessing CT-based Volumetric Analysis via Transfer Learning with MRI and Manual Labels for Idiopathic Normal Pressure Hydrocephalus

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