The syndrome of normal-pressure hydrocephalus

1984 ◽  
Vol 61 (3) ◽  
pp. 501-509 ◽  
Author(s):  
John Vassilouthis
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Content Type ◽  
Postoperative Death ◽  
Shunting System ◽  
Fine Print

✓ A series of 40 patients with the syndrome of normal-pressure hydrocephalus is presented. Diagnosis was based on clinical and computerized tomography (CT) scan criteria and was followed by the insertion of a ventriculoperitoneal shunt in every instance. All patients responded favorably to treatment (four of them had a fair outcome), and this response was maintained. There was one postoperative death, but no other serious complications. This study demonstrates that it is possible to diagnose the syndrome of normal-pressure hydrocephalus on the basis of clinical and CT scan criteria without any other invasive investigations. Such patients should respond favorably to an adequately functioning shunting system.

Cerebral hemodynamics in normal-pressure hydrocephalus

1984 ◽  
Vol 61 (3) ◽  
pp. 510-514 ◽  
Author(s):  
Norihiko Tamaki ◽  
Tadaki Kusunoki ◽  
Toshimitsu Wakabayashi ◽  
Satoshi Matsumoto
Keyword(s):  
Computerized Tomography ◽  
Transit Time ◽  
Normal Pressure Hydrocephalus ◽  
Mean Transit Time ◽  
Contrast Material ◽  
Normal Pressure ◽  
Cerebral Hemodynamics ◽  
Content Type ◽  
Poor Outcome ◽  
Fine Print

✓ Cerebral hemodynamics in 31 patients with suspected normal-pressure hydrocephalus were studied by means of the xenon-133 (133Xe) inhalation method and on dynamic computerized tomography (CT) scanning. Cerebral blood flow (CBF) is reduced in all patients with dementia. Hypoperfusion was noted in a frontal distribution in these patients compared with normal individuals. There was no difference in CBF patterns between patients with good and those with poor outcome. The CBF was increased following cerebrospinal fluid (CSF) shunting in patients who responded to that procedure: increase in flow correlated with clinical improvement, frontal and temporal lobe CBF was most markedly increased, and the CBF pattern became normal. In contrast, CBF was decreased after shunt placement in patients who were considered to have suffered from degenerative dementia, as evidenced by non-response to shunting. Dynamic computerized tomography studies demonstrated that patients with a good outcome showed a postoperative reduction in mean transit time of contrast material, most prominent in the frontal and temporal gray matter, and slight in the deep frontal structures, but not in the major cerebral vessels. Patients with poor outcome after shunting, however, had an increase in transit time in all regions. This corresponded well with the results as determined by the 133Xe inhalation method.

A variant of normal-pressure hydrocephalus simulating Pick's disease on computerized tomography

1983 ◽  
Vol 59 (5) ◽  
pp. 902-904 ◽  
Author(s):  
Naman A. Salibi ◽  
Gerald L. Lourie ◽  
Herbert Lourie
Keyword(s):  
Computerized Tomography ◽  
Normal Pressure Hydrocephalus ◽  
Clinical Picture ◽  
Normal Pressure ◽  
Cortical Atrophy ◽  
Pick's Disease ◽  
Pick’S Disease ◽  
Content Type ◽  
Ventriculoperitoneal Shunting ◽  
Fine Print

✓ The authors present two cases of normal-pressure hydrocephalus that simulated Pick's disease radiographically and that were initially diagnosed as cortical atrophy. In both cases, Sylvian cisternoperitoneal shunts improved the clinical picture only temporarily, but ventriculoperitoneal shunting produced dramatic relief of all symptoms.

Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts

1998 ◽  
Vol 88 (3) ◽  
pp. 490-495 ◽  
Author(s):  
Agnita J. W. Boon ◽  
Joseph T. J. Tans ◽  
Ernst J. Delwel ◽  
Saskia M. Egeler-Peerdeman ◽  
Patrick W. Hanlo ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Content Type ◽  
Efficacy Analysis ◽  
Intention To Treat ◽  
Medium Pressure ◽  
Shunt Group ◽  
Fine Print

Object. The goal of this prospective study was to compare outcome after placement of a low- or medium-pressure shunt in patients with normal-pressure hydrocephalus (NPH). Methods. Ninety-six patients with NPH were randomized to receive a low-pressure ventriculoperitoneal shunt (LPV; 40 ± 10 mm H2O) or medium high—pressure ventriculoperitoneal shunt (MPV; 100 ± 10 mm H2O). The patients' gait disturbance and dementia were quantified by applying an NPH scale, and their level of disability was evaluated by using the modified Rankin scale (mRS). Patients were examined prior to and 1, 3, 6, 9, and 12 months after surgery. Primary outcome measures were determined by differences between preoperative and last NPH scale scores and mRS grades. The LPV and MPV shunt groups were compared by calculating both the differences between mean improvements and the proportions of patients showing improvement. Intention-to-treat analysis of mRS grades yielded a mean improvement of 1.27 ± 1.41 for patients with LPV shunts and 0.68 ± 1.58 for patients with MPV shunts (p = 0.06). Improvement was found in 74% of patients with LPV shunts and in 53% of patients with MPV shunts (p = 0.06) and a marked-to-excellent improvement in 45% of patients with LPV shunts and 28% of patients with MPV shunts (p = 0.12). All outcome measures indicated trends in favor of the LPV shunt group, with only the dementia scale reaching significance. After exclusion of serious events and deaths unrelated to NPH, efficacy analysis showed the advantage of LPV shunts to be diminished. Reduction in ventricular size was also significantly greater for patients in the LPV shunt group (p = 0.009). Subdural effusions occurred in 71% of patients with an LPV shunt and in 34% with an MPV shunt; however, their influence on patient outcome was limited. Conclusions. Outcome was better for patients who had an LPV shunt than for those with an MPV shunt, although most differences were not statistically significant. The authors advise that patients with NPH be treated with an LPV shunt.

Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma

1974 ◽  
Vol 40 (3) ◽  
pp. 372-375 ◽  
Author(s):  
David C. McCullough ◽  
John L. Fox
Keyword(s):  
Intracranial Pressure ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Csf Shunts ◽  
Improvement Rate ◽  
Content Type ◽  
Subdural Hematomas ◽  
Significant Clinical Improvement ◽  
Fine Print

✓ Subdural hematomas and effusions have been noted in at least 20% of adult patients treated with CSF shunts for normal pressure hydrocephalus. In a series of 39 cases the incidence of this complication is correlated with the low 41% improvement rate. The very low intracranial pressure achieved with conventional shunt systems is probably the most important factor causing subdural collections of blood or fluid. In a study of pre- and post-shunt CSF pressures in 25 patients it was found that in the erect position ventriculoatrial and ventriculoperitoneal shunt systems produced pressures averaging —238 and —251 mm H2O respectively. Although the new antisiphon valves produced much smaller decrements of CSF pressure with significant clinical improvement in some cases, these units did not always prevent subdural hematomas.

Cerebral blood flow in patients with normal-pressure hydrocephalus before and after shunting

1987 ◽  
Vol 66 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Sissel Vorstrup ◽  
John Christensen ◽  
Flemming Gjerris ◽  
P. Soelberg Sørensen ◽  
Anne Marie Thomsen ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Ct Scan ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Low Flow ◽  
Ventricular Size ◽  
Content Type ◽  
Before And After ◽  
Fine Print

✓ Cerebral blood flow (CBF) was measured by xenon-133 inhalation and single photon emission tomography in 17 demented patients with normal-pressure hydrocephalus before and after shunt treatment. All patients had a decreased conductance to outflow (Cout) of cerebrospinal fluid as measured by lumboventricular perfusion (COut < 0.12 ml ⋅ mm Hg−1 ⋅ min−1). Computerized tomography (CT) scanning, clinical assessment, and neuropsychological grading were performed pre- and postoperatively. The preoperative CBF studies revealed abnormal flow patterns in all patients. Fourteen patients showed moderate-sized, large, or very large central low-flow areas, and four patients had reduced flow bilaterally in the occipital and contiguous temporoparietal regions. After shunting, six patients had a significant reduction in the size of the central low-flow area on the CBF map, agreeing well with the changes of ventricular size on the CT scan. All six patients showed an improvement in either clinical or neuropsychological grading. In 10 of the remaining 11 patients flow patterns were essentially unchanged; one patient deteriorated further. Four of these 11 patients improved on postoperative clinical or neuropsychological testing. Thus, a positive correlation was found between the changes in CBF and the reduction of the ventricular size on the CT scan, but changes in CBF as measured by the present technique did not accompany improvement in the functional state in all patients.

Analysis of hearing loss after shunt placement in patients with normal-pressure hydrocephalus

2001 ◽  
Vol 95 (3) ◽  
pp. 432-434 ◽  
Author(s):  
Marie-Lise C. van Veelen-Vincent ◽  
Ernst J. Delwel ◽  
Rozemarijn Teeuw ◽  
Erkan Kurt ◽  
Dirk A. de Jong ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Pure Tone ◽  
Pure Tone Audiometry ◽  
Normal Pressure ◽  
Shunt Insertion ◽  
Content Type ◽  
Shunt Placement ◽  
Fine Print

Object. Following shunt placement for treatment of normal-pressure hydrocephalus (NPH), several patients suffered hearing loss. The authors undertook a study to analyze this outcome. Methods. Sixteen patients in whom NPH was diagnosed were treated by placement of a ventriculoperitoneal shunt. Their hearing was assessed pre- and postoperatively by using pure tone audiometry. Two thirds of the ears tested showed a postoperative hearing loss of more than 10 dB. Recovery of the hearing loss occurred 6 to 12 weeks after shunt placement in 75% of the ears examined. Conclusions. Although shunt insertion for treatment of NPH results in a decrease in hearing, most of the loss can be recovered.

Preliminary experience with Brown-Roberts-Wells (BRW) computerized tomography stereotaxic guidance system

1983 ◽  
Vol 59 (2) ◽  
pp. 217-222 ◽  
Author(s):  
M. Peter Heilbrun ◽  
Theodore S. Roberts ◽  
Michael L. J. Apuzzo ◽  
Trent H. Wells ◽  
James K. Sabshin
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Guidance System ◽  
Production Model ◽  
Ct Scanner ◽  
Content Type ◽  
Ct Scanners ◽  
Guidance Systems ◽  
Fine Print

✓ The production model of the Brown-Roberts-Wells (BRW) computerized tomography (CT) stereotaxic guidance system is described. Hardware and software modifications to the original prototype now allow the system to be used independently of the CT scanner after an initial scan with the localizing components fixed to the skull. The system is simple and efficient, can be used universally with all CT scanners, and includes a phantom simulator system for target verification. Preliminary experience with 74 patients at two institutions is described. It is concluded that CT stereotaxic guidance systems will become important tools in the neurosurgical armamentarium, as they allow accurate approach to any target identifiable on the CT scan.

CT infusion scanning for the detection of cerebral aneurysms

1989 ◽  
Vol 71 (2) ◽  
pp. 175-179 ◽  
Author(s):  
David W. Newell ◽  
Peter D. LeRoux ◽  
Ralph G. Dacey ◽  
Gary K. Stimac ◽  
H. Richard Winn
Keyword(s):  
Intracerebral Hemorrhage ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Cerebral Aneurysms ◽  
Spontaneous Intracerebral Hemorrhage ◽  
Content Type ◽  
Spontaneous Hemorrhage ◽  
Fine Print

✓ Computerized tomography (CT) infusion scanning can confirm the presence or absence of an aneurysm as a cause of spontaneous intracerebral hemorrhage. Eight patients who presented with spontaneous hemorrhage were examined using this technique. In five patients the CT scan showed an aneurysm which was later confirmed by angiography or surgery; angiography confirmed the absence of an aneurysm in the remaining three patients. This method is an easy effective way to detect whether an aneurysm is the cause of spontaneous intracerebral hemorrhage.

Cerebral cysticercosis with aqueductal obstruction

1980 ◽  
Vol 53 (2) ◽  
pp. 252-255 ◽  
Author(s):  
Tung Pui Poon ◽  
Edward J. Arida ◽  
Wolodymyr P. Tyschenko
Keyword(s):  
Intracranial Hypertension ◽  
Brain Stem ◽  
Normal Pressure Hydrocephalus ◽  
Signs And Symptoms ◽  
Normal Pressure ◽  
Content Type ◽  
Neurological Signs ◽  
Cerebral Cysticercosis ◽  
The Brain ◽  
Fine Print

✓ The authors report a case of cerebral cysticercosis which presented with generalized nonspecific neurological signs and symptoms attributed to acute aqueductal obstruction, with concomitant intracranial hypertension. These were characteristic intracranial calcifications along with angiographically demonstrated signs of hydrocephalus. Contrast encephalography clearly demonstrated aqueductal obstruction. Pathologically, the aqueductal obstruction was shown to be due to parasitic invasion of the brain stem with compression of the aqueduct. The presence of typical intracranial calcification in conjunction with either obstructive or normal-pressure hydrocephalus should alert the observer to the possibility of cerebral cysticercosis.

Obstructive hydrocephalus caused by an abnormal vein in the aqueduct

1991 ◽  
Vol 75 (6) ◽  
pp. 960-962 ◽  
Author(s):  
Akira Watanabe ◽  
Ryoji Ishii ◽  
Masaki Kamada ◽  
Yasuo Suzuki ◽  
Kazuhiro Hirano ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Computerized Tomography ◽  
Ventriculoperitoneal Shunt ◽  
Obstructive Hydrocephalus ◽  
Aqueductal Stenosis ◽  
Resonance Imaging ◽  
Content Type ◽  
Fine Print

✓ A case is reported of aqueductal stenosis caused by an abnormal draining vein and demonstrated by computerized tomography and magnetic resonance imaging. Placement of a ventriculoperitoneal shunt relieved the patient's progressive headaches.

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