The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure

Hakim, S; Adams, Raymond D.

doi:10.1016/0022-510x(65)90016-x

Cited by 1,090 publications

(517 citation statements)

References 7 publications

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“…NPH was defined as elderly patients presenting with the clinical triad of gait disturbance, dementia, and incontinence who had radiographic evidence of communicating hydrocephalus, i.e., ventricular enlargement out of proportion to cortical sulcal enlargement (1,2). This ventricular enlargement has always been presumed to occur later in life, at the time of clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Idiopathic normal pressure hydrocephalus may be a “Two Hit” disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood

Bradley

Bahl

Alksne

2006

Magnetic Resonance Imaging

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Purpose: To determine if normal pressure hydrocephalus (NPH) could result from decreased resorption of cerebrospinal fluid (CSF) by the arachnoidal villi, leading to benign external hydrocephalus [BEH] in infancy, followed by deep white matter ischemia (DWMI) in late adulthood (the more hydrophilic environment increasing resistance to CSF flow through the extracellular space (ECS) of the brain). Materials and Methods:CSF outflow via the fourth ventricle and the ECS of the brain was mathematically modeled using a parallel electrical circuit analog. The apparent diffusion coefficient (ADC) was measured as a surrogate of the amount of water in the ECS in normals, patients with symptomatic NPH, and patients with dilated ventricles without symptoms of NPH ("pre-NPH"). Results:The electrical circuit model demonstrates increasing ventricular volume with increasing resistance to flow through the ECS of the brain. ADC measurements performed in the centrum semiovale are significantly higher in patients with NPH and "pre-NPH" than in age-matched controls (P Ͻ 0.05), controlling for the same degree of DWMI indicating increased fluid in the ECS of the brain. Conclusion:The electrical circuit analog and finding of increased periventricular ADC support the theory that NPH is a "two hit" disease.

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Section: Discussionmentioning

confidence: 99%

Idiopathic normal pressure hydrocephalus may be a “Two Hit” disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood

Bradley

Bahl

Alksne

2006

Magnetic Resonance Imaging

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“…A special chronic type of communicating hydrocephalus is a normal-pressure hydrocephalus described as a syndrome of ventricular enlargement which occurs in the absence of elevated CSF pressure and is accompanied with gait disturbance, dementia and incontinence (Bergsneider et al, 2005;Hakim and Adams, 1965;Marmarou et al, 2007;Vanneste et al, 1993). Despite the clinical problems indicated in the guidelines for diagnosing and treating such patients, the main interest of this article is to discuss the nature of its development.…”

Section: Communicating Hydrocephalusmentioning

confidence: 99%

Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: Facts and illusions

Orešković

Klarica

2011

Progress in Neurobiology

126

111

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“…Normal pressure hydrocephalus (NPH) was first des cri bed by Hakim and Adams as a syndrome that consisted of the triad of gait dysfunction, dementia, and urinary in continence, was associated with ventricular dilation, was potentially treatable by cerebrospinal fluid (CSF) surgical derivation (shunt surgery) 1 . Enthusiasm for shunt surgery de creased, however, as further studies revealed complications of the surgical procedure and lack of improvement in many cases.…”

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confidence: 99%

Normal pressure hydrocephalus: a qualitative study on outcome

Bugalho

Alves

Ribeiro

2013

Arq. Neuro-Psiquiatr.

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Objective: To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method: Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results: Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion: Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.Keywords: normal pressure hydrocephalus, natural history, shunt surgery. REsumo:Objetivo: Descrever a história natural e o prognóstico após cirurgia de derivação ventricular em doentes com hidrocefalia de pressão normal (HPN), e as variáveis que potencialmente os influenciam. Método: Foram registados os parâmetros motores e cognitivos de 35 doentes com HPN, assim como o status relativo a cirurgia, em dois pontos no tempo (T0 e T1). Resultados: Treze doentes foram submetidos a cirurgia. Melhoria na marcha ocorreu em 5 doentes e relacionou-se com idade mais jovem, ausência de factores de risco cardio-vascular (FRCV), ausência de lesões da substância branca (LSB) e colocação de derivação ventricular. Verificou-se melhoria cognitiva em 9 doentes, associada (p=0,05) com colocação de derivação ventricular. Em doentes submetidos a cirurgia, o prognóstico favorável a nível motor relacionou-se com idade mais jovem em T0, ausência de FRCV e de LSB. Conclusão: A cirurgia para colocação de derivação ventricular teve um efeito significativo sobre a marcha e menor na cognição. O prognóstico favorável na marcha parece também associar-se a idade mais jovem, a ausência de FRV e de LSB.Palavras-chave: hidrocefalia de pressão normal, história natural, cirurgia de derivação ventriculo-peritoneal.Normal pressure hydrocephalus (NPH) was first des cri bed by Hakim and Adams as a syndrome that consisted of the triad of gait dysfunction, dementia, and urinary in continence, was associated with ventricular dilation, was potentially treatable by cerebrospinal fluid (CSF) surgical derivation (shunt surgery) 1

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The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure

Cited by 1,090 publications

References 7 publications

Idiopathic normal pressure hydrocephalus may be a “Two Hit” disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood

Idiopathic normal pressure hydrocephalus may be a “Two Hit” disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood

Development of hydrocephalus and classical hypothesis of cerebrospinal fluid hydrodynamics: Facts and illusions

Normal pressure hydrocephalus: a qualitative study on outcome

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