scholarly journals Neuroimaging in normal pressure hydrocephalus

2015 ◽  
Vol 9 (4) ◽  
pp. 350-355 ◽  
Author(s):  
Benito Pereira Damasceno
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Cerebral Atrophy ◽  
High Sensitivity ◽  
Normal Pressure ◽  
Evans Index ◽  
Flow Void ◽  
High Positive Predictive Value ◽  
Subarachnoid Spaces ◽  
Magnetic Resonance Imaging Mri ◽  
Improved Accuracy

ABSTRACT Normal pressure hydrocephalus (NPH) is a syndrome characterized by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation (triad) may be atypical or incomplete, or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, such as CSF tap-tests and computed tomography (CT) or magnetic resonance imaging (MRI). The CSF tap-test, especially the 3 to 5 days continuous external lumbar drainage of at least 150 ml/day, is the only procedure that simulates the effect of definitive shunt surgery, with high sensitivity (50-100%) and high positive predictive value (80-100%). According to international guidelines, the following are CT or MRI signs decisive for NPH diagnosis and selection of shunt-responsive patients: ventricular enlargement disproportionate to cerebral atrophy (Evans index >0.3), and associated ballooning of frontal horns; periventricular hyperintensities; corpus callosum thinning and elevation, with callosal angle between 40º and 90º; widening of temporal horns not fully explained by hippocampal atrophy; and aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of sulci and subarachnoid spaces over the high convexity and midline surface of the brain. On the other hand, other imaging methods such as radionuclide cisternography, SPECT, PET, and also DTI or resting-state functional MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases.

Normal Pressure Hydrocephalus as a Possible Reversible Cause of Dementia, Neuroimaging Findings

2017 ◽  
Vol 41 (S1) ◽  
pp. S629-S630 ◽  
Author(s):  
A. Zacharzewska-Gondek ◽  
T. Gondek ◽  
M. Sąsiadek ◽  
J. Bladowska
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Brain Atrophy ◽  
Correct Diagnosis ◽  
Normal Pressure ◽  
Third Ventriculostomy ◽  
Imaging Features ◽  
Central Brain ◽  
Flow Void ◽  
Competing Interest ◽  
Magnetic Resonance Imaging Mri

IntroductionNormal pressure hydrocephalus (NPH) occurs in 0.5% of persons over 65 years old. The etiology of NPH is still unknown. Clinically NPH is characterised by cognitive deterioration, gait impairment and urinary incontinence. NPH is a possible reversible cause of dementia. Neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) allow to assess typical brain changes in this disorder.The objectives are to present the typical findings of NPH on CT and MRI and to demonstrate differences between NPH and central brain atrophy in neuroimaging.ResultsThe imaging features of NPH include: supratentorial ventriculomegaly with callosal angle less than 90o, tight sulci at the vertex and considerable out of proportion enlargement of Sylvian fissures. In case of central brain atrophy there may be a predominance of ventriculomegaly and/or widened sulci without crowding of the gyri at the vertex and callosal angle greater than 90o. In both entities, the decrease of density in periventricular region may be seen: in NPH could be a sign of transependymal oedema or in brain atrophy as an accompanying leukoaraiosis. Additionally, it is possible to assess changes in flow of cerebrospinal fluid (CSF) on MRI: in NPH an increased pulsatile CSF circulation in aqueduct as flow void sign may be observed.ConclusionsCorrect diagnosis of NPH on CT or MRI in relation to clinical data is very important. Treatment with ventriculoperitoneal shunt or third ventriculostomy may partially improve the quality of life in some patients with cognitive impairment due to NPH.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review

2022 ◽  
Vol 13 ◽  
Author(s):  
Xi Zhou ◽  
Jun Xia
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Clinical Symptoms ◽  
Normal Pressure ◽  
Clinical Value ◽  
Incontinence Surgery ◽  
Special Software ◽  
Evans Index ◽  
Ventricle Volume ◽  
Threshold Setting ◽  
Urinary Incontinence Surgery

With an ever-growing aging population, the prevalence of normal pressure hydrocephalus (NPH) is increasing. Clinical symptoms of NPH include cognitive impairment, gait disturbance, and urinary incontinence. Surgery can improve symptoms, which leads to the disease's alternative name: treatable dementia. The Evans index (EI), defined as the ratio of the maximal width of the frontal horns to the maximum inner skull diameter, is the most commonly used index to indirectly assess the condition of the ventricles in NPH patients. EI measurement is simple, fast, and does not require any special software; in clinical practice, an EI >0.3 is the criterion for ventricular enlargement. However, EI's measurement methods, threshold setting, correlation with ventricle volume, and even its clinical value has been questioned. Based on the EI, the z-EI and anteroposterior diameter of the lateral ventricle index were derived and are discussed in this review.

scholarly journals Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Hajime Yokota ◽  
Arvind Vijayasarathi ◽  
Milos Cekic ◽  
Yoko Hirata ◽  
Michael Linetsky ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Normal Pressure Hydrocephalus ◽  
Diagnostic Performance ◽  
Roc Analysis ◽  
Diffusion Tensor ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Glymphatic System ◽  
Evans Index ◽  
Diffusion Tensor Imaging Dti

Purpose. To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis. Materials and Methods. 24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case. Results. ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016). Conclusion. Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.

The role of diffusion tensor imaging in idiopathic normal pressure hydrocephalus: A literature review

2020 ◽  
pp. 197140092097515
Author(s):  
Irene Grazzini ◽  
Duccio Venezia ◽  
Gian Luca Cuneo
Keyword(s):  
Diffusion Tensor Imaging ◽  
Normal Pressure Hydrocephalus ◽  
Clinical Symptoms ◽  
Diffusion Tensor ◽  
Clinical History ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Csf Shunt ◽  
Magnetic Resonance Imaging Mri

Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome that comprises a triad of gait disturbance, dementia and urinary incontinence, associated with ventriculomegaly in the absence of elevated intraventricular cerebrospinal fluid (CSF) pressure. It is important to identify patients with iNPH because some of its clinical features may be reversed by the insertion of a CSF shunt. The diagnosis is based on clinical history, physical examination and brain imaging, especially magnetic resonance imaging (MRI). Recently, some papers have investigated the role of diffusion tensor imaging (DTI) in evaluating white matter alterations in patients with iNPH. DTI analysis in specific anatomical regions seems to be a promising MR biomarker of iNPH and could also be used in the differential diagnosis from other dementias. However, there is a substantial lack of structured reviews on this topic. Thus, we performed a literature search and analyzed the most recent and pivotal articles that investigated the role of DTI in iNPH in order to provide an up-to-date overview of the application of DTI in this setting. We reviewed studies published between January 2000 and June 2020. Thirty-eight studies and four reviews were included. Despite heterogeneity in analysis approaches, the majority of studies reported significant correlations between DTI and clinical symptoms in iNPH patients, as well as different DTI patterns in patients with iNPH compared to those with Alzheimer or Parkinson diseases. It remains to be determined whether DTI could predict the success after CSF shunting.

Flow Void of Cerebrospinal Fluid in Idiopathic Normal Pressure Hydrocephalus of the Elderly: Can It Predict Outcome after Shunting?

Neurosurgery ◽  
1997 ◽  
Vol 40 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Joachim K. Krauss ◽  
Jens P. Regel ◽  
Werner Vach ◽  
Freimut D. J??ngling ◽  
Dirk W. Droste ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Flow Void

Morphologic Features and Flow Void Phenomenon in Normal Pressure Hydrocephalus and Other Dementias

2009 ◽  
Vol 16 (11) ◽  
pp. 1373-1380 ◽  
Author(s):  
Oktay Algin ◽  
Bahattin Hakyemez ◽  
Ozlem Taskapilioglu ◽  
Gokhan Ocakoglu ◽  
Ahmet Bekar ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Flow Void

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

2014 ◽  
Vol 34 (11) ◽  
pp. 1771-1778 ◽  
Author(s):  
Johan Virhammar ◽  
Katarina Laurell ◽  
André Ahlgren ◽  
Kristina Giuliana Cesarini ◽  
Elna-Marie Larsson
Keyword(s):  
White Matter ◽  
Normal Pressure Hydrocephalus ◽  
Intraclass Correlation ◽  
Correlation Coefficients ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Regional Variability ◽  
Mri Scans ◽  
Magnetic Resonance Imaging Mri ◽  
Gait Function

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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