Document Detail

Alteration of cerebral perfusion in patients with idiopathic normal pressure hydrocephalus measured by 3D perfusion weighted magnetic resonance imaging.
MedLine Citation:
PMID:  16021357     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: It is controversial whether alteration of cerebral perfusion plays an important role in the pathophysiology of patients with idiopathic normal pressure hydrocephalus (NPH) and can help to predict the outcome after shunt surgery. MATERIALS AND METHODS: 28 patients with suspected NPH were examined clinically (Homburg Hydrocephalus Scale, walking test, incontinence protocol) and by 3D dynamic susceptibility based perfusion weighted magnetic resonance imaging (PWI-MRI) before and after cerebrospinal fluid release (spinal tap test, STT). The perfusion parameters (negative integral (NI), time of arrival (T0), time to peak (TTP), mean transit time, and the difference TTP-T0 were analysed. RESULTS: Three different groups of patients were identified preoperatively: In group 1 seven patients showed an increase in the cerebral perfusion and a clinical improvement after STT. The second group (9 patients) also revealed an increase of the cerebral perfusion, but no significant alteration of the clinical assessment could be found. In the third group neither the cerebral perfusion nor the clinical assessment changed. 14 of the 16 patients (group 1 and 2) were examined three months after shunt placement. 11 patients showed a good or excellent result, 2 patients revealed a fair assessment, and only 1 patient had transiently improved. No patient was downgraded after shunting. In the patient group 1 and 2 the NI increased significantly (effect size: 34%), whereas in group 3 no significant alteration of NI was observed. CONCLUSION: PWI-MRI improves the prediction of outcome after shunt placement in patients with NPH and can offer new insights into the pathophysiology.
Christof Walter; F Hertel; E Naumann; M Mörsdorf
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2005-07-20
Journal Detail:
Title:  Journal of neurology     Volume:  252     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-19     Completed Date:  2006-06-28     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1465-71     Citation Subset:  IM    
Dept. of Radiology and Neuroradiology, Krankenhaus der Barmherzigen Brüder, Nordallee 1, 54292 Trier, Germany.
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MeSH Terms
Aged, 80 and over
Analysis of Variance
Brain Mapping
Cerebrospinal Fluid Shunts / methods
Cerebrovascular Circulation / physiology*
Follow-Up Studies
Hydrocephalus, Normal Pressure / pathology*,  physiopathology*,  surgery
Imaging, Three-Dimensional*
Middle Aged
Perfusion / methods*
Preoperative Care
Sensitivity and Specificity
Spinal Puncture / methods
Time Factors

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