Dissertations / Theses: 'Normal pressure hydrocephalus'

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Owler, Brian Kenneth. "Pathophysiology of normal pressure hydrocephalus." Thesis, The University of Sydney, 2004. http://hdl.handle.net/2123/685.

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Normal pressure hydrocephalus (NPH), a CSF circulation disorder, is important as a reversible cause of gait and cognitive disturbance in an aging population. The inconsistent response to CSF shunting is usually attributed to difficulties in differential diagnosis or co-morbidity. Improving outcome depends on an increased understanding of the pathophysiology of NPH. Specifically, this thesis examines the contribution of, and inter-relationship between, the brain parenchyma and CSF circulation in the pathophysiology of NPH. Of the four core studies of the thesis, the first quantifies the characteristics of the CSF circulation and parenchyma in NPH using CSF infusion studies to measure the resistance to CSF absorption and brain compliance. The second study assesses cerebral blood flow (CBF) was using O15-labelled positron emission tomography (PET) with MR co-registration. By performing CSF infusion studies in the PET scanner, CBF at baseline CSF pressure and at a higher equilibrium pressure is measured. Regional changes and autoregulatory capacity are assessed. The final study examines the microstructural integrity of the parenchyma using MR diffusion tensor imaging. These studies confirm the importance of the inter-relationship of the brain parenchyma and CSF circulation. NPH symptomatology and its relationship to the observed regional CBF reductions in the basal ganglia and thalamus are discussed. Regional CBF reductions with increased CSF pressure and the implications for autoregulatory capacity in NPH are considered. The reduction in CBF when CSF was increased was most striking in the periventricular regions. In addition, periventricular structures demonstrated increased diffusivity and decreased anisotropy. The relationship between these changes and mechanisms such as transependymal CSF passage are reviewed. The findings of this thesis support a role of both the CSF circulation and the brain parenchyma in the pathophysiology of NPH. The results have implications for the approach to the management of patients with NPH.

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2

Owler, Brian Kenneth. "Pathophysiology of normal pressure hydrocephalus." University of Sydney. Surgery, 2004. http://hdl.handle.net/2123/685.

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Abstract:

Normal pressure hydrocephalus (NPH), a CSF circulation disorder, is important as a reversible cause of gait and cognitive disturbance in an aging population. The inconsistent response to CSF shunting is usually attributed to difficulties in differential diagnosis or co-morbidity. Improving outcome depends on an increased understanding of the pathophysiology of NPH. Specifically, this thesis examines the contribution of, and inter-relationship between, the brain parenchyma and CSF circulation in the pathophysiology of NPH. Of the four core studies of the thesis, the first quantifies the characteristics of the CSF circulation and parenchyma in NPH using CSF infusion studies to measure the resistance to CSF absorption and brain compliance. The second study assesses cerebral blood flow (CBF) was using O15-labelled positron emission tomography (PET) with MR co-registration. By performing CSF infusion studies in the PET scanner, CBF at baseline CSF pressure and at a higher equilibrium pressure is measured. Regional changes and autoregulatory capacity are assessed. The final study examines the microstructural integrity of the parenchyma using MR diffusion tensor imaging. These studies confirm the importance of the inter-relationship of the brain parenchyma and CSF circulation. NPH symptomatology and its relationship to the observed regional CBF reductions in the basal ganglia and thalamus are discussed. Regional CBF reductions with increased CSF pressure and the implications for autoregulatory capacity in NPH are considered. The reduction in CBF when CSF was increased was most striking in the periventricular regions. In addition, periventricular structures demonstrated increased diffusivity and decreased anisotropy. The relationship between these changes and mechanisms such as transependymal CSF passage are reviewed. The findings of this thesis support a role of both the CSF circulation and the brain parenchyma in the pathophysiology of NPH. The results have implications for the approach to the management of patients with NPH.

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3

Peterson, Katie Ann. "Cognition and apathy in normal pressure hydrocephalus." Thesis, University of Cambridge, 2018. https://www.repository.cam.ac.uk/handle/1810/274898.

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Normal pressure hydrocephalus (NPH) is characterised by a build-up of cerebrospinal fluid (CSF) in the brain despite apparently normal CSF pressure at lumbar puncture. In addition to movement and urinary symptoms, patients commonly display cognitive decline and apathy. NPH is recognised as an important cause of cognitive decline as it is thought be reversible with surgical CSF diversion (e.g. shunt surgery). However, this remains controversial and the neuropsychology of NPH is relatively poorly understood. Further, despite being the most commonly reported neuropsychiatric symptom in NPH, the significance of the symptom of apathy has not yet been elucidated. This thesis aims to expand on the neuropsychological and neuropsychiatric research in NPH, with the main objectives being to investigate neuropsychological outcome, and the significance of the symptom of apathy in NPH. In order to investigate neuropsychological outcome following shunt surgery in NPH, a systematic review and meta-analysis was conducted (Chapter 2). The findings from studies which used a battery of neuropsychological tests to assess cognitive outcome in NPH were combined. Meta-analyses were conducted on pre-operative and difference scores for the most commonly used neuropsychological tests. These were seven tests which spanned global cognitive function, learning and memory, executive function and psychomotor speed. Results for all tests were significant in the direction of improvement. However, the significance of the results for two measures of executive function were deemed not to be robust. This is discussed in line with previous research which suggests that executive function may be less likely to improve following shunt surgery than other neuropsychological domains. Next, the thesis focuses on the symptom of apathy. Chapter 3 investigated whether apathy in NPH relates to cognitive outcome and to a measure of ventricular enlargement. A reduction in apathetic symptoms following treatment was associated with better performance in a measure of global cognitive function. Further, larger ventricles (which may indicate greater disease severity/ brain damage) was associated with more severe apathy. A structural MRI study was then conducted to expand on these findings and to define brain structural correlates of apathy in NPH (Chapter 4). Results from this study suggested a potential role of the caudate nuclei in apathetic symptoms in NPH. Finally, consideration is given to the assessment of apathy in NPH. Since apathy is rarely investigated in patients with NPH it is unclear which assessment method is most appropriate for this patient group. Chapter 5 presents findings from a feasibility study of a novel reward learning task to determine whether it might be useful as an objective measure of motivation and apathy in NPH.

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Toma, Ahmed Kassem Abbass. "Conservative versus treatment of idiopathic normal pressure hydrocephalus." Thesis, University of London, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.558383.

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Objectives: Idiopathic normal pressure hydrocephalus (INPH) is a condition that affects the elderly population with clinical presentation of gait and balance impairment, cognitive impairment and urinary incontinence. Brain imaging shows -. ventriculomegaly in the absence of raised intracranial pressure. Shunt insertion is the standard method of treatment. However; there is a lack of good quality evidence of its effectiveness. As a result, many physicians and even few surgeons are sceptic about the existence of this condition as a separate entity. The aim of this thesis is to provide evidence supporting or refuting the role of surgical management in INPH, through a prospective randomized controlled double blinded study. Methods: Fourteen probable INPH patients who showed clinical improvement following extended lumbar drainage were randomized to have ventriculoperitoneal shunt insertion with an open or closed adjustable valve. Closed shunts were opened after three months. Primary endpoint was improvement in walking speed. Secondary endpoints were improvement in cognitive function, urinary symptoms and incidence of complications. Results: There was a statistically significant advantage of the open shunt in improving walking speed compared with the closed shunt at the study endpoint (43% vs. 0% p=0.02). In addition, the prospectively collected data has shown that both groups improved in terms of mobility one year following shunt insertion (47% and 46.7% respectively). There was a trend suggesting that delay in opening the shunt has delayed improvement beyond the 3 months hypothesized in study design. However; this delay was not statistically significant (p=0.08). 4 us.

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Tarnaris, A. "Biomarkers in patients with idiopathic normal pressure hydrocephalus." Thesis, University College London (University of London), 2012. http://discovery.ucl.ac.uk/1360351/.

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Idiopathic normal pressure hydrocephalus (iNPH) is a condition affecting a small percentage of the elderly population; however it is the only known treatable cause of dementia. Surgical cerebrospinal fluid (CSF) diversion is the only known treatment for the condition today. However, such a procedure is not to be offered lightly and any expected benefit has to balance the associated surgical risks. The prognosis of a favourable surgical outcome has been problematic since the conception of the syndrome. None of current prognostic tests reaches 100% sensitivity or specificity and it is felt that there might be a need for a combination of tests, rather than a single one to maximize the chances of selecting the right patients to offer a surgical CSF diversion procedure. Biomarkers are biological substances that may act as surrogate markers of response to a treatment or to characterise a disease’s progression over time. The aim of this study was to identify CSF markers of favourable surgical outcome in patients with iNPH undergoing the insertion of a ventriculoperitoneal shunt (VPS). We first describe the effects of external lumbar drainage (ELD) on the CSF biochemistry of these patients. Correlations are made with imaging data obtained from volumetric analysis and neuropsychological tests in order to obtain a complete profile of these patients. The rostrocaudal gradients of the CSF markers examined are reported showcasing the need to understand that commonly reported values from lumbar CSF do not necessarily reflect pathological changes occurring at cerebral level. Finally, we report on the individual as well as combined prognostic value of 7 CSF markers on surgical outcomes at 6 months. The pathophysiological significance of these markers is discussed individually. It is concluded that the combined power of total tau and Aβ 1-42 may be useful in predicting favourable surgical outcomes at 6 months; further studies applying the findings in a larger cohort and correlating findings with longer outcomes are warranted to enhance the clinical application. The biochemical profile of patients with iNPH appears unique and different than patients with Alzheimer’s dementia or control subjects.

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Lenfeldt, Niklas. "The search for reversibility of idiopathic normal pressure hydrocephalus : aspects on intracranial pressure measurements and advanced MRI techniques in combination with CSF volume alteration /." Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1422.

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7

Solomon, Daniel L. "Evaluation of normal pressure hydrocephalus with diffusion tensor imaging." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12226.

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Thesis (M.A.)--Boston University
Purpose: Normal Pressure Hydrocephalus (NPH) is a clinical diagnosis with no formal definition. Textbooks describe NPH as a clinical triad of gait abnormality, dementia, and urinary incontinence. Few patients present with all three symptoms, forcing the clinician to rely on a “preponderance of evidence” approach, which involves weighing triad symptoms with radiological findings, Cerebrospinal Fluid (CSF) opening pressure, response to Tap Test, external lumbar CSF drainage, lumbar infusion, and finally shunting. Radiological findings in NPH are limited to enlarged ventricles out of proportion to sulcal atrophy, callosal angles greater than 40 degrees, and ventricles with Evan’s ratios greater than 0.3. When radiologists evaluate suspected NPH patients they are limited to excluding disease, as opposed to searching for any particular finding. In this study we used Diffusion Tensor Imaging (DTI) to determine if differences can be identified on a group basis between NPH and normal groups to see if DTI (including tractography) can be a useful tool for understanding disease morphology and laying the groundwork for future clinical use of DTI for identification of NPH. Materials and Methods: A retrospective study of patients who underwent brain MRI imaging with a Philips 3T magnet. NPH patients were classified as “definite” or “probable NPH” by their referring physicians. Normal subjects were patients found to have no anatomical brain abnormality. DTI and tractography data were acquired using Philips Fibertrak software, and post-processing was done using Tract Based Spacial Statistics (TBSS). Conclusion: NPH patients were found to have higher Fractional Anisotropy (FA) values in the upper corticospinal tract, lower FA values in the Corpus Callosum and mixed results in the internal capsule, to p ≤ 0.05 levels, consistent with previous reports. NPH tractography was also characterized with a distinct “heart-shaped” sign. Possible uses for tractography for patients under suspicion of NPH will be discussed.

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Gelling, Leslie. "The illness experiences of people with idiopathic normal pressure hydrocephalus." Thesis, Anglia Ruskin University, 2007. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.442143.

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9

Lundin, Fredrik. "Idiopathic Normal Pressure Hydrocephalus : Aspects on Pathophysiology, Clinical Characteristics and Evaluation Methods." Doctoral thesis, Linköpings universitet, Neurologi, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-84243.

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Introduction. Idiopathic normal pressure hydrocephalus (iNPH) is a condition with enlargement of the cerebral ventricular system and an intracranial pressure (ICP) within normal limits. Cerebrospinal fluid circulation is disturbed but the mechanisms behind the symptoms: gait and balance difficulties, cognitive dysfunction and micturition problems, are as yet mostly unexplained. Aim. In Studies I and II the aim was to investigate cerebral metabolism in the frontal deep white matter (FDWM) and the thalamus in iNPH using Magnetic Resonance Spectroscopy (MRS) before and after shunt surgery and to compare this with healthy individuals (HI). In Study III the aim was, by use of actigraphy, to measure motor function, energy expenditure and resting/sleeping time in iNPH patients before and after shunt surgery, in comparison with HI. In Study IV the aim was to study postural function using computerised dynamic posturography (CDP) before and after shunt surgery as well as in comparison with HI. Patients and Methods. In all studies the patients had a neurological examination and baseline bedside assessments of motor, balance and cognitive function were performed. Motor function was assessed using a motor score (MOS) consisting of the following items: 10 metre walk time in seconds and number of steps and TUG time in seconds and number of steps. MOS was considered significant if there was an increase of 5% or more. The HI were also tested for motor, balance and cognitive function. In Study I the patients (n=16) and the HI (n=15) were examined with MRS (absolute quantification) with voxels placed in the thalamus and in FDWM and compared with one another. In Studies III and IV the preoperative results of actigraphy and CDP respectively in patients (Study III n=33; study IV n=35) were compared with the HI: Study III, n=17; Study IV, n=16. The HI performed these examinations twice and the average was calculated. In Study II, 14 patients, and in Studies III and IV, 20 patients underwent shunt surgery and new MRS/actigraphy/CDP examinations were performed three months postoperatively and compared with the preoperative results. Results. In the patients decreased total N-acetyl compounds (tNA) and N-acetyl aspartate (NAA) were found in the thalamus compared to the HI. No metabolic differences were seen in the FDWM between the groups. Postoperatively there were no metabolic changes in the thalamus but an increased total Choline (tCho) and a borderline significant decrease in myo-inositol (mIns).During the day the patients took fewer steps and had also lower total energy expenditure (TEE) than the HI. There was no difference concerning resting/sleeping time between patients and the HI. Postoperatively there were no differences of either number of steps, TEE or time spent resting or sleeping compared with the preoperative state. Postural function was worse in the patients compared to the HI, this difference being more pronounced in tests measuring vestibular function, where loss of balance (LOB) was frequent. There was only a slight improvement in balance after shunt surgery. A positive response to the shunt operation was seen in 86% in Study II, 85% in Study III and 90% in Study IV. Conclusions. Our results suggest that the thalamus may be involved in the pathogenesis of iNPH. In contrast to others, we did not find any metabolic abnormalities in the FDWM, nor detect an increment of tNA or NAA postoperatively in the thalamus. The postoperative increase in tCho and borderline decrease in mIns in the FDWM might reflect a state of metabolic recovery since high tCho, a major component of the cell membrane, may be a sign of increased membrane turnover, and a decrease in mIns may indicate diminished gliosis. The low gait capacity seen in the iNPH patients was not surprising but well that time spent resting/sleeping did not differ from the HI. Another unexpected finding was the unchanged ambulatory activity after shunt surgery despite improvement in a point test to determine capacity to walk a short distance. We believe this could be due to strong habits that are difficult to break and/or shortage of rehabilitation after surgery. There was a profound postural dysfunction in the patients with many falls, especially in test situations intended to measure vestibular function. This implies that there is a central vestibular disturbance. The discrete improvement in postural function postoperatively was lower than previously reported.

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Balamurali, Gopal. "Predicting the response to ventriculoperitoneal shunt in patients with normal pressure hydrocephalus." Thesis, University of Central Lancashire, 2011. http://clok.uclan.ac.uk/2391/.

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The diagnosis and management of normal pressure hydrocephalus (NPH) remains controversial. The aim of this prospective study was to assess the usefulness of clinical and radiological criteria together with supplemental neuropsychological and gait tests, cerebrospinal fluid (CSF) hydrodynamic studies and external lumbar drainage (ELD) in identifying those who may respond to a shunt and to compare the outcomes with the non-shunted patients at one year. Method: Forty patients with a clinical diagnosis of NPH were prospectively studied according to a fixed management protocol. Resistance to CSF (Rcsf) was measured using a lumbar infusion study and an ELD was used to determine improvement in neuropsychological and gait tests following CSF drainage. Based on specific criteria those who showed improvement were shunted. Clinical and radiological outcomes were assessed at one year in all patients. Results: Twenty three (57.5%) patients were shunted. Improvement was observed in 74% of shunted patients, while 17% did not improve and 9% deteriorated following surgery. Age, etiology, presentation, duration of symptoms and presence of co-morbid factors were unrelated to outcome. Improvement was found in 63% of shunted patients with RCSF of 12 mmHg/ml/min or higher. The sensitivity was 64% with a positive predictive value of 68%. Both Rcsf testing and ELD enhanced the positive predictive outcome of shunt operation. Using the non-shunted patients as controls, the mean difference between the two groups over time differed significantly in all the neuropsychological tests and some gait test. Conclusions: No single test was able to predict overall success with shunting but the results showed that a high percentage of improvement could be achieved by using continuous ELD and a rigorous protocol. Greater improvements were observed in cognitive and gait function than in sphincter control. An Rcsf of 12mmHg/ml/min or more was related to better outcomes. Consideration was given to the significant limitations in the study design and outcome measures.

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Behrens, Anders. "Measurements in Idiopathic Normal Pressure Hydrocephalus : Computerized neuropsychological test battery and intracranial pulse waves." Doctoral thesis, Umeå universitet, Klinisk neurovetenskap, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96195.

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Idiopathic Normal Pressure Hydrocephalus (INPH) is a condition affecting gait, cognition and continence. Radiological examination reveals enlarged ventricles of the brain. A shunt that drains CSF from the ventricles to the abdomen often improves the symptoms. Much research on INPH has been focused on identifying tests that predict the outcome after shunt surgery. As part of this quest, there are attempts to find measurement methods of intracranial parameters that are valid, reliable, tolerable and safe for patients. Today's technologies for intracranial pressure (ICP) measurement are invasive, often requiring a burr-hole in the skull. Recently, a method for non-invasive ICP measurements was suggested: the Pulsatile Index (PI) calculated from transcranial Doppler data assessed from the middle cerebral artery. In this thesis the relation between PI and ICP was explored in INPH patients during controlled ICP regulation by lumbar infusion. The confidence interval for predicted ICP, based on measured PI was too large for the method to be of clinical utility. In the quest for better predictive tests for shunt success in INPH, recent studies have shown promising results with criteria based on cardiac related ICP wave amplitudes. The brain ventricular system, and the fluid surrounding the spinal cord are in contact. In this thesis it was shown that ICP waves could be measured via lumbar subarachnoid space, with a slight underestimation. One of the cardinal symptoms of hydrocephalus is cognitive impairment. Neuropsychological studies have demonstrated cognitive tests that are impaired and improve after shunt surgery in INPH patients. However, there is currently no standardized test battery and different studies use different tests. In response, in this thesis a fully automated computerized neuropsychological test battery was developed. The validity, reliability, responsiveness to improvement after shunt surgery and feasibility for testing INPH patients was demonstrated. It was also demonstrated that INPH patients were impaired in all subtests, compared to healthy elderly.

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Andersson, Nina. "Cerebrospinal fluid infusion methods : development and validation on patients with idiopathic normal pressure hydrocephalus." Doctoral thesis, Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1359.

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13

Hakim, Carlos A. "The physics and physicopathology of the hydraulic complex of the central nervous system (the mechanics of hydrocephalus and normal pressure hydrocephalus)." Thesis, Massachusetts Institute of Technology, 1985. http://hdl.handle.net/1721.1/15309.

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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 1985.
MICROFICHE COPY AVAILABLE IN ARCHIVES AND ENGINEERING.
Bibliography: leaves 144-150.
by Carlos A. Hakim.
Ph.D.

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14

Lenfeldt, Niklas. "The search for reversibility of Idiopathic normal pressure hydrocephalus : Aspects on intracranial pressure measurments and CSF volume alteration." Doctoral thesis, Umeå universitet, Farmakologi och klinisk neurovetenskap, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1422.

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BACKGROUND: Idiopathic normal pressure hydrocephalus (INPH) is still a syndrome generating more questions than answers. Today, research focuses mainly on two areas: understanding the pathophysiology – especially how the malfunctioning CSF system affects the brain parenchyma – and finding better methods to select patients benefiting from a shunt operation. This thesis targets the aspect of finding better selection methods by investigating the measurability of intracranial pressure via lumbar space, and determining if intraparenchymal measurement of long-term ICP-oscillations (B-waves) could be replaced by short-term measurements of CSF pulse pressure waves via lumbar space. Furthermore, I look into the interaction between the CSF system and the parenchyma itself by investigating how the cortical activity of the brain changes after long-term CSF drainage, and if there is any regress in the suggested ischemia after this intervention. Finally, I examine if the neuronal integrity in the INPH brain is impaired, and if this feature is relevant for the likeliness of improvement after CSF diversion. METHODS: The comparison of intracranial and lumbar pressure was made over a vast pressure interval using our unique CSF infusion technique, and it included ten INPH patients. Pressure was measured via lumbar space and in brain tissue, and the pressures were compared using a general linear model. Short-term lumbar pressure waves were quantified by determining the slope between CSF pulse pressure and mean pressure, defined as the relative pulse pressure coefficient (RPPC). The correlation between RPPC, B-waves and CSF outflow resistance was investigated. In a prospective study, functional MRI was used to assess brain activity before and after long-term CSF drainage of 400 ml of CSF in eleven INPH patients. The functionalities tested included finger movement, memory, and attention. The results were benchmarked against the activity in ten healthy controls to identify the brain areas improving after drainage. The ischemia (Lactate) and neuronal integrity (NAA and Choline) were measured in a similar manner in 16 patients using proton MR spectroscopy, and the improvement of the patients after CSF drainage was based on assessment of their gait. RESULTS: There was excellent agreement between ICP measured in brain tissue and via lumbar space (regression coefficient = 0.98, absolute difference < 1 mm Hg). Adjusting for the separation distance between the measuring devices slightly worsened the agreement, indicating other factors influencing the measured difference as well. RPPC measured via lumbar space significantly correlated to the presence of B-waves, but not to outflow resistance. In the prospective study, controls outperformed patients on clinical tests as well as tasks related to the experiments. Improved behaviour after CSF drainage was found for motor function only, and it was accompanied by increased activation in the supplementary motor area (SMA). No lactate was detected, either before or after CSF drainage. NAA was decreased in INPH patients compared to controls, and the NAA levels were higher in the patients improving after drainage. CONCLUSIONS: ICP can be accurately measured via lumbar space in patients with communicating CSF systems. The close relation between RPPC and B-waves indicates that B-waves are primarily related to intracranial compliance, and that measurement of RPPC via lumbar space could possibly substitute B-wave assessment as selection method for finding suitable patients for shunt surgery. Improvement in motor function after CSF drainage was associated to enhanced activity in SMA, supporting the involvement of the cortico-basal ganglia-thalamo-cortical loop in the pathophysiology of INPH. There was no evidence indicating a widespread low-graded ischemia in INPH; however, there was a neuronal dysfunction in frontal white matter as indicated by the reduced levels of NAA. In addition, the level of neuronal dysfunction was related to the likeliness of improvement after CSF removal, normal levels of NAA predisposing for recovery.

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Israelsson, Larsen Hanna. "Comorbidity and vascular risk factors associated with idiopathic normal pressure hydrocephalus : the INPH-CRasH Study." Doctoral thesis, Umeå universitet, Institutionen för farmakologi och klinisk neurovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-120175.

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Idiopathic normal pressure hydrocephalus (INPH) is a dementia treatable by insertion of a cerebrospinal fluid shunt. It has been suggested that INPH has similar pathophysiological mechanisms as cerebrovascular disease, but the vascular risk factor (VRF) profile of INPH patients has not been assessed using a modern epidemiological approach. The cognitive symptoms of INPH resemble the symptoms of depression, but the prevalence of depression among INPH patients is unknown. In addition, few studies investigate the impact of shunting on the quality of life (QoL), and no study has investigated the impact of comorbidity on QoL in INPH patients. The objective of this dissertation was to present the VRF profile of INPH and to investigate the hypothesis that INPH may be a subgroup of vascular dementia. Additional objectives were to assess the prevalence of depression in INPH patients and to investigate the impact of shunting and comorbidities on QoL in INPH. In the first cohort, the prevalence of possible INPH was assessed through clinical and radiological examinations in patients with a transient ischemic attack (TIA), consecutively admitted to the same hospital during 2006-2008. In the second cohort, VRFs, vascular disease and QoL were analysed in INPH patients consecutively shunted 2008-2010 in five out of six neurosurgical centres in Sweden. Patients remaining after inclusion (n=176, within the age-span 60-85 years and not having dementia) were compared to population-based age- and gender-matched controls (n=368, same inclusion criteria as for the INPH patients). Assessed VRFs were: hypertension, diabetes, obesity, hyperlipidemia, psychosocial factors (stress and depression), smoking, alcohol intake, physical activity and, dietary pattern. Cardiovascular, cerebrovascular and peripheral vascular disease as well as QoL were also assessed. Parameters were assessed through questionnaires, clinical examinations, measurements, ECG and, blood samples. In the first cohort, 4% of the TIA patients had clinically and radiologically verified INPH. In the second cohort, VRFs were overrepresented among the INPH patients compared with the controls. The VRFs independently associated with INPH were: hyperlipidemia (Odds ratio (OR): 2.4, 95%CI: 1.4-4.0), diabetes (OR: 2.2, 95%CI: 1.2-3.9), obesity (OR: 5.4, 95%CI: 2.5-11.8) and, psychosocial factors (OR: 5.3, 95%CI: 3.2-8.9). When adding the VRFs that were overrepresented in INPH, although not independently (physical inactivity and hypertension), these six VRFs accounted for 24% of the INPH cases in the elderly population (population attributable risk %: 24). Depression was overrepresented in shunted INPH patients compared to the controls (46% vs. 13%, p<0.001) and the main predictor for low QoL was a coexisting depression (p<0.001). In conclusion, the results of the INPH-CRasH study are consistent with a vascular pathophysiological component of INPH and indicate that INPH may be subgroup of vascular dementia. In clinical care and research, a complete risk factor analysis as well as screening for depression and a measurement for quality of life should be included in the work-up of INPH patients. The effect of targeted interventions against modifiable VRFs and anti-depressant treatment in INPH patients should be evaluated.
Idiopatisk normaltryckshydrocefalus (INPH, från engelskans ”idiopathic normal pressure hydrocephalus”) är en neurokirurgiskt behandlingsbar demens. Behandlingen är att operera in en shunt som dränerar cerebrospinalvätska från ventriklarna. Det har föreslagits att INPH skulle kunna orsakas av liknande patofysiologiska mekanismer som vid cerebrovaskulär sjukdom, men den vaskulära riskfaktorprofilen hos INPH-patienter har aldrig undersökts i en modern epidemiologisk studie. De kognitiva symtomen vid INPH påminner om symtomen vid depression, men prevalensen av depression hos INPH-patienter är okänd. Få studier undersöker hur shuntning påverkar livskvalitet och ingen studie har undersökt hur komorbiditet påverkar livskvaliteten vid INPH. Syftet med den här avhandlingen var att undersöka den vaskulära riskfaktorprofilen hos INPH-patienter samt att utforska hypotesen att INPH skulle kunna vara en undergrupp till vaskulär demens. Ytterligare ett syfte med avhandlingen var att undersöka hur många INPH-patienter som har depression samt undersöka hur shunting och komorbiditet påverkar livskvalitet vid INPH. I den första kohorten undersöktes kliniska och radiologiska fynd som tydde på INPH hos de patienter som blivit diagnostiserade med en TIA (från engelskans: transient ischemic attack) 2006-2008 på Norrlands Universitetssjukhus i Umeå. I den andra kohorten undersöktes konsekutivt shuntade INPH-patienter 2008-2010 från fem av sex neurokirurgiska kliniker i Sverige. De patienter som inkluderades i studien (n=176, ålder: 60-85 år, ej dementa) jämfördes med köns- och åldersmatchade kontroller från normalpopulationen (n=368, samma inklusionskriterier som för INPH-patienterna). De riskfaktorer som undersöktes var: hypertension, hyperlipidemi, diabetes, fetma, psykosociala faktorer (stress och depression), rökning, alkohol, fysisk aktivitet och diet. Även kardiovaskulära och cerebrovaskulära sjukdomar undersöktes, liksom perifer vaskulär sjukdom samt livskvalitet. Datainsamling skedde genom frågeformulär, kliniska undersökningar, mätningar, EKG och blodprov. I den första kohorten hade 4% av TIA-patienterna kliniskt och radiologiskt verifierad INPH. I den andra kohorten var vaskulära riskfaktorer överrepresenterade hos INPH-patienterna jämfört med iv normalpopulationen. Hyperlipidemi (OR: 2.4, 95%CI: 1.4-4.0), diabetes (OR: 2.2, 95%CI: 1.2-3.9), fetma (OR: 5.4, 95%CI: 2.5-11.8) och psykosociala faktorer (OR: 5.3, 95%CI: 3.2-8.9) var associerade med INPH oberoende av kön, ålder och de andra riskfaktorerna. Hypertension och fysisk inaktivitet var också associerade med INPH, dock inte oberoende av övriga riskfaktorer. Sammanlagd PAR% (från engelskans: population attributable risk %) för de här sex riskfaktorerna var 24%. INPH-patienterna hade depression i högre utsträckning än kontrollerna (46% vs. 13%, p<0.001), och depression var den viktigaste prediktorn för låg livskvalitet. Resultaten tyder på att vaskulär sjukdom och vaskulära riskfaktorer är involverade i den patofysiologiska mekanismen vid INPH. INPH kan vara en undergrupp till vaskulär demens. En fullständig riskfaktoranalys och screening för depression bör ingå i den preoperativa utvärderingen såväl som i forskning på INPH-patienter, och ett mått på livskvalitet bör införas. Effekten av riktade insatser mot såväl vaskulära riskfaktorer som depression vid INPH bör utvärderas.

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16

Keong, Nicole Chwee Har. "The characterization of white matter injury patterns in normal pressure hydrocephalus using magnetic resonance imaging." Thesis, University of Cambridge, 2014. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.608298.

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17

Jingami, Naoto. "Two-Point Dynamic Observation of Alzheimer’s Disease Cerebrospinal Fluid Biomarkers in Idiopathic Normal Pressure Hydrocephalus." Kyoto University, 2020. http://hdl.handle.net/2433/253481.

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18

Virhammar, Johan. "Idiopathic Normal Pressure Hydrocephalus : Cerebrospinal Fluid Tap Test and Magnetic Resonance Imaging as Preoperative Prognostic Investigations." Doctoral thesis, Uppsala universitet, Neurologi, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-222779.

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Idiopathic normal pressure hydrocephalus (iNPH) is a condition with dilated cerebral ventricles but intracranial pressure within normal limits. The symptoms of gait impairment, cognitive decline and urinary incontinence develop gradually. Treatment with shunt insertion results in improvement in eight out of ten patients. The cerebrospinal fluid tap test (CSF TT) and preoperative magnetic resonance imaging (MRI) are methods used to select patients who may benefit from shunt surgery, but they are performed and interpreted differently in different centers throughout the world. The aim of this thesis was to evaluate the performance of the CSF TT and the underlying mechanisms of improvement in gait function after CSF removal, and to investigate the prognostic value of preoperative MRI scans. Improvement in gait and changes in cerebral blood flow (CBF) after a CSF TT were investigated in two prospective studies that included 39 and 20 patients, respectively. Gait assessment and perfusion MRI were done before and several times during the first 24 hours after a CSF TT. Perfusion was investigated with pseudo-continuous arterial spin labeling. At the group level, gait function was significantly improved at all investigation times, but only one-third of individual CSF TT responders were improved at all investigation times. In patients with increased CBF in lateral and frontal white matter after the CSF TT, gait function improved more than it did in patients with decreased CBF in these regions. However, in the whole sample, there was no significant increase in CBF after CSF removal. Preoperative MRI scans were retrospectively evaluated in 109 patients with iNPH who had undergone shunt surgery. The callosal angle was smaller in shunt responders compared with non-responders. The following findings showed the highest association with a positive outcome after shunting: a small callosal angle, wide temporal horns, and occurrence of disproportionally enlarged subarachnoid space hydrocephalus. In conclusion, CBF in white matter close to the lateral ventricles may play a role in the reversibility of symptoms after CSF removal in patients with iNPH. The CSF TT should be reevaluated if the patient does not initially improve, and preoperative MRI investigations can add prognostic information regarding the selection of shunt candidates.

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19

Qvarlander, Sara. "Analysis of ICP pulsatility and CSF dynamics : the pulsatility curve and effects of postural changes, with implications for idiopathic normal pressure hydrocephalus." Doctoral thesis, Umeå universitet, Radiofysik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-82784.

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The volume defined by the rigid cranium is shared by the brain, blood and cerebrospinal fluid (CSF). With every heartbeat the arterial blood volume briefly increases and venous blood and CSF are forced out of the cranium, leading to pulsatility in CSF flow and intracranial pressure (ICP). Altered CSF pulsatility has been linked to idiopathic normal pressure hydrocephalus (INPH), which involves enlarged cerebral ventricles and symptoms of gait/balance disturbance, cognitive decline and urinary incontinence that may be improved by implantation of a shunt. The overall aim of this thesis was to investigate the fluid dynamics of the CSF system, with a focus on pulsatility, and how they relate to INPH pathophysiology and treatment. Mathematical modelling was applied to data from infusion tests, where the ICP response to CSF volume manipulation is measured, to analyse the relationship between mean ICP and ICP pulse amplitude (AMP) before and after shunt surgery in INPH (paper I-II). The observed relationship, designated the pulsatility curve, was found to be constant at low ICP and linear at high ICP, corresponding to a shift from constant to ICP dependent compliance (paper I). Shunt surgery did not affect the pulsatility curve, but shifted baseline ICP and AMP along the curve towards lower values. Patients who improved in gait after surgery had significantly larger AMP reduction than those who did not, while ICP reduction was similar, suggesting that improving patients had baseline ICP in the linear zone of the curve before surgery. Use of this phenomenon for outcome prediction was promising (paper II). The fluid dynamics of an empirically derived pulsatility-based predictive infusion test for INPH was also investigated, with results showing strong influence from compliance (paper III). Clinical ICP data at different body postures was used to evaluate three models describing postural effects on ICP. ICP decreased in upright positions, whereas AMP increased. The model describing the postural effects based on hydrostatic changes in the venous system, including effects of collapse of the jugular veins in the upright position, accurately predicted the measured ICP (paper IV). Cerebral blood flow and CSF flow in the aqueduct and at the cervical level was measured with phase contrast magnetic resonance imaging, and compared between healthy elderly and INPH (paper V). Cerebral blood flow and CSF flow at the cervical level were similar in INPH patients and healthy elderly, whereas aqueductal CSF flow differed significantly. The pulsatility in the aqueduct flow was increased, and there was more variation in the net flow in INPH, but the mean net flow was normal, i.e. directed from the ventricles to the subarachnoid space (paper V). In conclusion, this thesis introduced the concept of pulsatility curve analysis, and provided evidence that pulsatility and compliance are important aspects for successful shunt treatment and outcome prediction in INPH. It was further confirmed that enhanced pulsatility of aqueduct CSF flow was the most distinct effect of INPH pathophysiology on cerebral blood flow and CSF flow. A new model describing postural and hydrostatic effects on ICP was presented, and the feasibility and potential importance of measuring ICP in the upright position in INPH was demonstrated.

Forskningsfinansiär:

European Union, ERDF: Objective 2, Northern Sweden (grant no. 158715-CMTF).

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20

Reiss-Zimmermann, Martin, Michael Scheel, Markus Dengl, Matthias Preuß, Dominik Fritzsch, and Karl-Titus Hoffmann. "The influence of lumbar spinal drainage on diffusion parameters in patients with suspected normal pressure hydrocephalus using 3T MRI." Sage, 2014. https://tud.qucosa.de/id/qucosa%3A35424.

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Background: Normal pressure hydrocephalus (NPH) has been an ongoing and challenging field of research for the past decades because two main issues are still not fully understood: the pathophysiologic mechanisms underlying ventricular enlargement and prediction of outcome after surgery. Purpose: To evaluate changes in diffusion tensor imaging (DTI) derived parameters in patients with suspected normal pressure hydrocephalus before and after withdrawal of cerebrospinal fluid (CSF). Material and Methods: Twenty-four consecutive patients with clinical and radiological suspicion of NPH and 14 agematched control subjects were examined with DTI on a clinical 3T scanner. Patients were examined before and 6–36 h after CSF drainage (interval between scans, 5 days). Fifteen patients were finally included in data analysis. Fractional anisotropy (FA) and mean, parallel, and radial diffusivity (MD, PD, RD) were evaluated using a combination of a ROI-based approach and a whole-brain voxel-by-voxel analysis. Results: Alteration of DTI parameters in patients with suspected NPH is regionally different. Compared to the control group, we found an elevation of FA in the subcortical white matter (SCWM) and corpus callosum, whereas the other diffusion parameters showed an increase throughout the brain in variable extent.We also found a slight normalization of RD in the SCWM in patients after lumbar drainage. Conclusion: Our results show that DWI parameters are regionally dependent and reflect multifactorial (patho-) physiological mechanisms, which need to be interpreted carefully. It seems that improvement of gait is caused by a decrease of interstitial water deposition in the SCWM.

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Sosa, Carrero Jordana Mag Lui [Verfasser], and Martin [Akademischer Betreuer] Schuhmann. "Computerized analysis of intracranial pressure and cerebrospinal fluid dynamics in patients with idiopathic normal pressure hydrocephalus and positive clinical response to lumbar CSF drainage / Jordana Mag Lui Sosa Carrero ; Akademischer Betreuer: Martin Schuhmann." Tübingen : Universitätsbibliothek Tübingen, 2017. http://d-nb.info/1199627240/34.

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22

Sosa, Carrero Jordana Mag-Lui [Verfasser], and Martin [Akademischer Betreuer] Schuhmann. "Computerized analysis of intracranial pressure and cerebrospinal fluid dynamics in patients with idiopathic normal pressure hydrocephalus and positive clinical response to lumbar CSF drainage / Jordana Mag Lui Sosa Carrero ; Akademischer Betreuer: Martin Schuhmann." Tübingen : Universitätsbibliothek Tübingen, 2017. http://d-nb.info/1199627240/34.

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23

Gustafsson, Agneta. "Personer med idiopatisk normaltryckshydrocefalus:deras förväntningar på behandling med shunt och syn på egen roll i rehabiliteringsprocessen-en intervjustudie." Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-267303.

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Bakgrund: Det har i vissa fall varit märkbart att patienter med idiopatisk normaltrycks hydrocefalus (iNPH) upplever att förväntat shuntbehandlingsresultat inte uppnåtts och de rapporterar försämring vid den postoperativa uppföljningen trots att standardiserade tester inte visar i den riktningen. Det har också visat sig att rehabiliteringsinsatserna varierat för patienterna allt från strukturerade rehabiliteringsperioder på exempelvis geriatrisk rehabiliteringsenhet till i princip ingen rehabilitering alls. Syfte: Att beskriva vilka förväntningar personer med iNPH har på behandling med shunt och hur de ser på sin egen roll i rehabiliteringsprocessen. Metod: Kvalitativ, deskriptiv design med manifest och induktiv ansats. Datainsamlingen skedde genom semistrukturerade intervjuer med sju patienter med iNPH preoperativt. Resultat: Det fanns en samstämmighet bland informanterna kring förväntningar på shuntbehandlingsresultatet. De rörde den symtomtriad (gång och balansstörning, överaktiv urinblåsa samt kognitiv nedsättning) som ofta finns vid iNPH. Varierade beskrivningar gavs på hur symtomen påverkade informanterna. Det fanns också en uppfattning bland informanterna att de hade ett eget ansvar i rehabiliteringsprocessen och förslag framkom på vad de själva kunde bidra med i processen men också olika hinder för att utöva fysisk aktivitet beskrevs. Slutsats: Förväntningar på shuntbehandlingsresultat behöver diskuteras med patienten (ibland även anhörig) inför shuntbehandling redan vid beslut om operation men också då patienten läggs in för behandlingen. Rehabiliteringsprocessen behöver också diskuteras med patienten såväl före shuntoperation som tidigt postoperativt. Detta är troligtvis mycket viktigt för att uppnå ett så optimalt behandlingsresultat som möjligt.
Background: It has been noticeable that some patients with idiopathic normal pressure hydrocephalus (iNPH) find the expected result of shunt treatment not achieved and they report detoriation at postoperative follow-up even though standardized tests do not show results in that direction. It has also been shown that rehabilitation possibilities for patients varied, ranging from structured rehabilitation periods, e.g. at geriatric rehabilitation units to basically no rehabilitation at all. Objective: To describe what expectations patients with iNPH have on treatment with shunt and how they view their own role in the rehabilitation process. Method: A quality, descriptive design with manifest and inductive approach. The data collection was done by semi-structured interviews with seven patients with iNPH preoperative. Results: There was consensus among informants regarding the expectations on the result of shunt treatment. The expectations concerned the symptom triad (gait-and balance disturbance, urgency bladder and cognitive dysfunction) which often occurs in iNPH. Varied descriptions were given on how the symptoms had affected the informants. There was also an opinion among the informants that they had own responsibility for the rehabilitation process and suggestions were given on what they could contribute with in the process but also different obstacles for performing physical activities were described. Conclusion: Expectations on shunt treatment results need to be discussed with the patient (sometimes together with a relative) prior to shunt treatment, already when the patient is offered a shunt operation and also on the day before operation when the patient is in the neurosurgery clinic. The rehabilitation process also needs to be discussed with the patient before the shuntoperation as well as early postoperative. This is probably very important in order to achieve as optimal treatment results as possible.

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Carlsson, Fredrik, and Sebastian Vusak. "Gamified CoGNIT: cognitive assessment with added game elements : Gamification of medical examination." Thesis, Blekinge Tekniska Högskola, Institutionen för datavetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:bth-19662.

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Background. CoGNIT is a computerized test battery for cognitive assessment, used in diagnosing and treating patients with idiopathic normal pressure hydrocephalus (INPH). The disorder causes symptoms of dementia, among other things. Apart from other diseases with similar symptoms, like Alzheimer’s, INPH can be countered. CoGNIT is performed by a patient before and after drainage of cerebrospinal fluid. If a significant improvement in cognition is detected after the extraction, the patient receives shunt surgery which reduces all symptoms. The test battery is long and tedious, which makes it difficult for people with cognitive impairments to complete. Objectives. The objectives of this study are to rework original CoGNIT with carefully selected game design elements and analyze the effects of the alteration on performance and user experience. If users perform better in a gamified environment, the validity of gathered data will have improved as the data should better reflect their cognitive capabilities. Another objective is to introduce gamification to the medical field. Methods. Game design elements were picked and designed based on suitability for elderly people and with the impairments of INPH patients in mind. A gamified prototype was developed and put to test with healthy individuals against the original version in an experiment. The effects of gamification on performance was examined by comparing resulting score values from both versions of the test. Participants also filled in a questionnaire as proxy for the test’s target group, meaning that questions were answered with how the participants expected a cognitively impaired person to answer. Answers were used to investigate the effect of gamification ofuser experience. Results. The gamified version of CoGNIT shows an improvement in test segments regarding attention, psychomotor speed, executive function, and manual dexterity, but a negative inclination in segments regarding memory. Results from the user experience questionnaire indicates that the gamified version feels less dramatic, more playful, less "test-like" and less tedious compared to the non-gamified version. This suggests that the added game elementsare affecting the user experience in the desired way. Conclusions. An overall positive impact on both performance and user experience from gamification is concluded. The negative effect on memory tests could not be determined to be a cause of the gamification per se.
Bakgrund. CoGNIT är ett datoriserat testbatteri för kognitiv bedömning som används vid diagnos och behandling av patienter med idiopatisk normaltryckshydrocefalus (INPH). Sjukdomen orsakar bland annat symptom som demens. Till skillnad från andra sjukdomar med liknande symptom, som Alzheimers, kan INPH motverkas. CoGNIT utförs av en patient före och efter dränering av cerebrospinalvätska. Om en förbättring av patientens kognitiva förmågor upptäcks efter dräneringen, shuntoperaras patienten och alla symptom minskas. Testbatteriet är långt och tråkigt, vilket gör det svårt för personer med kognitiva nedsättningar att slutföra. Syfte. Syftet med denna studie är att omarbeta CoGNIT med noggrant utvalda speldesignelement och analysera hur prestation och användarupplevelse påverkas av förändringen. Om användare presterar bättre i en spelifierad miljö kommer validiteten av insamlad data att förbättras eftersom datan borde bättre återspegla deras kognitiva förmågor. Ett annat mål är att introducera spelifiering till det medicinska området. Metod. Speldesignelement valdes ut och utformades baserat på dess lämplighet för äldre och med de funktionsnedsättnigar som INPH-patienter har i åtanke. En spelifierad prototyp utvecklades och testades med friska individer mot originalversionen i ett experiment. Effekterna av spelifiering på prestation undersöktes genom att jämföra poängvärden från båda versionerna av testet. Deltagarna fyllde också i ett frågeformulär som "proxy" för testets målgrupp, vilket innebär att frågorna besvarades med hur deltagarna förväntade sig att en kognitivt nedsatt person hade svarat. Svaren användes för att undersöka effekten av spelifiering på användarupplevelsen. Resultat. Den spelifierade versionen av CoGNIT visar en förbättring i testsegmenten som utvärderar uppmärksamhet, psykomotorisk hastighet, exekutiva funktioner och fingerfärdighet, men en försämring i segmenten som utvärderar minne. Resultat från frågeformuläret indikerar att den spelifierade versionen upplevs mindre dramatisk, mer lekfull, mindre "testliknande" och mindre tråkig jämfört medden icke-spelifierade versionen. Detta visar att de tillagda spelelementen påverkar användarupplevelsen som önskat. Slutsatser. En övergripande positiv inverkan på både prestanda och användarupplevelse från spelfiering fastställs. Den negativa effekten på minnestesterna kunde inte bedömas vara en orsak av spelifiering i sig.

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25

Tully, Brett. "Allostasis of cerebral water : modelling the transport of cerebrospinal fluid." Thesis, University of Oxford, 2010. http://ora.ox.ac.uk/objects/uuid:168586f0-f34a-4d5e-8acf-822cd0e1bfe2.

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A validated model of water transport in the cerebral environment is both an ambitious and timely task; many brain diseases relate to imbalances in water regulation. From tumours to strokes, chronic or acute, transport of fluid in the brain plays a crucial role. The importance and complexity of the brain, together with the range of unmet clinical needs that are connected with this organ,make the current research a high-priority. One of the most paradoxical cerebral conditions, hydrocephalus, serves as an excellent metric for judging the success of anymodel developed. In particular, normal pressure hydrocephalus (NPH) is a paradoxical condition with no known cure and existing treatments display unacceptably high failure rates. NPH is considered to be a disease of old age, and like many such diseases, it is related to a change in the transport of fluid in the cerebral environment. This complex system ranges from organ-level transport to cellular membrane channels such as aquaporins; through integrating it in a novel mathematical framework, we suggest that the underlying logic of treatment methods may be misleading. By modelling the transport of cerebrospinal fluid (CSF) between the ventricular system, cerebral tissue and blood networks, we find that changes to the biophysical properties of the brain (rather than structural changes such as aqueduct obstruction) are capable of producing clinically relevant ventriculomegaly in the absence of any obstruction to CSF flowthrough the ventricular system. Specifically, the combination of increased leakiness and compliance of the capillary bed leads to the development of enlarged ventricles with a normal ventricular pressure, replicating clinical features of the presentation of NPH. These results, while needing experimental validation, imply that treatment methods like shunting, that are focussed on structural manipulation, may continue to fail at unacceptably high rates.

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26

Lopes, Maria Izabel Romão. "Validação para Língua Portuguesa da escala de graduação do paciente com hidrocefalia de pressão normal." Universidade de São Paulo, 2014. http://www.teses.usp.br/teses/disponiveis/5/5138/tde-27022014-144806/.

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O presente estudo validou para a Língua Portuguesa a escala de graduação do paciente com hidrocefalia de pressão normal (HPN) desenvolvida na Língua Inglesa como \"Grading scale for idiopathic normal pressure hydrocephalus\". Duas traduções independentes da escala de HPN foram feitas por médicos brasileiros, fluentes na Língua Inglesa. Após harmonização dessas, a tradução resultante foi retrotraduzida independentemente por dois outros médicos, que desconheciam a escala original. Seguiu-se a última tradução e revisão para a Língua Portuguesa por uma profissional tradutora da área da saúde. A comparação da versão final traduzida com a escala original foi realizada pelo comitê multiprofissional que não estava envolvido no processo de tradução, pontuando-se para item distúrbio de marcha: 0 ausente; 1 marcha instável, mas independente; 2 anda com um apoio; 3 anda com 2 apoios ou andador e 4 não é possível andar. No item demência: 0 ausente; 1 sem demência aparente, mas apático; 2 socialmente dependente, mas independente na residência; 3 parcialmente dependente na residência e 4 totalmente dependente. Incontinência Urinária: 0 ausente; 1 ausente, mas com polaciúria ou urgência miccional; 2 às vezes, apenas à noite e 4 frequente. Para obtenção da pontuação final, devem-se somar os itens, sendo que, quanto maior o escore final, maior comprometimento do paciente. O resultado foi pré-testado em um estudo-piloto. A versão final da escala de HPN para o Português, bem como as escalas de equilíbrio de Berg, índice de marcha dinâmica e \"timed up and go\" foram aplicadas simultaneamente em cento e vinte e um pacientes consecutivos com diagnóstico médico de hidrocefalia de pressão normal (setenta e três homens e quarenta e oito mulheres) que procuraram o Ambulatório de Hidrodinâmica Cerebral, da Divisão de Neurocirurgia Funcional do Instituto de Psiquiatria do Hospital das Clínicas de São Paulo da FMUSP, no período de julho de 2010 a março de 2012. Foram testadas as propriedades psicométricas do questionário, como confiabilidade e validade. A idade mediana foi de 71,09 anos (intervalo de 35 a 92 anos). O período médio de reteste para a escala de HPN foi de sete dias. Nenhuma alteração do formato original da escala foi observada no final do processo de tradução e adaptação cultural. O grau de concordância e reprodutividade foi alta, como demonstrado pela medida de concordância Kappa, com excelente correlação intraobservador para itens da escala de HPN individualmente avaliados: marcha (0,8), demência (0,90) e incontinência (0,87). Na análise interobservador, o resultado foi excelente, com item marcha (0,91), demência (0,86) e incontinência (0,87). A correlação entre a escala de HPN com as demais escalas foi considerada de moderada a satisfatória para a maioria dos itens, variando de -,069 a 0,55 na correlação de Pearson. A avaliação individual entre escalas sobre os itens incontinência urinária, demência e marcha foram também satisfatórias e estatisticamente significantes. A versão para o Português da escala de graduação do paciente com HPN foi traduzida e validada com sucesso para aplicação em pacientes brasileiros de ambos os sexos, apresentando satisfatória confiabilidade e validade
The current study validated to Portuguese language the graduation scale for patients with normal pressure hydrocephalus (NPH) developed on English language as \"Grading scale for idiopathic normal pressure hydrocephalus\". Two translations independent of NPH scale were done by Brazilian doctors, fluent on English language. After harmonization of both, the resulting translation was back-translated independently by two other doctors, that unaware to the original scale. Followed the last translation and revision to Portuguese language by a professional translator of health area. The comparison of last translated version with original scale was performed by one multiprofessional committee not involved on translation process. Was established specific punctuation to components of NPH classical triad, the punctuation to gait: 0 absent; 1 unstable gait, but independent; 2 walk with a support; 3 walk with 2 supports or walker an 4 is not possible to walk. On dementia item: 0 absent; 1 without apparent dementia, but apathetic; 2 socially dependent, but independent on resistance; 3 partial dependent on resistance and totally dependent. Urinary incontinence: 0 absent, 1 absent but with pollakisuria or urinary urgency, 2 sometimes, just at night; 3 sometimes even during the day and 4 frequently. The obtained final punctuation was given by summation of three items, and the higher the final punctuation, greater involvement of the patient. The result was pre-tested in a pilot study. The last version of NPH to Portuguese, as well the Berg balance scales, Dynamic Gait Index and \"timed up and go\" were applied simultaneously in 121 consecutive patients with medical diagnostic of normal pressure hydrocephalus (73 men and 48 women) who sought the Ambulatory of Cerebral Hydrodynamics, Division of Functional Neurosurgery, Institute of Psychiatry, Hospital das Clínicas in Sao Paulo from FMUSP, on period July / 2010 to march / 2012. The psychometric properties, reliability and validity of questionnaire were tested. The mean age was 71,09 years, ranging from 35 to 92 years. The period of mean retest was 7 days. None change to the original format of the scale was observed at the end of the translation process and cultural adaptation. The rate of agreement and reproducibility was high, as confirmed by measure of agreement of Kappa, with excellent intra-observer correlation for NPH scale items individually evaluated: gait (0,80), dementia (0,90) and incontinence (0,87). The correlation between the NPH scale with the other scales was considered moderate to satisfactory for most items, ranging from - 069 to 0.55 in Pearson correlation. The individual evaluation between scales on the items on urinary incontinence, dementia and gait were also satisfactory and stistically significant. The Portuguese version of the graduation scale for patients with NPH was successfully translated and validated for use in Brazilian patients of both genders, with satisfactory reliability and validity

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Burazin, Andrijana. "Application of Mixture Theory to solid tumors and normal pressure hydrocephalus." Thesis, 2013. http://hdl.handle.net/10012/8140.

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In this thesis, the theory of poroelasticity, namely the Mixture Theory version -- a homogenized, macroscopic scale approach used to describe fluid flow through a porous medium -- is employed in three separate cases pertaining to a biological phenomenon. The first investigation explores the behavior of interstitial fluid pressure (IFP) in solid tumors. Thus, in Chapter 2, a Mixture Theory based approach is developed to describe the evolution of the IFP from that in a healthy interstitium to the elevated levels in cancerous tumors. Attention is focused on angiogenesis, a tightly regulated process in healthy tissue that provides all necessary nutrients through the creation of new blood vessels. Once this process becomes unruly within a tumor, angiogenesis gives rise to an abnormal vasculature by forming convoluted and leaky blood vessels. Thus, the primary focus of the model is on the capillary filtration coefficient and vascular density as they increase in time, which in turn elevates the tumor IFP. Later, the Mixture Theory model is extended to simulate the effects of vascular normalization, where the cancer therapy not only prunes blood vessels, but reverts the chaotic vasculature to a somewhat normal state, thereby temporarily lowering the tumor IFP. In Chapter 3, the validity of an assumption that was made in order to facilitate the mathematical calculations is investigated. In addition to all of the Mixture Theory assumptions, it is assumed that the pore pressure p is proportional to the tissue dilatation e. This assumption is examined to determine how appropriate and accurate it is, by using a heat type equation without the presence of sources and sinks under the assumption of a spherical geometry. The results obtained under the proportionality of p and e, are compared with the results obtained without this assumption. A substantial difference is found, which suggests that great care must be exercised in assuming the proportionality of p and e. The last application is reported in Chapter 4 and it investigates the pathogenesis of normal pressure hydrocephalus. In a normal brain, cerebrospinal fluid (CSF) is created by the choroid plexus, circulates around the brain and the spinal cord without any impediment, and then is absorbed at various sites. However, normal pressure hydrocephalus occurs when there is an imbalance between the production and absorption of CSF in the brain that causes the impaired clearance of CSF and the enlargement of ventricles; however, the ventricular pressure in this case is frequently measured to be normal. Thus, a mathematical model using Mixture Theory is formulated to analyze a possible explanation of this brain condition. Levine (1999) proposed the hypothesis that CSF seeps from the ventricular space into the brain parenchyma and is efficiently absorbed in the bloodstream. To test this hypothesis, Levine used the consolidation theory version of poroelasticity theory, with the addition of Starling's law to account for the absorption of CSF in the brain parenchyma at steady state. However, the Mixture Theory model does not agree with the results obtained by Levine (1999) which leads one to conclude that the pathogenesis of normal pressure hydrocephalus remains unknown. To conclude the thesis, all three applications of Mixture Theory are discussed and the importance and contribution of this work is highlighted. In addition, possible future directions are indicated based on the findings of this thesis.

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Cabral, Danielle. "Frequency of Alzheimer’s Disease Pathology at Autopsy in Patients with Clinical Normal Pressure Hydrocephalus." Thesis, 2011. http://hdl.handle.net/10150/170532.

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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Background: Normal pressure hydrocephalus (NPH) is considered potentially treatable with the placement of a cerebrospinal fluid (CSF) shunt. Yet, the procedure has had variable success, particularly with respect to improving the cognitive impairment in NPH. The presence of neurologic co-morbidities, particularly Alzheimer’s Disease (AD), may contribute to shunt responsiveness. Uncovering the extent to which AD and NPH co-occur has implications for diagnosis and treatment of NPH. Autopsy studies of patients with NPH during life would elucidate the frequency of such co-morbidities. Methods: We conducted a search of the Sun Health Research Institute Brain Donation Program database between 1/1/1997 and 4/1/09 to identify all cases with neuropathologic evidence of dementia as well as those cases of clinically diagnosed NPH. We reviewed the medical records and brain findings of each NPH case. Results: Of the 761 cases autopsied over the study interval, 563 cases were found to have neuropathological evidence meeting criteria for a dementing illness. AD was found exclusively in 313/563 (56%) cases with 94/563 cases having a secondary diagnosis of dementia. We identified 9/761 cases with a clinical diagnosis of NPH, all nine cases were among the 563 cases with neuropathology of dementing illness at autopsy, representing 1.6% (9/563). Upon review of brain autopsy reports, 8/9 (89%) cases were found to have AD and 1/9 (11%) had progressive supranuclear palsy. Review of the medical records of the nine NPH cases revealed the following clinical co-morbidities: 5/9 with AD; 1/9 with Parkinson’s Disease (PD); 1/9 with Mild Cognitive Impairment (MCI); 1/9 with seizure disorder. Conclusions: Given the findings of our study, we support the AD-NPH theory and posit that AD is a common pathological co-morbidity in the setting of NPH and may preclude cognitive improvement post-shunt placement. This may have influence on selection of cases for shunting in the future.

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29

Gallagher, Ryan. "iNPH QUEST Study: quantifying a battery of gait, cognitive and radiological examinations to improve identification of shunt candidates from the cerebrospinal fluid tap test." Thesis, 2019. http://hdl.handle.net/1959.13/1408424.

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Research Doctorate - Doctor of Philosophy (PhD)
Idiopathic normal Pressure hydrocephalus (iNPH), a condition resulting in abnormalities of gait, cognition and continence, is treated by the placement of a ventricular peritoneal (VP) shunt to drain cerebrospinal fluid (CSF). To identify surgical candidates the CSF tap test (TT) was devised to mimic VP shunt insertion. The CSF TT involves drainage of a small volume of CSF to assess for symptom improvement. Additionally, measurements of CSF flow on MRI imaging have been devised to identify VP shunt candidates. Limited research has investigated assessing what outcome measures can identify change from a CSF TT. Neither the tests capable of definitively identifying change from a CSF TT nor the degree of change required on any test constituting a clinically important difference have been extensively investigated. Additionally, whether any measure on MRI CSF flow studies can identify change using outcome measures has not been explored. This thesis aims to: 1. Identify a battery of standardised gait and balance outcome measures which can identify change from a CSF TT. 2. Identify a battery of standardised upper limb and cognitive outcome measures which can identify change from a CSF TT. 3. Develop minimally clinically important differences (MCIDs) for a battery of outcome measures. 4. Identify radiological markers on MRI CSF flow studies that are prognostic of response to CSF drainage. The ability of the Timed up and go (TUG), Timed up and go cognition (TUG-C), performance oriented mobility assessment (Tinetti), Berg balance scale (BBS), 10 metre walk test (10MWT), Montreal cognitive assessment (MoCA) and 9 hole peg test (9HPT) to identify change from a CSF TT was assessed. These studies demonstrated that the TUG, TUG-C, Tinetti and BBS could identify change from a CSF TT. Calculated MCIDs were 3.63sec for the TUG, 2.60sec for the TUG-C, 4 points for the Tinetti and 4 points for the BBS represent MCIDs for improvement from a CSF TT. Additionally, we have shown that the measurements of the sagittal sinus circumference and area can differentiate improvement in gait as a result of CSF drainage. Further research is required to evaluate the utility of these MCID values in identifying improvement following VP shunt insertion.

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30

Snöbohm, Carl. "The Predictive Value of White Matter Changes on Shunt Outcome in Patients With Idiopathic Normal Pressure Hydrocephalus." Thesis, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-392853.

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Lee, E.-Jian, and 李宜堅. "Cerebral Blood Flow Velocity and Vasomotor Reactivity before and after Shunting Surgery in Patients with Normal Pressure Hydrocephalus." Thesis, 1997. http://ndltd.ncl.edu.tw/handle/48826035231997811722.

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碩士
國立成功大學
醫學工程學系
86
ABSTRACTOBJECTIVE:The aim of the study was to evaluate the hemodynamic changes and their correlationwith the clinical results by measurement of cerebral blood flow velocity (CBFV) andcerebral vasomotor reserve before and after shunt placement in normal pressurehydrocephalus (NPH).METHODS:Ten demented patients with clinical signs suggestive of NPH received examinationsof blood flow velocity (BFV) and vasomotor reactivity (VMR) of the anterior cerebralartery (ACA) and the middle cerebral artery (MCA) by transcranial Doppler sonographywith carbogen testing before and after shunt treatment. Computerized tomography (CT),clinical assessment and neuropsychological grading were performed prior to and at 3months following surgery. A control group consisting of 7 patients, who underwentlumbar spine surgery, was included to establish baseline data for BFV and VMR values.RESULTS:Compared to the control group, the preoperative CBF studies revealed the NPH patienthad no significant decrease of BFVs in both the MCA and the ACA (P > 0.05), but hadsignificant decrease of carbogen VMR in both those two vessels (P < 0.05). Aftershunting, there were no significant changes of the BFVs in the 2 vessels as comparedto the pre-shunting data (P > 0.05). The post-shunting VMR of ACA was significantlyhigher than the pre-shunting one (p < 0.05), but there was no significance in thatof MCA (p > 0.05). Seven of the ten patients shown mentality or more symptomsimprovement were considered as good results (responsive to shunt). The remaining 3patients, who had consistent symptoms without recognizable problems, were consideredas bad results (shunt failure). Both the value of post-shunting VMR in ACA and thepost-shunting improvement of VMR in MCA of the 7 shunt- responsive patients weresignificantly higher than those of shunt-failure patients (p < 0.05). Within the tenpatients, five patients with gait improvement showed significantly in the value ofpost-shunting VMR of ACA and the post-shunting improvement of VMR for both ACA andMCA by comparing those patients without gait improvement (p < 0.05, respectively).CONCLUSION:Our results support that the patient with NPH did not have decreased BFVs, but hadvarious degrees of impaired vasomotor reserve in both the ACA and the MCA, increasingthe risk of ischemic brain insult. Shunt placement improves the VMR in responsivepatients, consequently preventing from the ischemic insult. Post-shunting increaseof VMR accompanies with the improvement of functional state in shunt-responsivepatients; however, post-shunting increase of VMR in the MCA only, and in both the ACAand the MCA are associated with symptomatic improvement in mentality, and improvementin gait, respectively. These close relationships have implications for prognosticimportance and pathophysiology in NPH.Key Words: Normal pressure hydrocephalus, Cerebral blood flow velocity, Vasomotorreactivity.

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Li, Yi-Jian, and 李宜堅. "Cerebral Blood Flow Velocity and Vasomotor Reactivity before and after Shunting Surgery in Patients with Normal Pressure Hydrocephalus." Thesis, 1997. http://ndltd.ncl.edu.tw/handle/24831229639771129866.

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Chou, Mei-Chuan, and 周美鵑. "Analysis of changes of gait and cognition after cerebrospinal fluid (CSF) tap test in patients with normal pressure hydrocephalus." Thesis, 2009. http://ndltd.ncl.edu.tw/handle/96771705295264723780.

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碩士
高雄醫學大學
醫學系神經學科碩士班
97
Background and Purpose: Normal pressure hydrocephalus is one of the few causes of dementia that is potentially reversible or treatable. Timely diagnosis and placement of a ventriculoperitoneal shunt can lead to significant improvement. The cerebrospinal fluid (CSF) tap test remains one of the most reliable methods to predict the response of shunting. The aim of the study is to investigate (1) whether the rate of positive CSF tap test responders differ between the patients with idiopathic normal pressure hydrocephalus ( INPH ) and secondary normal pressure hydrocephalus (SNPH ) . (2) the impact of vascular comorbidities on the CSF tap test in patients with INPH. (3) which individual domain of cognition improve after CSF tap test (4) the association between changes of gait and cognition. Methods: We retrospectively enrolled consecutive patients admitted for work-up for normal pressure hydrocephalus from Jan 2006 to April 2009 in Department of Neurology, Kaohsiung Medical University Hospital. The criteria of diagnosis of INPH and SNPH was based on the INPH guideline by Norman Relkin et al. published in neurosurgery in 2005. The studied subjects consisted of 50 patients with INPH and 9 patients with SNPH. We performed lumbar puncture and removed 30 ml of CSF. Rapid gait test and cognitive ability screening instrument ( CASI ) were assessed before and after CSF tap test. We defined CSF tap responders as the patients who improved either in gait or cognition after CSF tap test. The improvement of rapid gait test should be more than 10% and that of CASI should be more than one standard deviation (1 SD) for the patient’s age and education level. Results: We found that (1) the rate of CSF tap test responders was not significantly different between the patients with INPH and SNPH. (2) the rate of CSF tap test responders was not related to the presence or severity of vascular comorbidities in the patients with INPH. The vascular comorbidities being analyzed included hypertension, diabetes, hypercholesterolemia, ischemic heart disease, congestive heart failure, atrial fibrillation, ischemic stroke and while matter changes. (3) 72% of patients with INPH had total score of CASI below cut-off values for the patient’s age and education level. Regarding the percentage of patients with impairment in individual cognitive domain, the highest were recent memory, orientation and verbal fluency. Regarding the severity of impairment defined by the units of SD in the individual cognitive domain, the most significant deficits were seen in orientation, recent memory and verbal fluency. 40% of patient with INPH got improvement by more than 1SD of total score of CASI after CSF tap test. Regarding the percentage of patients with improvement by more than 1SD of the individual cognitive domain, the highest were attention, verbal fluency, abstract and construction. Regarding the degree of improvement defined by the units of SD in the individual cognitive domain, the most significant change was seen in attention, remote memory, verbal fluency and abstract. (4) there was a slightly negative correlation between scores of concentration and verbal fluency and rapid gait test. The correlation was observed both before and after CSF tap test in patients with INPH. Besides, the moderate correlation between improvement of orientation and abstract and that of rapid gait test was seen in the subset of CSF tap test responders who improved in both cognition and gait. Conclusions: The study suggested that the etiologies of normal pressure hydrocephalus did not affect the results of CSF tap test and the impact of vascular comorbidities on CSF tap test in patients with INPH was not significant. The neuropsychological deficits of the patients with INPH were mostly seen in recent memory, orientation and verbal fluency. The patients with INPH improved in overall cognition after CSF tap test. The most significant change was seen in attention, verbal fluency and abstract regarding both percentage of patients with improvement and the degree of improvement. Besides, the association between concentration and verbal fluency and gait disturbance was observed in patients with INPH and the improvement of gait was correlated with that of orientation and verbal fluency in the subset of CSF tap test responders who improved both in cognition and gait. Our results support that the major defect in INPH is in frontal-subcortical system.

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34

Beggs, Clive B. "Venous hemodynamics in neurological disorders: an analytical review with hydrodynamic analysis." 2013. http://hdl.handle.net/10454/9565.

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Yes
Venous abnormalities contribute to the pathophysiology of several neurological conditions. This paper reviews the literature regarding venous abnormalities in multiple sclerosis (MS), leukoaraiosis, and normal-pressure hydrocephalus (NPH). The review is supplemented with hydrodynamic analysis to assess the effects on cerebrospinal fluid (CSF) dynamics and cerebral blood flow (CBF) of venous hypertension in general, and chronic cerebrospinal venous insufficiency (CCSVI) in particular.CCSVI-like venous anomalies seem unlikely to account for reduced CBF in patients with MS, thus other mechanisms must be at work, which increase the hydraulic resistance of the cerebral vascular bed in MS. Similarly, hydrodynamic changes appear to be responsible for reduced CBF in leukoaraiosis. The hydrodynamic properties of the periventricular veins make these vessels particularly vulnerable to ischemia and plaque formation.Venous hypertension in the dural sinuses can alter intracranial compliance. Consequently, venous hypertension may change the CSF dynamics, affecting the intracranial windkessel mechanism. MS and NPH appear to share some similar characteristics, with both conditions exhibiting increased CSF pulsatility in the aqueduct of Sylvius.CCSVI appears to be a real phenomenon associated with MS, which causes venous hypertension in the dural sinuses. However, the role of CCSVI in the pathophysiology of MS remains unclear.

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Chen, Yung-Chieh, and 陳永介. "Diffusion tensor imaging analysis of the anterior thalamic nucleus: validating the role of Papez circuit in clinical memory performance within idiopathic normal pressure hydrocephalus disease model." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/32108194139463969915.

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博士
國立陽明大學
生物醫學影像暨放射科學系
104
The human thalamus plays a pivotal role in modulating and subserving complex functions of the brain. Diffusion tensor imaging (DTI) studies of the thalamus and its role in processing functional tasks are generally limited by the topographic orientation of its various function-specific thalamic nuclei, as well as the availability of simple yet reliable methods for localizing particular thalamic nuclei-of-interest in subjects under both normal and diseased state. This dissertation aims at establishing a simple yet practical, and topographically accurate tract-deterministic nuclei identification method under DTI that is capable of effectively localizing the anterior thalamic nucleus (AN), a pivotal component within the Papez circuit for memory, and quantitatively assess its reactive changes in terms of diffusion metrics, such as fractional anisotropy (FA) and q value, among patients with early idiopathic normal pressure hydrocephalus (iNPH) presented with memory impairment both before and after surgical management, in comparison with normal control subjects. Correlation analyses between changes in diffusion metrics of AN and neuropsychologic performance in memory among patients before treatment were also performed. On the other hand, the Papez circuit within the human brain was reconstructed by constrained spherical deconvolution tractography method for the first time. The findings of this dissertation highlight the potential compensatory role of the AN within the Papez circuit in response to functional compromise during the pathogenesis of iNPH, and further support the concept that effective thalamic evaluations in various disease models can offer a more disease- specific perspective to understand the structure and function of the thalamus and its nuclei.

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Παναγιωτόπουλος, Βασίλειος. "Η προγνωστική αξία της προσωρινής εξωτερικής οσφυικής παροχέτευσης με βαλβίδα μέσης πίεσης, στον υδροκέφαλο φυσιολογικής πίεσης." 2005. http://nemertes.lis.upatras.gr/jspui/handle/10889/356.

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Σποραδικές μελέτες περιγράφουν την προσωρινή εξωτερική οσφυϊκή παροχέτευση του ΕΝΥ, ως μία δοκιμασία υψηλής ακριβείας όσον αφορά στην πρόβλεψη του κλινικού αποτελέσματος μετά από κοιλιοπεριτοναϊκή παροχέτευση στους ασθενείς με ΥΦΠ. Παρόλα αυτά, σε μία πιο πρόσφατη μελέτη από τους Walchenbach και συνεργάτες, εκτιμήθηκε ότι η θετική προγνωστική αξία της ΕΟΠ ήταν υψηλή, ενώ η αρνητική χαμηλή. Δια ταύτα, πραγματοποιήσαμε μία προοπτική μελέτη με σκοπό να εκτιμήσουμε την προγνωστική αξία μιάς προσωρινής εξωτερικής οσφυικής παροχέτευσης (ΕΟΠ), η οποία ρυθμίζει την εκροή ΕΝΥ μέσω μιάς βαλβίδας μέσης πίεσης μονόδρομης ροής, σε ασθενείς με υδροκέφαλο φυσιολογικής πίεσης (ΥΦΠ). Είκοσι επτά 27 ασθενείς με ΥΦΠ εισήχθησαν στη Νευροχειρουργική Κλινική του ΠΓΝΠ και υπεβλήθησαν σε τοποθέτηση προσωρινής εξωτερικής οσφυικής παροχέτευσης (ΕΟΠ), η οποία ρυθμίζει την εκροή ΕΝΥ μέσω μιάς βαλβίδας μέσης πίεσης, για 5 ημέρες. 22 ασθενείς υπεβλήθησαν τελικά σε κοιλιοπεριτοναϊκή παροχέτευση με βαλβίδα μέσης πίεσης, βασιζόμενοι σε κλινικά και ακτινολογικά κριτήρια, ανεξαρτήτως του αποτελέσματος της ΕΟΠ. Κλινική εκτίμηση των διαταραχών της βάδισης, της ούρησης και της νόησης, όπως επίσης και ακτινολογική εκτίμηση, πραγματοποιήθηκε προ και μετά την δοκιμασία της ΕΟΠ καθώς και 3 μήνες μετά την ΚΠΠ. Είκοσι δύο 22 ασθενείς υπεβλήθησαν τελικά σε κοιλιοπεριτοναϊκή παροχέτευση και πληρούσαν τα κριτήρια για να συμπεριληφθούν τελικά στη μελέτη. Χρησιμοποιώντας ένα εγκεκριμένο σύστημα βαθμολόγησης, η συνολική βελτίωση μετά τη δοκιμασία ΕΟΠ συσχετιζόταν καλά με τη βελτίωση 3 μήνες μετά την μόνιμη ΚΠΠ. (Spearman’ s rho = 0,462, p=0,03). Όταν θεωρήσαμε κάθε βαθμό βελτίωσης ως θετική ανταπόκριση, η δοκιμασία ΕΟΠ-βαλβίδας μέσης πίεσης είχε υψηλή θετική προγνωστική αξία για κάθε μία ανεξάρτητη κλινική παράμετρο (διαταραχές της βάδισης 94%, 95% CI 71%-100%, ακράτεια στην ούρηση 100%, 95% CI 66%-100%, διαταραχές της νόησης 100%, 95% CI 66-100%), ενώ η αρνητική προγνωστική αξία ήταν χαμηλή (<50%) εκτός από τις διαταραχές της νόησης (85%, 95% CI 55%-98%). Η ανωτέρω μελέτη συμπεραίνει ότι η δοκιμασία της ΕΟΠ-βαλβίδας μέσης πίεσης, θα πρέπει να θεωρείται ένα αξιόπιστο κριτήριο για την προεγχειρητική επιλογή υδροκεφαλικών ασθενών φυσιολογικής πίεσης που βελτιώνονται κλινικά μετά την τοποθέτηση ΚΠΠ. Σε περίπτωση αρνητικής δοκιμασίας ΕΟΠ-βαλβίδας μέσης πίεσης, θα πρέπει να διενεργείται περαιτέρω διερεύνηση με επιπρόσθετες διαγνωστικές δοκιμασίες.
Although sporadic studies have described temporary external cerebrospinal fluid (CSF) lumbar drainage as a highly accurate test in predicting the outcome after ventricular shunting in normal pressure hydrocephalus (NPH) patients, a more recent study reports that the positive predictive value of external lumbar drainage (ELD) is high but the negative predictive value is deceptively low. Therefore, we conducted a prospective study in order to evaluate the predictive value of a continuous ELD, with CSF outflow controlled by medium pressure valve, in NPH patients. Twenty-seven patients with presumed NPH were admitted to our department and CSF drainage was carried out by a temporary (ELD), with CSF outflow controlled by medium pressure valve for five days. Twenty-two patients received a ventriculo¬peritoneal shunt with medium pressure valve based upon preoperative clinical and radiographic criteria of NPH, regardless of ELD outcome. Clinical evaluation of gait disturbances, urinary incontinence and mental status, and radiological evaluation with brain CT was performed prior to and after ELD test, as well as three months after shunting. Twenty-two patients were finally shunted and included in this study. In a three-month follow-up, using a previously validated score system, overall improvement after permanent shunting correlated well with improvement after ELD test (Spearman’s rho=0.462, p=0.03). When considering any degree of improvement as a positive response, ELD test yielded high positive predictive values for all individual parameters (gait disturbances 94%, 95% CI 71%-100%, urinary incontinence 100%, 95% CI 66%-100%, and mental status 100%, 95% CI 66%-100%) but negative predictive values were low (<50%) except for cognitive impairment (85%, 95% CI 55%-98%). This study suggests that a positive ELD-valve system test should be considered a reliable criterion for preoperative selection of shunt-responsive NPH patients. In case of a negative ELD-valve system test, further investigation of the presumed NPH patients with additional tests should be performed.

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37

Buksakowska, Irena. "Strukturální podklady kognitivního deficitu v zobrazování magnetické rezonance." Doctoral thesis, 2019. http://www.nusl.cz/ntk/nusl-405129.

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Abstract:

Structural and diffusion imaging patterns that can be evaluated using MRI in patients with cognitive deficits are the central theme of the proposed work. First, the clinical and neuroimaging background of dementias has been reviewed in a broader context, with a special focus on Alzheimer's disease (AD) and differential diagnoses. The second part of this thesis contains four consecutive experimental studies. The primary objective of the first two studies was to obtain structural and microstructural information on the neurodegenerative processes characteristic for AD on global and regional levels. For this purpose, several complementary approaches were used and the focus was shifted from grey to white matter (GM/WM). The following two studies focused on the differential context of WM microstructural alterations in normal pressure hydrocephalus (NPH) and distinctive patterns of WM disintegrity in temporal lobe epilepsy (TLE). The most important conclusion of our studies is that structural and diffusion imaging proved to be useful in identifying regionally specific and disproportionate loss of brain volume and microstructure in several pathological processes underlying cognitive deterioration. The use of distinctive morphometric methods yielded complementary information on AD-related atrophy patterns,...

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38

Elster, Judith. "Die Bedeutung von Aquaporin1- und Aquaporin4-Konzentrationen im Liquor cerebrospinalis für Patienten mit Normaldruckhydrozephalus und Pseudotumor cerebri." Doctoral thesis, 2011. http://hdl.handle.net/11858/00-1735-0000-0006-B2A5-4.

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Dissertations / Theses on the topic 'Normal pressure hydrocephalus'

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