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Kojoukhova M, Vanha KI, Timonen M, Koivisto AM, Nerg O, Rummukainen J, Rauramaa T, Vanninen R, Jääskeläinen JE, Sutela A, Leinonen V. Associations of intracranial pressure with brain biopsy, radiological findings, and shunt surgery outcome in patients with suspected idiopathic normal pressure hydrocephalus. Acta Neurochir (Wien) 2017; 159:51-61. [PMID: 27878614 DOI: 10.1007/s00701-016-3025-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/09/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND It remains unclear how intracranial pressure (ICP) measures are associated with brain biopsies and radiological markers. Here, we aim to investigate associations between ICP and radiological findings, brain biopsies, and shunt surgery outcome in patients with suspected idiopathic normal pressure hydrocephalus (iNPH). METHOD In this study, we retrospectively analyzed data from 73 patients admitted with suspected iNPH to Kuopio University Hospital. Of these patients, 71% underwent shunt surgery. The NPH registry included data on clinical and radiological examinations, 24-h intraventricular pressure monitoring, and frontal cortical biopsy. RESULTS The mean ICP and mean ICP pulse wave amplitude were not associated with the shunt response. Aggregations of Alzheimer's disease (AD)-related proteins (amyloid-β, hyperphosphorylated tau) in frontal cortical biopsies were associated with a poor shunt response (P = 0.014). High mean ICP was associated with Evans' index (EI; P = 0.025), disproportional sylvian and suprasylvian subarachnoid spaces (P = 0.014), and focally dilated sulci (P = 0.047). Interestingly, a high pulse wave amplitude was associated with AD-related biopsy findings (P = 0.032), but the mean ICP was not associated with the brain biopsy. The ICP was not associated with medial temporal lobe atrophy, temporal horn widths, or white matter changes. ICP B waves were associated with less atrophy of the medial temporal lobe (P = 0.018) and more severe disproportionality between the sylvian and suprasylvian subarachnoid spaces (P = 0.001). CONCLUSIONS The EI and disproportional sylvian and suprasylvian subarachnoid spaces were associated with mean ICP. Disproportionality was also associated with ICP B waves. These associations, although rather weak, with elevated ICP in 24-h measurements, support their value in iNPH diagnostics and suggest that these radiological markers are potentially related to the pathogenesis of iNPH. Interestingly, our results suggested that elevated pulse wave amplitude might be associated with brain amyloid accumulation.
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Affiliation(s)
- Maria Kojoukhova
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland.
| | - Krista-Irina Vanha
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
| | - Matti Timonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
| | - Anne M Koivisto
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Ossi Nerg
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurology of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jaana Rummukainen
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine-Pathology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
| | - Anna Sutela
- Department of Radiology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, P.O. Box 100, 70029, Kuopio, Finland
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102
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The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci 2016; 34:294-298. [DOI: 10.1016/j.jocn.2016.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022]
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Bogomyakova O, Stankevich Y, Mesropyan N, Shaybman L, Tulupov A. Evaluation of the flow of cerebrospinal fluid as well as gender and age characteristics in patients with communicating hydrocephalus, using phase-contrast magnetic resonance imaging. Acta Neurol Belg 2016; 116:495-501. [PMID: 26848963 DOI: 10.1007/s13760-016-0608-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Abstract
To determine the difference in the velocity parameters of cerebrospinal fluid flow in patients with varying severity of communicating hydrocephalus compared to a group of healthy volunteers without hydrodynamic disorders. The study involved 35 subjects with communicating hydrocephalus (25 subjects with Evans index of 0.31; 10 subject with Evans index of 0.46) and 62 healthy volunteers. The mean, volume, and peak flow velocities were determined at the different intracranial levels. Also were made an assessment of gender and age differences. Analysis of the differences between the mean values showed the progressive inhibition of cerebrospinal fluid outflow from the cranial cavity [in moderate communicating hydrocephalus-at 1.5 times (p < 0.05), in severe communicating hydrocephalus at 2-2.5 times (p < 0.01)], depending on the severity of enlargement of the ventricular system and, most likely, related to inhibition of its reabsorption. These changes may explain the clinical symptoms of subjects and serve as diagnostic criteria. Also it was revealed a significant influence of the factor of age on speed characteristics of the cerebrospinal fluid flow (F = 5.3303, p = 0.0003, for mean velocity).
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Affiliation(s)
- Olga Bogomyakova
- International Tomography Center Siberian Branch of the Russian Academy of Sciences, Institutskaya Str. 3a, Novosibirsk, 630090, Russian Federation.
| | - Yu Stankevich
- International Tomography Center Siberian Branch of the Russian Academy of Sciences, Institutskaya Str. 3a, Novosibirsk, 630090, Russian Federation
| | - N Mesropyan
- International Tomography Center Siberian Branch of the Russian Academy of Sciences, Institutskaya Str. 3a, Novosibirsk, 630090, Russian Federation
- Novosibirsk State University, Pirogova Str. 2, Novosibirsk, 630090, Russian Federation
| | - L Shaybman
- International Tomography Center Siberian Branch of the Russian Academy of Sciences, Institutskaya Str. 3a, Novosibirsk, 630090, Russian Federation
| | - A Tulupov
- International Tomography Center Siberian Branch of the Russian Academy of Sciences, Institutskaya Str. 3a, Novosibirsk, 630090, Russian Federation
- Novosibirsk State University, Pirogova Str. 2, Novosibirsk, 630090, Russian Federation
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104
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Börcek AÖ, Uçar M, Karaaslan B. Simplest radiological measurement related to clinical success in endoscopic third ventriculostomy. Clin Neurol Neurosurg 2016; 152:16-22. [PMID: 27863276 DOI: 10.1016/j.clineuro.2016.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/02/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Radiologic criteria for a successful endoscopic third ventriculostomy are not clearly defined and there is an ongoing need for determining simplest and strongest radiological criteria for this purpose. This paper aims to determine the easiest radiological parameter related to surgical outcome METHODS: Between January 2012 and December 2015 all patients receiving endoscopic third ventriculostomy with various indications were reviewed and 29 patients whose preoperative and early postoperative 3D-CISS images were available were studied. There were 13 males and 16 females, and there were 11 pediatric cases (mean age: 9.90±5.2; range: 2-18). The mean age of the entire population was 26.58±18.32 (range: 2-68 years). Measurements were performed using the ruler tool of a freely distributed medical imaging software. Simple ruler measurements of ventricular floor depression, lamina terminalis bowing, anterior commissure to tuber cinereum distance, mamillary body to lamina terminalis distance, third ventricular width, frontal horn width and occipital horn width were recorded and compared between successful and failed interventions. RESULTS Of the ventriculostomies, 22 (75.9%) were considered successful and 7 (24.1%) as failed at the last follow-up visit. Of the measurements performed, only those related to the third ventricle itself were significantly higher in the failed group. There were no association with lateral ventricular measurements. CONCLUSION Simple ruler measurements of the suggested distances significantly correlate with clinical success. After validating our results with higher number of patients, complex measurements and calculations to determine the link between clinical success and radiological success of ventriculostomy procedures may not be needed.
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Affiliation(s)
- Alp Özgün Börcek
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey.
| | - Murat Uçar
- Deparment of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Burak Karaaslan
- Department of Neurosurgery, Division of Pediatric Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey
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105
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Topakian R, Artemian H, Metschitzer B, Lugmayr H, Kühr T, Pischinger B. Dramatic response to a 3-week course of ceftriaxone in late neuroborreliosis mimicking atypical dementia and normal pressure hydrocephalus. J Neurol Sci 2016; 366:146-148. [PMID: 27288794 DOI: 10.1016/j.jns.2016.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/01/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Herta Artemian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Bettina Metschitzer
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Herbert Lugmayr
- Institute of Radiology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Thomas Kühr
- Department of Internal Medicine IV, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
| | - Barbara Pischinger
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
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106
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Czepko R, Cieslicki K. Repeated assessment of suspected normal pressure hydrocephalus in non-shunted cases. A prospective study based on the constant rate lumbar infusion test. Acta Neurochir (Wien) 2016; 158:855-63; discussion 863. [PMID: 26923798 DOI: 10.1007/s00701-016-2732-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 02/02/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Only a few reports have been published on the natural history of non-shunted patients suspected of having NPH. The aim of this study is to follow up a group of such cases. METHODS It was possible to follow up 27 patients who had not been qualified for shunting after the primary diagnosis. An assessment of Hakim's triad was performed, together with an analysis of radiological parameters and the results of lumbar infusion tests (LITs), both on admission and at the later date (on average, after 5.6 months). All parameters were analyzed with respect to periventricular lucency (PVL), atrophy, type of NPH, and the age of the patients. RESULTS There were no deteriorations and six patients improved. Those who were over 50 and who had no PVL or secondary NPH tended to improve more frequently. Significant improvement of dementia was noted (p = 0.042) in all cases, and in the group of patients without PVL (p = 0.04). The size of the ventricles did not change significantly. The values of the resistance to outflow (R), elastance (E), and ICP remained stable. CONCLUSIONS Analysis of our series revealed that the patients suspected of having NPH who had not been qualified for shunting did not deteriorate, while some of them even improved significantly as far as the level of dementia was concerned. As the CT and LIT parameters remained stable, there were no indications for repeating these examinations, at least within the period of nearly 6 months, which followed the primary diagnosis.
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Affiliation(s)
- Ryszard Czepko
- Department of Neurosurgery, St. Raphael's Hospital, 12 Bochenka str, 30-001, Krakow, Poland.
| | - Krzysztof Cieslicki
- Laboratory of Bioflows, Institute of Automatic Control and Robotics, Warsaw University of Technology, Warsaw, Poland
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107
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Nassar BR, Lippa CF. Idiopathic Normal Pressure Hydrocephalus: A Review for General Practitioners. Gerontol Geriatr Med 2016; 2:2333721416643702. [PMID: 28138494 PMCID: PMC5119812 DOI: 10.1177/2333721416643702] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 03/09/2016] [Indexed: 11/15/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a potentially reversible neurodegenerative disease commonly characterized by a triad of dementia, gait, and urinary disturbance. Advancements in diagnosis and treatment have aided in properly identifying and improving symptoms in patients. However, a large proportion of iNPH patients remain either undiagnosed or misdiagnosed. Using PubMed search engine of keywords "normal pressure hydrocephalus," "diagnosis," "shunt treatment," "biomarkers," "gait disturbances," "cognitive function," "neuropsychology," "imaging," and "pathogenesis," articles were obtained for this review. The majority of the articles were retrieved from the past 10 years. The purpose of this review article is to aid general practitioners in further understanding current findings on the pathogenesis, diagnosis, and treatment of iNPH.
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Affiliation(s)
| | - Carol F. Lippa
- Drexel University, Philadelphia, PA, USA
- Carol F. Lippa, Department of Neurology, College of Medicine, Drexel University, Philadelphia, PA 19102, USA.
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108
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Abstract
Normal pressure hydrocephalus (NPH) is a syndrome characterized by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation (triad) may be atypical or incomplete, or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, such as CSF tap-tests and computed tomography (CT) or magnetic resonance imaging (MRI). The CSF tap-test, especially the 3 to 5 days continuous external lumbar drainage of at least 150 ml/day, is the only procedure that simulates the effect of definitive shunt surgery, with high sensitivity (50-100%) and high positive predictive value (80-100%). According to international guidelines, the following are CT or MRI signs decisive for NPH diagnosis and selection of shunt-responsive patients: ventricular enlargement disproportionate to cerebral atrophy (Evans index >0.3), and associated ballooning of frontal horns; periventricular hyperintensities; corpus callosum thinning and elevation, with callosal angle between 40º and 90º; widening of temporal horns not fully explained by hippocampal atrophy; and aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of sulci and subarachnoid spaces over the high convexity and midline surface of the brain. On the other hand, other imaging methods such as radionuclide cisternography, SPECT, PET, and also DTI or resting-state functional MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases.
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Affiliation(s)
- Benito Pereira Damasceno
- MD, PhD, Department of Neurology, Medical School, University of Campinas (UNICAMP), Campinas SP, Brazil
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109
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Normative values for Evan's index on CT scan for apparently healthy individuals. J ANAT SOC INDIA 2015. [DOI: 10.1016/j.jasi.2015.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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110
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Yamada S, Ishikawa M, Yamamoto K. Optimal Diagnostic Indices for Idiopathic Normal Pressure Hydrocephalus Based on the 3D Quantitative Volumetric Analysis for the Cerebral Ventricle and Subarachnoid Space. AJNR Am J Neuroradiol 2015; 36:2262-9. [PMID: 26359148 DOI: 10.3174/ajnr.a4440] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/01/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Despite the remarkable progress of 3D graphics technology, the Evans index has been the most popular index for ventricular enlargement. We investigated a novel reliable index for the MR imaging features specified in idiopathic normal pressure hydrocephalus, rather than the Evans index. MATERIALS AND METHODS The patients with suspected idiopathic normal pressure hydrocephalus on the basis of the ventriculomegaly and a triad of symptoms underwent the CSF tap test. CSF volumes were extracted from a T2-weighted 3D spin-echo sequence named "sampling perfection with application-optimized contrasts by using different flip angle evolutions (SPACE)" on 3T MR imaging and were quantified semiautomatically. Subarachnoid spaces were divided as follows: upper and lower parts and 4 compartments of frontal convexity, parietal convexity, Sylvian fissure and basal cistern, and posterior fossa. The maximum length of 3 axial directions in the bilateral ventricles and their frontal horns was measured. The "z-Evans Index" was defined as the maximum z-axial length of the frontal horns to the maximum cranial z-axial length. These parameters were evaluated for the predictive accuracy for the tap-positive groups compared with the tap-negative groups and age-adjusted odds ratios at the optimal thresholds. RESULTS In this study, 24 patients with tap-positive idiopathic normal pressure hydrocephalus, 25 patients without response to the tap test, and 23 age-matched controls were included. The frontal horns of the bilateral ventricles were expanded, with the most excessive expansion being toward the z-direction. The CSF volume of the parietal convexity had the highest area under the receiver operating characteristic curve (0.768), the z-Evans Index was the second (0.758), and the upper-to-lower subarachnoid space ratio index was the third (0.723), to discriminate the tap-test response. CONCLUSIONS The CSF volume of the parietal convexity of <38 mL, upper-to-lower subarachnoid space ratio of <0.33, and the z-Evans Index of >0.42 were newly proposed useful indices for the idiopathic normal pressure hydrocephalus diagnosis, an alternative to the Evans Index.
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Affiliation(s)
- S Yamada
- From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan.
| | - M Ishikawa
- From the Normal Pressure Hydrocephalus Center (S.Y., M.I.) Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
| | - K Yamamoto
- Department of Neurosurgery and Stroke Center (S.Y., M.I., K.Y.), Rakuwakai Otowa Hospital, Kyoto, Japan
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111
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Chen HL, Lu CH, Chang CD, Chen PC, Chen MH, Hsu NW, Chou KH, Lin WM, Lin CP, Lin WC. Structural deficits and cognitive impairment in tuberculous meningitis. BMC Infect Dis 2015. [PMID: 26198732 PMCID: PMC4510907 DOI: 10.1186/s12879-015-1011-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background Chronic neuropsychological sequelae may occur in patients with tuberculous meningitis (TBM). The impact of structural abnormalities on the clinical performance of patients with TBM is unknown. This study applied the Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra (DARTEL) voxel-based morphometry (VBM) to determine if gray matter deficits in TBM are associated with acute presentations and chronic cognitive impairment. Methods Seventeen patients with TBM who discontinued their anti-TB therapy for more than six months, and 17 age-, sex-, and education-matched healthy subjects were enrolled. Differences in gray matter volume (GMV) between patients and healthy controls were investigated using DARTEL-VBM to determine structural abnormalities. Disease severity during the acute stage was scored by clinical profiles and conventional imaging findings. Correlations among chronic structural deficits, cognitive impairment, and initial disease severity were assessed. Results The patients with TBM had worse neuropsychological subtest performances than the healthy controls. Compared to the controls, the patients showed smaller GMVs in the right thalamus, right caudate nucleus, right superior and middle temporal gyrus, right precuneus, and left putamen (p < 0.001). The smaller GMVs in the right thalamus, right superior temporal gyrus, right precuneus, left putamen, and right caudate nucleus (p < 0.05) were further associated with worse cognitive function. More severe initial disease also correlated with smaller GMVs in the right caudate nucleus (p < 0.05). Conclusion Multiple domain cognitive impairment may persist in patients with chronic TBM even after appropriate treatment. Worse initial disease severity may contribute to the vulnerability of brain tissue to damage, with subsequent neuropsychological consequences.
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Affiliation(s)
- Hsiu-Ling Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan. .,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Ching-Di Chang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
| | - Pei-Chin Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
| | - Meng-Hsiang Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
| | - Nai-Wen Hsu
- Department of Radiology, Yuan's General Hospital, Kaohsiung, Taiwan.
| | - Kun-Hsien Chou
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.
| | - Wei-Ming Lin
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chang Gung University College of Medicine, Chiayi, Taiwan.
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan. .,Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, 123 Ta-Pei Road, Niao-Sung, Kaohsiung, 83305, Taiwan.
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Maldaner N, Guhl S, Mielke D, Musahl C, Schmidt NO, Wostrack M, Rüfenacht DA, Vajkoczy P, Dengler J. Changes in volume of giant intracranial aneurysms treated by surgical strategies other than direct clipping. Acta Neurochir (Wien) 2015; 157:1117-23; discussion 1123. [PMID: 26002711 DOI: 10.1007/s00701-015-2448-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Giant intracranial aneurysms (GIA) are often not eligible for direct clip occlusion. Surgical alternatives include partial clip occlusion or the placement of a cerebrovascular bypass or the combination of both. These alternative indirect strategies are expected to lead to a decrease in GIA volume over time rather than instantaneously. To examine whether this is the case, we analyzed follow-up imaging results 1 year after surgery. METHODS We retrospectively screened the prospective GIA Registry's imaging database for anterior circulation GIA treated by surgical strategies other than direct clipping. We measured pre- and 1-year post-treatment GIA volume, lateral ventricle volume (LVV), and mid-line shift (MLS) in 19 cases. RESULTS After a mean follow-up of 466 days (standard deviation ±171) GIA volumes decreased from 9.6 cm(3) (interquartile range (IQR) 6.1-14.1) to 4.3 cm(3) (IQR 2.9-5.7; p < 0.01). Ipsilateral LVV increased from 8.6 cm(3) (IQR 6.4-24.9) to 16.0 cm(3) (IQR 9.1-27.2; p < 0.01) while contralateral LVV increased from 10.3 cm(3) (IQR 7.3-20.1) to 11.7 cm(3) (IQR 8.2-19.4; p = 0.02). MLS changed from 0.1 mm (IQR -1.9 to 2.0) to -0.9 mm (IQR -1.8 to 0.4; p = 0.03). The decrease in GIA volume correlated with the increase in ipsilateral LVV (rs = 0.60; p = 0.01) but not with the changes in MLS (rs = 0.41; p = 0.08). CONCLUSIONS In our patient cohort, surgical strategies other that direct clipping for the treatment of anterior circulation GIA lead to a significant decrease in GIA volume over time. The resulting decrease in mass effect was more sensitively monitored by the measurement of changes in ipsilateral LVV than changes in MLS. CLINICAL TRIAL REGISTRATION-URL http://www.clinicaltrials.gov . Unique identifier: NCT02066493.
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Affiliation(s)
- Nicolai Maldaner
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Reinard K, Basheer A, Phillips S, Snyder A, Agarwal A, Jafari-Khouzani K, Soltanian-Zadeh H, Schultz L, Aho T, Schwalb JM. Simple and reproducible linear measurements to determine ventricular enlargement in adults. Surg Neurol Int 2015; 6:59. [PMID: 25883851 PMCID: PMC4399169 DOI: 10.4103/2152-7806.154777] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background: Recent studies have suggested that Evan's Index (EI) is not accurate and instead endorse volumetric measurements. Our aim was to evaluate the reproducibility of linear measurements and their correlation to ventricular volume. Methods: Using magnetic resonance (MR) images of 30 patients referred for normal pressure hydrocephalus (NPH), EI, frontal-occipital horn ratio (FOR), third ventricular width and height, frontal horn width (FHW), and callosal angle (CA) at the foramen of Monro and the posterior commissure (PC) were independently measured by residents in neurosurgery and radiology, a neurosurgeon and radiologist, and a medical student. Intraclass correlation coefficients (ICC) were calculated to establish inter-rater agreement among the reviewers. Pearson's correlation coefficients were done to assess the relationship of the linear measurements with total ventricular volume. Kappa analyses were performed to assess the degree of agreement between cutpoints determined by the ROC analysis for the linear measurements and reviewers’ gestalt impression about ventricular size with volumetric abnormality. Results: The overall inter-rater agreement among reviewers was almost perfect for EI (ICC = 0.913), FOR (ICC = 0.830), third ventricular width, FHW (ICC = 0.88), and CA at PC (ICC = 0.865), substantial for temporal horn width (ICC = 0.729) and CA at foramen of Monro (ICC = 0.779), and moderate for third ventricular height (ICC = 0.496). EI, FOR, third ventricular width, temporal horn width, and CA at PC measures correlated with total ventricular volume. There was fair-to-almost-perfect agreement of the individual reviewer's gestalt responses of abnormatility with volumetric abnormality. Gestalt responses were better for more senior raters. Conclusion: Linear measurements are reliable and reproducible methods for determining ventricular enlargement.
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Affiliation(s)
- Kevin Reinard
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Azam Basheer
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Scott Phillips
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
| | - Allison Snyder
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Ajay Agarwal
- Department of Diagnostic Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Kourosh Jafari-Khouzani
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Lonni Schultz
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA ; Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - Todd Aho
- Department of Diagnostic Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Hospital, Detroit, MI, USA
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Results of endoscopic third ventriculostomy in elderly patients ≥65 years of age. Clin Neurol Neurosurg 2015; 130:48-54. [DOI: 10.1016/j.clineuro.2014.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/01/2014] [Accepted: 12/20/2014] [Indexed: 11/23/2022]
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115
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Kim E, Lim YJ, Park HS, Kim SK, Jeon YT, Hwang JW, Lee YS, Park HP. The lack of relationship between intracranial pressure and cerebral ventricle indices based on brain computed tomography in patients undergoing ventriculoperitoneal shunt. Acta Neurochir (Wien) 2015; 157:257-63. [PMID: 25503296 DOI: 10.1007/s00701-014-2295-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In this study we investigated whether cerebral ventricle indices based on brain computed tomography (CT) scans are reliable for predicting intracranial pressure (ICP) in hydrocephalic patients. METHODS Electronic medical records of 221 patients undergoing ventriculoperitoneal shunt due to hydrocephalus were retrospectively reviewed. Cerebral ventricle indices including Evans' index, third ventricle index, cella media index, and ventricular score were calculated from transverse diameters measured at various levels on preoperative brain CT scans. ICP was considered as CSF opening pressure. Patients were categorized into three groups: communicating hydrocephalus, non-communicating hydrocephalus, and normal pressure hydrocephalus (NPH). The non-communicating hydrocephalus group was further divided according to the obstruction site; aqueduct, fourth ventricle outlet, third ventricle, and the foramen of Monro. The primary endpoint was the extent of the correlation between cerebral ventricle indices and ICP in each hydrocephalus group. RESULTS No cerebral ventricle index correlated with ICP in patients with communicating hydrocephalus (n = 113) and NPH (n = 62). In the non-communicating hydrocephalus group (n = 46), only the third ventricle index revealed moderate negative correlation with ICP (r = -0.395, p < 0.01). In subgroup analyses, the third ventricle index showed a strong negative relationship with ICP only in patients with the third ventricle obstruction (r = -0.779, p < 0.05). CONCLUSIONS In this study we showed that although an inverse correlation existed between ICP and the third ventricle index only in patients with non-communicating hydrocephalus due to obstruction of the third ventricle, cerebral ventricle indices based on brain CT scan were non-reliable predictors of ICP in hydrocephalic patients.
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Hamidu AU, Olarinoye-Akorede SA, Ekott DS, Danborno B, Mahmud MR, Balogun MS. Computerized tomographic study of normal Evans index in adult Nigerians. J Neurosci Rural Pract 2015; 6:55-8. [PMID: 25552852 PMCID: PMC4244789 DOI: 10.4103/0976-3147.143195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The evaluation of degree of ventricular enlargement should be based on established indices rather than on personal experience as this is highly subjective. Our aim was to establish normal values for Evans index in a Nigerian adult population as none has been found in the Nigerian medical literature. Materials and Methods: Axial computerized tomographic brain scans of 488 normal subjects were reviewed retrospectively. Of them, 319 (65.36%) of the patients were males and 169 (34.63%) were females; their ages ranged from 18 to 84 years with a mean age of 37.26 years. The images were acquired using a multi-slice GE Sigma excite scanner. Evans index was measured as the linear ratio of the total width of the frontal horns of the cerebral lateral ventricles to the maximum intracranial diameter. Results: The mean value for Evans index for the studied population was 0.252 ± 0.04. The EI increased with age and it was slightly higher among males. The difference in Evans value in males and females was not statistically significant. Individuals above 60 years old had the highest Evans values in both sexes. Conclusion: This study has established ranges of normal value for Evans index in a Nigerian population. It agrees with the diagnostic cut-off value of > 0.3 for hydrocephalus and it compares well with that of the Caucasians.
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Affiliation(s)
- Ahmed Umdagas Hamidu
- Department of Radiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | | | - David Solomon Ekott
- Department of Anatomy, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Barnabas Danborno
- Department of Anatomy, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Muhammad Raj Mahmud
- Department of Surgery, Neurosurgery Unit, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
| | - Muhammad Shakir Balogun
- Department of Medical Microbiology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna, Nigeria
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Serulle Y, Rusinek H, Kirov II, Milch H, Fieremans E, Baxter AB, McMenamy J, Jain R, Wisoff J, Golomb J, Gonen O, George AE. Differentiating shunt-responsive normal pressure hydrocephalus from Alzheimer disease and normal aging: pilot study using automated MRI brain tissue segmentation. J Neurol 2014; 261:1994-2002. [PMID: 25082631 DOI: 10.1007/s00415-014-7454-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 07/23/2014] [Accepted: 07/24/2014] [Indexed: 11/26/2022]
Abstract
Evidence suggests that normal pressure hydrocephalus (NPH) is underdiagnosed in day to day radiologic practice, and differentiating NPH from cerebral atrophy due to other neurodegenerative diseases and normal aging remains a challenge. To better characterize NPH, we test the hypothesis that a prediction model based on automated MRI brain tissue segmentation can help differentiate shunt-responsive NPH patients from cerebral atrophy due to Alzheimer disease (AD) and normal aging. Brain segmentation into gray and white matter (GM, WM), and intracranial cerebrospinal fluid was derived from pre-shunt T1-weighted MRI of 15 shunt-responsive NPH patients (9 men, 72.6 ± 8.0 years-old), 17 AD patients (10 men, 72.1 ± 11.0 years-old) chosen as a representative of cerebral atrophy in this age group; and 18 matched healthy elderly controls (HC, 7 men, 69.7 ± 7.0 years old). A multinomial prediction model was generated based on brain tissue volume distributions. GM decrease of 33% relative to HC characterized AD (P < 0.005). High preoperative ventricular and near normal GM volumes characterized NPH. A multinomial regression model based on gender, GM and ventricular volume had 96.3% accuracy differentiating NPH from AD and HC. In conclusion, automated MRI brain tissue segmentation differentiates shunt-responsive NPH with high accuracy from atrophy due to AD and normal aging. This method may improve diagnosis of NPH and improve our ability to distinguish normal from pathologic aging.
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Affiliation(s)
- Yafell Serulle
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA,
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Ohara N, Suzuki H, Suzuki A, Kaneko M, Ishizawa M, Furukawa K, Abe T, Matsubayashi Y, Yamada T, Hanyu O, Shimohata T, Sone H. Reversible brain atrophy and cognitive impairment in an adolescent Japanese patient with primary adrenal Cushing's syndrome. Neuropsychiatr Dis Treat 2014; 10:1763-7. [PMID: 25246796 PMCID: PMC4168879 DOI: 10.2147/ndt.s70611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Endogenous Cushing's syndrome is an endocrine disease resulting from chronic exposure to excessive glucocorticoids produced in the adrenal cortex. Although the ultimate outcome remains uncertain, functional and morphological brain changes are not uncommon in patients with this syndrome, and generally persist even after resolution of hypercortisolemia. We present an adolescent patient with Cushing's syndrome who exhibited cognitive impairment with brain atrophy. A 19-year-old Japanese male visited a local hospital following 5 days of behavioral abnormalities, such as money wasting or nighttime wandering. He had hypertension and a 1-year history of a rounded face. Magnetic resonance imaging (MRI) revealed apparently diffuse brain atrophy. Because of high random plasma cortisol levels (28.7 μg/dL) at 10 AM, he was referred to our hospital in August 2011. Endocrinological testing showed adrenocorticotropic hormone-independent hypercortisolemia, and abdominal computed tomography demonstrated a 2.7 cm tumor in the left adrenal gland. The patient underwent left adrenalectomy in September 2011, and the diagnosis of cortisol-secreting adenoma was confirmed histologically. His hypertension and Cushingoid features regressed. Behavioral abnormalities were no longer observed, and he was classified as cured of his cognitive disturbance caused by Cushing's syndrome in February 2012. MRI performed 8 months after surgery revealed reversal of brain atrophy, and his subsequent course has been uneventful. In summary, the young age at onset and the short duration of Cushing's syndrome probably contributed to the rapid recovery of both cognitive dysfunction and brain atrophy in our patient. Cushing's syndrome should be considered as a possible etiological factor in patients with cognitive impairment and brain atrophy that is atypical for their age.
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Affiliation(s)
- Nobumasa Ohara
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Hiroshi Suzuki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Akiko Suzuki
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Masanori Kaneko
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Masahiro Ishizawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Kazuo Furukawa
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Takahiro Abe
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Yasuhiro Matsubayashi
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Takaho Yamada
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Osamu Hanyu
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
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Bodilsen J, Schønheyder HC, Nielsen H. Hydrocephalus is a rare outcome in community-acquired bacterial meningitis in adults: a retrospective analysis. BMC Infect Dis 2013; 13:321. [PMID: 23855442 PMCID: PMC3717123 DOI: 10.1186/1471-2334-13-321] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 07/09/2013] [Indexed: 01/30/2023] Open
Abstract
Background Community-acquired bacterial meningitis (CABM) continues to have a high mortality rate and often results in severe sequelae among survivors. Lately, an increased effort has been focused on describing the neurological complications of meningitis including hydrocephalus. To aid in this field of research we set out to ascertain the risk and outcome of hydrocephalus in patients with community-acquired bacterial meningitis (CABM) in North Denmark Region. Methods We conducted a retrospective population-based cohort study of CABM cases above 14 years of age. Cases diagnosed during a 13-year period, 1998 through 2010, were identified in a laboratory register and data were acquired through patient records. Cases not confirmed by culture met other strict inclusion criteria. The diagnosis of hydrocephalus relied upon the radiologists’ reports on cranial imaging. Outcome was graded according to the Glasgow Outcome Scale at discharge from the primary admission. Long-term sequelae were based upon any subsequent hospital contacts until the end of 2011. Results Hydrocephalus was diagnosed in five of 165 episodes (3%) and all were classified as communicating. Only 120 patients had cranial imaging done and in this group the rate was 4.2%. In three cases hydrocephalus was present at admission, while two cases were diagnosed on days 44 and 99, respectively, due to altered mental status. The aetiology was either Eschericia coli (n = 2) or Streptococcus pneumoniae (n = 3). Case fatality was 60% among cases with hydrocephalus and 17% among other cases. Case fatality was similar irrespective of whether patients had a cranial CT or not. Conclusions Hydrocephalus was diagnosed in 3% of adolescent and adult cases with CABM and had a high case fatality rate in spite of specialised medical care and neurosurgical interventions. Our findings are comparable with a recent Dutch national prospective study.
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Matys T, Horsburgh A, Kirollos RW, Massoud TF. The aqueduct of Sylvius: applied 3-T magnetic resonance imaging anatomy and morphometry with neuroendoscopic relevance. Neurosurgery 2013; 73:ons132-40; discussion ons140. [PMID: 23615083 DOI: 10.1227/01.neu.0000430286.08552.ca] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aqueduct of Sylvius (AqSylv) is a structure of increasing importance in neuroendoscopic procedures. However, there is currently no clear and adequate description of the normal anatomy of the AqSylv. OBJECTIVE To study in detail hitherto unavailable normal magnetic resonance imaging morphometry and anatomic variants of the AqSylv. METHODS We retrospectively studied normal midsagittal T1-weighted 3-T magnetic resonance images in 100 patients. We measured widths of the AqSylv pars anterior, ampulla, and pars posterior; its narrowest point; and its length. We recorded angulation of the AqSylv relative to the third ventricle as multiple deviations of the long axis of the AqSylv from the Talairach bicommissural line. We statistically determined age- and sex-related changes in AqSylv morphometry using the Pearson correlation coefficient. We measured angulation of the AqSylv relative to the fourth ventricle and correlated this to the cervicomedullary angle (a surrogate for head position). RESULTS Patients were 13 to 83 years of age (45% male, 55% female). Mean morphometrics were as follows: pars anterior width, 1.1 mm; ampulla width, 1.2 mm; pars posterior width, 1.4 mm; length, 14.1 mm; narrowest point, 0.9 mm; and angulation in relation to the third and fourth ventricles, 26° and 18°, respectively. Age correlated positively with width and negatively with length of the AqSylv. There was no correlation between AqSylv alignment relative to the foramen magnum and the cervicomedullary angle. CONCLUSION Normative dimensions of the AqSylv in vivo are at variance with published cadaveric morphometrics. The AqSylv widens and shortens with cerebral involution. Awareness of these normal morphometrics is highly useful when stent placement is an option during aqueductoplasty. Reported data are valuable in guiding neuroendoscopic management of hydrocephalus and aqueductal stenosis.
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Affiliation(s)
- Tomasz Matys
- *Section of Neuroradiology; and ‡Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom; §Department of Radiology, University of Cambridge, Cambridge, United Kingdom
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Hydrocephalus after decompressive craniectomy for hemispheric cerebral infarction. J Clin Neurosci 2013; 20:377-82. [DOI: 10.1016/j.jocn.2012.03.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/14/2012] [Accepted: 03/14/2012] [Indexed: 01/01/2023]
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Raut T, Garg RK, Jain A, Verma R, Singh MK, Malhotra HS, Kohli N, Parihar A. Hydrocephalus in tuberculous meningitis: Incidence, its predictive factors and impact on the prognosis. J Infect 2013; 66:330-7. [PMID: 23291048 DOI: 10.1016/j.jinf.2012.12.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Revised: 12/24/2012] [Accepted: 12/26/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hydrocephalus is one of the most common complications of tuberculous meningitis. The present study evaluated the incidence, predictive factors and impact of hydrocephalus on overall prognosis of tuberculous meningitis. MATERIAL AND METHODS In a prospective cohort study, all patients fulfilling the inclusion criteria of tuberculous meningitis underwent clinical and cerebrospinal fluid evaluation, together with magnetic resonance imaging of the brain. Patients were treated with antituberculosis drugs and dexamethasone. Follow up neuroimaging was done after 6 months. Hydrocephalus was assessed using Evan's index. RESULTS Of 80 patients with tuberculous meningitis, 52(65%) had hydrocephalus at presentation. During follow up, 8 new patients developed hydrocephalus. Factors associated with hydrocephalus included advanced stage of disease, severe disability, duration of illness > 2 months, diplopia, seizures, visual impairment, papilledema, cranial nerve palsy, hemiparesis, CSF total cell count > 100/cu.mm, CSF protein > 2.5 g/l. Neuroimaging factors that were significantly associated with hydrocephalus included basal exudates, tuberculoma and infarcts. Multivariate analysis revealed visual impairment, cranial nerve palsy and the presence of basal exudates as significant predictors of hydrocephalus. In 13 patients, with early tuberculous meningitis, there was complete resolution of hydrocephalus. Hydrocephalus was significantly associated with mortality and poor outcome. CONCLUSION Hydrocephalus occurs in approximately two-third of patients with tuberculous meningitis and has an unfavorable impact on the prognosis. Hydrocephalus in early stages of tuberculous meningitis may resolve completely.
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Affiliation(s)
- Tushar Raut
- Department of Neurology, King George Medical University, Uttar Pradesh, Lucknow 226003, India
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Alteration of brain viscoelasticity after shunt treatment in normal pressure hydrocephalus. Neuroradiology 2011; 54:189-96. [PMID: 21538046 DOI: 10.1007/s00234-011-0871-1] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 04/05/2011] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Normal pressure hydrocephalus (NPH) represents a chronic neurological disorder with increasing incidence. The symptoms of NPH may be relieved by surgically implanting a ventriculoperitoneal shunt to drain excess cerebrospinal fluid. However, the pathogenesis of NPH is not yet fully elucidated, and the clinical response of shunt treatment is hard to predict. According to current theories of NPH, altered mechanical properties of brain tissue seem to play an important role. Magnetic resonance elastography (MRE) is a unique method for measuring in vivo brain mechanics. METHODS In this study cerebral MRE was applied to test the viscoelastic properties of the brain in 20 patients with primary (N = 14) and secondary (N = 6) NPH prior and after (91 ± 16 days) shunt placement. Viscoelastic parameters were derived from the complex modulus according to the rheological springpot model. This model provided two independent parameters μ and α, related to the inherent rigidity and topology of the mechanical network of brain tissue. RESULTS The viscoelastic parameters μ and α were found to be decreased with -25% and -10%, respectively, compared to age-matched controls (P < 0.001). Interestingly, α increased after shunt placement (P < 0.001) to almost normal values whereas μ remained symptomatically low. CONCLUSION The results indicate the fundamental role of altered viscoelastic properties of brain tissue during disease progression and tissue repair in NPH. Clinical improvement in NPH is associated with an increasing complexity of the mechanical network whose inherent strength, however, remains degraded.
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