Intracranial cerebrospinal fluid measurement studies in suspected idiopathic normal pressure hydrocephalus, secondary normal pressure hydrocephalus, and brain atrophy

Tsunoda, Akira; Mitsuoka, Hideyuki; Bandai, Hideki; Endo, Toshiki; Arai, Hajime; Sato, K.

doi:10.1136/jnnp.73.5.552

Cited by 33 publications

(19 citation statements)

References 13 publications

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“…80 Other studies have further suggested that patients with sNPH may have a more favorable shunt outcome than patients with iNPH, because patients with iNPH may have brain atrophy in addition to hydrocephalic features, whereas sNPH patients only have a CSF circulatory disorder. 64,67 Although our results support the separation of iNPH and sNPH based on outcome, iNPH and sNPH do not represent separate entities; rather, they represent a clinical syndrome associated with a subset of patients with acquired hydrocephalus-patients of different ages with different etiologies and vastly different pathophysiology. Both iNPH and sNPH represent a disorder of CSF flow and absorption, although iNPH may be associated with other factors including white matter ischemic changes, increased transmantle pressure, asymptomatic fibrosing meningitis, and insufficiency of the transcortical subarachnoid space.…”

Section: 5mentioning

confidence: 48%

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

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OBJECTIVE There are several etiologies that can lead to the development of secondary normal pressure hydrocephalus (sNPH). The aim of this study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences between the separate etiologies. METHODS A comprehensive review of the literature was performed to identify studies conducted between 1965 and 2015 that included data regarding the etiology, treatment, diagnosis, and outcome in patients with sNPH. Sixty-four studies with a total of 1309 patients were included. The inclusion criteria of this study were articles that were written in English, included more than 2 patients with the diagnosis of sNPH, and contained data regarding the etiology, diagnosis, treatment, or outcome of NPH. The most common assessment of clinical improvement was based on the Stein and Langfitt grading scale or equivalent improvement on other alternative ordinal grading scales. RESULTS The main etiologies of sNPH were subarachnoid hemorrhage (SAH) in 46.5%, head trauma in 29%, intracranial malignancies in 6.2%, meningoencephalitis in 5%, and cerebrovascular disease in 4.5% of patients. In 71.9% of patients the sNPH was treated with ventriculoperitoneal shunt placement, and 24.4% had placement of a ventriculoatrial shunt. Clinical improvement after shunt placement was reported in 74.4% and excellent clinical improvement in 58% of patients with sNPH. The mean follow-up period after shunt placement was 13 months. Improvement was seen in 84.2% of patients with SAH, 83% of patients with head trauma, 86.4% of patients with brain tumors, 75% of patients with meningoencephalitis, and 64.7% of patients with NPH secondary to stroke. CONCLUSIONS Secondary NPH encompasses a diverse group of clinical manifestations associated with a subset of patients with acquired hydrocephalus. The most common etiologies of sNPH include SAH and traumatic brain injury. Secondary NPH does indeed exist, and should be differentiated from idiopathic NPH based on outcome and on clinical, pathophysiological, and epidemiological characteristics, but should not be considered as a separate entity.

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Section: 5mentioning

confidence: 48%

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

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“…17 It should be noted that cerebrospinal fluid volume in humans is ~200 ml 18 and with large hemorrhages and associated perihaematomaloedema, this displacement capacity exhausted. With smaller haemorrhages, most patients survive the initial ictus but haematoma-induced secondary brain injury can result in severe neurological deficits and death.…”

Section: Natural Historymentioning

confidence: 99%

Intracerebral haemorrhage: mechanisms of injury and therapeutic targets

Keep

Hua

2012

The Lancet Neurology

1,059

889

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Intracerebral haemorrhage (ICH) accounts for about 10–15% of all strokes. ICH is associated with high mortality and morbidity and there has been no successful Phase III clinical trial for this condition. The last six years has seen a great increase in the number of pre-clinical and clinical studies focused on ICH. There have been significant advances in the animal models available to study ICH and in our understanding of the mechanisms underlying brain injury following haemorrhage. This has led to the identification of several therapeutic targets that are now being pursued into clinical trials. These advances are described in this review in addition to information on past and current clinical trials. Many of the former were based on very limited pre-clinical data and possible guidelines on the nature of pre-clinical results that justify proceeding to the clinic are discussed.

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“…Although it does not provide any nutrition it clears metabolites formed in the brain such as CO 2 and lactate [29]. The mean intracranial CSF volumes in normal pressure hydrocephalus patients and healthy controls have been measured as 280 and 195 ml, respectively, using magnetic resonance imaging [66].…”

Section: Anatomical Considerationsmentioning

confidence: 99%

Assessment of cerebrospinal fluid outflow resistance

et al. 2007

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The brain and the spinal cord are contained in a cavity and are surrounded by cerebrospinal fluid (CSF), which provides physical support for the brain and a cushion against external pressure. Hydrocephalus is a disease, associated with disturbances in the CSF dynamics, which can be surgically treated by inserting a shunt or third ventriculostomy. This review describes the physiological background, modeling and mathematics, and the investigational methods for determining the CSF dynamic properties, with specific focus on the CSF outflow resistance, R out. A model of the cerebrospinal fluid dynamic system, with a pressure-independent R out, a pressure-dependent compliance and a constant formation rate of CSF is widely accepted. Using mathematical expressions calculated from the model, along with active infusion of artificial CSF and observation of corresponding change in ICP allows measurements of CSF dynamics. Distinction between normal pressure hydrocephalus and differential diagnoses, prediction of clinical response to shunting and the possibility of assessment of shunt function in vivo are the three most important applications of infusion studies in clinical practice.

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Intracranial cerebrospinal fluid measurement studies in suspected idiopathic normal pressure hydrocephalus, secondary normal pressure hydrocephalus, and brain atrophy

Cited by 33 publications

References 13 publications

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Intracerebral haemorrhage: mechanisms of injury and therapeutic targets

Assessment of cerebrospinal fluid outflow resistance

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