Cerebral hemodynamics before and after shunting in normal pressure hydrocephalus

Bakker, S. L. M.; Boon, Andrea J.; Wijnhoud, Annemarie D.; Dippel, Diederik W.J.; Delwel, Ernst J.; Koudstaal, Peter J.

doi:10.1034/j.1600-0404.2002.01329.x

Cited by 24 publications

(14 citation statements)

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“…In iNPH, cerebrospinal fluid (CSF) pressure is normal despite ventricular dilatation, and symptoms are alleviated by a CSF shunt operation (Hakim & Adams, 1965). Since each of the above symptoms has negative effects on activities of daily living (ADL), its accurate and early detection, diagnosis, and treatment are important, and its clinical background and pathological features are attracting increasing interest (Bakker et al., 2002; Boon et al., 2000; Gallia, Rigamonti, & Williams, 2006). …”

Section: Introductionmentioning

confidence: 99%

Nationwide hospital‐based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics

et al. 2017

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ObjectivesThere have been no nationwide epidemiological studies of idiopathic normal pressure hydrocephalus (iNPH) in Japan. Therefore, a nationwide epidemiologic survey of iNPH was performed to determine the number of cases and clinical characteristics by sex and diagnostic level.MethodsThe first survey examined the numbers of cases that met the diagnostic criteria of iNPH and those who underwent shunt operations in 2012. The second survey gathered patients' details to clarify their clinical background characteristics.ResultsThe estimated number of cases meeting the diagnostic criteria in 2012 was 12,900, with 6,700 undergoing shunt operations. The estimated crude prevalence was 10.2/100,000 persons. The age of onset was in the 70s in more than 50% of both men and women. Significantly higher (p < .05) frequencies of gait impairment in men and cognitive decline in women were observed as initial symptoms. At the time of definitive diagnosis, gait impairment was observed most frequently in patients with definite iNPH (77.7%). Hypertension was the most frequent comorbidity (40.0%), followed by diabetes mellitus (17.8%) and Alzheimer's disease (14.8%). Hypertension was observed more frequently in men, but diabetes was observed more frequently in women (p < .05). An LP shunt was the first‐choice (55.1%) treatment of iNPH, followed by a VP shunt (43.2%).ConclusionThis study showed that iNPH occurs most frequently in the 70s, gait impairment and cognitive decline are the most frequent initial symptoms in men and women, respectively, and hypertension and diabetes are the most frequent comorbidities in men and women, respectively.

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Section: Introductionmentioning

confidence: 99%

Nationwide hospital‐based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics

et al. 2017

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“…Theoretically, after shunting, there is less pressure in ventricle walls, determining better perfusion and potentially re-establishing functions. Hemodynamic evaluations have already shown a higher cerebral blood flow in patients with iNPH 7,8 . Another theoretical statement is the linkage between perfusion and function, but also depending in increasing complexity of the neural network after shunting [9][10][11] .…”

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confidence: 99%

Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients

Oliveira

Saad

Reis

et al. 2013

Arq. Neuro-Psiquiatr.

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Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence without causative disorders, as well as dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure and no secondary cause [1][2][3] . It is a differential diagnosis for most of the dementia syndromes and occurs mainly in elderly populations 4 .The known incidence is approximately 6 per 100,000 and it has a prevalence of 22 per 100,000 for suspected iNPH.There are associations with hypertension, cerebrovascular and Alzheimer diseases [1][2][3] .The clinical evolution of iNPH is not clear 5 . Without surgery, most iNPH patients present early clinical deterioration. A small number of patients might improve without shunting; however, the extent of improvement is not clear 3 .Ventricular CSF shunting is the main treatment in the management of iNPH and its results in reducing the caregiver's burden when caring for iNPH patients are well-established 6 . ABSTRACTIdiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata ® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/ worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata ® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH.Key words: hydrocephalus, normal pressure, cerebrospinal fluid shunts, treatment. RESUMOA hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata ® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatad...

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“…Aber auch bei stenookklusiven Erkrankungen des hinteren Hirnkreislaufs [12] und beim Normaldruckhydrozephalus [1] ist die CVRK von klinischem Interesse.…”

Section: Introductionunclassified

BOLD-Kontrast-MRT und zerebrovaskul�re Reservekapazit�t

Ziyeh

Rick

Weber

et al. 2004

Klinische Neuroradiolgie

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ZusammenfassungDie zerebrovaskuläre Reservekapazität bezeichnet die Fähigkeit des Gehirns, auf bestimmte Stimuli, wie etwa eine Hyperkapnie oder die Applikation von Acetazolamid, mit einer Durchblutungssteigerung zu reagieren. Eine Einschränkung der zerebrovaskulären Reservekapazität geht bei Patienten mit stenookklusiven Erkrankungen der A. carotis interna bzw. communis mit einem erhöhten Risiko für ischämische Ereignisse einher. In der vorliegenden Arbeit soll auf die Möglichkeit hingewiesen werden, die zerebrovaskuläre Reservekapazität mittels BOLD-Kontrast-Magnetresonanztomographie (MRT) zu bestimmen. Anhand von zwei Fallbeispielen sollen typische Befunde dieser Methode demonstriert werden. Schlüsselwörter: Zerebrovaskuläre Reservekapazität · BOLD · MRT AbstractThe cerebrovascular reserve capacity indicates the increase of cerebral blood flow induced by vasodilatory stimuli such as hypercapnia and administration of acetazolamide. In patients with high-grade stenosis or occlusion of the carotid artery, a decreased cerebrovascular reserve capacity implies an increased risk of stroke. This paper proposes BOLD magnetic resonance imaging (MRI) as a method to determine cerebrovascular reserve capacity. A single-shot multi-echo gradient-echo EPI sequence was used, where four echoes are read out per measurement. The sequence permits the calculation of the T2* time for every pixel and time point. 100 measurements were acquired, the patients breathing room air and 7% CO 2 , respectively. T2* time courses were fitted to a reference function, and parameter maps of ∆T2*, ∆R2* and relative ∆T2* were calculated. BOLD response to CO 2 is most pronounced in gray matter and venous blood vessels, but is also discernible in white matter. Reduced cerebrovascular reserve capacity is characterized by decreased BOLD effects in the territory dependent on a stenosed carotid artery. Typical findings are demonstrated by means of two case reports.

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Cerebral hemodynamics before and after shunting in normal pressure hydrocephalus

Abstract: Our data suggest that higher cerebral blood flow velocity before surgery in patients with NPH is related to clinical improvement after shunt surgery. Cerebral hemodynamic parameters may develop into predictors of successful shunt surgery in patients with normal pressure hydrocephalus.

Cited by 24 publications

References 24 publications

Nationwide hospital‐based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics

Nationwide hospital‐based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics

Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients

BOLD-Kontrast-MRT und zerebrovaskul�re Reservekapazit�t

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