• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryCurrent TOCInstructions for authors
J Neurol Neurosurg Psychiatry. Nov 2002; 73(5): 552–555.
PMCID: PMC1738128

Intracranial cerebrospinal fluid measurement studies in suspected idiopathic normal pressure hydrocephalus, secondary normal pressure hydrocephalus, and brain atrophy

Abstract

Objective: To investigate intracranial cerebrospinal fluid (CSF) distribution in patients with a clinical diagnosis of idiopathic normal pressure hydrocephalus (INPH).

Methods: 24 patients with a clinical diagnosis of INPH were studied. Control groups comprised 17 patients with secondary normal pressure hydrocephalus (SNPH), 21 patients with brain atrophy, and 18 healthy volunteers. Ventricular volume (VV) and intracranial CSF volume (ICV) were measured using a magnetic resonance based method and the VV/ICV ratio was calculated.

Results: The SNPH group showed a marked increase in the VV/ICV ratio compared with the healthy volunteers (37.8% v 15.6%, p < 0.0001). The brain atrophy group showed a significant increase in ICV compared with the healthy volunteers (284.4 ml v 194.7 ml, p =0.0002). The INPH group showed an increase in ICV (281.2 ml, p = 0.0002) and an increase in the VV/ICV ratio (38.0%, p < 0.0001). Fifteen of 24 INPH patients underwent shunting; 11 improved and four did not.

Conclusions: The results suggest that INPH patients have brain atrophy in addition to hydrocephalic features. This may help to explain the difficulties encountered in the diagnosis and the unpredictable response rate to shunt surgery in INPH patients.

Full Text

The Full Text of this article is available as a PDF (108K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Vanneste JA. Three decades of normal pressure hydrocephalus: are we wiser now? J Neurol Neurosurg Psychiatry. 1994 Sep;57(9):1021–1025. [PMC free article] [PubMed]
  • Vanneste J, van Acker R. Normal pressure hydrocephalus: did publications alter management? J Neurol Neurosurg Psychiatry. 1990 Jul;53(7):564–568. [PMC free article] [PubMed]
  • Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J. Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg. 1999 Feb;90(2):221–226. [PubMed]
  • Savolainen S, Paljärvi L, Vapalahti M. Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir (Wien) 1999;141(8):849–853. [PubMed]
  • Bech RA, Waldemar G, Gjerris F, Klinken L, Juhler M. Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir (Wien) 1999;141(6):633–639. [PubMed]
  • Thomsen AM, Børgesen SE, Bruhn P, Gjerris F. Prognosis of dementia in normal-pressure hydrocephalus after a shunt operation. Ann Neurol. 1986 Sep;20(3):304–310. [PubMed]
  • Tsunoda A, Mitsuoka H, Sato K, Kanayama S. A quantitative index of intracranial cerebrospinal fluid distribution in normal pressure hydrocephalus using an MRI-based processing technique. Neuroradiology. 2000 Jun;42(6):424–429. [PubMed]
  • Tsunoda A, Mitsuoka H, Bandai H, Arai H, Sato K, Makita J. Intracranial cerebrospinal fluid distribution and its postoperative changes in normal pressure hydrocephalus. Acta Neurochir (Wien) 2001;143(5):493–499. [PubMed]
  • Marmarou A, Shulman K, Rosende RM. A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics. J Neurosurg. 1978 Mar;48(3):332–344. [PubMed]
  • Matsumae M, Kikinis R, Mórocz I, Lorenzo AV, Albert MS, Black PM, Jolesz FA. Intracranial compartment volumes in patients with enlarged ventricles assessed by magnetic resonance-based image processing. J Neurosurg. 1996 Jun;84(6):972–981. [PubMed]
  • Grant R, Condon B, Lawrence A, Hadley DM, Patterson J, Bone I, Teasdale GM. Human cranial CSF volumes measured by MRI: sex and age influences. Magn Reson Imaging. 1987;5(6):465–468. [PubMed]
  • Murphy DG, DeCarli C, Schapiro MB, Rapoport SI, Horwitz B. Age-related differences in volumes of subcortical nuclei, brain matter, and cerebrospinal fluid in healthy men as measured with magnetic resonance imaging. Arch Neurol. 1992 Aug;49(8):839–845. [PubMed]
  • Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR Am J Neuroradiol. 1998 Aug;19(7):1277–1284. [PubMed]
  • Benzel EC, Pelletier AL, Levy PG. Communicating hydrocephalus in adults: prediction of outcome after ventricular shunting procedures. Neurosurgery. 1990 Apr;26(4):655–660. [PubMed]
  • Børgesen SE, Gjerris F. The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain. 1982 Mar;105(Pt 1):65–86. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...