Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients

Skalický, Petr; Vlasák, Aleš; Mládek, Arnošt; Vrána, J.; Bajaček, Michal; Whitley, Helen; Beneš, Vladimı́r; Bradáč, Ondřej

doi:10.1016/j.jocn.2020.11.020

Cited by 6 publications

(5 citation statements)

References 29 publications

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“…Integrity of the brain structure is a prerequisite for normal brain function. Studies have shown that the degree of brain deformation after an iNPH CSF shunt is related to preoperative clinical symptoms ( 5 , 6 ). Voxel-based morphometry (VBM) is a comprehensive and objective brain structure analysis method that replaces the traditional method of manually delineating a region of interest (ROI) and improves the accuracy and repeatability of measurements.…”

Section: Introductionmentioning

confidence: 99%

Gray matter volume of cerebellum associated with idiopathic normal pressure hydrocephalus: A cross-sectional analysis

Yang

Zhou

et al. 2022

Front. Neurol.

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The cause of idiopathic normal pressure hydrocephalus's (iNPH) clinical symptoms remains unclear. The cerebral cortex is the center of the brain and provides a structural basis for complex perception and motor function. This study aimed to explore the relationship between changes in cerebral cortex volume and clinical symptoms in patients with iNPH. This study included 21 iNPH patients and 20 normal aging (NA) controls. Voxel-based morphometry statistical results showed that, compared with NA, the gray matter volumes of patients with iNPH in the bilateral temporal lobe, bilateral hippocampus, bilateral thalamus, bilateral insula, left amygdala, right lenticular nucleus, right putamen, and cerebellum decreased, while the volumes of gray matter in the bilateral paracentral lobules, precuneus, bilateral supplementary motor area, medial side of the left cerebral hemisphere, and median cingulate and paracingulate gyri increased. Correlation analysis among the volumes of white matter and gray matter in the cerebrum and cerebellum and the iNPH grading scale (iNPHGS) revealed that the volume of white matter was negatively correlated with the iNPHGS (P < 0.05), while the gray matter volumes of cerebellar area 6 and area 8 were negatively correlated with the clinical symptoms of iNPH (P < 0.05). The volume of gray matter in the cerebellar vermis was negatively correlated with gait, and the gray matter volume of cerebellar area 6 was negatively correlated with cognition. Our findings suggest that the cerebellum also plays an important role in the pathogenesis of iNPH, potentially highlighting new research avenues for iNPH.

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Section: Introductionmentioning

confidence: 99%

Gray matter volume of cerebellum associated with idiopathic normal pressure hydrocephalus: A cross-sectional analysis

Yang

Zhou

et al. 2022

Front. Neurol.

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“…Nevertheless. according to other studies, DESH score could not predict shunt responsiveness [83,101].…”

Section: Imaging Markers Of Inph With Possible Prognostic Valuementioning

confidence: 66%

“…EI and CA have been, according to many studies, correlated to both tap test and shunt responsiveness [16,[79][80][81]85]. Nevertheless, CA failed to predict shunt responsiveness according to Skalický et al, (2021) [83]. The load of white matter lesions has been negatively correlated to the tap test response [87], whereas a post-shunt decrease of periventricular white matter hyperintensities has been proposed as a potential marker for shunt responsiveness [90].…”

Section: Discussionmentioning

confidence: 99%

“…Results of correlation of composite imaging scales such as Radscale [80,[101][102][103][104] or DESH score [49,83,86,101] to either tap test or shunt responsiveness are rather inconclusive. Aqueductal CSF flow measurements using phase-contrast MRI, along with flow void sign may be helpful in predicting outcome after shunt [29,98,99], although ASV alone does not seem to predict shunt responsiveness [47].…”

Section: Discussionmentioning

confidence: 99%

“…Virhammar et al, (2018) found that CA increased, and ventricular volume decreased after shunt surgery, with the alteration of CA being most explicit, indicating that this imaging marker could be used as an indirect tool to evaluate shunt function [82]. According to another study, neither CA nor cingulate sulcus sign were able to predict shunt responsiveness [83]. ACA has been significantly correlated with the improvement in gait and balance following shunt placement, suggesting that it could be used, along with the CA, as a possible predictor of shunt responsiveness in iNPH [84].…”

Section: Imaging Markers Of Inph With Possible Prognostic Valuementioning

confidence: 99%

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Imaging Markers for Normal Pressure Hydrocephalus: An Overview

et al. 2023

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Idiopathic bormal pressure hydrocephalus (iNPH) is a neurological syndrome that clinically presents with Hakim’s triad, namely cognitive impairment, gait disturbances, and urinary incontinence. The fact that iNPH is potentially reversible makes its accurate and early diagnosis of paramount importance. Its main imaging characteristic is the dilation of the brain’s ventricular system and the imaging parameters are also included in its diagnostic criteria along with clinical data. There is a variety of different modalities used and a great number of imaging markers that have been described while assessing iNPH patients. The present literature review attempts to describe the most important of these imaging markers and to shed some light on their role in diagnosis, differential diagnosis, and possibly prognosis of this potentially reversible neurological syndrome.

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The “Hedgehog‐Halo Sign” Is Associated with Gait Symptom Severity and Tap Response in Normal Pressure Hydrocephalus

Ha,

Lee,

Kim

et al. 2024

Movement Disord Clin Pract

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BackgroundReduced cerebrospinal fluid (CSF) clearance may play a vital role in the pathogenesis of normal pressure hydrocephalus (NPH), but the radiologic marker is yet to be elucidated.ObjectivesThis open‐label study presents two novel neuroimaging biomarkers based on enlarged perivascular spaces (ePVS) of the sub‐insular territory: the Hedgehog and Hedgehog‐Halo (H‐H) sign, designed to predict gait symptom severity and tap response in NPH.MethodsWe retrospectively reviewed 203 patients with possible NPH with baseline magnetic resonance imaging and gait analyses before and after lumbar puncture (LP). The Hedgehog/H‐H sign was scored using T2‐weighted images. The clinical severity at baseline and post‐tap gait improvement was compared in patients with and without Hedgehog/H‐H sign. The association between Hedgehog/H‐H sign and post‐tap gait outcomes was assessed using multivariate regression. The diagnostic performance of Hedgehog/H‐H sign was compared with conventional radiological markers.ResultsPatients with H‐H showed higher global disability and more severe gait impairment than those without any signs. Following LP, patients with Hedgehog/H‐H sign significantly improved in various gait parameters, unlike those with neither sign. Additionally, sub‐insular ePVS was significantly associated with post‐tap gait improvement after adjusting covariates. Finally, the Hedgehog/H‐H sign showed a higher performance than conventional markers in predicting post‐tap gait response.ConclusionsThe Hedgehog/H‐H sign is a useful neuroimaging biomarker related to the severity and tap response in NPH. This biomarker can be readily applied in clinical practice before undergoing LP, independent of conventional radiological signs. Further research is warranted to determine applicability in predicting post‐shunt gait response.

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Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients

Cited by 6 publications

References 29 publications

Gray matter volume of cerebellum associated with idiopathic normal pressure hydrocephalus: A cross-sectional analysis

Gray matter volume of cerebellum associated with idiopathic normal pressure hydrocephalus: A cross-sectional analysis

Imaging Markers for Normal Pressure Hydrocephalus: An Overview

The “Hedgehog‐Halo Sign” Is Associated with Gait Symptom Severity and Tap Response in Normal Pressure Hydrocephalus

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