normal pressure hydrocephalus radiology

Notably, there was no significant difference in mean gray matter volumes between NPH and HC groups. Normal-pressure hydrocephalus (NPH), also called malresorptive hydrocephalus, is form of communicating hydrocephalus in which excess cerebrospinal fluid (CSF) occurs in the ventricles, and with normal or slightly elevated cerebrospinal fluid pressure. 30. Sandler MP, Coleman RE, Patton JA et-al. Demonstration of the obtained regions of interest is shown in Figure 2. Many neurodegenerative diseases with overlapping symptoms affect elderly patients, which makes radiologic differentiation difficult (9,10). Normal pressure hydrocephalus (NPH) is remarkable for two reasons: 1) it is one of the few treatable causes of dementia, and 2) neuroradiologists are usually involved in making the diagnosis. Ventricular volume differences across the three groups were statistically significant (F = 93.7; P < .0001). If the address matches an existing account you will receive an email with instructions to reset your password. Imaging appearances are nonspecific. From the Dept of Radiology, Brigham and Women’s Hospital, Boston, Mass (N.M.); Riverside Regional Medical Center, Newport News, Va (H.P. What do physicians know about normal pressure hydrocephalus and when did they know it? 2008;81 (1): 19-29. Table 2 shows the results of multivariate binary logistic regression models constructed for each reader separately to diagnose NPH (ie, a positive finding). Adachi M, Kawanami T, Ohshima F et-al. There is a general agreement that NPH is complex and underdiagnosed, and a detailed characterization of its severity is lacking (2). Note.—Data in parentheses are numerator and denominator. 14. We also plan to analyze volumetric measures of patients presumed to have NPH who did not respond to high-volume lumbar puncture or spinal drain procedures to identify imaging features that may predict response to cerebrospinal fluid removal. MRI features are in favor of normal pressure hydrocephalus "NPH" and supported by patient aqueduct showing accentuated CSF flow void signal within its lumen. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 10.4 Imaging 10.4.1 Modalities 10.4.1.1 Computed Tomography The slow enlargement of the ventricles means that the fluid pressure in the brain may not be as high as in other types of hydrocephalus. Mean volume of the hippocampus in patients with AD was less than mean volume of the hippocampus in HC and NPH groups (Tukey honest significant difference test, P < .01). (2018) European journal of neurology. Multivariable logistic regression models were used to predict NPH (27). This study compared the accuracy of traditional measures of NPH, namely CA and EI, with segmentation metrics for diagnosis. ; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, N.M., H.P., A.M.F., B.A.A., A.L., B.E.D., C.S., Y.S., O.G., H.R., A.E.G. Hurley RA, Bradley WG, Latifi HT et-al. 2008;29 (1): 1-3. All clinical evaluations performed after shunt were performed on average 10 months after surgery (range, 6–18 months). Hayhow B, Begic F, Evans A et-al. The patient on the left (a), reveals normal involution of the brain characterized by deepening of the sulci and prominence of the gyri together with a prominent ventricular system. However, CA and EI are not sufficient to accurately discriminate patients with AD from HC volunteers. Bradley WG, Scalzo D, Queralt J et-al. Radiology. Bradley WG (2015) CSF flow in the brain in the context of normal pressure hydrocephalus. Author contributions: Guarantors of integrity of entire study, N.M., B.A.A., A.L., A.E.G. The regression model that used volumetric predictors of gray matter and white matter was 94.3% accurate. Brean A, Eide PK. The combination of ventriculomegaly, Sylvian fissure widening, and crowding at the vertex has been termed disproportionately enlarged subarachnoid space hydrocephalus (DESH), reflecting disproportionality between the superior and inferior CSF spaces 1,23,27. ||P value corresponds to ventricular volume. ); Dept of Radiology, University of Maryland Medical Center, Baltimore, Md (Y.S. The periventricular white matter ischemic change has also been hypothesized to slow the flow of CSF through the extracellular spaces, resulting in a "back-pressure" effect, leading to ventricular enlargement. Normal-pressure hydrocephalus remains a controversial entity with often ambiguous imaging findings. The current larger patient sample confirms our previous work (11) with highly accurate three-way differential diagnosis that uses the volumetric model. In the normal conditions of compliance, P1 > P2 > P3. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. The most recent advance in shunt valve design is the development of adjustable or programmable valves. There was no overlap in remaining 70 reference patients (ie, patients without NPH). 236 patients studied, • 47 normal elderly patients • 115 patients with cognitive impairment including 46 with Alzheimer’s disease • 31 patients in whom NPH was suspected but ultimately excluded, • 43 patients with a final clinical diagnosis of NPH. The sensitivity and specificity of this cutoff were 71.3% (77 of 108) and 86.7% (182 of 210), respectively. The quantitative functional ambulation performance gait score showed a significant (P = .02) improvement from 71.1 ± 16.3 (standard deviation) before shunt to 80.3 ± 14.5 after shunt. VNT = ventricular volume. EI is a component of the NPH diagnostic criteria in both the United States (16) and Japan (14). American journal of neuroradiology. A classic neurological sign in NPH is magnetic gait, where the patients' feet appear to be magnetically attached to the floor. AIC = Akaike information criterion. This process took approximately 8 hours per case. Prevalence of probable idiopathic normal pressure hydrocephalus in a Norwegian population. Normal pressure hydrocephalus (NPH) is an abnormal buildup of cerebrospinal fluid (CSF) in the brain's ventricles, or cavities. Extensive demographics, family history, and medical history are available for all ADNI participants. Bradley WG Jr, Whittemore AR, Kortman KE, et al. Our results support this result. The sensitivity and specificity for this cutoff were 87.0% (94 of 108) and 89.5% (188 of 210), respectively. Yale J Biol Med. Normal Pressure Hydrocephalus. Analysis of variance was used to compare mean values of individual variables across study groups. These images show gray matter (in red), white matter (in yellow), ventricular (in blue), and hippocampal (in green) regions. 13. 2008;29 (1): 192-7. Volumetric assessments require more infrastructure and may take several hours to generate, but they further categorize patients with age-related comorbidities. ■ Segmentation metrics may be used as a secondary tool after CA and EI in equivocal cases for more resource intensive but more accurate distinction of NPH from AD or HC. (2014) AJNR. Cognitive recovery in idiopathic normal pressure hydrocephalus. A Picture Archiving and Communications in Medicine multiplanar reconstruction tool (Intellispace PACS Enterprise v4.4.516; Philips Healthcare, Amsterdam, the Netherlands) was used for three-dimensional reformatting. 9. normal pressure hydrocephalus radiology. Harrison's Principles of Internal Medicine: Cardinal manifestations and presentation of diseases. Average gray matter volume in AD was significantly lower than in NPH or HC volunteers (Tukey honest significant difference test, P < .01). 29. It is important to note that there are many causes of communicating hydrocephalus without elevated opening CSF pressures, such as trauma, prior subarachnoid hemorrhage, and meningitis. Criteria b and c are met by all ADNI participants. We then matched the AD and HC groups with the NPH group for sex and sample size.For the groups, we obtained 34 patients with AD and 36 HC volunteers. Normal-pressure hydrocephalus (NPH) is characterized by often incapacitating gait dysfunction, cognitive impairment, and urinary incontinence, with the presence of enlarged ventricles despite normal intracranial pressure (1). These measures were tested by using multivariable logistic regression models to determine which combination of metrics is most accurate in diagnosis. Figure 1: By using MPRAGE sequences, a coronal plane was obtained at the level of the posterior commissure from each observer’s best approximation (blue and red lines, left), with plane oriented 90° to anterior-posterior commissure line. Infection with tick borne Borrelia Burgdorferi (Lyme disease) can without treatment rarely develop into a chronic phase. Measures of white matter and hippocampus were not statistically significant predictors. Cerebral atrophy versus normal pressure hydrocephalus, Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus, Noninvasive biomarkers in normal pressure hydrocephalus: evidence for the role of neuroimaging, Analysis of movement through utilisation of clinical instrumentation, The validity of the GaitRite and the Functional Ambulation Performance scoring system in the analysis of Parkinson gait, Hydrocephalus as a cause of disturbances of gait in the elderly, Normal-pressure hydrocephalus. 31. We assessed the systematic bias and the discrepancy for gray matter, white matter, ventricular, and hippocampal volumes. J Neurosurg. Note.—Data in parentheses are numerator and denominator. Whereas our NPH population was limited to patients who responded to shunt placement, it is controversial whether this exclusion constitutes a selection bias. 402, Current Gerontology and Geriatrics Research, Vol. In addition, the mean volume of hippocampus in the HC group was greater than that of the NPH group (Tukey honest significant difference test, P < .01). Figure 2: Sample sagittal (left), posterior coronal (middle), and midtransaxial (right) segmentation masks overlaid on T1-weighted MR images of shunt-responsive NPH, definitive AD, and HC volunteers. Table 4 Simulated Exclusion of Patients with NPH with Largest Ventricular Volume. We excluded participants who did not meet these criteria to ensure high confidence of accurate NPH diagnosis. 35 (12): 2311-8. As the fluid builds up, it causes the ventricles to enlarge and the pressure inside the head to increase, compressing surrounding brain tissue and leading to neurological complications. 2006;24 (8): 568-72. Segmentation of global gray matter, white matter, ventricle, and hippocampus (left and right) was performed by using software (FreeSurfer version 5.1; http://surfer.nmr.mgh.harvard.edu). (2008) European radiology. There was no significant difference among the three groups regarding age (analysis of variance; F = 0.33; P = .72) or sex (χ2 = 0.03; P = .98). The sensitivity and diagnostic accuracy of these groups overlapped, indicating no statistically significant difference in this subgroup analysis. The reformatted images were directly provided to the observers. This task greatly benefits from volumetric segmentation. ; and manuscript editing, N.M., H.P., A.M.F., B.A.A., B.E.D., Y.S., J.G., O.G., H.R., A.E.G. Clinical FDG and Amyloid Brain PET in the Investigation of Cognitive Impairment: How, When & Why? These measures for both AD and HC groups were obtained directly from the ADNI database, which used the same software (FreeSurfer 5.1) to perform these segmentations. The purpose of this study was to construct a radiological scale, composed of morphological signs of iNPH, and compare it … Upper midbrain profile sign and cingulate sulcus sign: MRI findings on sagittal images in idiopathic normal-pressure hydrocephalus, Alzheimer's disease, and progressive supranuclear palsy. Participants in the ADNI were used as both patients with AD and HC volunteers (Table 1). Relative to mean value, the bias was 1.0% for gray matter, −0.4% for white matter, 0% for ventricle, and 1.3% for hippocampus. 2008;118 (1): 48-53. Curr Neurol Neurosci Rep. 2008;8 (5): 371-6. Check for errors and try again. Aqueductal Stroke Volume: Comparisons with Intracranial Pressure Scores in Idiopathic Normal Pressure Hydrocephalus. AUC = area under the curve, GM = gray matter volume, VNT = ventricular volume. 2002;77 (6): 507-8. Hurley RA, Bradley WG Jr, Latifi HT, Taber KH. 1996;198 (2): 523-9. In our patients, functional ambulation performance was determined by using the GaitRite system (CIR Syst… 26. 63, 20 January 2018 | Journal of Neural Transmission, Vol. † On the basis of observer with median accuracy. 8. Bradley WG. ; clinical studies, N.M., A.M.F., A.L., C.S., Y.S., J.G., A.E.G. Normal Pressure Hydrocephalus-MRI. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. 31 years experience Neurosurgery. As such, the investigators within the ADNI contributed to the design and implementation of ADNI and/or provided data but did not participate in analysis or writing of this report. 4, © 2021 Radiological Society of North America, For the Alzheimer’s Disease Neuroimaging Initiative, Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure. The structures involved in this study are part of fundamental neuroanatomy expected during medical school training. Fifteen patients with NPH were previously reported (11) by using a voxel-based segmentation method rather than the subvoxel vertex-based tissue segmentation method used in this study. The term normal pressure hydrocephalus was based on the finding that all 3 patients reported by Hakim and Adams showed low CSF pressures at lumbar puncture, namely 150, 180, and 160 mm H … CA was determined by using the methods of Ishii et al (14) as the angle between the medial superior borders of the left and right lateral ventricles (Fig 1). This article is focused on idiopathic cases. MRI is the best modality to image anatomical changes and can further support the diagnosis with CSF flow studies and magnetic resonance spectroscopy. 72, Journal d'imagerie diagnostique et interventionnelle, Magnetic Resonance in Medical Sciences, Vol. J. Neurol. Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology. N.M. and H.R. Since normal pressure hydrocephalus (NPH) was first described as a clinical entity, its diagnosis has been aided by a variety of radiologic procedures and examinations. 57 (3 Suppl): S4-16; discussion ii-v. 3. Urinary incontinence: Urinary frequency, urgency, or frank incontinence 3. 35. 127 (6): 1436-1442. The final sample size was 36 patients. 25. The majority (65 patients) excluded from the study failed to meet criteria mentioned in a. Gait impairment is the principal symptom that affects older adults with NPH (22) and the parameter most likely to improve with shunt surgery (23,24); hence, we chose gait impairment as the primary criterion for verifying shunt and lumbar puncture response. NPH is different than other types of hydrocephalus in that it develops slowly over time. Springer. Bradley WG. Holodny AI, George AE, de Leon MJ, Golomb J, Kalnin AJ, Cooper PR. It is possible that these patients may fall into the aforementioned comorbid category. 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