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Results for “Hydrocephalus, Normal Pressure”

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PubMed2000

Magnetisation transfer ratio is low in normal-appearing cerebral white matter in patients with normal pressure hydrocephalus.

We measured the magnetisation transfer ratios (MTR) of normal-appearing rostral (PR) and caudal (PC) periventricular white matter, the genu (CG) and the splenium (CS) of the corpus callosum and the thalamus (TH) in 12 patients with normal-pressure hydrocephalus (NPH) and compared them with 16 healthy control subjects. We found a significantly lower MTR in the NPH group than in the normal group for PR, PC, CG, and CS but not for TH. MT measurements give additional information which cannot be gained by conventional MRI, suggesting that NPH is associated with diffuse white matter damage, even in normal-appearing cerebral white matter.

Adult↗

PubMed1995

The relation of intracranial pressure B-waves to different sleep stages in patients with suspected normal pressure hydrocephalus.

The interpretation of data from continuous monitoring of intracranial pressure (ICP) in patients with suspected normal pressure hydrocephalus (NPH) is the subject of controversy. Despite the fact that overnight ICP monitoring is widely used for the diagnosis of NPH, normative criteria are poorly defined. The present study demonstrates that there is a relationship between the relative frequency, the absolute amplitude, the wavelength and the morphology of B-waves and different sleep stages. Intraventricular intracranial pressure was recorded continuously overnight in 16 patients with suspected normal pressure hydrocephalus. Simultaneous polysomnography was performed to investigate the relation of spontaneous ICP oscillations to different sleep stages. A correlative analysis was done with the data of 13 patients. Three patients were excluded, one who was awake throughout the night and two in whom polysomnography was incomplete due to technical reasons. The mean resting cerebrospinal fluid (CSF) pressure was 12.87 cm CSF. B-waves were observed in the ICP recordings of all patients. They were present for a mean of 72% of the total recording time. The relative frequency of B-waves was higher during REM sleep and sleep stage 2 as compared to wakefulness (87.8% and 83.2% vs. 56. p < 0.05). The absolute amplitude was higher during REM sleep than in wakefulness (9.56 vs. 3.44 cm CSF, p < 0.05). Wavelengths were longer in REM sleep than in wakefulness and stages 1 and 2 (62.4 vs. 42, 40.7 and 44.8 sec, p < 0.05). The morphology of B-waves was also related to different sleep stages. Ramp-type B-waves were associated with REM sleep in six patients, however, were also present in sleep stage 2 in three of them. Knowledge of the relation of spontaneous ICP oscillations to different sleep stages may help to establish physiological foundations and alterations. Furthermore, polysomnography may be useful to avoid erroneous interpretation of ICP recordings due to sleep stage related variability.

Adult↗

PubMed1997

[Diagnosis of normal pressure hydrocephalus. A calculation model for determining intracranial pressure-dependent resistance and compliance].

Computer-aided analysis of the results of the intrathecal infusion test using our mathematical computation leads to simplification of this investigation, and therefore normal pressure hydrocephalus is more easily diagnosed. Simultaneous measurement of resistance and compliance during a single investigation allows the exertion of the patients to be minimized. In contrast to classic methods it is not necessary that the ICP reaches a plateau. Our mathematical method diverges with the description of a pressure-dependent slope of the function for the resistance from the static examination models. For that we are able to take the non-linearity of the cerebrospinal fluid resorption into consideration. The intrathecal infusion tests is a reliable diagnostic method for measuring resistance and compliance in patients suspected of having normal pressure hydrocephalus.

Cerebral Ventricles↗

PubMed2001

Normal pressure hydrocephalus and cerebral blood flow: a review.

Normal pressure hydrocephalus is a neurological disease which poses both diagnostic and therapeutic problems for the clinician. The measurement and characterisation of cerebral blood flow has been proposed as a tool for resolving such problems as well as elucidating its pathophysiology. We review the results of studies in which this tool has been applied to normal pressure hydrocephalus patients and consider the merits of the techniques that have been utilised. Finally, consideration is given to feasible future studies and the methods that could be employed in the study of cerebral blood flow and metabolism in patients with normal pressure hydrocephalus.

Brain↗

PubMedDate not supplied

The association of normal-pressure hydrocephalus with obstructive sleep apnea.

This report describes a 70-year-old man with obstructive sleep apnea who deteriorated rapidly when nasal continuous positive airway pressure was begun. The patient was found to have normal-pressure hydrocephalus, which was possibly exacerbated by the nasal continuous positive airway pressure. A review of the literature indicates several significant associations between apnea, normal-pressure hydrocephalus, and increased intracranial pressure and suggests that the association of obstructive sleep apnea and hydrocephalus might not be rare. Implications for diagnosis and treatment are discussed.

Aged↗

PubMed1996

Multi-layer neural network analysis of cerebrospinal fluid pressure patterns in idiopathic normal-pressure hydrocephalus.

The cerebrospinal fluid (CSF) pressure patterns have been reported as one of the most relevant indexes for the diagnosis and treatment of idiopathic normal-pressure hydrocephalus (INPH). Forty consecutive patients coming from our observations with the classic Hakim's triad underwent continuous CSF pressure monitoring via lumbar puncture for at least 12 hours. Twenty-eight patients were diagnosed as having INPH and underwent CSF shunt. A multi-layer neural network (perceptron) was employed to study the pressure patterns in order to try an alternative classification to the "expert" neurosurgeon one. Differences between expert and neural network classifications were indeed observed. Such differences may depend on the small group studied or on the inadequacy of CFS pressure patterns in correctly individuating those INPH patients who benefit from shunt surgery. The authors think that neural network processing of INPH could add relevant information to select the "responder" patients to surgery: in fact neural networks represent a powerful methodology for aiding the expert to select the proper choice on the basis of "what learnt" by the networks themselves.

Cerebrospinal Fluid↗

PubMed1987

Normal pressure hydrocephalus presenting as mania.

A case of normal pressure hydrocephalus presented as a secondary mania. The patient responded to neurosurgical intervention. Psychiatric aspects of diagnosis and management of normal pressure hydrocephalus are discussed.

Bipolar Disorder↗

PubMed1988

[Continuous lumbar subarachnoid pressure monitoring as an indicator of shunt operation for so-called normal pressure hydrocephalus].

Lumbar subarachnoid pressure (LSP) was continuously monitored via intrathecally introduced polyethylene catheter to select the patients for shunt operation. A total of seventy cases included so-called normal pressure hydrocephalus (NPH) secondary to subarachnoid hemorrhage (SAH; 34 cases), idiopathic NPH (17 cases), secondary NPH whose symptoms developed after operations for brain tumors, head injuries or meningitis (12 cases) and other intracranial diseases including pseudotumor cerebri or meningeal carcinomatosis, etc. (7 cases). Shunt operation was effective in 36 cases and not effective in 9 cases, while 25 cases were not shunted since LSP was not elevated or clinical manifestations were slight. Mean values of baseline pressure and maximum pressure in shunt effective group, shunt non-effective group and non-shunted group were 14.5, 12.7, 9.0 and 29.9, 25.0, 17.9 mmHg, respectively. Statistical difference was observed between shunt effective group and non-shunted group. Frequency of pressure waves was also significantly higher in shunt effective group than in non-shunted group. Above all, measurement of LSP was regarded as useful in idiopathic NPH. However, preoperative clinical symptoms had a closer relationship to shunt response than results of LSP in post SAH patients. Complication related to this monitoring was negligible except in one case of meningitis which was easily treated by administration of antibiotics. Follow-up study also justified our selection since no further deterioration was noted in non-shunted group. The present study indicates that measurement of LSP would be useful in selecting the patients who will benefit from shunting and in eliminating unnecessary shunt operations because this simple method is easily performed at bed side without perforating the skull.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Simultaneous recording of cerebrospinal fluid pressure and middle cerebral artery blood flow velocity in patients with suspected symptomatic normal pressure hydrocephalus.

CSF pressure (intracranial pressure, in one patient lumbar pressure) was monitored continuously for one night in 23 patients with suspected symptomatic normal pressure hydrocephalus (NPH) to identify patients who might benefit from subsequent shunt surgery. In 20 patients middle cerebral artery (MCA) blood flow velocity by means of transcranial Doppler sonography (TCD) and CSF pressure were recorded simultaneously. In three patients transcranial Doppler signals were insufficient. Spontaneous changes in CSF pressure always paralleled changes in the TCD signal. Equivalents of B-waves as well as intermediate waves (in between B- and A-waves), and C-waves could be identified easily and always appeared in phase. The Doppler signal, however, could not be used to evaluate the absolute changes in CSF pressure. Fast Fourier Transform of the Doppler signal was a useful tool to indicate the relative frequency of B-wave equivalents. In five patients the injection of 10ml saline into the ventricle raised intracranial pressure considerably, but hardly affected the MCA blood flow velocity. Continuous TCD monitoring might be useful as a noninvasive screening procedure in patients with suspected symptomatic NPH before continuous invasive CSF pressure measurements are performed.

Aged↗

PubMed2004

The role of altered impedance in the pathophysiology of normal pressure hydrocephalus, Alzheimer's disease and syringomyelia.

Normal pressure hydrocephalus, Alzheimer's disease and syringomyelia appear to be completely unrelated diseases, however, they share a reduction in subarachnoid space compliance as part of their pathophysiology. This paper discusses the physiology of pulsatile fluid flow and its relationship to compliance/impedance. Unlike continuous or non-pulsatile flow where the vessel resistance and pressure gradient are the major determinants of the volume of fluid flowing, when the fluid flow in a vessel pulsates then the vessel compliance/impedance becomes important. A reduction in compliance in the craniospinal cavity in each of the three diseases discussed, leads to a limitation of the outflow vessel compliance. Therefore, there is an increase in outflow vessel impedance. The venous blood, CSF and interstitial brain/spinal cord fluid all have significantly pulsatile flow and an increase in the impedance of the fluid outflow in each disease would limit the volume of these fluids as they attempt to cross the subarachnoid space. It is hypothesised that a reduction in the efficiency of the outflow of venous blood, CSF and interstitial brain/spinal cord fluid would lead to the accumulation of CSF in NPH, cord fluid in syringomyelia and delay the excretion of beta amyloid via the interstitial drainage pathways in AD.

Alzheimer Disease↗

PubMed2005

Broadening a classic clinical triad: The hypokinetic motor disorder of normal pressure hydrocephalus also affects the hand.

The clinical spectrum of normal pressure hydrocephalus is thought to comprise the triad of hypokinetic gait disorder, dementia and urinary incontinence. In contrast, motor abnormalities involving the upper limbs in normal pressure hydrocephalus have not yet received a great deal of attention. The present study was designed to quantitatively assess grasping movements in normal pressure hydrocephalus and to compare the performance with that in Parkinson's disease. Eight subjects with normal pressure hydrocephalus, eight subjects with Parkinson's disease and eight healthy control subjects grasped to lift an instrumented object. The built-up of fingertip forces during the early phase and the kinematics of the lifting movement during the late phase of the grip-lift synergy were slower for patients compared to healthy controls. Patients generated abnormally high fingertip forces when lifting and holding the object stationary. The slowness of the grip-lift synergy and the force overshoot was similar for both patient groups. Our data demonstrate that the hypokinetic motor deficit in normal pressure hydrocephalus also involves the hand, and that the pattern of deficits shares several features of those found in Parkinson's disease.

Aged↗

PubMed1991

[Changes in CSF pressure induced by acetazolamide administration test--as an indicator of shunt operation for so-called normal pressure hydrocephalus].

Lumber subarachnoid pressure was monitored via intrathecally introduced catheter in 9 patients, who showed ventricular dilatation on brain CT and were suspected of normal pressure hydrocephalus. During the pressure measurement, 500 mg of acetazolamide was rapidly injected intravenously and changes of CSF pressure were recorded. The results of the study were compared to clinical signs, brain CT findings and results of continuous pressure monitoring. The types of response of CSF pressure induced by acetazolamide administration were classified into 2 groups. In 5 cases (Group A), more than 50 percent increase of CSF pressure compared to the resting value was noted. On the contrary, in the remaining 4 cases (Group B), CSF pressure showed only slight increase (less than 25 percent or none). VP shunt was performed in 4 cases in Group A. Definite improvement of clinical symptoms was observed in all of these surgically treated cases. Correlation was found between the response to Acetazolamide administration and the appearance of B wave in the continuous spinal pressure monitoring. This study suggests that Acetazolamide test may be useful diagnostic test to select the patients for shunt operation.

Acetazolamide↗

PubMed2006

Intracranial pulse pressure amplitude levels determined during preoperative assessment of subjects with possible idiopathic normal pressure hydrocephalus.

BACKGROUND: It was previously reported that the intracranial pulse pressure amplitudes were elevated in idiopathic normal pressure hydrocephalus (iNPH) patients responding to shunt surgery. In this study, pulse pressure amplitudes were determined in all patients referred for tentative iNPH, and patients were selected for shunt surgery based on the determination of their threshold levels of intracranial pulse pressure amplitudes. PATIENTS AND METHODS: All patients referred to our department for tentative iNPH during a 12 months time period were included. Using intracranial pressure (ICP) monitoring the intracranial pulse pressure amplitudes were determined as the mean wave amplitude in consecutive 6-seconds time windows. Intracranial pulse pressure amplitudes were defined as being elevated when the mean wave amplitudes were either >or=4 mmHg in >or=70%, >or=5 mmHg in >or=40% or >or=6 mmHg in >or=10% of the ICP recording time. Shunt treatment was offered to those with elevated mean wave amplitudes. Clinical state was assessed by using a NPH Grading Scale and the Stein-Langfitt scale before ICP monitoring, and then repeated after 12 months. RESULTS: Among the 40 iNPH patients included during the 12 months period, the mean wave amplitudes were elevated in 24 patients (60%), while not being elevated in 16 (40%). Neither pre-operative clinical state, radiological ventricular size nor co-morbidity differed between patient groups with elevated or non-elevated mean wave amplitudes. In the shunted patients who had pre-operatively elevated mean wave amplitudes, 91% had very significant clinical change after 12 months (median change in NPH score +4). In those with non-elevated amplitudes and no shunt, clinical state was somewhat worse after 12 months (median change in NPH score -1). CONCLUSIONS: In this one-year material, mean wave amplitudes were elevated in 60% of iNPH patients. In those with elevated mean wave amplitudes who were treated with shunt, 91% had a significant clinical response.

Aged↗

PubMed1993

[Shunt indication of CSF circulatory disturbance with cerebral atrophy (atypical normal pressure hydrocephalus): evaluation of serum alpha 1-antichymotrypsin and pressure wave on epidural pressure monitoring].

PURPOSE: The purpose of this study was to evaluate serum alpha 1-antichymotrypsin (alpha 1-ACT) and pressure wave on continual epidural pressure (EDP) monitoring as the indices for shunt operations in CSF circulatory disturbance associated with cerebral atrophy (atypical normal pressure hydrocephalus: ANPH). METHOD: The subjects adopted were 10 patients (aged 48-79, averaging 64.9, male: female = 8.2). V-P shunt was performed on all the cases, and venous blood was collected from the internal jugular vein before and after the operation to measure serum alpha 1-ACT value (nephelometry method, SRL Co.). Continual measurement of EDP was made preoperatively (Geltec Co.). A comparative assessment was made regarding the preoperative alpha 1-ACT value and appearance or not of pressure wave at EDP in the group whose symptom was improved by shunt (effective group: E) and the other group (non-effective group: NE). RESULTS: 1. The cases were 6 in group E and 4 in group NE. 2. The mean values of the preoperative alpha 1-ACT were 43.47 +/- 8.08mg/dl in group E and 63.68 +/- 5.48mg/dl in group NE. The former exhibited evidently low values, and all the cases whose values were less than 55mg/dl belonged to group E (p < 0.001). 3) Pressure wave (A or B wave) at EDP were observed in 5 cases, all in group E. CONCLUSION: 1. Serum alpha 1-ACT value can be regarded as an index for shunt indication for ANPH, and the value was lower in group E than group NE. The value at the boundary between effectiveness and ineffectiveness was 55 mg/dl. 2. Appearance of pressure wave at measurement of EDP was observed in all of group E. 3. Shunt operation should be taken into consideration for ANPH patients whose preoperative serum alpha 1-ACT value is low (less than 55mg/dl) and in whom pressure wave emerges at continual measurement of EDP, even though their cerebral atrophy is found to be severe by CT.

Aged↗

PubMed2006

Theoretical considerations on the pathophysiology of normal pressure hydrocephalus (NPH) and NPH-related dementia.

Normal pressure hydrocephalus (NPH) is considered to be an example of reversible dementia although clinical improvement after shunting varies from subject to subject, and recent studies have pointed to a possible link with other dementia. The authors consider that the craniospinal compartment is a partially closed sphere with control device systems represented by the spinal axis and the sagittal sinus-arachnoid villi complex which interact with each other in the clinical patient setting. We hypothesise that changing spinal compliance by altering the flow process and CSF dynamics lead to hydrocephalus. Therefore four NPH types have been distinguished according to the alterations in spinal compliance, decrease in CSF absorption at the sagittal sinus or both occurrences. The authors consider that NPH and NPH-related diseases (NPH-RD) are initiated by the same common final pathway and demonstrate that NPH could represent an initial stage of NPH-RD. Progression of clinical signs can be explained as damage to the cerebral tissue by both intermittent increased intracranial pressure and pulse pressure waves leading to periventricular ischaemia. In addition, they believe that both volume equilibrium and spinal compliance are restored in patients who improve after CSF shunt, whereas in patients whose condition does not improve, only volume equilibrium is restored and not spinal compliance, which was the underlying cause of hydrocephalus in such cases. They therefore wonder whether cervical decompression should not be indicated in patients who show no improvement. Although attractive, this analysis warrants confirmation from clinical, radiological, and hydrodynamic studies.

Cerebrospinal Fluid↗

PubMed1998

CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry.

PURPOSE: Idiopathic normal pressure hydrocephalus (NPH) is an important cause of dementia in the elderly; however, idiopathic NPH is often difficult to differentiate from normal aging and vascular dementias in which brain atrophy with ventricular dilatation (hydrocephalus ex vacuo or central atrophy) is present. To elucidate the distinctive features of the distribution of CSF in idiopathic NPH, we used MR imaging to investigate the morphologic features and volume of the CSF space in patients with idiopathic NPH compared with those with other dementias. METHODS: We assessed the size of four CSF compartments (the ventricle, basal cistern, sylvian space, and suprasylvian subarachnoid space) in 11 shunt-responsive patients with idiopathic NPH by semiquantitative and volumetric analyses of coronal T1-weighted MR images. The results were compared with those in 11 age- and sex-matched patients with Alzheimer disease and in 11 patients with vascular dementia. RESULTS: In patients with idiopathic NPH, the CSF volume was significantly increased in the ventricles and decreased in the superior convexity and medial subarachnoid spaces as compared with patients with other dementias. The sylvian CSF volume in patients with idiopathic NPH was significantly greater than in patients with Alzheimer disease. The volume of the basal cistern was comparable among the three groups. In several patients with idiopathic NPH, focally dilated sulci were observed over the convexity or medial surface of the hemisphere. CONCLUSION: Our results indicate that findings of enlarged basal cisterns and sylvian fissures and of focally dilated sulci support, rather than exclude, the diagnosis of shunt-responsive idiopathic NPH and suggest that this condition is caused by a suprasylvian subarachnoid block.

Aged↗

PubMed1999

Third ventriculostomy in normal pressure hydrocephalus.

Improvement in three out of four cases of normal pressure hydrocephalus after third ventriculostomy is reported. Pre- and postoperative ventricular pressure recording suggested that this improvement may be occurring in the absence of an improvement in ventricular pressures. Third ventriculostomy may relieve periventricular tissue stress and thus improve local blood flow, which is a likely mechanism in the syndrome of normal pressure hydrocephalus.

Aged↗

PubMedDate not supplied

Normal pressure hydrocephalus: relationship among clinical picture, CT scan and intracranial pressure monitoring.

Fifty-five patients suffering from normal pressure hydrocephalus were considered. All patients underwent chronic intracranial pressure (ICP) monitoring for at least 24 h. The decision to perform surgery was made on the basis of the ICP monitoring data only. A retrospective analysis on clinical pictures, CT findings and ICP monitoring data was carried out in the attempt to find more selective criteria, in order to submit patients to chronic ICP monitoring. Clinical findings showed controversial data, whereas the enlargement of the III ventricle showed a strict, but not absolute, correlation to pathological pressure profiles. The follow-up of non-shunted patients is briefly discussed.

Adult↗