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1.
Dement Geriatr Cogn Disord ; 47(1-2): 91-103, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30861516

RESUMO

BACKGROUND/AIMS: The C9ORF72 expansion is known to cause frontotemporal lobar degeneration (FTLD) and amyotrophic lateral sclerosis (ALS). We aim to identify the prevalence of the C9ORF72 expansion in idiopathic normal pressure hydrocephalus (iNPH). METHODS: We analysed the C9ORF72 expansion in a large cohort of patients with possible iNPH (n = 487) and cognitively intact elderly controls (n = 432; age > 65 years). RESULTS: While the C9ORF72 expansion was detected in 1.6% (n = 8/487) of cases with possible iNPH, no control subject was found to carry the mutation. The mean age at onset of symptoms of C9ORF72 expansion carriers was 59 years (range: 52-67 years), 11 years less than non-carriers (p = 0.0002). The most frequent initial/main symptom pertained to gait difficulties. Despite identified mutation, only 3 of the patients fulfilled the criteria for the FTLD-ALS spectrum. Clinically significant shunt response was detected in 6 out of 7 shunted C9ORF72 expansion carriers. CONCLUSION: This is the first study cohort identifying the underlying C9ORF72 expansion in patients with iNPH providing evidence for the potential comorbidity between iNPH and the FTLD-ALS spectrum. Analysis of the C9ORF72 expansion should be considered for patients with probable iNPH presenting with frontal atrophy and personality changes or other severe psychiatric symptoms.


Assuntos
Esclerose Amiotrófica Lateral , Sintomas Comportamentais , Proteína C9orf72/genética , Degeneração Lobar Frontotemporal , Hidrocefalia de Pressão Normal , Idade de Início , Idoso , Esclerose Amiotrófica Lateral/diagnóstico , Esclerose Amiotrófica Lateral/epidemiologia , Esclerose Amiotrófica Lateral/genética , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/fisiopatologia , Estudos de Coortes , Correlação de Dados , Expansão das Repetições de DNA , Feminino , Finlândia/epidemiologia , Degeneração Lobar Frontotemporal/diagnóstico , Degeneração Lobar Frontotemporal/epidemiologia , Degeneração Lobar Frontotemporal/genética , Humanos , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/genética , Hidrocefalia de Pressão Normal/psicologia , Masculino , Prevalência
2.
Continuum (Minneap Minn) ; 25(1): 165-186, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30707192

RESUMO

PURPOSE OF REVIEW: Since it was first described in 1965, normal pressure hydrocephalus (NPH) has been a controversial subject. New studies have shed light on its epidemiology and pathogenesis and provided objective ways to measure outcome in patients with NPH. Neuroimaging has improved and allows better recognition of both NPH and the presence of overlapping diseases RECENT FINDINGS: Several recent epidemiologic studies confirm that NPH is a rare disease, but the presence of large ventricles is a common finding with aging. NPH may be multifactorial, including congenital causes, vascular disease, and impaired CSF absorption. MRI features of NPH include enlarged ventricular size and CSF fluid collection outside the ventricles not due to atrophy. The term disproportionately enlarged subarachnoid space hydrocephalus (DESH) has been used to describe prognostic MRI features in NPH, including a "tight high convexity" and enlargement of CSF spaces in the sylvian fissure. DESH has been included in the Japanese guideline for the diagnosis and treatment of NPH. A new NPH scale has been published that provides an objective framework for evaluating patients with NPH before and after shunt placement. Programmable shunts can noninvasively manage overdrainage complications. Surgical outcome has been improving over time. Recent studies have led to improved recognition of overlapping diseases such as Alzheimer pathology, which co-occurs in about 30% of NPH cases. Fludeoxyglucose positron emission tomography (FDG-PET) is a promising imaging modality for diagnosing NPH and detecting concomitant degenerative disease. SUMMARY: A systematic approach to patients with possible NPH allows recognition of the subset of patients who will respond to shunt surgery and identification of those with alternative diagnoses.


Assuntos
Atrofia/patologia , Encéfalo/patologia , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/etiologia , Atrofia/diagnóstico , Humanos , Imagem por Ressonância Magnética/métodos , Prognóstico , Fatores de Risco
3.
Acta Neurol Scand ; 139(4): 389-394, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30676642

RESUMO

OBJECT: We characterize idiopathic normal pressure hydrocephalus (NPH) following treatment with lumbar puncture (LP) and shunt placement through clinical evaluation and quantitative ProtoKinetics Zeno walkway assessments. We evaluate the symptomology by determining gait characteristics altered by treatment. METHODS: Patients at Barrow Neurological Institute (BNI) who underwent a LP, removing 30-32 mL cerebrospinal fluid) followed by ventriculoperitoneal shunt placement in February 2015 to February 2017 were analyzed for gait impairments. Inclusion in the study required a diagnosis of NPH, no conflicting comorbidities, and pre-LP, post-LP, and 6-month post-shunt assessments. Analyses of gait and balance data recorded by physical therapists and the ProtoKinetics Zeno Walkway at pre-LP, post-LP, and post-shunt were performed. RESULTS: A total of 28 patients were included and one-way analysis of variance and Tukey-Kramer HSD was performed. Among the 15 clinical assessments, nine were significantly altered. Using the ProtoKinetics Zeno Walkway, 7 out of 10 characteristics recorded were considered significantly different among the three data sets. Furthermore, there were more significant differences between pre-LP assessments and post-shunt assessments in comparison to differences between pre-LP assessments and post-LP assessments. CONCLUSIONS: Our results indicate that certain gait characteristics better fit NPH than others. By focusing on the features that are caused by NPH and alleviated by LP and/or shunt placement, a more definitive NPH diagnosis can be attained. Additionally, our findings confirm a cumulative effect of continuous drainage via shunt placement may lead to increased improvement in NPH symptoms over LP results.


Assuntos
Transtornos Neurológicos da Marcha/etiologia , Hidrocefalia de Pressão Normal/diagnóstico , Idoso , Feminino , Humanos , Hidrocefalia de Pressão Normal/complicações , Hidrocefalia de Pressão Normal/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Punção Espinal , Derivação Ventriculoperitoneal
4.
Int J Neurosci ; 129(6): 623-626, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30475083

RESUMO

OBJECTIVE: Traumatic brain injury (TBI) is nondegenerative insult to brain from external mechanical forces. It may cause cognitive impairment, psychological problems in the long period. Besides traumatic brain injury also induces neuroinflammation and neurodegeneration process, and increases risk of dementia. It may cause various psychiatric complications such as depression, posttraumatic stress disorder, generalized anxiety disorder, and other cognitive and behavioral sequela according to site of involvement in the brain. METHODS: We report a patient who has behavioral symptoms, amnesia and gait apraxy after TBI. Patient's symptoms were similar to behavioral variant Frontotemporal Dementia (bv FTD). RESULTS: After detailed neurocognitive and radiologic evaluation he was diagnosed with Normal Pressure Hydrocephalus (NPH), and Alzheimer's Disease (AD) following TBI. CONCLUSION: Comprehensive geriatric assessment, including detailed radiological examinations, if it is necessary, is recommended for the optimum management of elderly patients with cognitive and psychosocial problems in order to avoid misdiagnosis and inappropriate treatment.


Assuntos
Doença de Alzheimer/diagnóstico , Sintomas Comportamentais/diagnóstico , Lesões Encefálicas Traumáticas/diagnóstico , Demência Frontotemporal/diagnóstico , Hidrocefalia de Pressão Normal/diagnóstico , Idoso , Doença de Alzheimer/complicações , Doença de Alzheimer/diagnóstico por imagem , Sintomas Comportamentais/diagnóstico por imagem , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Diagnóstico Diferencial , Demência Frontotemporal/diagnóstico por imagem , Humanos , Hidrocefalia de Pressão Normal/complicações , Hidrocefalia de Pressão Normal/diagnóstico por imagem , Masculino
7.
Cogn Behav Neurol ; 31(4): 201-206, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30562229

RESUMO

BACKGROUND: In patients suspected of having idiopathic normal-pressure hydrocephalus (iNPH), improvement in impaired cognition is common after a diagnostic cerebrospinal fluid tap test (CSFTT). Measures used to evaluate cognitive function before and after a CSFTT include the Mini-Mental State Examination (MMSE), Frontal Assessment Battery (FAB), and Trail Making Test (TMT). However, the time point at which cognitive function should be reevaluated after a CSFTT remains controversial. OBJECTIVE: To investigate differences in cognitive function 1 day and 1 week after a CSFTT (versus baseline) in patients with suspected iNPH. METHODS: This retrospective study, conducted between October 2012 and January 2017, involved 39 patients with suspected iNPH. We analyzed their MMSE, FAB, and TMT scores on tests conducted before and 1 day and 1 week after the CSFTT. RESULTS: Changes in MMSE scores were negligible 1 day after the CSFTT but began to appear 1 week later. Changes in FAB scores were observed from 1 day to 1 week after the CSFTT. Although no statistically significant differences in TMT scores were observed at either time point, the execution time for the test tended to be shorter on the day after the CSFTT. Changes in cognitive function were not associated with demographic or morphological parameters. More severe impairments at baseline, however, were associated with greater changes in cognitive function. CONCLUSIONS: Performing several reevaluations using each test may enable more accurate assessment of cognitive function in patients with suspected iNPH. Our results highlight the need for long-term follow-up, regardless of the severity of cognitive impairment.


Assuntos
Derivações do Líquido Cefalorraquidiano/métodos , Cognição/fisiologia , Hidrocefalia de Pressão Normal/diagnóstico , Idoso , Feminino , Humanos , Hidrocefalia de Pressão Normal/patologia , Masculino , Estudos Retrospectivos
8.
Arq Neuropsiquiatr ; 76(10): 692-696, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30427509

RESUMO

OBJECTIVE: The current study translated to Portuguese and validated the normal pressure hydrocephalus (NPH) scale originally developed in English as the Grading Scale for Idiopathic Normal Pressure Hydrocephalus. METHODS: Following Guillemin's validation protocol, the last version of the Portuguese NPH scale was applied to 121 consecutive patients with a diagnosis of normal pressure hydrocephalus (73 men and 48 women) from the Group of Cerebral Hydrodynamics from July 2010 to March 2012. RESULTS: The mean age was 71.09 years old, ranging from 35 to 92 years. The rate of agreement and reproducibility was high, as confirmed by Cohen's Kappa coefficient, with excellent intraobserver correlation for the NPH scale items individually evaluated: gait (0.80), dementia (0.90) and incontinence (0.87). CONCLUSIONS: The Portuguese version of the Grading Scale for Idiopathic Normal Pressure Hydrocephalus was successfully translated and validated for use in Brazilian patients.


Assuntos
Hidrocefalia de Pressão Normal/diagnóstico , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Comparação Transcultural , Estudos Transversais , Demência/diagnóstico , Feminino , Apraxia da Marcha/diagnóstico , Humanos , Linguagem , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Traduções , Incontinência Urinária/diagnóstico
10.
Brain Behav ; 8(11): e01125, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30259701

RESUMO

OBJECTIVES: Constant infusion lumbar infusion test (LIT) is an important way to find which patients, of those with signs and symptoms corresponding to normal pressure hydrocephalus (NPH) who will improve from shunt operation. LIT is a stress test on the ability for cerebrospinal fluid re-absorbtion. The aim of this study is to show how the information from LIT can be improved by quantitative analysis and avoidance of methodological pitfalls. MATERIAL AND METHODS: The potential pitfalls, and the analysis method, are described in detail. The analysis was applied on pre-operative constant infusion LIT from 31 patients operated for NPH, with known outcome. The pre- and post-operative walking speed was used to grade pathology progression or improvement. RESULTS: The maximal, plateau, intra-spinal pressure at constant infusion LIT is an ambivalent indicator for NPH: while low maximal pressure indicates no cerebrospinal fluid (CSF) absorbtion pathology, too high pressure (≥47 mmHg) may mean no diagnosis, because of stenosis of the Sylvian aqueduct. When subjects with too high intra-spinal pressure were excluded, the new analysis gave a couple of diagnostic volume parameters, of which one appears to be an optimal LIT parameter for identifying NPH patients with 14% better accuracy than plateau pressure. CONCLUSION: By avoiding methodological pitfalls, and optimal analysis of the results from lumbar infusion test, the number of NPH patients who do not have a successful outcome after shunt operation may be further decreased.


Assuntos
Hidrocefalia de Pressão Normal/diagnóstico , Adulto , Idoso , Aqueduto do Mesencéfalo , Constrição Patológica/complicações , Feminino , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Derivação Ventriculoperitoneal/efeitos adversos
11.
Clin Neurol Neurosurg ; 174: 92-96, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30219624

RESUMO

OBJECTIVES: To determine which cognitive and upper limb assessments can identify change in patients undergoing a Cerebrospinal fluid (CSF) tap test (TT) diagnosed with idiopathic Normal Pressure Hydrocephalus (iNPH). PATIENTS AND METHODS: Prospective observational study of 74 iNPH patients undergoing a CSF TT for consideration of a ventricular peritoneal shunt. Patients who were offered surgical intervention were classified as responders. Patients were assessed with a battery of cognitive and upper limb assessments prior to and following a CSF TT. The Timed up and go cognition (TUG-C), Montreal Cognitive assessment (MoCA) and 9-hole peg test were utilised. RESULTS: 40 patients were classified responders. Significant differences were identified for responders for the MoCA (0.62 points) and TUG-C (-6.02 s). Only the executive function and orientation sub scores of the MoCA showed significant changes for responders. The 9 hole peg test mean change of 4.33 s for responders was not significant. Non-responder change scores for the MoCA (0.22 points), TUG-C (0.3 s) and 9 hole peg test (2.58 s) were not significant. CONCLUSION: The TUG-C has the potential to identify change in patients resulting from a CSF TT. While statistically significant change was found for the MoCA, a mean change of less than 1 point on this scale is unlikely to be clinically relevant. Similarly, the 9 hole peg test cannot be endorsed as an assessment tool for identifying changed performance in iNPH.


Assuntos
Cognição/fisiologia , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Hidrocefalia de Pressão Normal/diagnóstico , Testes de Estado Mental e Demência , Punção Espinal/tendências , Extremidade Superior/fisiologia , Idoso , Idoso de 80 Anos ou mais , Função Executiva/fisiologia , Feminino , Humanos , Masculino , Estudos Prospectivos , Punção Espinal/efeitos adversos , Punção Espinal/métodos
12.
Neurología (Barc., Ed. impr.) ; 33(7): 449-458, sept. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-175953

RESUMO

Introducción: Desde la descripción hace 5 décadas de la hidrocefalia crónica del adulto idiopática (HCAi), su fisiopatología ha sido considerada básicamente relacionada con el efecto que la dilatación ventricular ejerce sobre las estructuras adyacentes al sistema ventricular. Sin embargo, las alteraciones en el flujo sanguíneo cerebral (FSC) y, sobre todo, la reducción en el recambio licuoral parecen emerger como componentes fisiopatológicos principales de esta enfermedad. Desarrollo: En la HCAi se observa una compresión del tracto piramidal, de los circuitos cortico-subcorticales fronto-estriatales y fronto-reticulares, y de las fibras profundas del fascículo longitudinal superior. En el cuerpo calloso se objetiva un descenso en el número de fibras comisurales, que son reemplazadas por gliosis. El FSC se encuentra alterado, con un patrón de última pradera en la región subcortical adyacente a los ventrículos, correspondiente a la intersección entre las arterias subependimarias y las arterias perforantes dependientes de los grandes troncos arteriales de la circulación anterior. El recambio diario del LCR se ve disminuido en un 75%, lo que conlleva una reducción del aclaramiento de neurotóxicos y la interrupción de las señalizaciones neuroendocrinas y paracrinas que ocurren a través del LCR. Conclusiones: La HCAi emerge como una entidad nosológica compleja, en la que los efectos de la microangiopatía subcortical y la disminución del recambio de LCR desempeñan un papel fundamental. Esta base fisiopatológica aleja la HCAi del concepto clásico de hidrocefalia y la acerca al perfil de otras enfermedades neurodegenerativas, como la enfermedad de Alzheimer o la enfermedad de Binswanger


Introduction: Since its description five decades ago, the pathophysiology of idiopathic chronic adult hydrocephalus (iCAH) has been traditionally related to the effect that ventricular dilatation exerts on the structures surrounding the ventricular system. However, altered cerebral blood flow, especially a reduction in the CSF turnover rate, are starting to be considered the main pathophysiological elements of this disease. Development: Compression of the pyramidal tract, the frontostriatal and frontoreticular circuits, and the paraventricular fibres of the superior longitudinal fasciculus have all been reported in iCAH. At the level of the corpus callosum, gliosis replaces a number of commissural tracts. Cerebral blood flow is also altered, showing a periventricular watershed region limited by the subependymal arteries and the perforating branches of the major arteries of the anterior cerebral circulation. The CSF turnover rate is decreased by 75%, leading to the reduced clearance of neurotoxins and the interruption of neuroendocrine and paracrine signalling in the CSF. Conclusions: iCAH presents as a complex nosological entity, in which the effects of subcortical microangiopathy and reduced CSF turnover play a key role. According to its pathophysiology, it is simpler to think of iCAH more as a neurodegenerative disease, such as Alzheimer disease or Binswanger disease than as the classical concept of hydrocephalus


Assuntos
Humanos , Hidrocefalia de Pressão Normal/fisiopatologia , Doenças Neurodegenerativas/fisiopatologia , Ventrículos Cerebrais/fisiopatologia , Pressão do Líquido Cefalorraquidiano/fisiologia , Circulação Cerebrovascular/fisiologia , Doença Crônica , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/líquido cefalorraquidiano , Doenças Neurodegenerativas/líquido cefalorraquidiano , Doenças Neurodegenerativas/diagnóstico
14.
J Neurol Sci ; 391: 54-60, 2018 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-30103972

RESUMO

INTRODUCTION: Idiopathic Normal Pressure Hydrocephlaus (iNPH) is, despite a vastly improved knowledge of the disorder since its first description still underdiagnosed and undertreated. Because of this, there is a need for further large studies describing the typical symptomatology and reversibility of symptoms in iNPH, which was the aim of this study. METHODS: In all, 429 patients (mean age 71 years) were included. Detailed pre- and postoperative examinations of symptoms and signs were analyzed. A composite outcome measure was constructed. RESULTS: Sixty-eight % improved after surgery. Preoperatively, 72% exhibited symptoms from three or four of the assessed domains (gait, balance, neuropsychology and continence) while 41% had symptoms from all four domains. Ninety % had gait disturbances, of which 75% had broad-based gait, 65% shuffling gait and 30% freezing of gait. These disturbances coexisted in most patients preoperatively, but were more likely to appear as isolated findings after surgery. Impaired balance was seen in 53% and retropulsion in 46%. MMSE <25 was seen in 53% and impaired continence in 86%. Improvements were seen in all symptom domains postoperatively. CONCLUSIONS: The iNPH phenotype is characterized by a disturbance in at least 3/4 symptom domains in most patients, with improvements in all domains after shunt surgery. Most patients present with a broad-based and shuffling gait as well as paratonia. Present symptoms in all domains and a shuffling gait at the time of diagnosis seem to predict a favorable postoperative outcome, whereas symptom severity does not.


Assuntos
Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/cirurgia , Idoso , Cognição , Feminino , Marcha , Humanos , Hidrocefalia de Pressão Normal/fisiopatologia , Hidrocefalia de Pressão Normal/psicologia , Masculino , Fenótipo , Equilíbrio Postural , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Incontinência Urinária
15.
Eur J Phys Rehabil Med ; 54(5): 724-729, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29962192

RESUMO

BACKGROUND: Gait disturbance (GD) is usually the first and most prominent symptom observed in idiopathic normal pressure hydrocephalus (iNPH). The reversibility of symptoms is related to early diagnosis and treatment. Nowadays early recognition of patients is challenging because GD in the elderly is frequently neglected, leading to late diagnosis and increased disability. In addition, GD is generally assessed by clinical evaluation since computerized gait analysis methods are rarely available. In the present study, we demonstrate the clinical application of an inertial sensor system for gait analysis in iNPH. AIM: The primary aim was to test the sensor performance in quantifying impairment in gait parameters in iNPH. The secondary aim was to detect a range of improvement after CSF subtraction test, which could be considered as predictive of favorable shunt response. DESIGN: We performed a case-control prospective study from March 2012 to May 2014. SETTING: Inpatients at the Division of Neurology, Department of Clinical and Experimental Sciences, Brescia. POPULATION: We enrolled 79 patients with clinical and radiological findings of iNPH and 300 healthy adults over 70 years old without GD as a control group. METHODS: We performed gait analysis, CSF Tap Test (TT), and shunt surgery in all patients with a diagnosis of iNPH according to the International Guidelines. According to clinical outcomes, we divided patients in responsive (group A) and non-responsive (group B). We then compared pre-operative gait analysis of group A with the control group, and calculated the percentage of improvement after TT between group A and group B. RESULTS: Shunt surgery was performed in 52 patients. After 3 months, 35 patients (group A: 67.3%) showed a positive response to shunt. We quantified the impaired gait parameters in iNPH and assessed the differences with controls. Improvement of speed, stride length and double support time after TT was predictive of positive shunt response. CONCLUSIONS: The proposed inertial sensor system is a reliable and easy-to-use system for early detection of iNPH and may be used in any clinical setting. CLINICAL REHABILITATION IMPACT: Identification of a GD pattern for iNPH, especially in rehabilitation, may be useful for recognizing patients who are candidates for surgery, thus avoiding permanent disability.


Assuntos
Transtornos Neurológicos da Marcha/diagnóstico , Hidrocefalia de Pressão Normal/diagnóstico , Idoso , Estudos de Casos e Controles , Derivações do Líquido Cefalorraquidiano/métodos , Drenagem/métodos , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Hidrocefalia de Pressão Normal/fisiopatologia , Hidrocefalia de Pressão Normal/cirurgia , Masculino , Estudos Prospectivos , Resultado do Tratamento
16.
Clin Neurol Neurosurg ; 170: 113-115, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29772402

RESUMO

OBJECTIVE: Recent Normal Pressure Hydrocephalus (NPH) practice guidelines describe a serious adverse event (SAE) rate following surgery of 11%. PATIENTS & METHODS: We conducted a retrospective review of 162 consecutive patients who have undergone work-up at our center's multidisciplinary NPH clinic over a 47 month time period (2/2014-12/2017). Of these, 22 ultimately underwent neurosurgical ventricular shunt surgery as treatment for NPH. Clinical records were reviewed for SAEs categorized as possibly/probably/definitely related to NPH surgery. RESULTS: In 10/22 (45.5%) operated subjects, there were 11 qualifying SAEs over this 3-year period: 1 central nervous system infections, 4 subdural hematomas, 2 seizures resulting in hospitalization, 1 catheter malfunction, 2 perioperative AEs, and 1 death of uncertain cause. Eight SAEs were coded as probably/definitely related. Six occurred >3 months from the time of surgery. CONCLUSIONS: SAEs following NPH surgery are common. Additional studies are needed to determine the long-term safety of NPH surgery in older adults.


Assuntos
Hidrocefalia de Pressão Normal/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Derivação Ventriculoperitoneal/tendências
18.
Acta Neurochir Suppl ; 126: 133-137, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29492548

RESUMO

OBJECTIVES: The objectives were to compare three methods of estimating critical closing pressure (CrCP) in a scenario of a controlled increase in intracranial pressure (ICP) induced during an infusion test in patients with suspected normal pressure hydrocephalus (NPH). METHODS: We retrospectively analyzed data from 37 NPH patients who underwent infusion tests. Computer recordings of directly measured intracranial pressure (ICP), arterial blood pressure (ABP) and transcranial Doppler cerebral blood flow velocity (CBFV) were used. The CrCP was calculated using three methods: first harmonics ratio of the pulse waveforms of ABP and CBFV (CrCPA) and two methods based on a model of cerebrovascular impedance, as a function of cerebral perfusion pressure (CrCPinv), and as a function of ABP (CrCPninv). RESULTS: There is good agreement among the three methods of CrCP calculation, with correlation coefficients being greater than 0.8 (p < 0.0001). For the CrCPA method, negative values were found for about 20% of all results. Negative values of CrCP were not observed in estimators based on cerebrovascular impedance. During the controlled rise of ICP, all three estimators of CrCP increased significantly (p < 0.05). The strongest correlation between ICP and CrCP was found for CrCPinv (median R = 0.41). CONCLUSION: Invasive CrCP is most sensitive to variations in ICP and can be used as an indicator of the status of the cerebrovascular system during infusion tests.


Assuntos
Pressão Arterial/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Circulação Cerebrovascular/fisiologia , Hidrocefalia de Pressão Normal/diagnóstico , Pressão Intracraniana/fisiologia , Artéria Cerebral Média/diagnóstico por imagem , Monitorização Fisiológica/métodos , Adulto , Impedância Elétrica , Feminino , Análise de Fourier , Humanos , Infusão Espinal , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Ultrassonografia Doppler Transcraniana
19.
Acta Neurochir Suppl ; 126: 163-165, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29492554

RESUMO

OBJECTIVES: Arterial hypertension is among the leading risks for mortality. This burden requires in hypertensive patients the use of single, double or more antihypertensive drugs. The relationship between intracranial pressure (ICP) and arterial blood pressure is complex and still under debate. The impact of antihypertensive drugs on ICP is unknown. We wanted to understand whether the use of antihypertensive drugs has a significant influence on ICP and cerebrospinal fluid (CSF)/brain related parameters. MATERIALS AND METHODS: In a cohort of 95 patients with suspected normal pressure hydrocephalus, we prospectively collected drug details according to the Anatomical Therapeutic Chemical (ATC) classification. Lumbar infusion studies were performed. Using ICM+ software, we calculated at baseline and plateau ICP and pulse amplitude, resistance to CSF outflow, elastance, and pressure in the sagittal sinus and CSF production rate. We studied the influence of the administration of 1, 2, 3 or more antihypertensive drugs on ICP-derived parameters. We compared the data using Student's and Mann-Whitney tests or Chi-squared and Fisher's exact test. RESULTS: Elastance is significantly higher in patients with at least one antihypertensive drug compared with patients without medication. On the contrary, pressure volume index (PVI) is significantly decreased in patients with antihypertensive drugs compared with patients not on these medications. However, the number of antihypertensive drugs does not seem to influence other ICP parameters. CONCLUSIONS: Patients on antihypertensive drugs seem to have a stiffer brain than those not on them.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hidrocefalia de Pressão Normal/fisiopatologia , Hipertensão/tratamento farmacológico , Pressão Intracraniana/fisiologia , Idoso , Estudos de Coortes , Quimioterapia Combinada , Elasticidade , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico , Masculino , Estudos Prospectivos
20.
Acta Neurochir Suppl ; 126: 229-232, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29492566

RESUMO

OBJECTIVE: The term "hydrocephalus" encompasses a range of disorders characterised by clinical symptoms, abnormal brain imaging and derangement of cerebrospinal fluid (CSF) dynamics. The ability to elucidate which patients would benefit from CSF diversion (a shunt or third ventriculostomy) is often unclear. Similar difficulties are encountered in shunted patients to predict the scope for improvement by shunt re-adjustment or revision. MATERIALS AND METHODS: We compared retrospective pre-shunting infusion test results performed in 310 adult patients diagnosed with normal pressure hydrocephalus (NPH) and their improvement after shunting. RESULTS: Resistance to CSF outflow correlated significantly with improvement (p < 0.05). Other markers known from the literature, such as amplitude in CSF pulse pressure, the slope of the amplitude-pressure regression line, or elasticity did not show any correlation with outcome. CONCLUSION: Outcome following shunting in adult NPH is associated with resistance to CSF outflow; however, the latter cannot be taken as an absolute predictor of shunt response.


Assuntos
Derivações do Líquido Cefalorraquidiano , Hidrocefalia de Pressão Normal/fisiopatologia , Pressão Intracraniana/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hidrocefalia de Pressão Normal/diagnóstico , Hidrocefalia de Pressão Normal/cirurgia , Infusão Espinal , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
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