scholarly journals Neurofibrillary Tangles in the Dementia of “Normal Pressure” Hydrocephalus

1976 ◽  
Vol 3 (4) ◽  
pp. 227-235 ◽  
Author(s):  
Melvyn J. Ball
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Matched Control ◽  
Neurofibrillary Tangle ◽  
Total Duration ◽  
Normal Pressure ◽  
Normal Subjects ◽  
Dramatic Improvement ◽  
Normal Limits ◽  
Positive Linear Correlation ◽  
The One

SUMMARY:Routine neuropathological examination could not explain the dramatic improvement exhibited by one patient with “normal pressure” hydrocephalus after shunting. The improved patient contrasted remarkably with the unchanged condition of four others also shunted successfully. The five brains were analysed by quantitative morphometry to determine the degree of neurofibrillary tangle formation in mesial temporal neurons. The density of tangle-bearing nerve cells in the four unimproved cases was markedly greater than in age-matched control brains from nineteen normal subjects, and fell in the same range as that of eight dements with neuropathologically confirmed Alzheimer's disease. The density of the one who recovered was within normal limits.The duration of dementia before shunting, and the total duration of dementia in these five patients rank in the same order as their degree of neurofibrillary formation. Furthermore, a positive linear correlation exists between the Tangle Indices and the total duration of dementia. The data suggest that early diagnosis may improve the chances of reversing the dementia of normal pressure hydrocephalus before histological alterations prove too severe.

scholarly journals Normal pressure hydrocephalus secondary to Lyme disease, a case report and review of seven reported cases

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Louise Nørreslet Gimsing ◽  
Anne-Mette Hejl
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Normal Pressure Hydrocephalus ◽  
Chronic Phase ◽  
Normal Pressure ◽  
Ventricular System ◽  
One Year ◽  
The One ◽  
The Right ◽  
Balance Problems

Abstract Background Infection with tick borne Borrelia Burgdorferi (Lyme disease) can without treatment rarely develop into a chronic phase. Secondary Normal Pressure Hydrocephalus (sNPH) based on chronic infection with Borrelia Burgdorferi (Bb) is an even rarer entity, that with the right treatment is potentially curable. Case presentation A 67-year-old male with a slow onset of progressive balance problems, also presented unspecified dizziness, urge feeling, neck soreness and discrete cognitive complaints. An MRI scan revealed an enlarged ventricular system compatible with NPH. After further liquor dynamic procedures, cerebrospinal fluid (CSF) was analysed with the surprising results of lymphocytic pleocytosis, and signs of increased antibody production. Microbiology revealed chronic neuroborreliosis and the patient was treated with antibiotics accordingly. At the one-year follow-up no symptoms remained and the ventricular system almost normalized. Conclusions We describe the 7th published case of sNPH secondary to chronic Borreliosis in a previous healthy adult. Existing published literature has been reviewed and previous cases showed similarly nearly full clinical recovery. Primary/idiopathic NPH (iNPH) is treated with the surgical intervention of ventriculoperitoneal shunt and can be mistaken for a sNPH. The awareness of rare causes of sNPH like chronic Borreliosis is important as it is easily treated non surgically.

scholarly journals Neuropsychiatric manifestations in patient with normal pressure hydrocephalus improved with therapeutic lumbar tapping

2019 ◽  
Vol 7 (5) ◽  
pp. 1979
Author(s):  
Kumari Padma ◽  
Chandini . ◽  
Siddharth Shetty A. ◽  
Safeekh A. T. ◽  
Raghavendra B. S.
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Normal Pressure ◽  
Communicating Hydrocephalus ◽  
Psychomotor Activity ◽  
Manic Symptoms ◽  
Normal Limits ◽  
Neuropsychiatric Manifestations ◽  
General Physical

Normal pressure hydrocephalus is a communicating hydrocephalus without evident obstruction of the normal pathway of CSF flow. Normal-pressure hydrocephalus is a common cause of reversible dementia and it can also present with various psychiatric symptoms. A 76-year old man was brought to psychiatry OPD with history suggestive of decreased need for sleep for 8 days, disinhibited behaviour, increased libido, increased activity and increased talk for 4 days. On examination patient was noticed to be having increased psychomotor activity with increased talk, mood reported to be happy with elated affect, no content or perceptual disturbances were elicited. Cognitive functions were within normal limits. Personal and social judgement was impaired with grade 0 insight. General physical and systematic examinations were within normal limits. MRI reports showed ventricular enlargement suggestive of normal pressure hydrocephalus. Patient underwent diagnostic and therapeutic lumbar tapping. There was significant improvement in patient’s behavioural symptoms following therapeutic lumbar tapping. Therapeutic lumbar tapping in this case of normal pressure hydrocephalus was effective in the management of manic symptoms. Early identification of organic cause in late onset psychiatric disorders is necessary. Prompt intervention of the organic cause was effective in the management of manic symptoms.

scholarly journals Comparative Stereological Analysis of Intracranial Volume fractions among Patients with Brain Atrophy and Normal Pressure Hydrocephalus from a Nigerian Population

2021 ◽  
Vol 3 (2) ◽  
pp. 192-196
Author(s):  
Mohammed Abba ◽  
Anthony Chukwuka Ugwu ◽  
Azuoma L. Asomugha ◽  
Hassan Ismail
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Brain Atrophy ◽  
Matched Control ◽  
Volume Fraction ◽  
Normal Pressure ◽  
Volume Estimation ◽  
Diagnostic Methods ◽  
Intracranial Volume ◽  
Cross Sectional ◽  
Volume Fractions

Background: Differentiation between symptoms of normal pressure hydrocephalus (NPH) and other neurodegenerative disorders such as Brain Atrophy (BA) are usually confusing. Available diagnostic methods are invasive while the few non-invasive methods did not take care of potential factors known to influence intracranial volumes. We, therefore, aim to determine and compare the intracranial volume fractions among patients with NPH and BA. Methods: This was a prospective, cross-sectional age-matched control study among consenting patients that were diagnosed with NPH, BA and healthy control in Aminu Kano Teaching Hospital from March 2018 to November 2020. Each patient was routinely examined with CT-Scan; However, control participants were from other reasons. Participants with a medical history known to influence the intracranial volume were excluded. Volume estimation was based on a stereological Cavalieri method and three volume fractions were determined mathematically for each of the group. Test-point computing was facilitated through a locally developed software (voXas_2018). Ethical approval was sort prior to the study. Results: Patients with NPH have higher total CSF: brain ratio, intraventricular volume: brain ratio and extra-ventricular: brain ratio. Similar pattern was exhibited according to age grouping, except in the older age category where BA volume fractions were higher. Conclusion: Age, gender and statue are known to influence intracranial volumes. We controlled their potential effects through age-matched control of participants between groups and the use of intracranial volume ratios for objective diagnosis of NPH and BA. However, Tcsf:Br and InV:Br volume fraction ratios were found to be reliable indices for distinguishing patients with NPH and BA.

Intracranial pressure and conductance to outflow of cerebrospinal fluid in normal-pressure hydrocephalus

1979 ◽  
Vol 50 (4) ◽  
pp. 489-493 ◽  
Author(s):  
Svend Erik Børgesen ◽  
Flemming Gjerris ◽  
Søren Claus Sørensen
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Intraventricular Pressure ◽  
Content Type ◽  
Normal Limits ◽  
Selection Of Patients ◽  
Selection Of ◽  
Fine Print ◽  
High Conductance

✓ Forty patients with clinical evidence of normal-pressure hydrocephalus were studied by monitoring intraventricular pressure during a 24-hour period, and by a lumboventricular perfusion test for measurement of the conductance to outflow of cerebrospinal fluid (CSF). The purpose of the study was to investigate whether there is a relationship between intraventricular pressure and conductance to outflow of CSF, and whether it is possible to use the results from pressure monitoring in the selection of patients who may be expected to benefit from shunting therapy. The conductance to outflow was used as an evaluation factor in the selection of patients to be treated by a shunt. The conductance to CSF outflow differed by twelvefold between the lowest and highest values. The level of resting intraventricular pressure was within normal limits in all patients. Accordingly, there was no evidence of a relationship between conductance to outflow and intraventricular pressure. So-called B-waves were seen more frequently in patients with decreased conductance to outflow, but were also present in patients with high conductance to outflow. Therefore, the presence of B-waves does not imply a low conductance to outflow of CSF.

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