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Idiopathic Normal Pressure Hydrocephalus (idiopathic + normal_pressure_hydrocephalus)
Selected AbstractsAssessment of idiopathic normal pressure patients in neurological practice: the role of lumbar infusion testing for referral of patients to neurosurgeryEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2008A. Brean Background and purpose:, In neurological practice patients with tentative idiopathic normal pressure hydrocephalus (iNPH) usually are referred to neurosurgery based on clinical and radiological findings. Hydrodynamic assessment using lumbar infusion testing might be helpful in selecting patients. To retrospectively analyse lumbar infusion tests done in neurological practice in iNPH patients to see how infusion test results relate to the clinical course and shunt response. Materials and methods:, Sixty-three consecutive patients with Possible/Probable iNPH were tested during a 1-year period. The pre-operative lumbar infusion tests were assessed according to two strategies: (i) Determining the resistance to cerebrospinal fluid (CSF) outflow (Rout). (ii) Quantification of the CSF pressure (CSFP) pulsatility during lumbar infusion (Qpulse). The results were related to the prospectively followed clinical course and shunt response after 12 months. Results:, The lumbar infusion-derived parameters Rout and Qpulse related weakly. Shunt response after 12 months was not related to Rout, but was highly related to the Qpulse. False negative results of lumbar infusion testing were observed in 16% of the patients. Discussion:, In neurological practice lumbar infusion testing may be useful for determining which patients to refer to neurosurgery. Our data favour determination of CSFP pulsatility (Qpulse) rather than Rout for prediction of shunt response. [source] Value of quantitative MRI biomarkers (Evans' index, aqueductal flow rate, and apparent diffusion coefficient) in idiopathic normal pressure hydrocephalusJOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 4 2009FRCR, Samuel E.S. Ng MBBS Abstract Purpose To define the value of Evans' index (EI), aqueductal flow rate (FR), and apparent diffusion coefficient (ADC) in the diagnosis of normal pressure hydrocephalus (NPH) and to assess the ability of these markers preoperatively to predict shunt response. To shed some light as to the mechanisms responsible for the symptoms of NPH. Materials and Methods Preoperative EI, FR, and ADC readings in nine cases of clinically diagnosed NPH were compared with those of age- and gender-matched controls. Similar pre- and postoperative readings of responders and nonresponders were subsequently compared. Results Compared with the controls, all measurements were statistically significant except for peak systolic flow rate (pSfr), which was near statistical significance. Comparison of pre- and postoperative readings of responders and nonresponders revealed a decrease in ADC in all responders (P = 0.032). Subdural hemorrhage was found in all nonresponders (P = 0.012). Conclusion For patients presenting with signs and symptoms of NPH, readings on MRI greater than 0.3, 10 mL/min, ,9.0 mL/min, and 10.65 × 10,4 mm2/s for EI, peak diastolic flow rate (pDfr), pSfr, and ADC, respectively, add further weight to the diagnosis. The strong correlation between shunt response and ADC decline support our hypothesis that water accumulation in the cerebrum is the major cause for the symptoms of NPH. The presence of subdural hemorrhage in all nonresponders raises suspicion of decreased compliance as the other major cause. J. Magn. Reson. Imaging 2009;30:708,715. © 2009 Wiley-Liss, Inc. [source] Arterial blood pressure vs intracranial pressure in normal pressure hydrocephalusACTA NEUROLOGICA SCANDINAVICA, Issue 4 2010P. K. Eide Eide PK, Park E-H, Madsen JR. Arterial blood pressure vs intracranial pressure in normal pressure hydrocephalus. Acta Neurol Scand: 2010: 122: 262,269. © 2010 John Wiley & Sons A/S. Objective,,, To characterize the association between arterial blood pressure (ABP) and intracranial pressure (ICP) in idiopathic normal pressure hydrocephalus (iNPH) patients, and its impact on outcome of shunt surgery. Materials and methods,,, We analyzed all 35 iNPH patients whose ABP and ICP were recorded simultaneously during 6 years (2002,2007). The static and pulsatile pressures were averaged over consecutive 6-s intervals; the moving correlations between ICP and ABP (static and pulsatile) were determined during consecutive 4-min periods to explore time-related variations. Results,,, Neither static nor pulsatile ABP were altered in iNPH shunt responders. Elevated pulsatile ICP, but normal static ICP, was seen in responders. The time-varying correlations of static and of pulsatile pressures were generally low, and did not differ between shunt responders/non-responders. Conclusions,,, In iNPH shunt responders, static or pulsatile ABP were not altered and only pulsatile ICP was elevated. [source] Five-year incidence of surgery for idiopathic normal pressure hydrocephalus in NorwayACTA NEUROLOGICA SCANDINAVICA, Issue 5 2009A. Brean Objectives ,, We have previously determined the incidence and prevalence of idiopathic normal pressure hydrocephalus (iNPH) in the county of Vestfold in Norway. This study aimed at determining the incidence of surgeries for iNPH. Materials and methods ,, Information about age, sex, operation year and operation type was collected retrospectively for all patients hospitalized from 2002 to 2006 with any diagnosis of iNPH and operated with insertion of a ventriculo-peritoneal or ventriculoatrial shunt system, or with endoscopic third ventriculostomy in any of Norway's five regional neurosurgical centers. Results ,, Two hundred fifty-two patients were operated during the 5-year period, making the total incidence 1.09/100,000/year. The yearly incidence ranged from a minimum of 0.84/100,000 in 2006 to a maximum of 1.47/100,000 in 2004. The incidence was highest in the age group 70,79 years. There were little regional differences regarding incidence, sex, and age and operation type. Conclusions ,, The data suggest that too few patients are being offered surgical treatment for iNPH in Norway. [source] White matter diffusion is higher in Binswanger disease than in idiopathic normal pressure hydrocephalusACTA NEUROLOGICA SCANDINAVICA, Issue 4 2009M. Tullberg Objectives,,, To explore diagnostic differences in periventricular white matter (PWM) and deep white matter (DWM) diffusion patterns in patients diagnosed with Binswanger disease (BD) and in patients diagnosed with probable idiopathic normal pressure hydrocephalus (INPH) using diffusion-weighted imaging (DWI). Materials and methods,,, Apparent diffusion coefficient (ADC) values were calculated in the PWM and DWM in patients with INPH (n = 14) and BD (n = 9) and in controls (n = 10) using an spin echo echo planar imaging single-shot diffusion sequence and region of interest (ROI) analysis. Results,,, Patients with BD had higher ADC values than patients with INPH in the PWM and DWM in the frontal and occipital regions (P < 0.05) and higher values than controls in the frontal PWM and DWM (P < 0.01). After shunt surgery, ADC values were reduced in the frontal PWM in patients with INPH (P < 0.05). Conclusions,,, Increased diffusion in the PWM and DWM in patients with BD may reflect irreversible breakdown of axonal integrity caused by the subcortical ischaemic vascular disease. By contrast, the normal white matter diffusion in patients with INPH indicates structurally intact axons, compatible with the reversibility of this disorder. DWI may be an important non-invasive diagnostic tool for differentiating between INPH and BD and identifying shunt responders and reversible brain damage in patients with INPH. However, the overlap between patients with INPH and BD in this study restricts the predictive value of the method. [source] | ||||||||||