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Normal pressure hydrocephalus and cisternography

John J Halperin, Roger Kurlan, Jason M Schwalb, Michael D Cusimano, Gary Gronseth, David Gloss
OBJECTIVE: We evaluated evidence for utility of shunting in idiopathic normal pressure hydrocephalus (iNPH) and for predictors of shunting effectiveness. METHODS: We identified and classified relevant published studies according to 2004 and 2011 American Academy of Neurology methodology. RESULTS: Of 21 articles, we identified 3 Class I articles. CONCLUSIONS: Shunting is possibly effective in iNPH (96% chance subjective improvement, 83% chance improvement on timed walk test at 6 months) (3 Class III)...
December 8, 2015: Neurology
Daniel P Thut, Alena Kreychman, J Antonio Obando
Although new MR imaging techniques can provide high-resolution information on CSF dynamics and are not associated with ionizing radiation, SPECT/CT cisternography is a valuable alternative for those with contraindications to MR imaging. SPECT/CT cisternography combines functional and anatomic imaging to provide accurate and detailed information on CSF distribution to be used in conjunction with clinical findings for the diagnosis and evaluation of NPH, as illustrated in this case report.
March 2014: Journal of Nuclear Medicine Technology
Hiroaki Kazui, Etsuro Mori, Shingo Ohkawa, Takaharu Okada, Takeo Kondo, Ryuji Sakakibara, Osamu Ueki, Yoshiyuki Nishio, Kazunari Ishii, Tetsuro Kawaguchi, Masatsune Ishikawa, Masatoshi Takeda
We identified factors that predict the disappearance of the triad of symptoms (gait disturbance, cognitive impairment and urinary incontinence) of idiopathic normal pressure hydrocephalus (iNPH) following shunt surgery in this study. We classified 71 patients with iNPH into those whose objective symptoms disappeared (disappearance group) or remained (residual group), for each of the triad symptoms 12 months after shunt surgery. Logistic regression analyses were used to identify the predictors of the disappearance of symptoms among 10 variables before shunt surgery (e...
May 15, 2013: Journal of the Neurological Sciences
Tetsuro Kawaguchi, Yoshihumi Hirata, Masahiko Bundo, Takeshi Kondo, Hisayuki Owaki, Susumu Ito, Masaaki Hashimoto, Masatsune Ishikawa
BACKGROUND: We prospectively evaluate the role of computerized tomographic cisternography (CTC) in idiopathic normal pressure hydrocephalus (iNPH). METHODS: The cerebrospinal fluid kinetics of 70 patients who passed the entry criteria for the Study of iNPH on Neurological Improvement (SINPHONI) and underwent insertion of a shunt were studied. RESULTS: Stasis of the contrast medium at the lateral ventricles over 24 h (positive ventricular stasis) was observed in 60 patients and at the Sylvian fissure or parietal sulci over 48 h (positive surface stasis) in 59 patients...
October 2011: Acta Neurochirurgica
Oktay Algin, Bahattin Hakyemez, Gökhan Ocakoğlu, Müfit Parlak
PURPOSE: The aim of this study was to evaluate the efficiency of MR cisternography (MRC) in the diagnosis of idiopathic normal-pressure hydrocephalus (INPH) and in the prediction of the response to shunt treatment. MATERIALS AND METHODS: Thirty-six patients with the diagnosis of "probable INPH" were included in the study group and 15 asymptomatic age-matched individuals were included in the control group. Pre-contrast T1-weighted (T1W) imaging was followed by intrathecal administration of 1 ml gadopentetate dimeglumine...
June 2011: Diagnostic and Interventional Radiology: Official Journal of the Turkish Society of Radiology
Hak Young Rhee, Dae Jean Jo, Jun-Hwan Lee, Sung Hun Kim
We describe a patient with an intraspinal paraganglioma who presented with normal pressure hydrocephalus. A 70-year-old man presented with a 6-month history of gait disturbance and cognitive dysfunction. Computed tomography of the brain and magnetic resonance imaging of the spine revealed communicating hydrocephalus and a spinal mass at the T12-L1 level which proved to be a paraganglioma of the filum terminale. Radioisotope cisternography revealed a severe delay in cerebrospinal fluid circulation. Symptoms related to communicating hydrocephalus resolved after tumor resection...
September 2010: Clinical Neurology and Neurosurgery
Seiichiro Sugimoto, Akiko Sugimoto, Kazuko Saita, Masahiko Kishi, Keiichi Shioya, Toshinobu Higa
A 67-year-old woman developed gait disturbance, dysarthria, cognitive impairment and incontinence at age 65, and became bedridden. She showed mutism, stupor and lower limb spasticity. Cranial CT and MRI revealed marked ventricular enlargement and a cerebellopontine angle tumor. CSF study showed normal pressure (125 mmH2O) and elevated protein (143 mg/dl). Radionuclide cisternography showed redistribution of radionuclide to the ventricles and intraventricular residual radionuclide after 72 hours, which allowed a diagnosis of normal pressure hydrocephalus...
August 2008: Rinshō Shinkeigaku, Clinical Neurology
Metin Halaç, Sait Albayram, Elvan Ceyhan, Harun Ozer, Ismail Dogan, Sait Sager, Ilhami Uslu
Spontaneous intracranial hypotension (SIH) is characterized by severe postural headache and low cerebrospinal fluid (CSF) pressure. Radionuclide cisternography (RC) is of some value in diagnosing CSF leakage causing SIH. However, the sensitivity of RC is too low to demonstrate the site of leakage. In these cases, the early appearance of the radioactivity in the urinary bladder has also been used as an indirect finding in the diagnosis of SIH. The aim of this study was to evaluate the diagnostic reliability of early urinary bladder activity as an indirect sign of SIH...
November 2007: Clinical Nuclear Medicine
K Kilic, A Czorny, J Auque, Z Berkman
We studied retrospectively the effectiveness of the repeated lumbar CSF tap test (RTT), lumbar external CSF drainage (LED) and radioisotope cisternography (RIC) in predicting the outcome of shunt surgery, as well as the diagnostic and prognostic value of periventricular hyperintensity (PVH) and of the classic clinical triad in normal pressure hydrocephalus. Two hundred and seventy patients were referred to the Departments of Neurosurgery, in Nancy, France and in Istanbul, Turkey. The decision to perform surgery was based on the clinical presentation (all patients had at least two symptoms of the classic clinical triad), neuroimaging examinations and the results of the RTT (taps were performed on three consecutive days and at each tap a minimum of 30 to 40 cc of CSF was removed), the LED (drainage was performed for 3 days and the volume of CSF drained daily was a minimum of 150 to 250 cc) or the RIC...
August 2007: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Chih-Yang Liu, Chuen-Der Kao, Jen-Tse Chen, Yu-Shu Yeh, Zin-An Wu, Kwong-Kum Liao
A 68-year-old man developed progressive four-limb weakness and areflexia 17 days after an influenza vaccination. He was diagnosed with Guillain-Barre syndrome (GBS), and remained ventilator dependent and bed-bound for 3 months, despite plasmapheresis and immunoglobulin infusion. However, cognitive impairment, excessive daytime sleepiness, and motor disability were still present, even when he was no longer ventilator dependent. Brain computerized tomography scan and isotope cisternography was consistent with normal pressure hydrocephalus...
October 2006: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Miwako Takahashi, Toshimitsu Momose, Masashi Kameyama, Shinji Mizuno, Yoshitaka Kumakura, Kuni Ohtomo
UNLABELLED: Radionuclide cisternography is an indispensable examination to detect cerebrospinal fluid (CSF) leakage in patients suspected of having spontaneous intracranial hypotension (SIH). However, it sometimes fails to demonstrate the site of CSF leakage, and in such cases, early bladder visualization is utilized for the diagnosis of SIH as an indirect finding. The aim of this work is to improve the diagnostic ability of radionuclide cisternography and to reevaluate the reliability of early bladder visualization as an indirect finding of CSF leakage...
June 2005: Annals of Nuclear Medicine
Daniel Sigg, Ronald Rich, Sean Ashby, Bradley Jabour, Edwin Glass
An 81-year-old man with a history of ventriculoperitoneal (V-P) shunt placement for symptomatic normal pressure hydrocephalus presented with recurrence of confusion and gait disturbance. Radionuclide cisternography demonstrated loculation of In-111 DTPA in the abdominal wall. A soft tissue mass palpated at the location of tracer accumulation was confirmed to be extraperitoneal pooling of fluid at the site of coiling of the distal shunt tip. After surgical revision, with repositioning of the distal tube in the peritoneal cavity, the patient's symptoms promptly improved...
August 2005: Clinical Nuclear Medicine
Katalin Borbély
The most common problem addressed by dynamic radionuclide imaging of cerebrospinal fluid (CSF) abnormalities is differentiating patients with normal-pressure hydrocephalus (NPH) from those with other forms of degenerative brain disorder who would clearly not benefit from surgical treatment by ventricular shunting. Radionuclide cisternography (RC) SPECT and regional cerebral blood flow (rCBF) SPECT are critically important for the diagnosis and therapy management of patients with chronic hydrocephalus. However, radionuclide imaging is helpful not only in identifying patients with NPH showing improvement after shunting...
September 20, 2004: Ideggyógyászati Szemle
Karol Chmielowski, Jan Krzysztof Podgórski, Paweł Twarkowski, Jacek Pietrzykowski, Norbert Szaluś
An overview of significant research results of the last four decades as well as the author's own experience have served as a basis for the presentation of the radioisotope method and the radiopharmaceuticals in the diagnostics of normal pressure hydrocephalus (NPH). Also the physiology of the formation of PM-R its flow and absorption have shortly been discussed. Hydrocephalus is a major clinical, diagnostic and therapeutical problem. In the initial diagnosis of that pathology, methods like CT and MRI play an important role, which has also been the subject of this article...
June 2004: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
J K Krauss, B Halve
BACKGROUND: There is no agreement on the best diagnostic criteria for selecting patients with normal pressure hydrocephalus (NPH) for CSF shunting. The primary objective of the present study was to provide a contemporary survey on diagnostic algorithms and therapeutic decision-making in clinical practice. The secondary objective was to estimate the incidence of NPH. METHOD: Standardized questionnaires with sections on the incidence of NPH and the frequency of shunting, evaluation of clinical symptoms, and signs, diagnostic studies, therapeutic decision-making and operative techniques, postoperative outcome and complications, and the profiles of different centers, were sent to 82 neurosurgical centers in Germany known to participate in the care of patients with NPH...
April 2004: Acta Neurochirurgica
Kenichi Nishiyama, Hiroshi Mori, Ryuichi Tanaka
OBJECT: The aim of this study was to analyze physiological changes in cerebrospinal fluid (CSF) dynamics following endoscopic third ventriculostomy (ETV) for shunt-dependent noncommunicating hydrocephalus. METHODS: . Clinical data obtained in 15 patients treated with ETV for shunt malfunction were analyzed. Magnetic resonance imaging studies demonstrated the obstruction of the ventricular system preoperatively. After ETV, the existing shunt system was removed and a continuous extraventricular drain, set at 30 cm H2O in height, was installed to measure daily amounts of CSF outflow...
May 2003: Journal of Neurosurgery
K Mori
OBJECT: A cooperative study was undertaken to identify factors that could be used to predict a favorable outcome after extracranial cerebrospinal fluid (CSF) diversion (shunting) in patients with suspected idiopathic normal-pressure hydrocephalus (NPH). METHODS: Questionnaires concerning patients with suspected idiopathic NPH were sent to 14 members of the Committee for Scientific Research on Intractable Hydrocephalus, sponsored by the Ministry of Health and Welfare of Japan...
December 2001: Journal of Neurosurgery
T Takeuchi, E Kasahara, M Iwasaki
PURPOSE: To clarify clinical characteristics of atypical idiopathic normal pressure hydrocephalus (AINPH) and indications for shunt operations. SUBJECTS AND METHODS: Subjects examined in the present study included 65 patients who satisfied the following 4 diagnostic criteria of AINPH and underwent V.P shunt with Medos type shunt system; set pressure: epidural standard pressure x 13.6 - 20 mmH2O (omission of a figure in the first place). The diagnostic criteria were: 1) no apparent history of intra- or extra-cranial disease; 2) dementia was present as a main complaint; 3) the presence of moderate to severe cerebral atrophy and ventricular enlargement and PVL around the anterior horn on CT scans; 4) normal cerebrospinal pressure and filling of ventricles or subarachnoid space with contrast medium at 24 hours on cisternography...
June 2000: No Shinkei Geka. Neurological Surgery
T Takeuchi, E Kasahara, M Iwasaki, T Mima, K Mori
The indications for shunt operation in patients with idiopathic normal pressure hydrocephalus accompanied by brain atrophy (atypical idiopathic normal pressure hydrocephalus: AINPH) were investigated in 25 patients who satisfied the diagnostic criteria and underwent ventriculoperitoneal (VP) shunting. All patients had no apparent history of intra- or extracranial disease; dementia and gait disturbance as the main complaints; moderate to severe cerebral atrophy and ventricular dilatation and at least periventricular low density around the anterior horn on computed tomography; normal cerebrospinal fluid (CSF) pressure and filling of ventricles or cortical surface space with contrast medium at 24 hours on cisternography...
January 2000: Neurologia Medico-chirurgica
K Iino, M Yoshinari, H Yoshizumi, K Ichikawa, M Iwase, M Fujishima
The pathophysiology of brain damage induced by severe hypoglycemia is still unknown. We experienced a case with type 1 diabetes and recurrent severe hypoglycemic coma who showed a central brain atrophy and an abnormal cerebrospinal fluid flow, suggesting normal pressure hydrocephalus. Following this case, the CSF flow was studied using 111In-DTPA cisternography in six consecutive diabetic patients admitted for repeated episodes of hypoglycemic coma. All the patients showed the central brain atrophy on computed tomography and four of them (67%) had the ventricular reflux, with delayed clearance of 111In-DTPA...
February 2000: Diabetes Research and Clinical Practice
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