Changes in callosal angle and evans’ index after placing a lumboperitoneal shunt in patients with idiopathic normal pressure hydrocephalus

2021 ◽  
Author(s):  
Mustafa Cemil Kilinc ◽  
Gokmen Kahilogullari ◽  
Ihsan Dogan ◽  
Baran Can Alpergin ◽  
Macit Terzi ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Lumboperitoneal Shunt ◽  
Evans Index

scholarly journals Diagnostic Performance of Glymphatic System Evaluation Using Diffusion Tensor Imaging in Idiopathic Normal Pressure Hydrocephalus and Mimickers

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Hajime Yokota ◽  
Arvind Vijayasarathi ◽  
Milos Cekic ◽  
Yoko Hirata ◽  
Michael Linetsky ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Normal Pressure Hydrocephalus ◽  
Diagnostic Performance ◽  
Roc Analysis ◽  
Diffusion Tensor ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Glymphatic System ◽  
Evans Index ◽  
Diffusion Tensor Imaging Dti

Purpose. To investigate the pathological change of the glymphatic system in idiopathic normal pressure hydrocephalus (iNPH) using diffusion tensor imaging (DTI) analysis. Materials and Methods. 24 right-handed patients were referred to our hydrocephalus clinic for assessment of ventriculomegaly and gait impairment. 12 of 24 were diagnosed as pseudo-iNPH (piNPH) based on assessment by a neurologist. Diffusivity maps in the direction of the x-axis (right-to-left) (Dx), y-axis (anterior-to-posterior) (Dy), and z-axis (inferior-to-superior) (Dz) were computed. The diffusion map was coregistered to International Consortium for Brain Mapping (ICBM) DTI-81 atlas. The analysis along the perivascular space (ALPS) index was defined as mean (Dxpro, Dypro)/mean (Dypro, Dzasc), where Dxpro and Dxasc are Dx values in the projection and association fiber areas, respectively. Evans index and callosal angle were also assessed on each case. Results. ALPS indexes of the control, piNPH, and iNPH cases were 1.18 ± 0.08, 1.08 ± 0.03, and 0.94 ± 0.06, respectively, and there were significant differences among the groups (control vs. piNPH, P = 0.003; control vs. iNPH P < 0.001; piNPH vs. iNPH, P < 0.001). Area under curve (AUC) was 0.92, 1.00, and 1.00 on control vs. piNPH, control vs. iNPH, and piNPH vs. iNPH on ROC analysis. Between piNPH and NPH, ALPS index has higher diagnostic performance than Evans index and callosal angle (AUC = 1.00 vs. 0.84, P = 0.028; AUC = 1.00 vs. 0.74, P = 0.016). Conclusion. Atlas-based ALPS index using the DTI method differentiated among iNPH, piNPH, and controls clearly.

scholarly journals Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Mitsuaki Ishii ◽  
Toshio Kawamata ◽  
Ichiro Akiguchi ◽  
Hideo Yagi ◽  
Yuko Watanabe ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Postural Stability ◽  
Rating Scale ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Stepwise Multiple Regression ◽  
Ct Findings ◽  
Before And After ◽  
Evans Index ◽  
Disease Rating

We aimed to investigate the characteristics of Parkinsonian features assessed by the unified Parkinson's disease rating scale (UPDRS) and determine their correlations with the computed tomography (CT) findings in patients with idiopathic normal pressure hydrocephalus (iNPH). The total score and the scores for arising from chair, gait, postural stability, and body hypokinesia in the motor examination section of UPDRS were significantly improved after shunt operations. Stepwise multiple regression analysis revealed that postural stability was the determinant of the gait domain score of the iNPH grading scale. The canonical correlation analysis between the CT findings and the shunt-responsive Parkinsonian features indicated that Evans index rather than midbrain diameters had a large influence on the postural stability. Thus, the pathophysiology of postural instability as a cardinal feature of gait disturbance may be associated with impaired frontal projections close to the frontal horns of the lateral ventricles in the iNPH patients.

WP1-10 Prevalence of normal pressure hydrocephalus in falls clinic patients

2019 ◽  
Vol 90 (3) ◽  
pp. e4.2-e4 ◽  
Author(s):  
S Sennik ◽  
C Craven ◽  
L D’Antona ◽  
H Asif ◽  
W Dawes ◽  
...  
Keyword(s):  
General Hospital ◽  
Normal Pressure Hydrocephalus ◽  
Normal Population ◽  
District General Hospital ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
List Type ◽  
Ventricular Enlargement ◽  
Evans Index ◽  
One Year

ObjectivesPatients with idiopathic Normal Pressure Hydrocephalus (iNPH) present with Hakim Adams triad and radiological findings suggestive of iNPH. We compare the presence of clinical and radiological signs of iNPH present in patients presenting to falls clinic at a District General Hospital with the general population.DesignRetrospective analysis of patients referred to falls clinic (January 2017 to December 2017) and interpretation of CT or MRI head imaging with Evans index.SubjectsFalls clinic patients presenting to a District General Hospital outpatient clinic.MethodsRetrospective cohort of patients admitted to a single District General Hospital with falls and recent CT or MRI head. An Evans Index above 0.35 was used as an indicator of hydrocephalic ventricular enlargement.Results371 patients were seen in one year. 216 had previous CT or MRI head. 6.75% of all patients seen in falls clinic (11.6% who have had brain imaging) have hydrocephalic ventricular enlargement. This is compared to 4.5% in a study of patients aged 70 and over in a normal population.1ConclusionsPatients seen in Falls clinic have an increased probability of having radiological signs consistent with idiopathic normal pressure hydrocephalus.ReferenceJaraj D, Marlow T, Jensen C, Skoog I, Wikkelso C. Prevalence of idiopathic normal-pressure hydrocephalus. Neurology2014April 22;82(16):1449–1454.

scholarly journals The splenial angle: a novel radiological index for idiopathic normal pressure hydrocephalus

2021 ◽  
Author(s):  
Ling Ling Chan ◽  
Robert Chen ◽  
Huihua Li ◽  
Amanda J. Y. Lee ◽  
Wei Ying Go ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Parkinson’S Disease ◽  
Alzheimer's Disease ◽  
Fractional Anisotropy ◽  
Normal Pressure Hydrocephalus ◽  
Multivariable Analysis ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Evans Index

Abstract Objectives To evaluate the utility of the splenial angle (SA), an axial angular index of lateral ventriculomegaly measured on diffusion tensor MRI color fractional anisotropy maps, in differentiating NPH from Alzheimer’s disease (AD), Parkinson’s disease (PD), and healthy controls (HC), and post-shunt changes in NPH, compared to Evans’ index and callosal angle. Methods Evans’ index, callosal angle, and SA were measured on brain MRI of 76 subjects comprising equal numbers of age- and sex-matched subjects from each cohort of NPH, AD, PD, and HC by two raters. Receiver operating characteristics (ROC) and multivariable analysis were used to assess the screening performance of each measure in differentiating and predicting NPH from non-NPH groups respectively. Temporal changes in the measures on 1-year follow-up MRI in 11 NPH patients (with or without ventriculoperitoneal shunting) were also assessed. Results Inter-rater and intra-rater reliability were excellent for all measurements (intraclass correlation coefficients > 0.9). Pairwise comparison showed that SA was statistically different between NPH and AD/PD/HC subjects (p < 0.0001). SA performed the best in predicting NPH, with an area under the ROC curve of > 0.98, and was the only measure left in the final model of the multivariable analysis. Significant (p < 0.01) change in SA was seen at follow-up MRI of NPH patients who were shunted compared to those who were not. Conclusions The SA is readily measured on axial DTI color FA maps compared to the callosal angle and shows superior performance differentiating NPH from neurodegenerative disorders and sensitivity to ventricular changes in NPH after surgical intervention. Key Points • The splenial angle is a novel simple angular radiological index proposed for idiopathic normal pressure hydrocephalus, measured in the ubiquitous axial plane on DTI color fractional anisotropy maps. • The splenial angle quantitates the compression and stretching of the posterior callosal commissural fibers alongside the distended lateral ventricles in idiopathic normal pressure hydrocephalus (NPH) using tools readily accessible in clinical practice and shows excellent test-retest reliability. • Splenial angle outperforms Evans’ index and callosal angle in predicting NPH from healthy, Parkinson’s disease, and Alzheimer’s disease subjects on ROC analysis with an area under the curve of > 0.98 and is sensitive to morphological ventricular changes in NPH patients after ventricular shunting.

scholarly journals Timed up and go test at tap test and shunt surgery in idiopathic normal pressure hydrocephalus

2017 ◽  
Vol 7 (2) ◽  
pp. 98-108 ◽  
Author(s):  
Shigeki Yamada ◽  
Masatsune Ishikawa ◽  
Masakazu Miyajima ◽  
Madoka Nakajima ◽  
Masamichi Atsuchi ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Ventriculoperitoneal Shunt ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Timed Up And Go ◽  
Tap Test ◽  
Lumboperitoneal Shunt ◽  
Shunt Implantation ◽  
Percent Improvement

AbstractBackground:The 3-meter Timed Up and Go test (TUG) is a reliable quantitative test for assessment of gait and balance. We aimed to establish an optimal threshold of TUG at the tap test for predicting outcomes 12 months after shunt surgery in patients with idiopathic normal pressure hydrocephalus (iNPH).Methods:The TUG was measured in a total of 151 patients with possible iNPH before and after a tap test and 12 months after shunt surgery. Among them, 81 patients underwent ventriculoperitoneal shunt implantation (SINPHONI) and 70 underwent lumboperitoneal shunt implantation (SINPHONI-2). The areas under the curve (AUCs), sensitivities, and specificities for predicting shunt effectiveness were assessed.Results:The simple differences of time on TUG at the tap test were significantly more accurate for predicting shunt effectiveness than percent improvement of time. The highest AUC for the synchronized moving cutoff point of TUG time was 0.81 (sensitivity 81.0%; specificity 81.6%) at the threshold of 5 seconds in the SINPHONI-2. For predicting improvements of ≥10 seconds 12 months after lumboperitoneal shunt implantation, the AUC was 0.90, and the sensitivity and specificity at the threshold of 5.6 seconds were 83.3% and 81.0%. Only for patients with a <5-second improvement at the tap test, ventriculoperitoneal shunt implantation conveyed significantly better improvements in TUG time 12 months after surgery than lumboperitoneal shunt implantation.Conclusions:An improvement of 5 seconds was a useful threshold of TUG time at the tap test for predicting a ≥10-second improvement 12 months after shunt surgery, rather than the percent improvement of TUG time.

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