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.

scholarly journals Intracranial compartment volumes and their distribution among clinically diagnosed patients with normal pressure hydrocephalus and brain atrophy in a Nigerian population

2021 ◽  
Vol 14 (1) ◽  
pp. 71-78
Author(s):  
A. Mohammed ◽  
C. U. Anthony
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Brain Atrophy ◽  
Obstructive Hydrocephalus ◽  
Normal Pressure ◽  
Cross Sectional Study ◽  
Test Point ◽  
Intracranial Volume ◽  
Cross Sectional ◽  
Mean Values ◽  
And Control

Normal pressure hydrocephalus is a form of non-obstructive hydrocephalus characterized by the triad of symptoms. These symptoms are typical or atypical. Because of its potential reversibility, researchers have paid attention to its diagnosis and in differentiating it with other forms of dementia such as brain atrophy. To determine the intracranial compartment volumes and their differences among patients with NPH and Brain Atrophy (BA). This was a cross-sectional study involving consenting patients diagnosed with NPH and BA who were referred for routine brain CT. Medical conditions known to influence intracranial volume were excluded. Age -matched normal control were clinically and radiologically confirmednormal and were also recruited. Intracranial volumes and CSF distribution determination was based on Cavalieri test point computation principle. Test point summation was on a locally developed software for this purpose. Overall, the values of BA recorded higher mean values for most of the intracranial compartment volumes. Intraventricular volume was consistently higher in NPH groups. Statistical difference exists among intraventricular and total intracranial CSF volume across patients with BA, NPH and control. A post hoc test revealed control-NPH comparison across these variables. Control-BA comparison was evident in total intracranial CSF volume only. Higher mean values of intracranialcompartment volumes were observed in patients with BA than among patients with NPH and their control. Anthropometric indices did not show any difference between patients with BA, NPH and their control. These indices can be used as basis in objectively differentiating NPH from BA.

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 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.

Ventriculoperitoneal Shunting of Idiopathic Normal Pressure Hydrocephalus Increases Midbrain Size: A Potential Mechanism for Gait Improvement

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 847-851 ◽  
Author(s):  
J Mocco ◽  
Matthew I. Tomey ◽  
Ricardo J. Komotar ◽  
William J. Mack ◽  
Steven J. Frucht ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Medical Center ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Cross Sectional ◽  
Mean Values ◽  
Shunt Placement ◽  
Ventriculoperitoneal Shunting ◽  
The Mean

Abstract OBJECTIVE: Idiopathic normal pressure hydrocephalus (INPH) is characterized by a classic clinical triad of symptoms, including dementia, urinary incontinence, and gait disturbance. Recent work has demonstrated that the maximal midbrain anteroposterior (AP) diameter is significantly smaller in patients with INPH than in healthy, age-matched controls. The current study was undertaken to determine the effect of ventriculoperitoneal shunt placement on midbrain dimensions in INPH patients. METHODS: Twelve consecutive INPH patients undergoing ventriculoperitoneal shunt placement with pre- and postoperative computed tomographic scans at the Columbia University Medical Center were enrolled. Each patient's pre- and postoperative maximum AP and left-to-right diameters of the midbrain at the pontomesencephalic junction were independently measured in a blinded fashion by two of the authors. The average value of each dimension was computed by calculating the mean values of the measurements of the two observers. RESULTS: Both the mean AP diameter (preoperative mean, 2.06 ± 0.04 cm; postoperative mean, 2.27 ± 0.05; P = 0.0007) and left-to-right diameter (preoperative mean, 2.80 ± 0.07; postoperative mean, 3.03 ± 0.08; P = 0.0029) increased from pre- to postoperative imaging. The approximate cross-sectional area determined as the product of AP and left-to-right diameters also increased from pre- to postoperative images (preoperative mean, 5.79 ± 0.22 cm2; postoperative mean, 6.90 ± 0.25 cm2; P = 0.00049). CONCLUSION: This study provides supportive evidence that midbrain cytoarchitecture may play a role in the pathophysiology and post-ventriculoperitoneal shunt gait improvement of INPH patients.

scholarly journals Cerebrospinal fluid closing pressure-guided tap test for the diagnosis of idiopathic normal pressure hydrocephalus: A descriptive cross-sectional study

2020 ◽  
Vol 11 ◽  
pp. 315
Author(s):  
Diego Fernando Gómez-Amarillo ◽  
Luis Fernando Pulido ◽  
Isabella Mejía ◽  
Catalina García-Baena ◽  
María Fernanda Cárdenas ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Opening Pressure ◽  
Cross Sectional ◽  
Tap Test ◽  
The Mean ◽  
Closing Pressure

Background: Tap test improves symptoms of idiopathic normal pressure hydrocephalus (iNPH); hence, it is widely used as a diagnostic procedure. However, it has a low sensitivity and there is no consensus on the parameters that should be used nor the volume to be extracted. We propose draining cerebrospinal fluid (CSF) during tap test until a closing pressure of 0 cm H2O is reached as a standard practice. We use this method with all our patients at our clinic. Methods: This is a descriptive cross-sectional study where all patients with presumptive diagnosis of iNPH from January 2014 to December 2019 were included in the study. We used a univariate descriptive analysis and stratified analysis to compare the opening pressure and the volume of CSF extracted during the lumbar puncture, between patients in whom a diagnosis of iNPH was confirmed and those in which it was discarded. Results: A total of 92 patients were included in the study. The mean age at the time of presentation was 79.4 years and 63 patients were male. The diagnosis of iNPH was confirmed in 73.9% patients. The mean opening pressure was 14.4 cm H2O mean volume of CSF extracted was 43.4 mL. Conclusion: CSF extraction guided by a closing pressure of 0 cm H2O instead of tap test with a fixed volume of CSF alone may be an effective method of optimizing iNPH symptomatic improvement and diagnosis.

scholarly journals Cerebral ventriculomegaly in myotonic dystrophy type 1: normal pressure hydrocephalus-like appearances on magnetic resonance imaging

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Saya Iida ◽  
Hiroko Seino ◽  
Fumiko Nagahata ◽  
Soichiro Tatsuo ◽  
Sho Maruyama ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Axial Length ◽  
Brain Atrophy ◽  
Normal Pressure ◽  
Myotonic Dystrophy Type 1 ◽  
Myotonic Dystrophy Type ◽  
Imaging Characteristics ◽  
Evans Index ◽  
Ctg Repeat

Abstract Background Cerebral ventriculomegaly is an abnormal feature characteristic of myotonic dystrophy type 1 (DM1). This retrospective study investigated the morphologic changes accompanied by ventriculomegaly in DM1 on brain MRI. Methods One hundred and twelve adult patients with DM1 and 50 sex- and age-matched controls were assessed. The imaging characteristics for evaluations included the z-Evans Index (ventriculomegaly), callosal angle (CA), enlarged perivascular spaces in the centrum semiovale (CS-EPVS), temporo-polar white matter lesion (WML) on 3D fluid-attenuated inversion recovery (FLAIR), disproportionately enlarged subarachnoid-space hydrocephalus (DESH), and pathological brain atrophy. The “z-Evans Index” was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. To determine the imaging characteristics and genetic information (CTG repeat numbers) that were associated with the z-Evans Index, we used binominal logistic regression analyses. Results The z-Evans Index was significantly larger in the patients than in the controls (0.30 ± 0.05 vs. 0.24 ± 0.02; p < 0.01). The z-Evans Index was independently associated with the callosal angle (p < 0.01) and pathological brain atrophy (p < 0.01) but not with age, gender, CTG repeat numbers, or CS-EPVS. Of the 34 patients older than 49 years, 7 (20.6%) were considered to have DESH. Conclusions Our MRI study revealed a normal pressure hydrocephalus (NPH)-like appearance as a morphologic finding accompanied by ventriculomegaly in DM1 that tends to occur in elderly patients.

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