Document Detail


Brain metabolism in adult chronic hydrocephalus.
MedLine Citation:
PMID:  18419769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Normal pressure hydrocephalus (NPH) is the most frequent form of chronic hydrocephalus in adults. NPH remains underdiagnosed although between 5% and 10% of all demented patients may suffer from this disorder. As dementia is an increasing demographic problem, treatable forms such as in NPH have become a central issue in neurology. Despite the traditional perception of hydrocephalus being a disorder of disturbed CSF dynamics, in NPH metabolic impairment seems at least as important. So far, the only valid animal model of NPH is chronic adult kaolin hydrocephalus. In this model, opening of alternative CSF outflow pathways leads to normal or near-normal intracranial pressure and CSF outflow resistance. Yet, various metabolic disturbances cause ongoing ventricular enlargement and characteristic symptoms including cognitive decline and gait ataxia. Delayed hippocampal neuronal death, accumulation of beta-amyloid and disturbed cholinergic neurotransmission may contribute to memory dysfunction. Compromised periventricular blood flow, decreased dopamine levels in the substantia nigra and damaged striatal GABAergic interneurons may reflect basal ganglia symptoms. At least in human hydrocephalus cerebrovascular co-morbidity of the white matter plays an important role as well. It seems that in hydrocephalus from a certain 'point of no return' metabolic impairment becomes decoupled from CSF dynamics and, at least partly, self-sustained. This is probably the reason why despite restored CSF circulation by shunting many patients with chronic hydrocephalus still suffer from severe neurological deficits. The present paper offers a comprehensive review of the experimental and clinical data suggesting metabolic disturbances in chronic hydrocephalus.
Authors:
Daniel Kondziella; Ursula Sonnewald; Mats Tullberg; Carsten Wikkelso
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-04-14
Journal Detail:
Title:  Journal of neurochemistry     Volume:  106     ISSN:  1471-4159     ISO Abbreviation:  J. Neurochem.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-07     Completed Date:  2008-09-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985190R     Medline TA:  J Neurochem     Country:  England    
Other Details:
Languages:  eng     Pagination:  1515-24     Citation Subset:  IM    
Affiliation:
Department of Neurology, Sahlgrenska University Hospital, Göteborg, Sweden. daniel.kondziella@vgregion.se
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MeSH Terms
Descriptor/Qualifier:
Adult
Aging / pathology,  physiology*
Animals
Brain / metabolism*,  physiopathology
Chronic Disease
Humans
Hydrocephalus, Normal Pressure / metabolism*,  physiopathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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