scholarly journals Susceptibility Weighted Imaging (SWI) Recommended as a Regular Magnetic Resonance Diagnosis for Vascular Dementia to Identify Independent Idiopathic Normal Pressure Hydrocephalus Before Ventriculo-Peritoneal (V-P) Shunt Treatment: A Case Study

2019 ◽  
Vol 10 ◽  
Author(s):  
Wen-Qing Huang ◽  
Hui-Nuan Lin ◽  
Qing Lin ◽  
Chi-Meng Tzeng
Keyword(s):  
Magnetic Resonance ◽  
Vascular Dementia ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Susceptibility Weighted Imaging ◽  
Shunt Treatment

IMPROVEMENT AFTER CEREBROSPINAL FLUID DRAINAGE IS RELATED TO LEVELS OF N-ACETYL-ASPARTATE IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 62 (1) ◽  
pp. 135-142 ◽  
Author(s):  
Niklas Lenfeldt ◽  
Jon Hauksson ◽  
Richard Birgander ◽  
Anders Eklund ◽  
Jan Malm
Keyword(s):  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Magnetic Resonance Spectroscopy ◽  
Normal Pressure Hydrocephalus ◽  
Proton Magnetic Resonance ◽  
Proton Magnetic Resonance Spectroscopy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Resonance Spectroscopy ◽  
Frontal White Matter

AbstractOBJECTIVEThis study uses proton magnetic resonance spectroscopy to investigate whether or not idiopathic normal pressure hydrocephalus is associated with neuronal dysfunction or ischemia in the brain. We evaluate whether or not proton magnetic resonance spectroscopy is useful for predicting improvement after long-term external lumbar drainage (ELD) of cerebrospinal fluid.METHODSEighteen patients (mean age, 73 yr; six women) and 10 matching controls participated. Participants were characterized by clinical features, cognitive and motor function tests, and cerebrospinal fluid hydrodynamics (patients only). Signals from N-acetyl-aspartate (NAA), choline, lactate, and creatine (Cr) (reference) were sampled once in controls and twice in patients (before and after a 3-day ELD of ∼ 135 mL/24 h) by proton magnetic resonance spectroscopy (1.5 T) from a 7.2-mL volume in the frontal white matter. Improvement was defined by video recordings of the patients' gait.RESULTSSixteen patients finished the ELD (one patient had meningitis, and one patient had catheter insertion failure) with a mean drain volume of 395 mL. NAA/Cr ratios were lower in patients than in controls (1.60 versus 1.84, P = 0.02), but no difference was found for choline/Cr ratios. No lactate signals were detected. Fifty percent of patients improved after ELD. They had higher NAA/Cr ratios than nonimproved patients (1.70 versus 1.51, P = 0.01), but no differences were found in choline/Cr ratios or drain volume.CONCLUSIONNAA/Cr ratios were decreased in patients with idiopathic normal pressure hydrocephalus, which is consistent with neuronal dysfunction in the frontal white matter. Improved patients had NAA/Cr ratios close to normal, indicating that enough functional neurons are a prerequisite for the cerebrospinal fluid drainage to have an effect.

scholarly journals Delayed clearance of cerebrospinal fluid tracer from choroid plexus in idiopathic normal pressure hydrocephalus

2019 ◽  
Vol 40 (9) ◽  
pp. 1849-1858 ◽  
Author(s):  
Per Kristian Eide ◽  
Lars Magnus Valnes ◽  
Are Hugo Pripp ◽  
Kent-Andre Mardal ◽  
Geir Ringstad
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cerebrospinal Fluid ◽  
Magnetic Resonance ◽  
Choroid Plexus ◽  
Normal Pressure Hydrocephalus ◽  
Amyloid Β ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Resonance Imaging ◽  
Lateral Ventricles

Impaired clearance of amyloid-β from choroid plexus is one proposed mechanism behind amyloid deposition in Alzheimer's disease. The present study examined whether clearance from choroid plexus of a cerebrospinal fluid tracer, serving as a surrogate marker of a metabolic waste product, is altered in idiopathic normal pressure hydrocephalus (iNPH), one sub-type of dementia. In a prospective observational study of close to healthy individuals (reference cohort; REF) and individuals with iNPH, we performed standardized T1-weighted magnetic resonance imaging scans before and through 24 h after intrathecal administration of a cerebrospinal fluid tracer (the magnetic resonance imaging contrast agent gadobutrol). Changes in normalized T1 signal within the choroid plexus and cerebrospinal fluid of lateral ventricles were quantified using FreeSurfer. The normalized T1 signal increased to maximum within choroid plexus and cerebrospinal fluid of lateral ventricles 6–9 h after intrathecal gadobutrol in both the REF and iNPH cohorts (enrichment phase). Peak difference in normalized T1 signals between REF and iNPH individuals occurred after 24 h (clearance phase). The results gave evidence for gadobutrol resorption from cerebrospinal fluid by choroid plexus, but with delay in iNPH patients. Whether choroid plexus has a role in iNPH pathogenesis in terms of delayed clearance of amyloid-β remains to be shown.

NEUROPSYCHOLOGICAL EFFECTS OF SHUNT TREATMENT IN IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Neurosurgery ◽  
2008 ◽  
Vol 63 (3) ◽  
pp. 527-536 ◽  
Author(s):  
Per Hellström ◽  
Mikael Edsbagge ◽  
Elisabeth Blomsterwall ◽  
Trevor Archer ◽  
Magnus Tisell ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Neuropsychological Tests ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Consecutive Series ◽  
Shunt Surgery ◽  
Healthy Individuals ◽  
Neuropsychological Effects ◽  
Wide Range ◽  
Shunt Treatment

ABSTRACT OBJECTIVE To prospectively evaluate the effects of shunting on the neuropsychological performance of patients with idiopathic normal pressure hydrocephalus (INPH), to compare their performance with that of healthy individuals, and to estimate the predictive utility of putatively important factors. METHODS A consecutive series of 47 patients with INPH underwent neurological, radiological, and neuropsychological examinations before and 3 months after shunt surgery. The same neuropsychological tests, measuring simple and target reaction times, dexterity, memory and learning, working memory, and aspects of executive functioning, were also administered to 159 healthy individuals. RESULTS Performance on all neuropsychological tests, except Simple Reaction Time and Digit Span, significantly improved after surgery, with more severe functional deficits showing greatest improvement. Age, education, duration, vascular comorbidity, sex, and onset symptom all failed to predict the neuropsychological effects of treatment. Despite improvement 3 months after shunt surgery, INPH patients were still outperformed by healthy individuals. CONCLUSION Most of the wide range of neuropsychological functions that are affected by INPH are markedly improved by shunt treatment, but not completely restored.

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