Citation: | WU Q, HE W J, ZHANG X J, et al. Clinical and MRI Characteristics of 56 Patients with Idiopathic Normal Pressure Hydrocephalus[J]. CT Theory and Applications, 2024, 33(2): 167-174. DOI: 10.15953/j.ctta.2023.095. (in Chinese). |
Objective: To analyze and summarize the clinical and MRI manifestations of patients with idiopathic normal pressure hydrocephalus (iNPH) diagnosed via surgery in order to improve the understanding of this disease. Methods: We performed a retrospective analysis of the clinical and preoperative MR (including 3DT1WI, T2WI, and T2 FLAIR) data of 56 patients with iNPH diagnosed via shunt surgery at our hospital to evaluate and describe MR linear parameters and common radiological features. Results: Among the 56 patients with iNPH, 91.1%, 60.7%, and 42.9% showed gait disturbance, cognitive impairment, and urinary disturbance, respectively; the classical triad accounted for 23.2%. The most common comorbidities were hypertension (51.8%), diabetes (28.6%), and PD (12.5%). In the analysis of the 56 patients’ MR images, 82.1% had acute callosal angle and 39.3%, positive disproportionately enlarged subarachnoid space (DESH) signs , with a mean DESH score of (5.24±1.27). Conclusion: Patients with confirmed iNPH most often also have hypertension, diabetes mellitus, and PD. The classical triad is less frequent, and the positive rate of typical MR signs is not high. Thus, the accurate diagnosis and prognosis prediction of negative patients remains challenging and should be combined with other clinical examinations to clarify the diagnosis and treatment.
[1] |
NAKAJIMA M, YAMADA S, MIYAJIMA M, et al. Guidelines for management of idiopathic normal pressure hydrocephalus (Third Edition): Endorsed by the Japanese society of normal pressure hydrocephalus[J]. Neurologia Medico-Chirurgica, 2021, 61(2): 63−97. DOI: 10.2176/nmc.st.2020-0292.
|
[2] |
MISKIN N, PATEL H, FRANCESCHI A M, et al. Diagnosis of normal-pressure hydrocephalus: Use of traditional measures in the era of volumetric MR imaging[J]. Radiology, 2017, 285(1): 197-205. DOI:10.1148/radiol.2017161216.
|
[3] |
KITAGAKI H, MORI E, ISHII K, et al. CSF spaces in idiopathic normal pressure hydrocephalus: Morphology and volumetry[J]. American Journal of Neuroradiology, 1998, 19(7): 1277−1284.
|
[4] |
王长春, 王作伟, 袁庆国, 等. 老年特发性正常压力脑积水患者的手术治疗及中期随访[J]. 中华老年医学杂志, 2011,30(8): 664−666. DOI: 10.3760/cma.j.issn.0254-9026.2011.08.014.
WANG C C, WANG Z W, YUAN Q G, et al. The surgical treatment of elderly patients with idiopathic normal pressure hydrocephalus and medium-term follow-up[J]. Journal of the Chinese Elderly Medical Journal, 2011, 30(8): 664−666. DOI: 10.3760/cma.j.issn.0254-9026.2011.08.014. (in Chinese).
|
[5] |
TOMA A K, HOLL E, KITCHEN N D, et al. Evans' index revisited: The need for an alternative in normal pressure hydrocephalus[J]. Neurosurgery, 2011, 68(4): 939−944. DOI: 10.1227/NEU.0b013e318208f5e0.
|
[6] |
ISHII K, KANDA T, HARADA A, et al. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus[J]. European Radiology, 2008, 18(11): 2678−2683. DOI: 10.1007/s00330-008-1044-4.
|
[7] |
FAZEKAS F, CHAWLUK J B, ALAVI A, et al. MR signal abnormalities at 1.5T in Alzheimer's dementia and normal aging[J]. American Journal of Neuroradiology, 1987, 149(2): 351−356. DOI: 10.2214/ajr.149.2.351.
|
[8] |
MIYAZAKI K, ISHII K, HANAOKA K, et al. The tight medial and high convexity subarachnoid spaces is the first finding of idiopathic normal pressure hydrocephalus at the preclinical stage[J]. Neurologia Medico-Chirurgica, 2019, 59(11): 436−443. DOI: 10.2176/nmc.oa.2019-0133.
|
[9] |
SASAKI M, HONDA S, YUASA T, et al. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI[J]. Neuroradiology, 2008, 50(2): 117−122. DOI: 10.1007/s00234-007-0318-x.
|
[10] |
VIRHAMMAR J, LAURELL K, CESARINI K G, et al. Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus[J]. American Journal of Neuroradiology, 2014, 35(12): 2311−2318. DOI: 10.3174/ajnr.A4046.
|
[11] |
HOLODNY A I, GEORGE A E, de-LEON M J, et al. Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus[J]. Journal of Neurosurgery, 1998, 89(5): 742−747. DOI: 10.3171/jns.1998.89.5.0742.
|
[12] |
SHINODA N, HIRAI O, HORI S, et al. Utility of MRI-based disproportionately enlarged subarachnoid space hydrocephalus scoring for predicting prognosis after surgery for idiopathic normal pressure hydrocephalus: Clinical research[J]. Journal of Neurosurgery, 2017, 127(6): 1436−1442. DOI: 10.3171/2016.9.JNS161080.
|
[13] |
中华医学会神经外科学分会, 中华医学会神经病学分会, 中国神经外科重症管理协作组. 中国特发性正常压力脑积水诊治专家共识(2016)[J]. 中华医学杂志, 2016,96(21): 1635−1638. doi: 10.3760/cma.j.issn.0376-2491.2016.021.003
|
[14] |
ARUGA S, KUWANA N, SHIROKI Y, et al. Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus[J]. Neurourology and Urodynamics, 2018, 37(3): 1053−1059. DOI: 10.1002/nau.23399.
|
[15] |
李勇, 方旭昊, 毛仁玲, 等. 老年正常压力脑积水患者与脑卒中患者三维步态参数的差异性研究[J]. 老年医学与保健, 2017,23(4): 324−327. doi: 10.3969/j.issn.1008-8296.2017.04.024
LI Y, FANG X H, MAO R L, et al. Difference of 3-dimensional gait parameters between the elderly patients with normal pressure hydrocephalus and the patients with hemiplegia after stroke[J]. Geriatrics and Health Care, 2017, 23(4): 324−327. (in Chinese). doi: 10.3969/j.issn.1008-8296.2017.04.024
|
[16] |
方旭昊, 舒卫权, 高幸, 等. 急诊跌倒老年人群特发性正常压力脑积水诊治的初步探索[J]. 老年医学与保健, 2018,24(1): 8−11, 21. doi: 10.3969/j.issn.1008-8296.2018.01.004
FANG X H, SHU W Q, GAO X, et al. Preliminary exploration of the diagnosis and treatment of iNPH in emergency elderly patients with falls[J]. Geriatrics and Health Care, 2018, 24(1): 8−11, 21. (in Chinese). doi: 10.3969/j.issn.1008-8296.2018.01.004
|
[17] |
KURIYAMA N, MIYAJIMA M, NAKAJIMA M, et al. Nationwide hospital-based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics[J]. Brain and Behavior, 2017, 7(3): e635. DOI: 10.1002/brb3.635.
|
[18] |
KAMOHARA C, NAKAJIMA M, KAWAMURA K, et al. Neuropsychological tests are useful for predicting comorbidities of idiopathic normal pressure hydrocephalus[J]. Acta Neurologica Scandinavica, 2020, 142(6): 623−631. DOI: 10.1111/ane.13306.
|
[19] |
HUDSON M, NOWAK C, GARLING R J, et al. Comorbidity of diabetes mellitus in idiopathic normal pressure hydrocephalus: A systematic literature review[J]. Fluids and Barriers of the CNS, 2019, 16(1): 5. DOI:10.1186/s12987-019-0125-x.
|
[20] |
ANDREN K, WIKKELSO C, SUNDSTROM N, et al. Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: A quality registry study[J]. Journal of Neurology, 2018, 265(1): 178−186. DOI: 10.1007/s00415-017-8680-z.
|
[21] |
WILLIAMS M A, RELKIN N R. Diagnosis and management of idiopathic normal pressure hydrocephalus[J]. Neurology Clinical Practice, 2013, 3(5): 375−385. doi: 10.1212/CPJ.0b013e3182a78f6b
|
[22] |
ALLALI G, GARIBOTTO V, ASSAL F. Parkinsonism differentiates idiopathic normal pressure hydrocephalus from its mimics[J]. Journal of Alzheimer's Disease, 2016, 54(1): 123−127. DOI: 10.3233/JAD-160428.
|
[23] |
LEMAY M, NEW P F. Radiological diagnosis of occult normal-pressure hydrocephalus[J]. Radiology, 1970, 96(2): 347−358. DOI: 10.1148/96.2.347.
|
[24] |
方旭昊, 舒卫权, 何文杰, 等. DESH评分预测特发性正常压力脑积水脑脊液放液试验的效果[J]. 老年医学与保健, 2020,26(4): 583−586, 601. DOI: 10.3969/j.issn.1008-8296.2020.04.019.
FANG X H, SHU W Q, HE W J, et al. Effect of DESH score on prediction of cerebrospinal fluid drainage test of idiopathic normal pressure hydrocephalus[J]. Geriatrics and Health Care, 2020, 26(4): 583−586, 601. DOI: 10.3969/j.issn.1008-8296.2020.04.019. (in Chinese).
|