Normal pressure hydrocephalus. Influences on cerebral hemodynamic and cerebrospinal fluid pressure-chemical autoregulation

Meyer, John Stirling; Tachibana, Hideki; Hardenberg, Jeffrey P.; Dowell, Richard E.; Kitagawa, Yasuhisa; Mortel, Karl F.

doi:10.1016/0090-3019(84)90342-2

Cited by 63 publications

(34 citation statements)

References 19 publications

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“…28 This was not confirmed in our study, since there were no negative correlations between ventricular volume and CBF, or correlations between changes in ventricular volume and CBF. Other mechanisms are probably involved in the reduction of perfusion and reversibility after CSF removal in some patients.…”

Section: Discussioncontrasting

confidence: 70%

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

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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.

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Section: Discussioncontrasting

confidence: 70%

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

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“…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%

“…9,[12][13][14][17][18][19][20][21][22]24,[26][27][28][29]31,32,34) The results from reports on preoperative ischemic sites and postoperative sites of increased blood flow have varied, 13,17,19,20,22,24,26,27,31,32) however, and no firm consensus has been reached. In this study we use N-isopropyl-( 123 I)-P-iodoamphetamine single photon emission computed tomography ( 123 I-IMP SPECT) to compare the CBF and perfusion patterns of the cerebral cortex assessed by the three-dimensional stereotactic surface projection (3D-SSP) Z-score images at each site before and after surgery in iNPH cases effectively resolved by shunt intervention (shunt-effective cases).…”

Section: Introductionmentioning

confidence: 99%

Pathophysiology of Cerebral Circulatory Disorders in Idiopathic Normal Pressure Hydrocephalus

Takeuchi

Goto

Izaki

et al. 2007

Neurol. Med. Chir.(Tokyo)

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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.

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“…Measurements of CBF in NPH, including patients with iNPH, have been conducted by the inhalation method or single photon emission computed tomography (SPECT) utilizing radio-labeled materials including xenon-133, 70,[74][75][76]117) technetium-99m hexamethylpropyleneamine oxime ( 99m Tc-HMPAO), 54B) nonradioactive xenon-CT, 118) and positron emission tomography (PET) with [ 15-O]H 2 O. 82,90) In a study measuring CBF in 31 patients of suspected Chapter 1: Diagnosis iNPH with 99m Tc-HMPAO SPECT, 54B) reduced blood flow over a wide area, especially in the cortex and subcortical white matter of the frontal and temporal lobes (expansion of central low-flow area), is seen.…”

Section: Cerebral Blood Flow (Cbf)mentioning

confidence: 99%

“…These findings are supported by other studies. 57,70,74,76,117,128) A PET study reported the mean CBF decreased in the cerebrum and cerebellum with regional decrease in the basal ganglia and thalamus but not in the white matter. 82) There are few studies supporting the correlation between reduced flow and degree of symptoms.…”

Section: Cerebral Blood Flow (Cbf)mentioning

confidence: 99%

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

Ishikawa

Hashimoto

Kuwana

et al. 2008

Neurol. Med. Chir.(Tokyo)

202

184

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With the rapid aging of Japanese society, medical care of the elderly has become an important social issue. Among various disorders manifesting dementia, gait disturbance, and urinary incontinence in the elderly population, normal pressure hydrocephalus (NPH), especially of idiopathic type (iNPH), is becoming noteworthy. The Guidelines for management of iNPH in Japan are created in compliance with the evidence-based medicine methods and published in 2004. This English version is made to show the diagnosis and treatment of iNPH with reference to the socio-medical background in Japan and to promote the international research on iNPH. They propose three diagnostic levels; possible, probable, and definite. They indicate the diagnostic importance of high convexity tightness and dilated sylvian fissure with mild to moderate ventriculomegaly on coronal magnetic resonance imaging. The cerebrospinal fluid tap test is regarded as an important diagnostic test because of its simplicity to perform and high predictability of the shunt efficacy. The use of programmable valves at shunt surgeries is recommended. Flowcharts for diagnosis, preoperative assessment, and prevention for complications of shunt surgery are made to promote a wide use of them.

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Normal pressure hydrocephalus. Influences on cerebral hemodynamic and cerebrospinal fluid pressure-chemical autoregulation

Cited by 63 publications

References 19 publications

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

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

Pathophysiology of Cerebral Circulatory Disorders in Idiopathic Normal Pressure Hydrocephalus

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

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