Cerebrospinal fluid conductance and compliance of the craniospinal space in normal-pressure hydrocephalus

1979 ◽  
Vol 51 (4) ◽  
pp. 521-525 ◽  
Author(s):  
Svend Erik Børgesen ◽  
Flemming Gjerris ◽  
Søren Claus Sørensen
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Bolus Injection ◽  
Normal Pressure ◽  
Poor Correlation ◽  
Injection Technique ◽  
Pressure Monitoring ◽  
Perfusion Technique ◽  
Content Type

✓ Conductance to outflow of cerebrospinal fluid (CSF) has been measured by both a lumboventricular perfusion and a bolus injection method in 24 patients with normal-pressure hydrocephalus. One purpose was to investigate whether the less time-consuming technique of bolus, injection gave results comparable to the results obtained by the lumboventricular perfusion technique. There was a poor correlation between the results obtained by the two measurements of conductance to outflow of CSF. It is concluded that the bolus-injection technique cannot substitute for the lumboventricular perfusion test. Compliance of the CSF space was measured by the bolus injection. The presence of B-waves, recorded from long-term intraventricular pressure monitoring, could be correlated to the sum of conductance to outflow and compliance. The correlation offers a possible explanation of the nature of B-waves.

LONG-TERM OUTCOME IN PATIENTS WITH SUSPECTED NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2007 ◽  
Vol 60 (2) ◽  
pp. 327-332 ◽  
Author(s):  
Babar Kahlon ◽  
Johan Sjunnesson ◽  
Stig Rehncrona
Keyword(s):  
Cerebrospinal Fluid ◽  
Reaction Time ◽  
Normal Pressure Hydrocephalus ◽  
Barthel Index ◽  
Normal Pressure ◽  
Shunt Surgery ◽  
Term Outcome ◽  
Long Term Outcome

Abstract OBJECTIVE To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt surgery. METHODS Seventy-five patients (mean age, 72.5 6 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 6 4.6 mo) and long-term (5.5 6 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index. RESULTS At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P < 0.05) in improved patients. CONCLUSION Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.

Variations of intraventricular pressure during pneumoencephalography

1974 ◽  
Vol 40 (1) ◽  
pp. 101-106 ◽  
Author(s):  
Jacques Philippon ◽  
Bernard George ◽  
Jean Metzger
Keyword(s):  
Cerebrospinal Fluid ◽  
Intracranial Hypertension ◽  
Normal Pressure Hydrocephalus ◽  
Initial Pressure ◽  
Normal Pressure ◽  
Intraventricular Pressure ◽  
Csf Dynamics ◽  
Content Type ◽  
Fine Print

✓ Intraventricular pressure was studied in eight patients during and after diagnostic pneumoencephalography. In cases with normal initial pressure and normal cerebrospinal fluid (CSF) dynamics, variations in pressure were moderate, immediate, and disappeared at the end of the examination. In cases of normal-pressure hydrocephalus, there was a slow but relatively important elevation that continued for at least 24 hours. In cases with intracranial hypertension, there was a rapid significant increase; return to normal depended principally upon the flow from a large CSF compartment.

Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus

1998 ◽  
Vol 89 (5) ◽  
pp. 742-747 ◽  
Author(s):  
Andrei I. Holodny ◽  
Ajax E. George ◽  
Mony J. de Leon ◽  
James Golomb ◽  
Andrew J. Kalnin ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular System ◽  
Cortical Atrophy ◽  
Imaging Studies ◽  
Content Type ◽  
Radiological Features ◽  
Shunting Procedure ◽  
Fine Print

Object. The authors describe a subgroup of patients with shunt-proven normal-pressure hydrocephalus (NPH) who presented with focal fissural and sulcal dilation on imaging studies. The specific radiological features and methods of differentiating this condition from cortical atrophy are delineated. Methods. Normal-pressure hydrocephalus has been described as dilation of the ventricles that is out of proportion to the sulci. Sulcal dilation has been taken as evidence of cortical atrophy and has even been used as a criterion to exclude patients from undergoing a shunting procedure. The authors describe five cases of patients with shunt-proven NPH who presented with focal dilation of cortical fissures and sulci. In three of the cases, there was a paradoxical decrease in the size of the dilated fissures and sulci that paralleled the decrease in the size of the lateral ventricles following successful shunting. Conclusions. This study demonstrates that focal fissural and sulcal dilation may represent reservoirs of cerebrospinal fluid analogous to the ventricular system. Patients should not be denied a shunting procedure solely on the basis of focally dilated fissures of sulci.

Cerebrospinal Fluid Shunting Improves Long-Term Quality of Life in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2019 ◽  
Author(s):  
Hanna Israelsson ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Quality Of Life ◽  
Cerebrospinal Fluid ◽  
Health Status ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Symptoms Of Depression ◽  
Cerebrospinal Fluid Shunting

Abstract BACKGROUND The short- and long-term impact of cerebrospinal fluid shunting on quality of life (QoL) in idiopathic normal pressure hydrocephalus (INPH) is poorly understood. OBJECTIVE To investigate QoL in shunted INPH patients compared to the population and to investigate which factors influence QoL in INPH. METHODS INPH patients consecutively shunted in Sweden during 2008-2010 were scrutinized. Population-based controls were age- and sex-matched to the patients. Included participants were the following: 176 INPH patients and 368 controls. QoL was assessed using the EuroQol 5-dimension 5-level (EQ5D5L) instrument, which measures overall QoL and health status in 5 dimensions. Independency (accommodation and/or need for in-home care) and comorbidities were assessed. Patients were followed up 6-45 mo after surgery (mean follow-up time: 21 mo). RESULTS Shunting improved QoL (P < .001) and health status in all dimensions (P < .005). Shunted INPH patients had lower QoL than controls (P < .001). The patients’ health status in mobility, self-care, daily activities, and anxiety/depression was worse than the controls both before and after surgery (P < .001). The main predictors of low QoL in INPH were symptoms of depression (P < .001) and severity of gait disturbance (P = .001). Fewer INPH patients than controls lived independently (45% vs 85%, P < .001). Time after shunting had no influence on QoL. CONCLUSION QoL remains improved in shunted INPH patients at a mean follow-up time of 21 mo, but the patients do not reach the same QoL as the population. Symptoms of depression and severity of gait disturbance are the strongest predictors of low QoL in INPH.

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.

Dutch Normal-Pressure Hydrocephalus Study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid

1997 ◽  
Vol 87 (5) ◽  
pp. 687-693 ◽  
Author(s):  
Agnita J. W. Boon ◽  
Joseph T. J. Tans ◽  
Ernst J. Delwel ◽  
Saskia M. Egeler-Peerdeman ◽  
Patrick W. Hanlo ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Scale Score ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Predictive Values ◽  
Content Type ◽  
Efficacy Analysis ◽  
Intention To Treat ◽  
Scale Scores ◽  
Fine Print

✓ The authors examined whether measurement of resistance to outflow of cerebrospinal fluid (Rcsf) predicts outcome after shunting for patients with normal-pressure hydrocephalus (NPH). In four centers 101 patients (most of whom had idiopathic NPH) who fulfilled strict entry criteria underwent shunt placement irrespective of their level of Rcsf obtained by lumbar constant flow infusion. Gait disturbance and dementia were quantified by using an NPH scale and the patient's level of disability was assessed by using the modified Rankin scale (mRS). In addition the Modified Mini-Mental State Examination was performed. Patients were assessed prior to and 1, 3, 6, 9, and 12 months after surgery. Primary outcome measures were based on differences between the preoperative and last NPH scale scores and mRS grades. Improvement was defined as a change measuring at least 15% in the NPH scale score and at least one mRS grade. Intention-to-treat analysis of all patients at 1 year yielded improvement for 57% in NPH scale score and 59% in mRS grade. Efficacy analysis, excluding serious events and deaths that were unrelated to NPH, was performed for 95 patients. Improvement rose to 76% in NPH scale score and 69% in mRS grade. Six cut-off levels of Rcsf were related to improvement in NPH scale score using two-by-two tables. Positive predictive values were approximately 80% for an Rcsf of 10, 12, or 15 mm Hg/ml/minute, 92% for an Rcsf of 18 mm Hg/ml/minute, and 100% for an Rcsf of 24 mm Hg/ml/minute. Negative predictive values were low. More important was the highest likelihood ratio of 3.5 for an Rcsf of 18 mm Hg/ml/minute. Extensive comorbidity was a major prognostic factor. Measurement of Rcsf reliably predicts outcome if the limit for shunting is raised to 18 mm Hg/ml/minute. At lower Rcsf values the decision depends mainly on the extent to which clinical and computerized tomography findings are typical of NPH.

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