Correlation between decreased ventricular size and positive clinical outcome following shunt placement in patients with normal-pressure hydrocephalus

2004 ◽  
Vol 100 (6) ◽  
pp. 1036-1040 ◽  
Author(s):  
Ullrich Meier ◽  
Sven Mutze
Keyword(s):  
Clinical Outcome ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Communicating Hydrocephalus ◽  
Ventricular Size ◽  
Content Type ◽  
Shunt Placement ◽  
Postoperative Change ◽  
Fine Print

Object. It is well known that in patients with communicating hydrocephalus or normal-pressure hydrocephalus (NPH), ventricular size decreases following implantation of shunts with differential pressure valves. The aim of this study was to determine whether ventricular size correlates with a positive clinical outcome following shunt placement. Methods. Hydrostatic valves (dual-switch valves) were implanted in 80 patients with NPH at Unfallkrankenhaus, Berlin, between September 1997 and January 2002. One year postoperatively, these patients underwent computerized tomography scanning, and their ventricular size was ascertained using the Evans Index. Among 80% of the patients who showed no postoperative change in ventricular volume, 59% nonetheless had good to excellent clinical improvements, 17% satisfactory improvement, and 24% no improvement. Furthermore, a moderate reduction in ventricular size was observed in 14% of patients in this cohort. Among these, 36% experienced good to excellent clinical improvements, 28% satisfactory improvement, and 36% unsatisfactory improvement. A marked reduction in ventricular size was observed in 6% of the patients. Of this latter group, 60% demonstrated good to excellent outcomes, whereas 40% had unsatisfactory outcomes. Conclusions. Favorable outcomes following the implantation of a hydrostatic shunt in patients with NPH did not correlate with decreased ventricular volume 1 year after surgery. In fact, better clinical outcomes were observed in patients with little or no alteration in ventricular size, compared with those in patients with a marked decrease in ventricular size. A postoperative change in ventricular volume should be assessed differently in patients with NPH compared with those suffering from hypertensive hydrocephalus.

Volumetric measurements in the detection of reduced ventricular volume in patients with normal-pressure hydrocephalus whose clinical condition improved after ventriculoperitoneal shunt placement

2002 ◽  
Vol 97 (1) ◽  
pp. 73-79 ◽  
Author(s):  
Richard C. Anderson ◽  
Jessica J. Grant ◽  
Robert de la Paz ◽  
Steven Frucht ◽  
Robert R. Goodman
Keyword(s):  
Clinical Improvement ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Ventricular Volume ◽  
Ventricular Size ◽  
Content Type ◽  
Shunt Placement ◽  
Lateral Ventricles ◽  
Fine Print ◽  
Volumetric Measurements

Object. The syndrome of normal-pressure hydrocephalus (NPH) refers to the clinical triad of gait disturbance, dementia, and urinary incontinence in association with idiopathic ventriculomegaly and normal intracranial pressure. Ventriculoperitoneal (VP) shunt placement often yields significant clinical improvements, sometimes without apparent reduction of ventricular size. The authors hypothesized that careful volumetric measurements would show a decrease in ventricular volume in these patients. Methods. Twenty consecutive patients with NPH underwent placement of VP shunts equipped with programmable valves. In 11 patients pre- and postoperative neuroimaging was performed, which allowed volumetric analysis. Volumetric measurements of the lateral ventricles were calculated in triplicate by National Institutes of Health image-processing software to assess standard computerized tomography (CT) scans (eight patients) or magnetic resonance (MR) images (three patients) obtained before and after shunt placement. Ventricular volumes were also assessed by an independent neuroradiologist. Postoperative studies were performed at a time of clinical improvement, between 1 and 9 months postsurgery (mean 5 months). Preoperative and postoperative Unified Parkinson's Disease Rating Scale evaluations were performed in four patients. Significant clinical improvement occurred in all patients after shunt placement (mean follow-up period 17.5 months). Although 10 (91%) of 11 patients demonstrated a calculable decrease in volume in the lateral ventricles (mean decrease 39%), formal interpretation of neuroimages indicated a definite decrease in lateral ventricular volume in only three (27%) of 11 patients. Conclusions. Volumetric measurements obtained to compare preoperative and postoperative CT or MR studies obtained in patients with NPH in whom clinical improvement was seen after shunt placement surgery show a demonstrable decrease in ventricular size. Volumetric measurements may be helpful in clinical assessment postoperatively and in guiding programmable valve pressure settings.

Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease

1999 ◽  
Vol 90 (2) ◽  
pp. 221-226 ◽  
Author(s):  
Agnita J. W. Boon ◽  
Joseph T. J. Tans ◽  
Ernst J. Delwel ◽  
Saskia M. Egeler-Peerdeman ◽  
Patrick W. Hanlo ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Cerebrovascular Disease ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Content Type ◽  
Shunt Placement ◽  
History Of ◽  
Intent To Treat ◽  
Fine Print

Object. This study was conducted to determine the prevalence of cerebrovascular disease and its risk factors among patients with normal-pressure hydrocephalus (NPH) and to assess the influence of these factors on the outcome of shunt placement.Methods. A cohort of 101 patients with NPH underwent shunt placement and was followed for 1 year. Gait disturbance and dementia were quantified using an NPH scale and handicap was determined using a modified Rankin scale (mRS). Primary outcome measures consisted of the differences between preoperative and last NPH scale and mRS scores. The presence of risk factors such as hypertension, diabetes mellitus, cardiac disease, peripheral vascular disease, male gender, and advancing age was recorded. Cerebrovascular disease was defined as a history of stroke or a computerized tomography (CT) scan revealing infarcts or moderate-to-severe white matter hypodense lesions.The prevalence of risk factors for cerebrovascular disease was higher in the 45 patients with cerebrovascular disease than the 56 without it. Risk factors did not influence outcome after shunt placement. Intent-to-treat analysis revealed that the mean improvement in the various scales was significantly less for patients with a history of stroke (14 patients), CT scans revealing infarctions (13), or white matter hypodense lesions (32 patients) than for those without cerebrovascular disease. The proportion of patients who responded to shunt placement was also significantly lower among patients with than those without cerebrovascular disease (p = 0.02).Conclusions. The authors identified a subgroup of patients with NPH and cerebrovascular disease who showed disappointing results after shunt placement. Cerebrovascular disease was an important predictor of poor outcome.

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.

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.

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.

Posttraumatic ventriculomegaly: hydrocephalus or atrophy? A new approach for diagnosis using CSF dynamics

1996 ◽  
Vol 85 (6) ◽  
pp. 1026-1035 ◽  
Author(s):  
Anthony Marmarou ◽  
Montasser A. Abd-Elfattah Foda ◽  
Kuniaki Bandoh ◽  
Masaaki Yoshihara ◽  
Takuji Yamamoto ◽  
...  
Keyword(s):  
Head Injury ◽  
Normal Pressure ◽  
Volume Index ◽  
Injection Technique ◽  
Benign Intracranial Hypertension ◽  
Ventricular Size ◽  
Csf Dynamics ◽  
Content Type ◽  
Group 5 ◽  
Fine Print

✓ Cerebrospinal fluid (CSF) dynamics were correlated to the changes in ventricular size during the first 3 months posttrauma in patients with severe head injury (Glasgow Coma Scale score ≤ 8, 75 patients) to distinguish between atrophy and hydrocephalus as the two possible causes of posttraumatic ventriculomegaly. Using the bolus injection technique, the baseline intracranial pressure (ICP), pressure volume index, and resistance for CSF absorption (R0) provided a threedimensional profile of CSF dynamics that was correlated with ventricular size and Glasgow Outcome Scale (GOS) score at 3, 6, and 12 months posttrauma. Patients were separated into five different groups based on changes in ventricular size, presence of atrophy, and CSF dynamics. Group 1 (normal group, 41.3%) demonstrated normal ventricular size and normal ICP. Group 2 (benign intracranial hypertension group, 14.7%) showed normal ventricular size and elevated ICP. Group × (atrophy group, 24%) displayed ventriculomegaly, normal ICP, and normal R0. Group 4 (normal-pressure hydrocephalus group, 9.3%) had ventriculomegaly, normal ICP, and high R0. Group 5 (high-pressure hydrocephalus group, 10.7%) showed ventriculomegaly and elevated ICP with or without high R0. The GOS score in the nonhydrocephalic groups (Groups 1, 2, and 3) was better than in the hydrocephalic groups (Groups 4 and 5). It is concluded from these results that 44% of head injury survivors may develop posttraumatic ventriculomegaly. Posttraumatic hydrocephalus, as identified by abnormal CSF dynamics, was diagnosed in 20% of survivors and their outcome was significantly worse. This study demonstrates the importance of using CSF dynamics as an aid in diagnosis of posttraumatic hydrocephalus and identifying those patients who may benefit from shunt placement.

scholarly journals B-32 The Use of Repeat Neuropsychological Assessment to Guide Treatment of Possible Normal Pressure Hydrocephalus in a Complex Case

2019 ◽  
Vol 34 (6) ◽  
pp. 978-978
Author(s):  
S Schneider ◽  
E Weiss ◽  
R Facchini ◽  
S Shagalow ◽  
S Jacobs ◽  
...  
Keyword(s):  
Neuropsychological Assessment ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Complex Case ◽  
Communicating Hydrocephalus ◽  
Shunt Placement ◽  
Mild Improvement ◽  
Inpatient Settings ◽  
Outpatient Settings

Abstract Objective Normal Pressure Hydrocephalus (NPH) is a condition that is characterized by the buildup of cerebrospinal fluid (CSF) in the brain that can cause urinary incontinence, gait disturbance, and cognitive impairment. NPH can be progressive but may be managed or reversed with shunt placement. External Lumbar Drainage (ELD) trials in determining if shunt placement is appropriate are common, but the role of repeat neuropsychological assessments during ELD procedures is not well documented in the literature. Repeat, pre-, peri and post- ELD trial, assessment in a complex case of possible NPH is presented. Method 33-year-old Hispanic English-Speaking female with cognitive/memory complaints following intraventricular hemorrhage (IVH) secondary to vasculopathy was initially seen for post IVH outpatient neuropsychological evaluation. MRI showed enlarged ventricles/communicating hydrocephalus and workup for NPH was initiated. Repeat inpatient evaluations were completed during the ELD trial, with annual outpatient neuropsychological follow-up. Results Gait evaluation was inconclusive. Inpatient testing demonstrated minor improvement immediately following ELD opening, but performances were variable across the 4 days of re-evaluation. Shunt placement was rejected due to neuropsychological findings. Outpatient follow-up of patient over several years has demonstrated mild improvement and not evidence of cognitive decline since ELD trial. Conclusions Assessment of cognitive functioning in outpatient and inpatient settings before, during, and for several years following ELD testing was beneficial to ascertain the decision not to place a shunt. Repeat neuropsychological assessment in inpatient and outpatient settings provided crucial information for guiding treatment decisions.

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