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Kadaba Sridhar S, Dysterheft Robb J, Gupta R, Cheong S, Kuang R, Samadani U. Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer's dementia and Parkinson's disease, and hydrocephalus versus atrophy in chronic TBI-a narrative review. Front Neurol 2024; 15:1347200. [PMID: 38576534 PMCID: PMC10991762 DOI: 10.3389/fneur.2024.1347200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Normal Pressure Hydrocephalus (NPH) is a prominent type of reversible dementia that may be treated with shunt surgery, and it is crucial to differentiate it from irreversible degeneration caused by its symptomatic mimics like Alzheimer's Dementia (AD) and Parkinson's Disease (PD). Similarly, it is important to distinguish between (normal pressure) hydrocephalus and irreversible atrophy/degeneration which are among the chronic effects of Traumatic Brain Injury (cTBI), as the former may be reversed through shunt placement. The purpose of this review is to elucidate the structural imaging markers which may be foundational to the development of accurate, noninvasive, and accessible solutions to this problem. Methods By searching the PubMed database for keywords related to NPH, AD, PD, and cTBI, we reviewed studies that examined the (1) distinct neuroanatomical markers of degeneration in NPH versus AD and PD, and atrophy versus hydrocephalus in cTBI and (2) computational methods for their (semi-) automatic assessment on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans. Results Structural markers of NPH and those that can distinguish it from AD have been well studied, but only a few studies have explored its structural distinction between PD. The structural implications of cTBI over time have been studied. But neuroanatomical markers that can predict shunt response in patients with either symptomatic idiopathic NPH or post-traumatic hydrocephalus have not been reliably established. MRI-based markers dominate this field of investigation as compared to CT, which is also reflected in the disproportionate number of MRI-based computational methods for their automatic assessment. Conclusion Along with an up-to-date literature review on the structural neurodegeneration due to NPH versus AD/PD, and hydrocephalus versus atrophy in cTBI, this article sheds light on the potential of structural imaging markers as (differential) diagnostic aids for the timely recognition of patients with reversible (normal pressure) hydrocephalus, and opportunities to develop computational tools for their objective assessment.
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Affiliation(s)
- Sharada Kadaba Sridhar
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Jen Dysterheft Robb
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rishabh Gupta
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
| | - Scarlett Cheong
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
| | - Rui Kuang
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Uzma Samadani
- Department of Bioinformatics and Computational Biology, University of Minnesota, Minneapolis, MN, United States
- Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, MN, United States
- University of Minnesota Twin Cities Medical School, Minneapolis, MN, United States
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, United States
- Division of Neurosurgery, Department of Surgery, Minneapolis Veterans Affairs Health Care System, Minneapolis, MN, United States
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Kadaba Sridhar S, Kuang R, Dysterheft Robb J, Samadani U. A ventriculomegaly feature computational pipeline to improve the screening of normal pressure hydrocephalus on CT. J Neurosurg 2024:1-11. [PMID: 38457801 DOI: 10.3171/2023.12.jns231780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/13/2023] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The objective of this study was to develop a computational pipeline that extracts objective features of ventriculomegaly from non-contrast CT (NCCT) for the accurate classification of idiopathic normal pressure hydrocephalus (NPH) from headache controls (HCs), Alzheimer's dementia (AD), and posttraumatic encephalomalacia (PTE). METHODS Patients with possible NPH (n = 79) and a subset with definite NPH (DefNPH; n = 29) were retrospectively identified in the Veterans Affairs Informatics and Computing Infrastructure system, along with the AD (n = 62), PTE (n = 53), and HC (n = 59) cohorts. Image-processing pipelines were developed to extract a novel feature capturing the maximum eccentricity of the lateral ventricles (MaxEccLV), a proxy splenial angle (p-SA), the Evans indices (EI-x, -y, and -z), callosal angle, normalized maximum third-ventricle width, and CSF to brain volume ratio from their NCCT scans. The authors used t-tests to examine group differences in the features and multivariate logistic regression models for classification. Additionally, the NPH versus HC classifier was validated on external data. RESULTS When NPH and DefNPH were compared with HC, AD, and PTE, significant differences were found in all features except the p-SA, which only significantly differed between NPH and PTE. The test-set area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were 0.98, 100%, and 98.3% for NPH versus HC classification; 0.94, 87.3%, and 85.5% for NPH versus AD; 0.96, 92.4%, and 90.6% for NPH versus PTE; and 0.96, 94%, and 88% for NPH versus the other groups using logistic regression under five-fold cross-validation. Consistently high performance was noted for DefNPH. The NPH versus HC classifier provided an AUC of 0.84, sensitivity of 76.9%, and specificity of 90% when assessed on external data. CONCLUSIONS Including the novel MaxEccLV, this framework computes useful features of ventriculomegaly, which had not previously been algorithmically assessed on NCCT. This framework successfully classified possible and definite NPH from HC, AD, and PTE. Following validation on larger representative cohorts, this objective and accessible tool may aid in screening for NPH and differentiating it from symptomatic mimics such as AD and PTE.
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Affiliation(s)
- Sharada Kadaba Sridhar
- 2Department of Bioinformatics and Computational Biology, University of Minnesota
- 4Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, Minnesota
| | - Rui Kuang
- 2Department of Bioinformatics and Computational Biology, University of Minnesota
- 3Department of Computer Science and Engineering, University of Minnesota; and
| | - Jen Dysterheft Robb
- 4Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, Minnesota
| | - Uzma Samadani
- 1Division of Neurosurgery, Department of Surgery, Minneapolis Veterans Affairs Health Care System
- 2Department of Bioinformatics and Computational Biology, University of Minnesota
- 4Neurotrauma Research Lab, Center for Veterans Research and Education, Minneapolis, Minnesota
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Bertani R, Perret C, Koester S, Santa Maria P, Batista S, Cavicchioli SDA, Arita STDAR, Monteiro R, Lucchesi G, Vasconcellos FA, Miranda M, Paiva WS, Pinto FG. Management of shunt dysfunction using noninvasive intracranial pressure waveform monitoring: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23437. [PMID: 38437677 PMCID: PMC10916843 DOI: 10.3171/case23437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/16/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND Normal pressure hydrocephalus (NPH) treatment consists of using valves for drainage, as it is for hydrocephalus in general. Despite this, complications can occur, putting the patient at risk, and neurological monitoring is crucial. OBSERVATIONS A 61-year-old male, who had been diagnosed with NPH 3 years prior and was being treated with a ventriculoperitoneal shunt with a programmable valve, presented to the emergency department because of a traumatic brain injury due to a fall from standing height. No previous complications were reported. He had an altered intracranial pressure (ICP) waveform in the emergency room when monitored with the brain4care device, with a P2/P1 ratio of 1.6. Imaging helped to confirm shunt dysfunction. Revision surgery normalized the ratio to 1.0, and the patient was discharged. Upon return after 14 days, an outpatient analysis revealed a ratio of 0.6, indicating improvement. LESSONS In selected cases of NPH, noninvasive ICP waveform morphology analysis can be effective as a diagnostic aid, as well as in the pre- and postsurgical follow-up, given the possibility of comparing the values of ICP preoperatively and immediately postoperatively and the outpatient P2/P1 ratio, helping to manage these patients.
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Affiliation(s)
- Raphael Bertani
- Department of Neurosurgery, Cerebral Hydrodynamics Group, University of São Paulo, São Paulo, Brazil
| | - Caio Perret
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Stefan Koester
- School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Paulo Santa Maria
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Savio Batista
- Medical School, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Ruy Monteiro
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | - Gianne Lucchesi
- Department of Neurosurgery, Hospital Municipal Miguel Couto, Rio de Janeiro, Brazil
| | | | - Matheus Miranda
- Department of Neurosurgery, Cerebral Hydrodynamics Group, University of São Paulo, São Paulo, Brazil
| | | | - Fernando Gomes Pinto
- Department of Neurosurgery, Cerebral Hydrodynamics Group, University of São Paulo, São Paulo, Brazil
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Patel M, Zhang Y, Xiao MF, Worley P, Moghekar A. Neuronal pentraxin 2 correlates with neurodegeneration but not cognition in idiopathic normal pressure hydrocephalus (iNPH). Neurol Neurochir Pol 2024; 58:47-53. [PMID: 38393959 DOI: 10.5603/pjnns.98212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
AIM OF THE STUDY Neuronal pentraxin-2 (NPTX2) is a synaptic protein responsible for modulating plasticity at excitatory synapses. While the role of NPTX2 as a novel synaptic biomarker in cognitive disorders has been elucidated recently, its role in idiopathic normal pressure hydrocephalus (iNPH) is not yet understood. CLINICAL RATIONALE FOR STUDY To determine if NPTX2 predicts cognition in patients with iNPH, and whether it could serve as a predictive marker for shunt outcomes. MATERIAL AND METHODS 354 iNPH patients underwent cerebrospinal fluid drainage (CSF) as part of the tap test or extended lumbar drainage. Demographic and clinical measures including age, Evans Index (EI), Montreal Cognitive Assessment (MoCA) score, Functional Activities Questionnaire (FAQ) score, and baseline and post-shunt surgery Timed Up and Go (TUG) test scores were ascertained. CSF NPTX2 concentrations were measured using an ELISA. CSF β-amyloid 1-40 (Aβ1-40), β-amyloid 1-42 (Aβ1-42), and phosphorylated tau-181 (pTau-181) were measured by chemiluminescent assays. Spearman's correlation was used to determine the correlation between CSF NPTX2 concentrations and age, EI, MoCA and FAQ, TUG, Aβ1-40/Aβ1-42 ratio, and pTau-181 concentrations. Logistic regression was used to determine if CSF NPTX2 values were a predictor of short-term improvement post-CSF drainage or long-term improvement post-shunt surgery. RESULTS There were 225 males and 129 females with a mean age of 77.7 years (± 7.06). Average CSF NPTX2 level in all iNPH patients was 559.97 pg/mL (± 432.87). CSF NPTX2 level in those selected for shunt surgery was 505.61 pg/mL (± 322.38). NPTX2 showed modest correlations with pTau-181 (r = 0.44, p < 0.001) with a trend for Aβ42/Aβ40 ratio (r = -0.1, p = 0.053). NPTX2 concentrations did not correlate with age (r = -0.012, p = 0.83) or MoCA score (r = 0.001, p = 0.87), but correlated negatively with FAQ (r = -0.15, p = 0.019). CONCLUSIONS While CSF NPTX2 values correlate with neurodegeneration, they do not correlate with cognitive or functional measures in iNPH. CSF NPTX2 cannot serve as a predictor of either short-term or long-term improvement after CSF drainage. CLINICAL IMPLICATIONS These results suggest that synaptic degeneration is not a core feature of iNPH pathophysiology.
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Affiliation(s)
- Megha Patel
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Yifan Zhang
- Department of Biostatistics, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Mei-Fang Xiao
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Paul Worley
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Abhay Moghekar
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, United States.
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Ferguson PB, Snavely K. Palinopsia in the Setting of Normal Pressure Hydrocephalus. Cureus 2024; 16:e55239. [PMID: 38558696 PMCID: PMC10981441 DOI: 10.7759/cureus.55239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Normal pressure hydrocephalus (NPH) is characterized by pathologic ventriculomegaly with normal opening pressures on lumbar puncture. It commonly presents with a triad of gait disturbance, cognitive impairment, and urinary bladder detrusor dysfunction. Its pathogenesis is complex but is thought to arise in the setting of imbalanced cerebrospinal fluid (CSF) secretion and absorption. Given that intracranial pressure often remains normal in the setting of NPH, visual symptoms are quite uncommon. Here we present a case of a 70-year-old female with a subacute history of visual aberration described as a seconds-long persistent recurrence of visual images after the stimulus was removed from the visual field in the setting of slowed and unstable gait, urinary urgency, and cognitive impairment. This patient was evaluated and ultimately diagnosed with NPH before undergoing definitive treatment with ventriculoperitoneal shunt implantation. She has shown persistent responsiveness to shunting of the CSF as manifested by sustained improvement in gait speed and stability, urinary bladder urgency, and palinopsia resolution at the six-month follow-up assessment.
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Affiliation(s)
- Paul B Ferguson
- Neurology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Kennedy Snavely
- Obstetrics and Gynecology, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Jaramillo-Velásquez D, Hakim F, Demetriades AK. Salomón Hakim, MD (1922-2011): A honeymoon with Neurosurgery. J Med Biogr 2024; 32:10-19. [PMID: 34714164 DOI: 10.1177/09677720211054025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Salomón Hakim (1922-2011) was a Colombian neurosurgeon and brain scientist This biography examines the social and cultural background through which he emerged as an inquisitive and multi-dimensional surgeon-scientist, and his lifelong contributions to the specialty of neurosurgery. With empirical knowledge in applied medical physics, electronics, electricity and chemistry, he understood the paradoxical phenomenon of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. This ultimately led Hakim to describe in exquisite detail the physics of the cranial cavity and brain hydrodynamics. His name is intertwined with the identification of the entity of a syndrome which had not previously been addressed in the medical literature: Normal Pressure Hydrocephalus (Hakim's syndrome). Additionally, he designed and built various models of valved shunting devices to treat the condition (eg the Hakim programmable valve). Through his selflessness and cogent work, Hakim left a legacy and intellectual heritage that has allowed many colleagues worldwide to save thousands of lives who would be otherwise condemned to oblivion.
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Affiliation(s)
| | - Fernando Hakim
- Neurosurgery Department, Fundación Santa Fe de Bogotá. Bogotá, D.C., Colombia
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Yang HW, Lee S, Berry BC, Yang D, Zheng S, Carroll RS, Park PJ, Johnson MD. A role for mutations in AK9 and other genes affecting ependymal cells in idiopathic normal pressure hydrocephalus. Proc Natl Acad Sci U S A 2023; 120:e2300681120. [PMID: 38100419 PMCID: PMC10743366 DOI: 10.1073/pnas.2300681120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is an enigmatic neurological disorder that develops after age 60 and is characterized by gait difficulty, dementia, and incontinence. Recently, we reported that heterozygous CWH43 deletions may cause iNPH. Here, we identify mutations affecting nine additional genes (AK9, RXFP2, PRKD1, HAVCR1, OTOG, MYO7A, NOTCH1, SPG11, and MYH13) that are statistically enriched among iNPH patients. The encoded proteins are all highly expressed in choroid plexus and ependymal cells, and most have been associated with cilia. Damaging mutations in AK9, which encodes an adenylate kinase, were detected in 9.6% of iNPH patients. Mice homozygous for an iNPH-associated AK9 mutation displayed normal cilia structure and number, but decreased cilia motility and beat frequency, communicating hydrocephalus, and balance impairment. AK9+/- mice displayed normal brain development and behavior until early adulthood, but subsequently developed communicating hydrocephalus. Together, our findings suggest that heterozygous mutations that impair ventricular epithelial function may contribute to iNPH.
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Affiliation(s)
- Hong Wei Yang
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA01655
| | - Semin Lee
- Brigham and Women’s Hospital, Boston, MA02115
- Harvard Medical School, Boston, MA02115
| | - Bethany C. Berry
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA01655
| | - Dejun Yang
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA01655
| | - Shaokuan Zheng
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA01655
| | - Rona S. Carroll
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA01655
- Brigham and Women’s Hospital, Boston, MA02115
- Harvard Medical School, Boston, MA02115
| | - Peter J. Park
- Brigham and Women’s Hospital, Boston, MA02115
- Harvard Medical School, Boston, MA02115
| | - Mark D. Johnson
- Department of Neurological Surgery, University of Massachusetts Chan Medical School, Worcester, MA01655
- Department of Neurological Surgery, University of Massachusetts Memorial Health, Worcester, MA01655
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Tipton PW, Elder BD, Cogswell PM, Graff-Radford N. Normal pressure hydrocephalus, or Hakim syndrome: review and update. Neurol Neurochir Pol 2023; 58:8-20. [PMID: 38054275 DOI: 10.5603/pjnns.97343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/07/2023]
Abstract
This review makes the case that idiopathic normal pressure hydrocephalus (iNPH) is an outdated term because new information indicates that the syndrome is less idiopathic and that the cerebrospinal fluid (CSF) pressure of normal individuals is affected by several factors such as body mass index, age, and sex. Our review updates the epidemiology of iNPH and provides a clinical approach to the management of these patients. All the clinical features of iNPH are common in older individuals, and each has many causes, so the diagnosis is difficult. The first step in reaching an accurate diagnosis is to address the possible contributory factors to the gait abnormality and determine what if any role iNPH may be playing. The two best diagnostic tests are neuroimaging and cerebrospinal fluid (CSF) diversion (large volume lumbar puncture or external lumbar drainage) with pre/post gait evaluation. This review provides an update on the growing evidence that vascular disease, impaired CSF absorption, congenital, and genetic factors all contribute to the pathogenesis of iNPH. We suggest replacing the term iNPH with the term Hakim syndrome (HS) in acknowledgement of the first person to describe this syndrome. Lastly, we discuss the improvements in shunt technology and surgical techniques that have decreased the risks and long-term complications of shunt surgery.
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Affiliation(s)
- Philip W Tipton
- Department of Neurology, Mayo Clinic, Jacksonville, Florida, United States.
| | - Benjamin D Elder
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, United States
| | - Petrice M Cogswell
- Department of Neuroradiology, Mayo Clinic, Rochester, Minnesota, United States
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Lang S, Dimond D, Isaacs AM, Dronyk J, Vetkas A, Conner CR, Germann J, Fasano A, Kalia S, Lozano A, Hamilton MG. Use of cortical volume to predict response to temporary CSF drainage in patients with idiopathic normal pressure hydrocephalus. J Neurosurg 2023; 139:1776-1783. [PMID: 37148227 DOI: 10.3171/2023.3.jns222787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/23/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Temporary drainage of CSF with lumbar puncture or lumbar drainage has a high predictive value for identifying patients with suspected idiopathic normal pressure hydrocephalus (iNPH) who may benefit from ventriculoperitoneal shunt insertion. However, it is unclear what differentiates responders from nonresponders. The authors hypothesized that nonresponders to temporary CSF drainage would have patterns of reduced regional gray matter volume (GMV) as compared with those of responders. The objective of the current investigation was to compare regional GMV between temporary CSF drainage responders and nonresponders. Machine learning using extracted GMV was then used to predict outcomes. METHODS This retrospective cohort study included 132 patients with iNPH who underwent temporary CSF drainage and structural MRI. Demographic and clinical variables were examined between groups. Voxel-based morphometry was used to calculate GMV across the brain. Group differences in regional GMV were assessed and correlated with change in results on the Montreal Cognitive Assessment (MoCA) and gait velocity. A support vector machine (SVM) model that used extracted GMV values and was validated with leave-one-out cross-validation was used to predict clinical outcome. RESULTS There were 87 responders and 45 nonresponders. There were no group differences in terms of age, sex, baseline MoCA score, Evans index, presence of disproportionately enlarged subarachnoid space hydrocephalus, baseline total CSF volume, or baseline white matter T2-weighted hyperintensity volume (p > 0.05). Nonresponders demonstrated decreased GMV in the right supplementary motor area (SMA) and right posterior parietal cortex as compared with responders (p < 0.001, p < 0.05 with false discovery rate cluster correction). GMV in the posterior parietal cortex was associated with change in MoCA (r2 = 0.075, p < 0.05) and gait velocity (r2 = 0.076, p < 0.05). Response status was classified by the SVM with 75.8% accuracy. CONCLUSIONS Decreased GMV in the SMA and posterior parietal cortex may help identify patients with iNPH who are unlikely to benefit from temporary CSF drainage. These patients may have limited capacity for recovery due to atrophy in these regions that are known to be important for motor and cognitive integration. This study represents an important step toward improving patient selection and predicting clinical outcomes in the treatment of iNPH.
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Affiliation(s)
- Stefan Lang
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
| | - Dennis Dimond
- 3Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Albert M Isaacs
- 2Department of Neurosurgery, Vanderbilt University, Nashville, Tennessee
| | - Jarred Dronyk
- 3Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Artur Vetkas
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
| | | | - Jurgen Germann
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
| | - Alfonso Fasano
- 4Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
- 6Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil Kalia
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
- 6Krembil Brain Institute, Toronto, Ontario, Canada
| | - Andres Lozano
- 1Department of Neurosurgery, University of Toronto, Ontario, Canada
- 6Krembil Brain Institute, Toronto, Ontario, Canada
| | - Mark G Hamilton
- 3Department of Clinical Neurosciences, Division of Neurosurgery, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada
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Haller S, Montandon ML, Rodriguez C, Herrmann FR, Giannakopoulos P. Automatic MRI volumetry in asymptomatic cases at risk for normal pressure hydrocephalus. Front Aging Neurosci 2023; 15:1242158. [PMID: 38020768 PMCID: PMC10655029 DOI: 10.3389/fnagi.2023.1242158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/05/2023] [Indexed: 12/01/2023] Open
Abstract
The occurrence of significant Alzheimer's disease (AD) pathology was described in approximately 30% of normal pressure hydrocephalus (NPH) cases, leading to the distinction between neurodegenerative and idiopathic forms of this disorder. Whether or not there is a specific MRI signature of NPH remains a matter of debate. The present study focuses on asymptomatic cases at risk for NPH as defined with automatic machine learning tools and combines automatic MRI assessment of cortical and white matter volumetry, risk of AD (AD-RAI), and brain age gap estimation (BrainAge). Our hypothesis was that brain aging and AD process-independent volumetric changes occur in asymptomatic NPH-positive cases. We explored the volumetric changes in normal aging-sensitive (entorhinal cortex and parahippocampal gyrus/PHG) and AD-signature areas (hippocampus), four control cortical areas (frontal, parietal, occipital, and temporal), and cerebral and cerebellar white matter in 30 asymptomatic cases at risk for NPH (NPH probability >30) compared to 30 NPH-negative cases (NPH probability <5) with preserved cognition. In univariate regression models, NPH positivity was associated with decreased volumes in the hippocampus, parahippocampal gyrus (PHG), and entorhinal cortex bilaterally. The strongest negative association was found in the left hippocampus that persisted when adjusting for AD-RAI and Brain Age values. A combined model including the three parameters explained 36.5% of the variance, left hippocampal volumes, and BrainAge values, which remained independent predictors of the NPH status. Bilateral PHG and entorhinal cortex volumes were negatively associated with NPH-positive status in univariate models but this relationship did not persist when adjusting for BrainAge, the latter remaining the only predictor of the NPH status. We also found a negative association between bilateral cerebral and cerebellar white matter volumes and NPH status that persisted after controlling for AD-RAI or Brain Age values, explaining between 50 and 65% of its variance. These observations support the idea that in cases at risk for NPH, as defined by support vector machine assessment of NPH-related MRI markers, brain aging-related and brain aging and AD-independent volumetric changes coexist. The latter concerns volume loss in restricted hippocampal and white matter areas that could be considered as the MRI signature of idiopathic forms of NPH.
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Affiliation(s)
- Sven Haller
- CIMC - Centre d’Imagerie Médicale de Cornavin, Geneva, Switzerland
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Marie-Louise Montandon
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Cristelle Rodriguez
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
| | - François R. Herrmann
- Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Panteleimon Giannakopoulos
- Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Capel C, Owashi K, Peltier J, Balédent O. Hydrodynamic and Hemodynamic Interactions in Chronic Hydrocephalus. Biomedicines 2023; 11:2931. [PMID: 38001933 PMCID: PMC10669187 DOI: 10.3390/biomedicines11112931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND During a cardiac cycle, intracranial pressure is related to arterial entry into the cranium and its interaction with intracranial compliance. The arterial inflow is compensated by intracranial compliance and, initially, the flushing of cerebrospinal fluid (CSF) into the cervical subarachnoid spaces. Our objective is to analyze the interactions between intracranial arteriovenous exchange and cerebrospinal fluid oscillations. METHOD A total of 23 patients (73 ± 8 years) with suspected chronic hydrocephalus (CH) underwent an infusion test and phase-contrast MRI. Rout is an important factor in the diagnosis of CH. Patients were divided into 2 populations: probableCH (Rout: resistance to CSF outflow) (Rout > 12 mmHg/mL/min, 13 patients) and unlikelyCH (Rout < 12 mmHg/mL/min, 10 patients). We measured the intracranial vascular volume (arteriovenous stroke volume: SVvasc) and CSF (CSF stroke volume at upper cervical level: SVCSF) volume variations during the cardiac cycle. RESULTS In the whole population, we observed a significant correlation between SVvasc and SVCSF (R2 = 0.43; p = 0.0007). In the population unlikelyCH, this correlation was significant (R2 = 0.76; p = 0.001). In the population probableCH, this correlation was not significant (R2 = 0.17, p = 0.16). CONCLUSIONS These results show that the link between the compliance of the oscillating CSF and the abrupt arterial inflow seems to be altered in CH. CSF oscillations between intracranial and cervical fluid spaces limit the impact of the abrupt arterial inflow.
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Affiliation(s)
- Cyrille Capel
- Department of Neurosurgery, Hospital University Center of Amiens-Picardie, 80054 Amiens, France;
- CHIMERE UR UPJV 7516, Jules Verne University, 80000 Amiens, France; (K.O.); (O.B.)
| | - Kimi Owashi
- CHIMERE UR UPJV 7516, Jules Verne University, 80000 Amiens, France; (K.O.); (O.B.)
- Image Processing Department, Hospital University Center of Amiens-Picardie, 80054 Amiens, France
| | - Johann Peltier
- Department of Neurosurgery, Hospital University Center of Amiens-Picardie, 80054 Amiens, France;
- CHIMERE UR UPJV 7516, Jules Verne University, 80000 Amiens, France; (K.O.); (O.B.)
| | - Olivier Balédent
- CHIMERE UR UPJV 7516, Jules Verne University, 80000 Amiens, France; (K.O.); (O.B.)
- Image Processing Department, Hospital University Center of Amiens-Picardie, 80054 Amiens, France
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12
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Hasselbalch SG, Carlsen JF, Alaouie MM, Munch TN, Holst AV, Taudorf S, Rørvig-Løppentien C, Juhler M, Waldemar G. Prediction of shunt response in idiopathic normal pressure hydrocephalus by combined lumbar infusion test and preoperative imaging scoring. Eur J Neurol 2023; 30:3047-3055. [PMID: 37433569 DOI: 10.1111/ene.15981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND AND PURPOSE Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable disorder, but prognostic tests or biomarkers are lacking. The aim was to study the predictive power of clinical, neuroimaging and lumbar infusion test parameters (resistance to outflow Rout , cardiac-related pulse amplitude PA and the PA to intracranial pressure ICP ratio). METHODS In all, 127 patients diagnosed with iNPH who had a lumbar infusion test, a subsequent ventriculo-peritoneal shunt operation and at least 2 months of postoperative follow-up were retrospectively included. Preoperative magnetic resonance images were visually scored for NPH features using the iNPH Radscale. Preoperative and postoperative assessment was performed using cognitive testing, as well as gait and incontinence scales. RESULTS At follow-up (7.4 months, range 2-20 months), an overall positive response was seen in 82% of the patients. Gait was more severely impaired at baseline in responders compared to non-responders. The iNPH Radscale score was borderline significantly higher in responders compared with non-responders, whereas no significant differences in infusion test parameters were seen between responders and non-responders. Infusion test parameters performed modestly with high positive (75%-92%) but low negative (17%-23%) predictive values. Although not significant, PA and PA/ICP seemed to perform better than Rout , and the odds ratio for shunt response seemed to increase in patients with higher PA/ICP, especially in patients with lower iNPH Radscale scores. CONCLUSION Although only indicative, lumbar infusion test results increased the likelihood of a positive shunt outcome. Pulse amplitude measures showed promising results that should be further explored in prospective studies.
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Affiliation(s)
- Steen Gregers Hasselbalch
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonathan Frederik Carlsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Radiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Mohamed Moussa Alaouie
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Tina Nørgaard Munch
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurosurgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Vedel Holst
- Department of Neurosurgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Sarah Taudorf
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Christina Rørvig-Løppentien
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Marianne Juhler
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Neurosurgery, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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13
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Levin Z, Leary OP, Mora V, Kant S, Brown S, Svokos K, Akbar U, Serre T, Klinge P, Fleischmann A, Ruocco MG. Cerebrospinal fluid transcripts may predict shunt surgery responses in normal pressure hydrocephalus. Brain 2023; 146:3747-3759. [PMID: 37208310 DOI: 10.1093/brain/awad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 05/21/2023] Open
Abstract
Molecular biomarkers for neurodegenerative diseases are critical for advancing diagnosis and therapy. Normal pressure hydrocephalus (NPH) is a neurological disorder characterized by progressive neurodegeneration, gait impairment, urinary incontinence and cognitive decline. In contrast to most other neurodegenerative disorders, NPH symptoms can be improved by the placement of a ventricular shunt that drains excess CSF. A major challenge in NPH management is the identification of patients who benefit from shunt surgery. Here, we perform genome-wide RNA sequencing of extracellular vesicles in CSF of 42 NPH patients, and we identify genes and pathways whose expression levels correlate with gait, urinary or cognitive symptom improvement after shunt surgery. We describe a machine learning algorithm trained on these gene expression profiles to predict shunt surgery response with high accuracy. The transcriptomic signatures we identified may have important implications for improving NPH diagnosis and treatment and for understanding disease aetiology.
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Affiliation(s)
- Zachary Levin
- Department of Neuroscience, Brown University, Providence, RI 02912, USA
- Carney Institute for Brain Science, Brown University, Providence, RI 02912, USA
| | - Owen P Leary
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Victor Mora
- Department of Neuroscience, Brown University, Providence, RI 02912, USA
- Carney Institute for Brain Science, Brown University, Providence, RI 02912, USA
| | - Shawn Kant
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Sarah Brown
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Konstantina Svokos
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Umer Akbar
- Department of Neurology, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Thomas Serre
- Carney Institute for Brain Science, Brown University, Providence, RI 02912, USA
- Department of Cognitive Linguistic and Psychological Sciences, Brown University, Providence, RI 02912, USA
| | - Petra Klinge
- Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School, Brown University, Providence, RI 02903, USA
| | - Alexander Fleischmann
- Department of Neuroscience, Brown University, Providence, RI 02912, USA
- Carney Institute for Brain Science, Brown University, Providence, RI 02912, USA
| | - Maria Grazia Ruocco
- Carney Institute for Brain Science, Brown University, Providence, RI 02912, USA
- Department of Cognitive Linguistic and Psychological Sciences, Brown University, Providence, RI 02912, USA
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14
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Reis RC, Yamashita RHG, Solla DJF, Ramin LF, Teixeira MJ, Pinto FCG. Treatment of Idiopathic Normal Pressure Hydrocephalus with a Novel Programmable Valve: Prospective Evaluation of Costs, Efficacy, and Safety. Asian J Neurosurg 2023; 18:548-556. [PMID: 38152509 PMCID: PMC10749867 DOI: 10.1055/s-0043-1771370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Objective Programmable valves provide an equal or superior neurological outcome when compared with fixed pressure ones, with fewer complications, in treating idiopathic normal pressure hydrocephalus (iNPH) patients. Long-term costs of these treatments have not been properly compared in literature. We sought to compare costs, efficacy, and safety of 1-year treatment of iNPH patients with programmable valve Sphera Pro and a fixed pressure valve. Materials and Methods A prospective cohort of iNPH patients treated with programmable valve was compared with a historical cohort of iNPH patients treated with fixed pressure valve. Our primary outcome was mean direct cost of treating iNPH up to 1 year. Efficacy in treating iNPH and safety were assessed as secondary outcomes. Statistical Analysis Proportions were compared using chi-square or Fisher's exact tests. Normally distributed variables were compared using the Student's t -test or the Mann-Whitney's U test. Differences in the evolution of the variables over time were assessed using generalized estimating equations. All tests were two-sided, with an α of 0.05. Results A total of 19 patients were analyzed in each group (mean age 75 years, the majority male). Comorbidities and clinical presentation were similar between groups. Both fixed pressure and programmable valve patients had neurological improvement over time ( p < 0.001), but no difference was seen between groups ( p = 0.104). The fixed pressure valve group had more complications than the programmable valve group (52.6% vs. 10.5%, respectively, p = 0.013). Annual treatment cost per patient was US$ 3,820 ± 2,231 in the fixed pressure valve group and US$ 3,108 ± 553 in the programmable valve group. Mean difference was US$712 (95% confidence interval, 393-1,805) in favor of the programmable valve group. Conclusion The Sphera Pro valve with gravitational unit had 1 year treatment cost not higher than that of fixed pressure valve, and resulted in similar efficacy and fewer complications.
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Affiliation(s)
- Rodolfo Casimiro Reis
- Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | | | - Laís Fajardo Ramin
- Neuroradiology Section, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
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15
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Pahwa B, Tayal A, Shukla A, Soni U, Gupta N, Bassey E, Sharma M. Utility of Machine learning in the Management of Normal Pressure Hydrocephalus (NPH): A Systematic Review. World Neurosurg 2023:S1878-8750(23)00847-1. [PMID: 37356488 DOI: 10.1016/j.wneu.2023.06.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND In the past decade many machine learning (ML) models have been utilized in the management of normal pressure hydrocephalus (NPH). This study aims at systematically reviewing those ML models. METHODS Pubmed, EMBASE and Web of Science databases were searched for studies reporting applications of ML in NPH. Quality assessment was performed using PROBAST and TRIPOD adherence reporting guidelines and statistical analysis was performed with level of significance <0.05. RESULTS A total of 22 studies with 53 models were included in the review of which convolutional neural network (CNN) was the most utilized model. Inputs used to train various models included clinical features, CT scan, MRI, intracranial pulse waveform characteristics and perfusion infusion. The overall mean accuracy of the models was 77% (highest for CNN, 98% while lowest for Decision tree (DT), 55% p=0.176). There was a statistically significant difference in the accuracy and AUC of diagnostic and interventional models (accuracy; 83.4% vs 69.4%, AUC; 0.882 vs 0.729, p <0.001). Overall, 59.09% (n = 13) and 81.82% (n = 18) of the studies had high-risk bias and high-applicability, respectively, on PROBAST assessment; however only 55.15% of the studies adhered to the TRIPOD statement. CONCLUSIONS Though highly accurate, there are many challenges to current ML models necessitating the need to standardize the ML models to enable comparison across the studies and enhance the NPH decision making and care.
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Affiliation(s)
- Bhavya Pahwa
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anish Tayal
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Anushruti Shukla
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Ujjwal Soni
- Medical Student, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Namrata Gupta
- Medical Student, KMC Manipal, Udupi, Karnataka, India
| | - Esther Bassey
- Student of BSc physiology, University of Uyo, Uyo, Akwa Ibom, Nigeria
| | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, United States of America.
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16
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Cakmak OO, Akar K, Youssef H, Samanci MY, Ertan S, Vural A. Comparative Assessment of Gait and Balance in Patients with Parkinson's Disease and Normal Pressure Hydrocephalus. Sisli Etfal Hastan Tip Bul 2023; 57:232-237. [PMID: 37899810 PMCID: PMC10600622 DOI: 10.14744/semb.2023.79990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 10/31/2023]
Abstract
Objectives We aim to compare balance and gait parameters in patients diagnosed with Parkinson's disease (PD) and normal pressure hydrocephalus (NPH). Methods A total of 13 patients with NPH, 20 with PD, and 13 healthy controls (HC) recruited in the study. Three IMU sensors (Ambulatory PD Monitoring Inc., OR, USA) were placed on the lumbar area and the feet of the participants. The balance evaluations comprised eight successive standing tasks; the modified clinical test of sensory interaction on balance test. These tasks involved standing with feet apart and eyes open as well as eyes closed on a firm and foam surface, standing with feet together and eyes open as well as eyes closed, and tandem stance with the right foot front and the left foot front. Functional evaluations of gait were conducted using the 10-M Walk Test (10 MWT), the 2 min-Walk Test (2 MWT), and the timed-up and go (TUG). Parameters of the gait and balance were analyzed and then compared. Results NPH patients displayed a notable decrease in both stride length and gait speed as compared with both PD patients and healthy participants. The balance tests revealed that the NPH group demonstrated significantly poorer performance, specifically in the feet-apart eyes-closed foam-surface test, and the tandem stance test. During the tasks while eyes were open on firm and foam surfaces, PD and NPH groups showed an increase in root mean square sway, range, and mean velocity (p<0.05) of sway in the anteroposterior plane. In addition, during the TUG test, the NPH group exhibited a significant prolongation in the time needed to complete the task and a decline in turning velocity as compared to PD, but no notable difference was seen in comparison to the HC group. Conclusion Our study indicated that the patients with NPH exhibited notably worse gait and balance measurements in comparison to both the PD patients and HC groups. These findings emphasize the significance of monitoring and managing gait and balance impairments in NPH patients. Sensor-based technologies may offer objective parameters for a more precise and efficient follow-up of these patients in terms of gait and balance.
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Affiliation(s)
- Ozgur Oztop Cakmak
- Department of Neurology, Koc University Faculty of Medicine, Istanbul, Türkiye
| | - Kardelen Akar
- Motion Analysis Laboratory, Koc University, KUTTAM, Istanbul, Türkiye
| | - Hussein Youssef
- Motion Analysis Laboratory, Koc University, KUTTAM, Istanbul, Türkiye
| | | | - Sibel Ertan
- Department of Neurology, Koc University Faculty of Medicine, Istanbul, Türkiye
| | - Atay Vural
- Department of Neurology, Koc University Faculty of Medicine, Istanbul, Türkiye
- Motion Analysis Laboratory, Koc University, KUTTAM, Istanbul, Türkiye
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17
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Vanninen A, Lukkarinen H, Kokkola T, Koivisto AM, Kokki M, Musialowicz T, Hiltunen M, Zetterberg H, Leinonen V, Herukka SK, Rauramaa T. Cerebrospinal Fluid Diagnostics of Alzheimer's Disease in Patients with Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis 2023:JAD230144. [PMID: 37334597 PMCID: PMC10357203 DOI: 10.3233/jad-230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common cause of dementia worldwide and a frequent comorbidity in idiopathic normal pressure hydrocephalus (iNPH). The presence of AD pathology is associated with worse outcomes after a shunt procedure in iNPH. Preoperative diagnosis of AD is challenging in patients with iNPH, which involves reduced concentrations of the cerebrospinal fluid (CSF) AD biomarkers. OBJECTIVE Our aim was to estimate the effect size of iNPH as a factor in CSF levels of AD biomarkers and to test if correction could be used to improve diagnostic value. METHODS Our cohort included 222 iNPH patients with data in the Kuopio NPH registry and brain biopsy and CSF samples available. We divided the patients into groups according to AD pathology per brain biopsy. For control cohorts, we had CSF samples from cognitively healthy individuals (n = 33) and patients with diagnosed AD and no iNPH (n = 39).*-31ptResults:Levels of all investigated biomarkers differed significantly between groups, with the exception of t-Tau levels between healthy individuals and iNPH patients with AD pathology. Applying a correction factor for each biomarker (0.842*Aβ 1 - 42, 0.779*t-Tau, and 0.610*P-Tau181) for the effect of iNPH yielded a sensitivity of 2.4% and specificity of 100%. The ratio of P-Tau181 to Aβ 1 - 42 was moderately effective in aiding recognition of AD pathology in iNPH patients (sensitivity 0.79, specificity 0.76, area under the curve 0.824). CONCLUSION Correcting for iNPH as a factor failed to improve diagnostic effectiveness, but the P-Tau181/Aβ 1 - 42 ratio showed some utility in the diagnosis of AD in iNPH patients.
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Affiliation(s)
- Aleksi Vanninen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heikki Lukkarinen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kokkola
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Anne M Koivisto
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
- Department of Neurosciences, University of Helsinki, Helsinki, Finland
- Department of Geriatrics, Helsinki University Hospital, Helsinki, Finland
| | - Merja Kokki
- School of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Tadeusz Musialowicz
- Department of Anaesthesia and Intensive Care Medicine, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Hiltunen
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sanna-Kaisa Herukka
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Rauramaa
- Department of Pathology, Kuopio University Hospital, Kuopio, Finland
- Pathology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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18
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Nienhaus S, Stummer W, Ghadiri MK. Normal pressure hydrocephalus and comorbidities: A quality study of the university hospital Münster. World Neurosurg 2023:S1878-8750(23)00769-6. [PMID: 37295465 DOI: 10.1016/j.wneu.2023.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (NPH) is commonly accompanied by diverse comorbidities that impact the postoperative course and result in a distinction between shunt responders and shunt non-responders. The objective of this study is to enhance diagnostics by identifying prognostic differences between NPH patients, individuals with comorbidities, and those with other differential diagnoses. METHODS The data of 119 patients with NPH coding at the University Clinic Münster from January 2009 to June 2017 were examined. The study primarily concentrated on examining symptoms, comorbidities, and radiological measurements, including callosal angle (CA) and Evans index (EI). To evaluate the progression of symptoms, a novel scoring system was developed to quantitatively assess the course at specific time points: 5-7 weeks, 1-1.5 years, and 2.5 years after the operation. This scoring system aimed to provide a standardized approach for measuring and tracking the development of symptoms over time. Logistic regression analyses were employed to identify predictors associated with three key outcomes: shunt implantation, surgical success, and the development of complications. RESULTS Among the comorbidities observed, hypertension was the most prevalent. Gait disturbance, in the absence of polyneuropathy, was identified as a predictor of a favorable surgical outcome. Hygroma development was associated with a combination of vascular factors and cognitive disorders. The presence of spinal/skeletal changes, diabetes, and vascular constellations were found to increase the likelihood of developing complications. CONCLUSIONS The evaluation of comorbidities holds significant importance and necessitates meticulous observation, expertise, and multidisciplinary care.
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Affiliation(s)
- Susanne Nienhaus
- Department of Pediatric, Christliches Kinderhospital Osnabrück, Osnabrück, Germany
| | - Walter Stummer
- Department of Neurosurgery, University of Münster, Münster, Germany
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Kafai Golahmadi A, Craven CL, Watkins LD. Neurosarcoidosis Mimicking Normal Pressure Hydrocephalus. Cureus 2023; 15:e40281. [PMID: 37448383 PMCID: PMC10336621 DOI: 10.7759/cureus.40281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Two female patients, aged 46 and 51, were referred to the National Hospital for Neurology and Neurosurgery with symptoms resembling normal pressure hydrocephalus (NPH) and with ventriculomegaly on the MRI. Both had a definite diagnosis of neurosarcoidosis (NS) on biopsy, and they underwent the medical and surgical management reserved for NPH. At follow-up, their presenting symptoms had resolved and they had clinically improved. Neurosarcoidosis can mimic NPH, and it should be excluded in patients presenting with NPH.
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Affiliation(s)
| | - Claudia L Craven
- Neurosurgery, National Hospital for Neurology and Neurosurgery, London, GBR
| | - Laurence D Watkins
- Neurosurgery, National Hospital for Neurology and Neurosurgery, London, GBR
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Yang F, Yang L, Fang X, Deng Y, Mao R, Yan A, Wei W. Increased Cerebrospinal Fluid Levels of Soluble Triggering Receptor Expressed on Myeloid Cells 2 and Chitinase-3-Like Protein 1 in Idiopathic Normal-Pressure Hydrocephalus. J Alzheimers Dis 2023:JAD221180. [PMID: 37182875 DOI: 10.3233/jad-221180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Neurodegenerative disease pathology is associated with neuroinflammation, but evidence on idiopathic normal pressure hydrocephalus (iNPH) remains limited and cerebrospinal fluid (CSF) biomarker profiles need to be elucidated. OBJECTIVE To investigate whether iNPH pathological mechanisms are associated with greater CSF markers of core Alzheimer's disease pathology (amyloid-β42 (Aβ 42), phosphorylated tau (P-tau)), neurodegeneration (total tau (T-tau)), and neuroinflammation (soluble triggering receptor expressed on myeloid cells 2 (sTREM2), chitinase-3-like protein 1 (YKL-40)). METHODS The study analyzed lumbar CSF samples from 63 patients with iNPH and 20 age-matched orthopedic surgery patients who had no preoperative gait or cognitive impairment (control group). Aβ 42, T-tau, P-tau, sTREM2, and YKL-40 in different subgroups were investigated. RESULTS CSF sTREM2 levels were significantly higher in the iNPH group than in the control group, but no significant between-group difference was noted in YKL-40. Moreover, YKL-40 levels were significantly higher in the tap test non-responders than in the tap test responders (p = 0.021). At the 1-year follow-up after shunt surgery, the CSF P-tau levels were significantly lower (p = 0.020) in those with gait improvement and the CSF sTREM2 levels were significantly lower (p = 0.041) in those with cognitive improvement. In subgroup analysis, CSF sTREM2 levels were strongly correlated with CSF YKL-40 in the iNPH group (r = 0.443, p < 0.001), especially in the tap test non-responders (r = 0.653, p = 0.002). CONCLUSION YKL-40 and sTREM2 are disease-specific markers of neuroinflammation, showing higher CSF levels in iNPH. In addition, sTREM2 is positively associated with YKL-40, indicating that interactions of glial cells play an important role in iNPH pathogenesis.
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Affiliation(s)
- Fuxia Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Lu Yang
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Xuhao Fang
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Yao Deng
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Renling Mao
- Department of Neurosurgery, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Aijuan Yan
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
| | - Wenshi Wei
- Department of Neurology, Huadong Hospital Affiliated to Fudan University, Shanghai, China
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Jusue-Torres I, Brown DA, Pennington Z, Cogswell PM, Ali F, Graff-Radford N, Jones DT, Cutsforth-Gregory JK, Graff-Radford J, Kaufman KR, Elder BD. Objective assessment of patients with idiopathic normal pressure hydrocephalus following ventriculoperitoneal shunt placement using activity-monitoring data: pilot study. Neurosurg Focus 2023; 54:E6. [PMID: 37004136 DOI: 10.3171/2023.1.focus22640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) results in significant morbidity in the elderly with symptoms of dementia, gait instability, and urinary incontinence. In well-selected patients, ventriculoperitoneal shunt (VPS) placement often results in clinical improvement. Most postshunt assessments of patients rely on subjective scales. The goal of this study was to assess the utility of remote activity monitoring to provide objective evidence of gait improvement following VPS placement for iNPH. METHODS Patients with iNPH were prospectively enrolled and fitted with 5 activity monitors (on the hip and bilateral thighs and ankles) that they wore for 4 days preoperatively within 30 days of surgery and for 4 days within 30 days postoperatively. Monitors collected continuous data for number of steps, cadence, body position (upright, prone, supine, and lateral decubitus), gait entropy, and the proportion of each day spent active or static. Data were retrieved from the devices and a comparison of pre- and postoperative movement assessment was performed. The gait data were also correlated with formal clinical gait assessments before and after lumbar puncture and with motion analysis laboratory testing at baseline and 1 month and 1 year after VPS placement. RESULTS Twenty patients fulfilled the inclusion and exclusion criteria (median age 76 years). The baseline median number of daily steps was 1929, the median percentage of the day spent inactive was 70%, the median percentage of the day with a static posture was 95%, the median gait velocity was 0.49 m/sec, and the median number of steps required to turn was 8. There was objective improvement in median entropy from pre- to postoperatively, increasing from 0.6 to 0.8 (p = 0.002). There were no statistically significant differences for any of the remaining variables measured by the activity monitors when comparing the preoperative to the 1-month postoperative time point. All variables from motion analysis testing showed statistically significant differences or a trend toward significance at 1 year after VPS placement. Among the significantly correlated variables at baseline, cadence was inversely correlated with percentage of gait cycle spent in the support phase (contact with ground vs swing phase). CONCLUSIONS This pilot study suggests that activity monitoring provides an early objective measure of improvement in gait entropy after VPS placement among patients with iNPH, although a more significant improvement was noted on the detailed clinical gait assessments. Further long-term studies are needed to determine the utility of remote monitoring for assessing gait improvement following VPS placement.
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Affiliation(s)
| | - Desmond A Brown
- 2National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland; and
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Cayuela N, Domínguez-Lizarbe M, Plans G, Alemany M, Sánchez JJ, Andrés B, Lucas A, Bruna J, Simó M. Normal Pressure Hydrocephalus Following Cranial Radiation: Identification of Shunting Responders. Cancers (Basel) 2023; 15:cancers15071949. [PMID: 37046610 PMCID: PMC10093348 DOI: 10.3390/cancers15071949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/19/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND We examined cognitive, brain MRI, and lumbar infusion test (LIT) features to identify predictors of response to ventriculoperitoneal shunting (VPS) in long-term cancer survivors with suspected normal pressure hydrocephalus (NPH) following cranial radiotherapy (RT). METHODS Patients who completed cranial RT at least 2 years before with clinically suspected NPH and an Evans' index (EI) ≥ 0.30 underwent a cognitive and a cerebrospinal fluid (CSF) volumetric (MRI) analysis (n = 36). For those in whom VPS was placed (n = 14), we explored whether adding a CSF volumetric analysis to classical MRI and LIT (Tap Test) features would better identify VPS responders. RESULTS Nearly 80% exhibited cognitive impairment. The CSF volume at NPH diagnoses was significantly larger in the group of VPS responders (p = 0.04). The addition of CSF volume to NPH diagnoses increased accuracy to 93%, with a positive and negative predictive value of 91% and 100%, respectively. CONCLUSION The addition of a quantitative MRI analysis of CSF volume to classical MRI and LIT NPH criteria, along with a high clinical suspicion of NPH, may help to identify VPS responders, thus improving the clinical management and prognosis of long-term survivors.
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Affiliation(s)
- Nuria Cayuela
- Neurology Department, Complex Hospitalari Moisès Broggi, 08970 Sant Joan Despí, Barcelona, Spain
| | - Manuel Domínguez-Lizarbe
- Neurology Department, Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Barcelona, Spain
| | - Gerard Plans
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (Oncobell Program), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Montserrat Alemany
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (Oncobell Program), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Juan José Sánchez
- Institute for Diagnostic Imaging, Hospital Universitari de Bellvitge, 08907 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Begoña Andrés
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (Oncobell Program), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Lucas
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (Oncobell Program), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Radiation Oncology Department, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (Oncobell Program), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d'Oncologia l'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (Oncobell Program), 08908 L'Hospitalet de Llobregat, Barcelona, Spain
- Cognition and Brain Plasticity Group, Institut d'Investigació Biomèdica de Bellvitge, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
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23
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Patel S, Ditamo M, Mangal R, Gould M, Ganti L. Normal Pressure Hydrocephalus. Cureus 2023; 15:e35131. [PMID: 36949988 PMCID: PMC10026533 DOI: 10.7759/cureus.35131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 02/20/2023] Open
Abstract
Normal Pressure Hydrocephalus (NPH) occurs when there is an accumulation of cerebrospinal fluid due to impeded flow or excess production, resulting in gait and memory impairment and urinary incontinence. The authors present the case of a 67-year-old male, who had symptoms for a year prior to being diagnosed. His neurological exam was significant for a slow, and unsteady wide-based gait. No underlying cause for his NPH was found. He underwent a shunt procedure following which he made a complete recovery.
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Affiliation(s)
- Shaan Patel
- Biology, John Burroughs School, St. Louis, USA
| | | | - Rohan Mangal
- Medical School, University of Miami Miller School of Medicine, Miami, USA
| | | | - Latha Ganti
- Emergency Medicine, HCA Florida Ocala Hospital, Ocala, USA
- Emergency Medicine, Envision Physician Services, Plantation, USA
- Emergency Medicine, University of Central Florida College of Medicine, Orlando, USA
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24
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Wang Y, Feng A, Xue Y, Shao M, Blitz AM, Luciano MG, Carass A, Prince JL. Investigation of probability maps in deep-learning-based brain ventricle parcellation. Proc SPIE Int Soc Opt Eng 2023; 12464:124642G. [PMID: 38013746 PMCID: PMC10679955 DOI: 10.1117/12.2653999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Normal Pressure Hydrocephalus (NPH) is a brain disorder associated with ventriculomegaly. Accurate segmentation of the ventricle system into its sub-compartments from magnetic resonance images (MRIs) could help evaluate NPH patients for surgical intervention. In this paper, we modify a 3D U-net utilizing probability maps to perform accurate ventricle parcellation, even with grossly enlarged ventricles and post-surgery shunt artifacts, from MRIs. Our method achieves a mean dice similarity coefficient (DSC) on whole ventricles for healthy controls of 0.864 ± 0.047 and 0.961 ± 0.024 for NPH patients. Furthermore, with the benefit of probability maps, the proposed method provides superior performance on MRI with grossly enlarged ventricles (mean DSC value of 0.965 ± 0.027) or post-surgery shunt artifacts (mean DSC value of 0.964 ± 0.031). Results indicate that our method provides a high robust parcellation tool on the ventricular systems which is comparable to other state-of-the-art methods.
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Affiliation(s)
- Yuli Wang
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Anqi Feng
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Yuan Xue
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Muhan Shao
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Ari M. Blitz
- Department of Radiology, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Mark G. Luciano
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Aaron Carass
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Jerry L. Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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Hattori T, Ohara M, Yuasa T, Azuma R, Chen Q, Hanazawa R, Hirakawa A, Orimo S, Yokota T. Correlation of callosal angle at the splenium with gait and cognition in normal pressure hydrocephalus. J Neurosurg 2023:1-11. [PMID: 36670530 DOI: 10.3171/2022.12.jns221825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/07/2022] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is characterized by ventricular enlargement that deforms the corpus callosum, making the callosal angle (CA) small. The authors aimed to evaluate the clinical usefulness of the CA in different planes in iNPH. METHODS Forty patients with iNPH were included in the study. As a control group, 241 patients with other neurological diseases and 50 healthy controls were included. The subjects had been seen at the authors' institutions from 2010 to 2020. The Timed Up and Go (TUG) test total time and Mini-Mental State Examination (MMSE) total score were evaluated. CAs were measured in the axial plane at the splenium and genu and in the coronal plane at the anterior commissure and posterior commissure by using 3-dimensional T1-weighted MR images. As other hydrocephalus parameters, the Evans index, frontal-occipital horn ratio, and third ventricular width were also measured in patients with iNPH. Associations between each CA or hydrocephalus parameter and clinical parameters were evaluated. The classification efficacy of each CA in differentiating between iNPH and other neurological diseases and healthy controls was evaluated. RESULTS The CA at the splenium, but no other hydrocephalus parameters, was correlated with TUG total time or MMSE total score in patients with iNPH. Receiver operating characteristic analysis showed that a CA of 71.1° at the splenium has 90.0% sensitivity and 89.0% specificity in discriminating iNPH from other neurological diseases and healthy controls. Probabilistic tractography analysis showed that neuronal fibers via the splenium connect the superior parietal lobules, temporal lobes, and occipital lobes. CONCLUSIONS The study results suggest that interhemispheric disconnections at the splenium are, at least in part, responsible for gait and cognitive disturbance in iNPH. The CA at the splenium is a unique morphological feature that correlates with gait and cognition in iNPH, and it is useful for discriminating iNPH from other neurological diseases and healthy controls.
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Affiliation(s)
| | | | - Tatsuhiko Yuasa
- 2Department of Neurology, Kamagaya General Hospital, Kamagaya, Chiba; and
| | - Reo Azuma
- 3Department of Neurology, Kanto Central Hospital, Setagaya-ku, Tokyo, Japan
| | | | - Ryoichi Hanazawa
- 4Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Akihiro Hirakawa
- 4Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo
| | - Satoshi Orimo
- 3Department of Neurology, Kanto Central Hospital, Setagaya-ku, Tokyo, Japan
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Bluett B, Ash E, Farheen A, Fasano A, Krauss JK, Maranzano A, Passaretti M, Tang‐Wai DF, Van Gerpen J, Alonso‐Canovas A, Youn J, Malm J, Martino D. Clinical Features of Idiopathic Normal Pressure Hydrocephalus: Critical Review of Objective Findings. Mov Disord Clin Pract 2023; 10:9-16. [PMID: 36704075 PMCID: PMC9847299 DOI: 10.1002/mdc3.13608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/07/2022] Open
Abstract
Background Idiopathic normal pressure hydrocephalus (iNPH) is characterized by the classic clinical triad of gait, cognitive, and urinary dysfunction, albeit incomplete in a relevant proportion of patients. The clinical findings and evolution of these symptoms have been variably defined in the literature. Objectives To evaluate how the phenomenology has been defined, assessed, and reported, we performed a critical review of the existing literature discussing the phenomenology of iNPH. The review also identified the instrumental tests most frequently used and the evolution of clinical and radiologic findings. Methods The review was divided into 3 sections based on gait, cognitive, and urinary dysfunction. Each section performed a literature search using the terms "idiopathic normal pressure hydrocephalus" (iNPH), with additional search terms used by each section separately. The number of articles screened, duplicates, those meeting the inclusion criteria, and the number of articles excluded were recorded. Findings were subsequently tallied and analyzed. Results A total of 1716 articles with the aforementioned search criteria were identified by the 3 groups. A total of 81 full-text articles were reviewed after the elimination of duplicates, articles that did not discuss phenomenological findings or instrumental testing of participants with iNPH prior to surgery, and articles with fewer than 10 participants. Conclusions "Wide-based gait" was the most common gait dysfunction identified. Cognitive testing varied significantly across articles, and ultimately a specific cognitive profile was not identified. Urodynamic testing found detrusor overactivity and "overactive bladder" as the most common symptom of urinary dysfunction.
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Affiliation(s)
- Brent Bluett
- Central California Movement DisordersPismo BeachCaliforniaUSA
| | - Elissa Ash
- Department of Neurology, Faculty of MedicineTel Aviv Sourasky Medical CenterTel AvivIsrael
| | - Amtul Farheen
- Department of NeurologyLebanon VA Medical CenterLebanonPennsylvaniaUSA
- Department of NeurologyPenn State Hershey Medical CenterHersheyPennsylvaniaUSA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's DiseaseMorton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health NetworkTorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Howard Cohen Normal Pressure Hydrocephalus ProgramUniversity Health Network, Toronto Western HospitalTorontoOntarioCanada
- Department of Medicine, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | | | - Alessio Maranzano
- Department of NeurologyIstituto Auxologico Italiano IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico)MilanItaly
- Department of Pathophysiology and TransplantationUniversity of MilanMilanItaly
| | | | - David F. Tang‐Wai
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
- Howard Cohen Normal Pressure Hydrocephalus ProgramUniversity Health Network, Toronto Western HospitalTorontoOntarioCanada
- Department of Medicine, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
- University Health Network Memory ClinicToronto Western HospitalTorontoOntarioCanada
| | - Jay Van Gerpen
- Department of NeurologyUniversity of Alabama at BirminghamHuntsvilleAlabamaUSA
| | - Araceli Alonso‐Canovas
- Movement Disorders Unit. Neurology DepartmentHospital Universitario Ramón y CajalMadridSpain
| | - Jinyoung Youn
- Department of NeurologySamsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jan Malm
- Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
| | - Davide Martino
- Department of Clinical Neurosciences and Hotchkiss Brain InstituteUniversity of CalgaryCalgaryAlbertaCanada
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Mendes GADS, Hayashi CY, Vilela GHF, Kido L, Teixeira MJ, Pinto FCG. Comparison of Noninvasive Measurements of Intracranial with Tap Test Results in Patients with Idiopathic Normal Pressure Hydrocephalus. Neuropsychiatr Dis Treat 2023; 19:1127-1143. [PMID: 37193548 PMCID: PMC10182791 DOI: 10.2147/ndt.s402358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/17/2023] [Indexed: 05/18/2023] Open
Abstract
Background Normal pressure hydrocephalus is a disease directly related to the change in intracranial compliance and consequent repercussions in the brain parenchyma. Invasive monitoring of such parameters proves to be reliable especially for prognosis in neurocritical patients; however, it is not applicable in an outpatient service setting. The present study describes the comparison between the tap test results and the parameters obtained with a non-invasive sensor for monitoring intracranial compliance in patients with suspected NPH. Methods Twenty-eight patients were evaluated before and after lumbar puncture of 50mL of CSF (the tap test), comprising clinical assessment, magnetic resonance imaging, physical therapy assessment using the Timed Up and Go test, Dynamic Gait Index, BERG test, neuropsychological assessment, and recording of non-invasive intracranial compliance data using the Brain4care® device in three different positions (lying, sitting, and standing) for 5 min each. The tap test results were compared to the Time to Peak and P2/P1 ratio parameters obtained by the device. Results The group that had a positive Tap test result presented a median P2/P1 ratio greater than 1.0, suggesting a change in intracranial compliance. In addition, there was also a significant difference between patients with positive, negative, and inconclusive results, especially in the lying position. Conclusion A non-invasive intracranial compliance device when used with the patient lying down and standing up obtained parameters that suggest correspondence with the result of the tap test.
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Affiliation(s)
- Gabriel André da Silva Mendes
- Physiotherapy Nucleous, Hospital of the State Public Servant of São Paulo, São Paulo City, São Paulo State, Brazil
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
- Correspondence: Gabriel André da Silva Mendes, Email
| | - Cintya Yukie Hayashi
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
- Braincare Desenvolvimento e Inovação Tecnológica S.A, São Carlos City, São Paulo State, Brazil
| | | | - Lissa Kido
- Braincare Desenvolvimento e Inovação Tecnológica S.A, São Carlos City, São Paulo State, Brazil
| | - Manoel Jacobsen Teixeira
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
| | - Fernando Campos Gomes Pinto
- Brain Hydrodynamics Group, Department of Neurosurgery, Hospital das Clínicas, University of São Paulo, São Paulo City, São Paulo State, Brazil
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28
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Greuter L, Schenker T, Guzman R, Soleman J. Endoscopic third ventriculostomy compared to ventriculoperitoneal shunt as treatment for idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Br J Neurosurg 2022:1-7. [PMID: 36537195 DOI: 10.1080/02688697.2022.2149697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The accepted treatment for idiopathic normal pressure hydrocephalus (iNPH) is the insertion of a ventriculoperitoneal shunt (VPS). Recently, some studies examined endoscopic third ventriculostomy (ETV) for the treatment of iNPH with controversial results. The aim of this systematic review and meta-analysis was to compare ETV to VPS regarding complications and outcome for the treatment of iNPH. METHODS We searched Medline, Embase and Scopus. Due to the scarcity of data, we did not include only randomized controlled trials, but also retro- and prospective studies. The primary outcome was failure of cerebrospinal fluid diversion method. Secondary endpoints were clinical postoperative improvement rate, morbidity and mortality. RESULTS Out of 311 screened studies, three were included in the quantitative analysis including one RCT and two retrospective cohort studies. No statistically significant difference concerning failure rate of CSF diversion method (ETV 27.5% vs. VPS 33.2%, RR 1.19, 95% CI [0.69-2.04], p = 0.52) or postoperative improvement was found (68% for ETV vs. 72.8% for VPS, RR 0.81, 95% CI [0.57-1.16], p = 0.26). ETV showed a significantly lower complication rate compared to VPS (7.5% vs. 51.1%, RR 0.25, 95% CI [0.08-0.76], p = 0.02). CONCLUSION ETV and VPS did not differ significantly regarding their failure rate for iNPH, while ETV showed a significantly lower complication rate than VPS. However, the data available is scarce with only one RCT investigating this important matter. Further well-designed trials are necessary to investigate the clinical outcome of ETV in iNPH. TRIAL REGISTRATION NUMBER PROSPERO (ID: CRD42020199173).
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Affiliation(s)
- Ladina Greuter
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
| | - Timo Schenker
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
- Division of Pediatric Neurosurgery, University Children Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jehuda Soleman
- Department of Neurosurgery, University Hospital Basel, Basel, Switzerland
- Division of Pediatric Neurosurgery, University Children Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
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29
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Pyrgelis ES, Boufidou F, Constantinides VC, Papaioannou M, Papageorgiou SG, Stefanis L, Paraskevas GP, Kapaki E. Cerebrospinal Fluid Biomarkers in iNPH: A Narrative Review. Diagnostics (Basel) 2022; 12. [PMID: 36552981 DOI: 10.3390/diagnostics12122976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a neurological syndrome characterized by the clinical triad of gait disorder, cognitive impairment and urinary incontinence. It has attracted interest because of the possible reversibility of symptoms, especially with timely treatment. The main pathophysiological theory is based on a vicious circle of disruption in circulation of cerebrospinal fluid (CSF) that leads to the deceleration of its absorption. Data regarding CSF biomarkers in iNPH are contradictory and no definite CSF biomarker profile has been recognized as in Alzheimer's disease (AD), which often co-exists with iNPH. In this narrative review, we investigated the literature regarding CSF biomarkers in iNPH, both the established biomarkers total tau protein (t-tau), phosphorylated tau protein (p-tau) and amyloid peptide with 42 amino acids (Aβ42), and other molecules, which are being investigated as emerging biomarkers. The majority of studies demonstrate differences in CSF concentrations of Aβ42 and tau-proteins (t-tau and p-tau) among iNPH patients, healthy individuals and patients with AD and vascular dementia. iNPH patients present with lower CSF Aβ42 and p-tau concentrations than healthy individuals and lower t-tau and p-tau concentrations than AD patients. This could prove helpful for improving diagnosis, differential diagnosis and possibly prognosis of iNPH patients.
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30
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Funnell JP, Noor K, Khan DZ, D'Antona L, Dobson RJB, Hanrahan JG, Hepworth C, Moncur EM, Thomas BM, Thorne L, Watkins LD, Williams SC, Wong WK, Toma AK, Marcus HJ. Characterization of patients with idiopathic normal pressure hydrocephalus using natural language processing within an electronic healthcare record system. J Neurosurg 2022:1-9. [PMID: 36401545 DOI: 10.3171/2022.9.jns221095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Idiopathic normal pressure hydrocephalus (iNPH) is an underdiagnosed, progressive, and disabling condition. Early treatment is associated with better outcomes and improved quality of life. In this paper, the authors aimed to identify features associated with patients with iNPH using natural language processing (NLP) to characterize this cohort, with the intention to later target the development of artificial intelligence-driven tools for early detection. METHODS The electronic health records of patients with shunt-responsive iNPH were retrospectively reviewed using an NLP algorithm. Participants were selected from a prospectively maintained single-center database of patients undergoing CSF diversion for probable iNPH (March 2008-July 2020). Analysis was conducted on preoperative health records including clinic letters, referrals, and radiology reports accessed through CogStack. Clinical features were extracted from these records as SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) concepts using a named entity recognition machine learning model. In the first phase, a base model was generated using unsupervised training on 1 million electronic health records and supervised training with 500 double-annotated documents. The model was fine-tuned to improve accuracy using 300 records from patients with iNPH double annotated by two blinded assessors. Thematic analysis of the concepts identified by the machine learning algorithm was performed, and the frequency and timing of terms were analyzed to describe this patient group. RESULTS In total, 293 eligible patients responsive to CSF diversion were identified. The median age at CSF diversion was 75 years, with a male predominance (69% male). The algorithm performed with a high degree of precision and recall (F1 score 0.92). Thematic analysis revealed the most frequently documented symptoms related to mobility, cognitive impairment, and falls or balance. The most frequent comorbidities were related to cardiovascular and hematological problems. CONCLUSIONS This model demonstrates accurate, automated recognition of iNPH features from medical records. Opportunities for translation include detecting patients with undiagnosed iNPH from primary care records, with the aim to ultimately improve outcomes for these patients through artificial intelligence-driven early detection of iNPH and prompt treatment.
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Affiliation(s)
- Jonathan P Funnell
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2National Hospital for Neurology and Neurosurgery, London
| | - Kawsar Noor
- 3Institute for Health Informatics, University College London
- 4NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London
| | - Danyal Z Khan
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2National Hospital for Neurology and Neurosurgery, London
| | - Linda D'Antona
- 2National Hospital for Neurology and Neurosurgery, London
- 5UCL Queen Square Institute of Neurology, University College London
| | - Richard J B Dobson
- 3Institute for Health Informatics, University College London
- 4NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London
- 6Health Data Research UK London, University College London
- 7NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King's College London
- 8Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London
| | - John G Hanrahan
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2National Hospital for Neurology and Neurosurgery, London
| | | | - Eleanor M Moncur
- 2National Hospital for Neurology and Neurosurgery, London
- 5UCL Queen Square Institute of Neurology, University College London
| | | | - Lewis Thorne
- 2National Hospital for Neurology and Neurosurgery, London
| | | | - Simon C Williams
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2National Hospital for Neurology and Neurosurgery, London
| | - Wai Keong Wong
- 4NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London
- 6Health Data Research UK London, University College London
| | - Ahmed K Toma
- 2National Hospital for Neurology and Neurosurgery, London
- 4NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London
- 5UCL Queen Square Institute of Neurology, University College London
| | - Hani J Marcus
- 1Wellcome/EPSRC Centre for Interventional and Surgical Sciences, University College London
- 2National Hospital for Neurology and Neurosurgery, London
- 4NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London
- 5UCL Queen Square Institute of Neurology, University College London
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White H, Webb R, McKnight I, Legg K, Lee C, Lee PH, Spicer OS, Shim JW. TRPV4 mRNA is elevated in the caudate nucleus with NPH but not in Alzheimer's disease. Front Genet 2022; 13:936151. [PMID: 36406122 PMCID: PMC9670164 DOI: 10.3389/fgene.2022.936151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/17/2022] [Indexed: 01/04/2023] Open
Abstract
Symptoms of normal pressure hydrocephalus (NPH) and Alzheimer's disease (AD) are somewhat similar, and it is common to misdiagnose these two conditions. Although there are fluid markers detectable in humans with NPH and AD, determining which biomarker is optimal in representing genetic characteristics consistent throughout species is poorly understood. Here, we hypothesize that NPH can be differentiated from AD with mRNA biomarkers of unvaried proximity to telomeres. We examined human caudate nucleus tissue samples for the expression of transient receptor potential cation channel subfamily V member 4 (TRPV4) and amyloid precursor protein (APP). Using the genome data viewer, we analyzed the mutability of TRPV4 and other genes in mice, rats, and humans through matching nucleotides of six genes of interest and one house keeping gene with two factors associated with high mutation rate: 1) proximity to telomeres or 2) high adenine and thymine (A + T) content. We found that TRPV4 and microtubule associated protein tau (MAPT) mRNA were elevated in NPH. In AD, mRNA expression of TRPV4 was unaltered unlike APP and other genes. In mice, rats, and humans, the nucleotide size of TRPV4 did not vary, while in other genes, the sizes were inconsistent. Proximity to telomeres in TRPV4 was <50 Mb across species. Our analyses reveal that TRPV4 gene size and mutability are conserved across three species, suggesting that TRPV4 can be a potential link in the pathophysiology of chronic hydrocephalus in aged humans (>65 years) and laboratory rodents at comparable ages.
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Affiliation(s)
- Hunter White
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Ryan Webb
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Ian McKnight
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Kaitlyn Legg
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States
| | - Chan Lee
- Department of Anesthesia, Indiana University Health Arnett Hospital, Lafayette, IN, United States
| | - Peter H.U. Lee
- Department of Cardiothoracic Surgery, Southcoast Health, Fall River, MA, United States,Department of Pathology and Laboratory Medicine, Brown University, Providence, RI, United States
| | - Olivia Smith Spicer
- National Institute of Mental Health, National Institute of Health, Bethesda, MD, United States
| | - Joon W. Shim
- Department of Biomedical Engineering, Marshall University, Huntington, WV, United States,*Correspondence: Joon W. Shim,
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Naskar A, Stezin A, Dharmappa A, Hegde S, Philip M, Kamble N, Saini J, Sandhya K, Tatu U, Yadav R, Pal PK, Alladi PA. Fibrinogen and Complement Factor H Are Promising CSF Protein Biomarkers for Parkinson's Disease with Cognitive Impairment─A Proteomics-ELISA-Based Study. ACS Chem Neurosci 2022; 13:1030-1045. [PMID: 35200010 DOI: 10.1021/acschemneuro.2c00019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Parkinson's disease (PD) with cognitive impairment (PDCI) is essentially diagnosed through clinical and neuropsychological examinations. There is a need to identify biomarkers to foresee cognitive decline in them. We performed label-free unbiased nontargeted proteomics (Q-TOF LC/MS-MS) on the CSF of non-neurological control; PDCI; PD; and normal pressure hydrocephalus (NPH) patients, followed by targeted ELISA for validation. Of the 281 proteins identified, 42 were differentially altered in PD, PDCI, and NPH. With a certain overlap, 28 proteins were altered in PDCI and 25 proteins were altered in NPH. Five significantly upregulated proteins in PDCI were fibrinogen, gelsolin, complement factor-H, and apolipoproteins A-I and A-IV, whereas carnosine dipeptidase-1, carboxypeptidase-E, dickkopf-3, and secretogranin-3 precursor proteins were downregulated. Those uniquely altered in NPH were the insulin-like growth factor-binding protein, ceruloplasmin, α-1 antitrypsin, VGF nerve growth factor, and neural cell adhesion molecule L1-like protein. The ELISA-derived protein concentrations correlated with neuropsychological scores of certain cognitive domains. In PDCI, the Wisconsin card sorting percentile correlated negatively with fibrinogen. Intraperitoneal injection of native fibrinogen caused motor deficits in C57BL/6J mice as assessed by the pole test. Thus, a battery of proteins such as fibrinogen-α-chain, CFAH, and APOA-I/APOA-IV alongside neuropsychological assessment could be reliable biomarkers to distinguish PDCI and NPH.
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Affiliation(s)
- Aditi Naskar
- Department of Clinical Psychopharmacology & Neurotoxicology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Albert Stezin
- Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Arpitha Dharmappa
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Shantala Hegde
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Mariamma Philip
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Jitender Saini
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - K. Sandhya
- Department of Anaesthesiology, Bangalore Medical College and Research Institute, Bengaluru 560002, India
| | - Utpal Tatu
- Department of Biochemistry, Indian Institute of Science, Bengaluru 560012, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
| | - Phalguni Anand Alladi
- Department of Clinical Psychopharmacology & Neurotoxicology, National Institute of Mental Health and Neuro Sciences, Bengaluru 560029, India
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Sakurai A, Tsunemi T, Shimada T, Kawamura K, Nakajima M, Miyajima M, Hattori N. Effect of comorbid Parkinson's disease and Parkinson's disease dementia on the course of idiopathic normal pressure hydrocephalus. J Neurosurg 2022; 137:1-8. [PMID: 35276660 DOI: 10.3171/2022.1.jns212282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to analyze the effect of concomitant Parkinson's disease (PD) and PD dementia (PD/PDD) on the course of idiopathic normal pressure hydrocephalus (iNPH), especially as related to the outcome of lumboperitoneal shunt (LPS) surgery. METHODS The authors retrospectively analyzed patients with iNPH without accompanying disorders (iNPH alone [iNPHa]) and iNPH concomitant with PD/PDD (iNPHc+PD/PDD) who had presented to their department between 2010 and 2019. The diagnosis of iNPHc+PD/PDD was established using the diagnostic criteria of the Movement Disorder Society. The effect of LPS surgery on clinical symptoms and striatum volumes was evaluated. RESULTS Thirty-three patients with iNPHa and 23 patients with iNPHc+PD/PDD were identified. Comorbid PD/PDD significantly worsened clinical outcome as measured by the iNPH grading scale, modified Rankin Scale (mRS), and Hoehn and Yahr (HY) scale. LPS surgery improved the iNPH score including gait disturbance (p < 0.01), cognitive impairment (p = 0.02), and urinary disturbance (p < 0.01) in iNPHa and improved gait disturbance (p = 0.01) and urinary disturbance (p = 0.03) in iNPHc+PD/PDD for 1 year. Comorbid synucleinopathies maintained worse mRS scores and HY stages for 3 years, and LPS surgery extended overall survival (p = 0.003), as well as the period of sustained mRS scores (p = 0.04) and HY stages (p = 0.004) in iNPHc+PD/PDD. Both caudate and putamen volumes were reduced in iNPHa (p < 0.01) compared to those in controls and in patients with iNPHc+PD/PDD compared to those in patients with PD/PDD (p < 0.01), and LPS surgery restored caudate volumes in both groups. CONCLUSIONS These results revealed that comorbid PD/PDD deteriorates the clinical course of iNPH and that LPS surgery is recommended regardless of this comorbidity.
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Affiliation(s)
- Anri Sakurai
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Taiji Tsunemi
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Tomoyo Shimada
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
| | - Kaito Kawamura
- 2Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Madoka Nakajima
- 2Department of Neurosurgery, Juntendo University School of Medicine, Tokyo; and
| | - Masakazu Miyajima
- 3Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Center, Tokyo, Japan
| | - Nobutaka Hattori
- 1Department of Neurology, Juntendo University School of Medicine, Tokyo
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Trungu S, Scollato A, Ricciardi L, Forcato S, Polli FM, Miscusi M, Raco A. Clinical Outcomes of Shunting in Normal Pressure Hydrocephalus: A Multicenter Prospective Observational Study. J Clin Med 2022; 11:jcm11051286. [PMID: 35268376 PMCID: PMC8911143 DOI: 10.3390/jcm11051286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Background: Normal pressure hydrocephalus (NPH) is characterized by the triad of dementia, gait disturbance and urinary incontinence, all potentially reversible following a ventriculoperitoneal shunt (VPS). This study aims to evaluate the clinical outcomes of shunting in normal pressure hydrocephalus following a new standardized protocol. Methods: This study is designed according to the STROBE guidelines. Demographical, clinical, surgical and radiological data were collected from May 2015 to November 2019. Gait, balance and incontinence data based on the NPH European scale were collected before and after one, six and twelve months of treatment with a VPS. Clinical symptoms and changes of the stoke volume, measured on phase-contrast MRI, were used to evaluate improvement after VPS surgery. Results: One hundred and eighty-one consecutive patients met the inclusion criteria. The mean age was 73.1 years (59−86) and mean follow-up was 38.3 months (13−50). The gait (58.5 ± 14.3 to 70.1 ± 13.4, p < 0.001), the balance (66.7 ± 21.5 to 71.7 ± 22.1, p = 0.001), continence domain (69.9 ± 20.5 to 76 ± 20, p = 0.002) scores and neuropsychological scales showed a statistically significant improvement over the follow-up. The overall improvement after 12 months was present in 91.2% of patients. An overall complication rate of 8.8% and a reoperation rate of 9.4% were recorded, respectively. Conclusions: Surgical treatment by VPS for NPH improves symptoms in most patients, when accurately selected. A standardized protocol and a multidisciplinary team dedicated to this disorder is needed to achieve an early and correct diagnosis of NPH. Follow-up with stroke volume measurement is a valuable tool for the early diagnosis of shunt malfunction or the need for valve adjustment.
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Affiliation(s)
- Sokol Trungu
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
- Correspondence:
| | - Antonio Scollato
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
| | - Luca Ricciardi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| | - Stefano Forcato
- Neurosurgery Unit, Card. G. Panico Hospital, 73039 Tricase, Italy; (A.S.); (S.F.)
| | | | - Massimo Miscusi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
| | - Antonino Raco
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy; (L.R.); (M.M.); (A.R.)
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35
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Tatsumura M, Koda M, Hirano A, Yamazaki M. Severe Normal Pressure Hydrocephalus Symptom Caused by Rheumatoid Arthritis-induced Atlantoaxial Subluxation: A Case Report. J Orthop Case Rep 2022; 12:58-61. [PMID: 36660156 PMCID: PMC9826544 DOI: 10.13107/jocr.2022.v12.i05.2816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/05/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction Normal pressure hydrocephalus (NPH) has three characteristics: Gait disorder, urinary incontinence, and amnesia. We report a case of atlantoaxial subluxation-related NPH in a patient whose symptoms were dramatically improved by atlantoaxial fusion surgery. Case Report A 67-year-old woman presented complaining of walking disturbance. 4 weeks after her first presentation and initial diagnosis of atlantoaxial subluxation associated with rheumatoid arthritis, the patient fell and fractured her right patella. After open surgery for the fracture with spinal anesthesia, she had urinary incontinence, cognitive decline, and gait disturbance, and brain computed tomography showed enlarged ventricles. Atlantoaxial fusion surgery was performed 8 weeks after the first presentation. Postsurgically, improvement of her memory and urinary function was noted and she was able to walk with the assistance of a cane and perform activities of daily living independently. Even 6 years after the surgery, the enlargement of the ventricles ameliorated, there was no abnormality in cognition, and she was able to walk alone and run a business. Conclusion The atlas was subluxated, even when the cervical spine was in a neutral position, and the spinal cord was seriously compressed, which impeded cerebrospinal fluid flow. We speculate changes in cerebrospinal pressure due to spinal anesthesia-induced NPH-like symptoms, which were improved by indirect spinal decompression by atlantoaxial reduction with atlantoaxial fusion.
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Affiliation(s)
- Masaki Tatsumura
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital Mito, 3-2-7 Miyamachi, Mito, Ibaraki, Japan,Address of Correspondence: Dr. Masaki Tatsumura, Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital Mito, 3-2-7 Miyamachi, Mito, Ibaraki 310-0015, Japan. E-mail:
| | - Masao Koda
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Atsushi Hirano
- Department of Orthopaedic Surgery and Sports Medicine, Tsukuba University Hospital Mito Clinical Education and Training Center, Mito Kyodo General Hospital Mito, 3-2-7 Miyamachi, Mito, Ibaraki, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, 1-1 Tennodai, Tsukuba, Ibaraki, Japan
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Baskar D, R Taallapalli AV, Kishore P, Arshad F, Kulanthaivelu K, Nashi S, Rajendran SP, Kulkarni GB, Alladi S. A Rare Case of Neurosyphilis Presenting As Normal Pressure Hydrocephalus Syndrome. Neurol India 2022; 70:377-379. [PMID: 35263920 DOI: 10.4103/0028-3886.338674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Neurosyphilis, a chronic infection of the nervous system by Treponema pallidum can present in all stages of syphilis. Recently, it is found that neurosyphilis presents with novel manifestations. Here, we report a young patient who had neurosyphilis presenting as Normal Pressure Hydrocephalus (NPH) with bilateral optic atrophy. The patient showed improvement with treatment for neurosyphilis. Hence, it is evident that in young patients presenting with NPH and associated features, secondary etiologies should be investigated.
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Affiliation(s)
- Dipti Baskar
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - A V R Taallapalli
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Pratik Kishore
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Karthik Kulanthaivelu
- Department of Neuro Imaging and Intervention Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Saraswati Nashi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Srijithesh P Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Girish B Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bengaluru, Karnataka, India
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Soon SXY, Kumar AA, Tan AJL, Lo YT, Lock C, Kumar S, Kwok J, Keong NC. The Impact of Multimorbidity Burden, Frailty Risk Scoring, and 3-Directional Morphological Indices vs. Testing for CSF Responsiveness in Normal Pressure Hydrocephalus. Front Neurosci 2021; 15:751145. [PMID: 34867163 PMCID: PMC8636813 DOI: 10.3389/fnins.2021.751145] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/21/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: Multimorbidity burden across disease cohorts and variations in clinico-radiographic presentations within normal pressure hydrocephalus (NPH) confound its diagnosis, and the assessment of its amenability to interventions. We hypothesized that novel imaging techniques such as 3-directional linear morphological indices could help in distinguishing between hydrocephalus vs. non-hydrocephalus and correlate with responsiveness to external lumbar drainage (CSF responsiveness) within NPH subtypes. Methodology: Twenty-one participants with NPH were recruited and age-matched to 21 patients with Alzheimer’s Disease (AD) and 21 healthy controls (HC) selected from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Patients with NPH underwent testing via the NPH programme with external lumbar drainage (ELD); pre- and post-ELD MRI scans were obtained. The modified Frailty Index (mFI-11) was used to stratify the NPH cohort, including Classic and Complex subtypes, by their comorbidity and frailty risks. The quantitative imaging network tool 3D Slicer was used to derive traditional 2-dimensional (2d) linear measures; Evans Index (EI), Bicaudate Index (BCI) and Callosal Angle (CA), along with novel 3-directional (3d) linear measures; z-Evans Index and Brain per Ventricle Ratio (BVR). 3-Dimensional (3D) ventricular volumetry was performed as an independent correlate of ventriculomegaly to CSF responsiveness. Results: Mean age for study participants was 71.14 ± 6.3 years (18, 85.7% males). The majority (15/21, 71.4%) of participants with NPH comprised the Complex subtype (overlay from vascular risk burden and AD); 12/21 (57.1%) were Non-Responders to ELD. Frailty alone was insufficient in distinguishing between NPH subtypes. By contrast, 3d linear measures distinguished NPH from both AD and HC cohorts, but also correlated to CSF responsiveness. The z-Evans Index was the most sensitive volumetric measure of CSF responsiveness (p = 0.012). Changes in 3d morphological indices across timepoints distinguished between Responders vs. Non-Responders to lumbar testing. There was a significant reduction of indices, only in Non-Responders and across multiple measures (z-Evans Index; p = 0.001, BVR at PC; p = 0.024). This was due to a significant decrease in ventricular measurement (p = 0.005) that correlated to independent 3D volumetry (p = 0.008). Conclusion. In the context of multimorbidity burden, frailty risks and overlay from neurodegenerative disease, 3d morphological indices demonstrated utility in distinguishing hydrocephalus vs. non-hydrocephalus and degree of CSF responsiveness. Further work may support the characterization of patients with Complex NPH who would best benefit from the risks of interventions.
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Affiliation(s)
- Shereen X Y Soon
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - A Aravin Kumar
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Audrey J L Tan
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Christine Lock
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Sumeet Kumar
- Department of Neuroradiology, National Neuroscience Institute, Singapore, Singapore
| | - Janell Kwok
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore
| | - Nicole C Keong
- Department of Neurosurgery, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Yavuz Ilik S, Otani T, Yamada S, Watanabe Y, Wada S. A subject-specific assessment of measurement errors and their correction in cerebrospinal fluid velocity maps using 4D flow MRI. Magn Reson Med 2021; 87:2412-2423. [PMID: 34866235 DOI: 10.1002/mrm.29111] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/17/2021] [Accepted: 11/17/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Phase-contrast MRI (PC-MRI) of cerebrospinal fluid (CSF) velocity is used to evaluate the characteristics of intracranial diseases, such as normal-pressure hydrocephalus (NPH). Nevertheless, PC-MRI has several potential error sources, with eddy-current-based phase offset error being non-negligible in CSF measurement. In this study, we assess the measurement error of CSF velocity maps obtained using 4D flow MRI and evaluate correction methods. METHODS CSF velocity maps of 10 patients with NPH were acquired using 4D flow MRI (velocity-encoding = 5 cm/s). Distributed phase offset error was estimated for a whole 3D background field by polynomial fitting using robust regression analysis. This estimated phase offset error was then used to correct the CSF velocity maps. The estimated error profiles were compared with those obtained using an existing 2D correction approach involving local background information near the region of interest. RESULTS The residual standard error of the polynomial fitting against the phase offset error extracted from the measured velocities was within 0.2 cm/s. The spatial dependencies of the phase offset errors showed similar tendencies in all cases, but sufficient differences in these values were found to indicate requirement of velocity correction. Differences of the estimated errors among other correction approaches were in the order of 10-2 cm/s, and the estimated errors were in good agreement with those obtained using existing approaches. CONCLUSION Our method is capable of estimating the measurement error of CSF velocity maps obtained from 4D flow MRI and provides quantitatively reasonable characteristics for the main CSF profile in the cerebral aqueduct in patients with NPH.
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Affiliation(s)
- Selin Yavuz Ilik
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Tomohiro Otani
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Yoshiyuki Watanabe
- Department of Radiology, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Shigeo Wada
- Department of Mechanical Science and Bioengineering, Graduate School of Engineering Science, Osaka University, Toyonaka, Osaka, Japan
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Nakajima M, Yamada S, Miyajima M, Kawamura K, Akiba C, Kazui H, Mori E, Ishikawa M. Tap Test Can Predict Cognitive Improvement in Patients With iNPH-Results From the Multicenter Prospective Studies SINPHONI-1 and -2. Front Neurol 2021; 12:769216. [PMID: 34795635 PMCID: PMC8593336 DOI: 10.3389/fneur.2021.769216] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: We analyzed the predictive value of the tap test (TT) on the outcome of cerebrospinal fluid (CSF) shunting in patients with idiopathic normal pressure hydrocephalus (iNPH) and cognitive impairment up to 12 months postoperatively. Methods: We analyzed the data of two prospective multicenter studies on ventriculoperitoneal shunt (VPS) and lumboperitoneal shunt (LPS) use in iNPH patients. We selected patients with Mini-Mental State Examination (MMSE) scores ≤ 26 points as study subjects. We used a multivariate logistic regression model to obtain the optimal threshold of MMSE scores after TT to predict the score improvement at 12 months following shunting and that helped to control for confounding factors such as age and MMSE scores before TT. We used logistic regression models to identify variables with age-adjusted odds ratio (A-OR) and multivariate-adjusted OR (M-OR). Results: For an improvement of ≥3 points in the MMSE score cutoff 7 days following TT in VPS and LPS cohort studies, the MMSE scores improved by 6 points after 12 months. The VPS cohort had sensitivity, specificity, and area under the curve (AUC) of 69.2, 73.7, and 0.771%, respectively; however, for the LPS cohort, they were 86.2, 90.9, and 0.906%, respectively. For MMSE scores that improved by ≥3 points in patients after the TT, the possibility of an improvement by 6 points at 12 months following CSF shunt had A-OR 7.77 and M-OR 6.3 times for the VPS, and A-OR 62.3 and M-OR 59.6 times for the LPS cohort. Conclusion: CSF shunting contributes to improved cognitive function in iNPH patients. Furthermore, MMSE score evaluation at the TT can sensitively predict improvement in postoperative MMSE scores following LPS intervention. Clinical Trial Registration: SINPHONI-1 (ClinicalTrials.gov, no. NCT00221091), first posted: September 22, 2005. SINPHONI-2 [University Hospital Medical Information Network (UMIN) Clinical Trials no. UMIN000002730], the posted: February 1, 2010.
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Affiliation(s)
- Madoka Nakajima
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Otsu, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Kaito Kawamura
- Department of Neurosurgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Koto Geriatric Medical Center, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroaki Kazui
- Department of Neuropsychiatry, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Etsuro Mori
- Department of Behavioral Neurology and Neuropsychiatry, Osaka University United Graduate School of Child Development, Suita, Japan
| | - Masatsune Ishikawa
- Normal Pressure Hydrocephalus Center, Rakuwakai Otowa Hospital, Kyoto, Japan
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Sotoudeh H, Sadaatpour Z, Rezaei A, Shafaat O, Sotoudeh E, Tabatabaie M, Singhal A, Tanwar M. The Role of Machine Learning and Radiomics for Treatment Response Prediction in Idiopathic Normal Pressure Hydrocephalus. Cureus 2021; 13:e18497. [PMID: 34754658 PMCID: PMC8569645 DOI: 10.7759/cureus.18497] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Ventricular shunting remains the standard of care for patients with idiopathic normal pressure hydrocephalus (iNPH); however, not all patients benefit from the shunting. Prediction of response in advance can result in improved patient selection for ventricular shunting. This study aims to develop a machine learning predictive model for treatment response after shunt placement using the clinical and radiomics features. Methods In this retrospective pilot study, the medical records of iNPH patients who underwent ventricular shunting were evaluated. In each patient, the "idiopathic normal pressure hydrocephalus grading scale" (iNPHGS) and a "Modified Rankin Scale" were calculated before and after surgery. The subsequent treatment response was calculated as the difference between the iNPHGS scores before and after surgery. iNPHGS score reduction of two or more than two were considered as treatment response. The presurgical MRI scans were evaluated by radiologists, the ventricular systems were segmented on the T2-weighted images, and the radiomics features were extracted from the segmented ventricular system. Using Orange data mining open-source platform, different machine learning models were then developed based on the presurgical clinical features and the selected radiomics features to predict treatment response after shunt placement. Results After the implementation of the inclusion criteria, 78 patients were included in this study. One hundred twenty radiomics features were extracted, and the 12 best predictive radiomics features were selected. Using only clinical data (iNPHGS and Modified Rankin Scale), the random forest model achieved the best performance in treatment prediction with an area under the curve (AUC) of 0.71. Adding the Radiomics analysis to the clinical data improved the prediction performance, with the support vector machine (SVM) achieving the highest rank in treatment prediction with an AUC of 0.8. Adding age and sex to the analysis did not improve the prediction. Conclusion Using machine learning models for treatment response prediction in patients with iNPH is feasible with acceptable accuracy. Adding the Radiomics analysis to the clinical features can further improve the predictive performance. SVM is likely the best model for this task.
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Affiliation(s)
- Houman Sotoudeh
- Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Zahra Sadaatpour
- Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Ali Rezaei
- Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Omid Shafaat
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Mohsen Tabatabaie
- Health Information Management, Arak University of Medical Sciences, Arak, IRN
| | - Aparna Singhal
- Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
| | - Manoj Tanwar
- Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, USA
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Mathew R, Archana NU, Sheetal S. Idiopathic Normal Pressure Hydrocephalus Presenting as Psychosis. Neurol India 2021; 69:1356-1358. [PMID: 34747812 DOI: 10.4103/0028-3886.329621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Normal pressure hydrocephalus (NPH) is a syndrome characterized by gait disturbance, dementia, urinary incontinence, and dilation of ventricular system with normal opening cerebrospinal fluid pressure. Idiopathic NPH (i NPH) presenting as psychosis is uncommon. Objectives The objective of this study is to describe idiopathic NPH presenting as Psychosis. Subjects and Methods Patients availing dementia care service from three tertiary care hospitals, across Kerala, with a diagnosis of psychosis were evaluated. Results Three patients with NPH, diagnosed as per the consensus criteria, presenting as psychosis are described. Patient 1: Fifty-five-year-old lady with psychosis was found to have iNPH. She gave history of psychosis relieved with successful shunting of the hydrocephalus. She developed recurrence of psychosis each time the hydrocephalus recurred due to shunt malfunction and was relieved with correction of hydrocephalus with shunting. Patient 2 was a 67-year-old gentleman with long history of pyschosis with paranoid ideas. Five years after onset of illness, he developed gait apraxia, and a CT scan done showed normal pressure hydrocephalus. Patient 3 had bipolar illness since age of 60 years of age. He also developed gait apraxia 5 years into the illness and was diagnosed as having iNPH following imaging. Conclusions All the patients had psychosis much before other features of iNPH developed. One of the patient's psychosis was temporally associated with onset and offset of hydrocephalus, thereby strongly supporting the causative nature of iNPH. iNPH though rare can be one of the causes for late onset secondary psychosis.
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Affiliation(s)
- Robert Mathew
- Prof and Head of Neurology, Sree Mookambika Institute of Medical Sciences, Padanilam, Kulasekharam, Tamil Nadu, India
| | - N U Archana
- Associate Professor, Psychiatrist, Anugraham Neurocare, Murinjapalam, Trivandrum, Kerala, India
| | - S Sheetal
- Department of Neurology, Pushpagiri Institute of Medical Sciences, Thiruvalla, Kerala, India
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Katiyar V, Sharma R, Tandon V, Garg K, Narwal P, Chandra PS, Suri A, Kale SS. Comparison of Programmable and Non-Programmable Shunts for Normal Pressure Hydrocephalus: A Meta-Analysis and Trial Sequential Analysis. Neurol India 2021; 69:S413-S419. [PMID: 35102997 DOI: 10.4103/0028-3886.332277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The use of programmable ventriculoperitoneal shunt (P-VPS) in idiopathic normal pressure hydrocephalus (iNPH) has increased over the last two decades, however, there is no definitive evidence to favor them over non-programmable VPS (NP-VPS). Thus, there is a growing need for studies comparing these two procedures for their efficacy and safety profile in iNPH. OBJECTIVE In this study, we attempt to quantitatively summarize the findings of all the prospective and retrospective studies that have directly compared the P-VPS and NP-VPS in terms of efficacy, complications, or overall healthcare expenditure. METHODS A systematic search was performed of PubMed, the Cochrane Library databases, and Google Scholar for studies till June 2021 comparing the outcomes of P-VPS with NP-VPS. Four studies were finally included in the quantitative analysis. A trial sequential analysis was done to evaluate the need for further studies. RESULTS The total rates of subdural collection (odds ratio (OR) 1.03; 95% Confidence interval (CI): 0.73-1.46; P = 0.85; I2 = 12%) as well as surgically evacuated subdural collection (OR 0.46; 95% CI: 0.14-1.55; P = 0.21; I2 = 75%) were not significantly different for P-VPS compared to NP-VPS with pooled data. Similarly, the rate of postoperative infection was found to be similar between the two types of VPS (OR 0.98; 95% CI: 0.39-2.5; P = 0.97; I2 = 0%). The trial sequential analysis (TSA) for the need of surgical evacuation of subdural collection and shunt revision revealed that the meta-analysis of the currently accrued information is not conclusive. CONCLUSIONS Though, associated with higher initial costs, P-VPS does not seem to result in increased healthcare costs in the long run while enabling the surgeon to titrate the opening pressure and avoiding additional surgical procedures like shunt revision or evacuation of subdural collection at least theoretically. However, further trials with a greater sample size are needed to confirm these findings as the current accrued information size is insufficient to reach an unequivocal verdict.
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Affiliation(s)
- Varidh Katiyar
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Priya Narwal
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Sinha M, Bajaj J, Kumar A, Hedaoo K, Sharma S, Konchada K, Ratre S, Parihar VS, Swamy NM, Yadav YR. Lumboperitoneal Shunts - Patient Selection, Technique, and Complication Avoidance: An Experience of 426 Cases. Neurol India 2021; 69:S481-S487. [PMID: 35103006 DOI: 10.4103/0028-3886.332265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Lumboperitoneal shunt is a known procedure for communicating hydrocephalus. Being an extracranial procedure, it can also be utilized in normal-sized ventricles. Objective To report our experience of lumboperitoneal shunt done with a minimal follow-up of 12 months with an emphasis on patient selection, technique, and complication avoidance. Methods This was a retrospective analysis of patients who underwent LP shunt during October 2014-October 2019 at the authors' institute. Inclusion criteria were patients with communicating hydrocephalus due to tubercular meningitis, normal pressure hydrocephalus, idiopathic intracranial hypertension, and postoperative refractory cerebrospinal fluid leaks. Data were collected for demographics, Glasgow coma scale and Glasgow outcome scale, vision, gait, memory, urinary incontinence, failed attempts, and complications. Results A total of 426 patients underwent the LP shunt procedure. The commonest indication was tubercular meningitis followed by idiopathic intracranial hypertension and normal pressure hydrocephalus. Age ranged from 16 to 72 years. There were 255 male and 171 female patients. The mean follow-up was 41 ± 8 months. Overall, 301 patients (70.6%) had neurological improvement. Shunt-related complications occurred in 112 (26.29%) patients, of which shunt block was the commonest. Other complications were infection in 17 (3.9%) patients and extrusion in four (0.9%) patients. Transient postural headache was seen in 46 (10.7%) patients, which gradually improved. Conclusion Lumboperitoneal shunt was found to be a safe and effective treatment in appropriately selected communicating hydrocephalus patients. A meticulous technique reduces the complication rate.
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Affiliation(s)
- Mallika Sinha
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Jitin Bajaj
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ambuj Kumar
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Sandeep Sharma
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Kamesh Konchada
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Shailendra Ratre
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vijay S Parihar
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Narayan M Swamy
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yad R Yadav
- Department Neurosurgery, Superspeciality Hospital, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Bin Saqyan TM, Basunbul LI, Badahdah AA, Saleh YA, Filimban SS, Alwabari AA, Almutairi AA, Alanazi SR, Alghamdi AS, Aldadi BO, Alghamdi BA, Alzahrani SA, Alzahrani AR, Alghamdi OH, Alshammari M. Abdominal Pseudocyst: A Rare Complication of Ventriculoperitoneal Shunts. Cureus 2021; 13:e18956. [PMID: 34815902 PMCID: PMC8606019 DOI: 10.7759/cureus.18956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
We present the case of a 69-year-old man patient who was brought with a history of gait disturbances, memory impairment, and urinary incontinence with gradual worsening over the past six months. The patient underwent magnetic resonance imaging of the brain which demonstrated enlarged ventricles, widening of the Sylvian fissure, and narrow sulci at the vertex. Subsequently, the patient underwent a lumbar puncture which revealed a normal opening pressure with normal cerebrospinal fluid analysis. The diagnosis of normal pressure hydrocephalus was established. The patient underwent a ventriculoperitoneal shunt for the management of his symptoms. Three years after the placement of the shunt, the patient was brought to the emergency department with an expanding right-sided subcutaneous abdominal mass. A computed tomography scan of the abdomen showed the subcutaneous mass superficial to the right rectus muscle and was containing the coiled distal end of the shunt. Such findings were consistent with a subcutaneous cerebrospinal fluid pseudocyst. The mass was aspirated and the fluid analysis was in keeping with the cerebrospinal fluid characteristics. The fluid culture revealed no bacterial growth. The ventriculoperitoneal shunt was replaced with a minimally invasive technique.
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Affiliation(s)
- Turki M Bin Saqyan
- College of Medicine, Prince Sattam Bin Abdulaziz University, Al-Kharj, SAU
| | | | | | - Yasir A Saleh
- College of Medicine, Umm Al Qura University, Mecca, SAU
| | | | | | | | | | | | | | | | | | | | | | - Malak Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Guo X, Popal AM, Zhu Z, Cai C, Lin J, Jiang H, Zheng Z, Zhang J, Shao A, Zhu J. Ventriculosternal Shunt for the Treatment of Idiopathic Normal Pressure Hydrocephalus: A Case Report. Front Surg 2021; 8:607417. [PMID: 34497825 PMCID: PMC8419424 DOI: 10.3389/fsurg.2021.607417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 07/27/2021] [Indexed: 01/15/2023] Open
Abstract
Background: Conventional corticospinal fluid (CSF) diversion surgery for idiopathic normal pressure hydrocephalus (iNPH) includes ventriculoperitoneal shunt and ventriculoatrial shunt. Ventriculosternal (VS) shunt may be considered if both the abdominal cavity and atrium are not feasible. Methods: A 76-year-old woman was admitted to our hospital with gait disturbance and urinary incontinence for 2 years, and the condition aggravated in the last 1 month. Based on clinical assessment and imaging findings, the patient was diagnosed with iNPH, with surgical indications. She was on peritoneal dialysis for chronic renal failure, and a cardiac Doppler echocardiogram showed enlargement of the left atrium and decreased diastolic function of the left ventricle. Due to these conditions, we chose the sternum as the vessel for CSF absorption and performed VS shunt. Results: No swelling, exudation, and effusion were found in the suprasternal fossa. Gait disturbance and urinary incontinence improved significantly immediately and 1 week after surgery, respectively. No shunt-related complication was reported at 16 months follow-up. Conclusion: This case demonstrated VS shunting as a feasible and alternative for the management of hydrocephalus.
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Affiliation(s)
- Xinxia Guo
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Abdul Malik Popal
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhoule Zhu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chengwei Cai
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jingquan Lin
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hongjie Jiang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhe Zheng
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianmin Zhang
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Anwen Shao
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Junming Zhu
- Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Marano M, Pompucci A, Motolese F, Rossi M, Coletta E, Di Lazzaro V, Fasano A, Petrella G. Normal Pressure Hydrocephalus in Down Syndrome: The Report of Two Cases. J Alzheimers Dis 2021; 77:979-984. [PMID: 32804139 DOI: 10.3233/jad-200409] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Down syndrome (DS) is the most common cause of intellectual disability in infants and has a well-known relationship with the Alzheimer's disease. The association between DS and the other pathologies of senescence, such as normal pressure hydrocephalus (NPH), has been poorly investigated. This series included two DS patients with NPH. In both cases, NPH symptoms were initially misdiagnosed as DS associated senescence. Patients were treated with ventricular-peritoneal shunt, showing a sustained improvement (1 and 4 years of follow-up). To our knowledge, this is the first description of the occurrence of NPH in adult patients with DS and surgical outcomes.
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Affiliation(s)
- Massimo Marano
- Neurology, Neurophysiology and Neurobiology unit, Department of Medicine, University Campus Bio-Medico of Rome, Italy
| | - Angelo Pompucci
- Department of Neurosurgery, S. Maria Goretti Hospital, Latina, Italy
| | - Francesco Motolese
- Neurology, Neurophysiology and Neurobiology unit, Department of Medicine, University Campus Bio-Medico of Rome, Italy
| | - Mariagrazia Rossi
- Neurology, Neurophysiology and Neurobiology unit, Department of Medicine, University Campus Bio-Medico of Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology unit, Department of Medicine, University Campus Bio-Medico of Rome, Italy
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre and the, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
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Alamoudi NB, Alnajim RK, AlFaraj D. The Typical Triad of Idiopathic Normal Pressure Hydrocephalus in a 62-Year-Old Male. Cureus 2021; 13:e18090. [PMID: 34692305 PMCID: PMC8525687 DOI: 10.7759/cureus.18090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/05/2022] Open
Abstract
Normal pressure hydrocephalus (NPH) is a rare pathological condition of the brain in which the ventricles are enlarged due to cerebrospinal fluid accumulation and is associated with normal opening pressure on lumbar puncture with a large-volume cerebrospinal fluid (CSF) tap. This results in three classical symptoms: mental impairment, gait disturbance, and urinary or fecal incontinence. We present a case of idiopathic NPH in which a 64-year-old retired man with diabetes was brought to the emergency department after recurrent previous falls. The patient complained of an unsteady gait and presented with the typical triad of NPH which is mental impairment, gait disturbance, and incontinence. The patient was a known diabetic, and his gait was characterized by shuffling, bradykinesia, and mild drifting toward the right side. A head computed tomography scan revealed brain tissue volume loss, with disproportionate dilation of the lateral and third ventricles. A lumbar puncture with a large-volume CSF tapping produced normal opening pressure (18 mmHg); thus, the diagnosis of NPH was made. The patient underwent shunt surgery, and his balance and memory improved significantly after the procedure. Also, no event of fecal incontinence occurred. NPH resembles several neurodegenerative disorders. Due to this, it can be difficult to diagnose. Emergency physicians, as frontline healthcare providers, may encounter such cases.NPH should be considered in patients presenting with an unsteady gait, memory impairment, and urinary or fecal incontinence by taking a detailed history and conducting a physical examination to prevent future complications.
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Affiliation(s)
- Naela B Alamoudi
- Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Ruba K Alnajim
- Emergency Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Dunya AlFaraj
- Emergency Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Kawamura K, Miyajima M, Nakajima M, Kanai M, Motoi Y, Nojiri S, Akiba C, Ogino I, Xu H, Kamohara C, Yamada S, Karagiozov K, Ikeuchi T, Kondo A, Arai H. Cerebrospinal Fluid Amyloid-β Oligomer Levels in Patients with Idiopathic Normal Pressure Hydrocephalus. J Alzheimers Dis 2021; 83:179-190. [PMID: 34275898 PMCID: PMC8461658 DOI: 10.3233/jad-210226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The amyloid-β oligomers, consisting of 10-20 monomers (AβO10-20), have strong neurotoxicity and are associated with cognitive impairment in Alzheimer's disease (AD). However, their role in patients with idiopathic normal pressure hydrocephalus (iNPH) is poorly understood. OBJECTIVE We hypothesized that cerebrospinal fluid (CSF) AβO10-20 accumulates in patients with iNPH, and its clearance after CSF shunting contributes to neurological improvement. We measured CSF AβO10-20 levels before and after CSF shunting in iNPH patients evaluating their diagnostic and prognostic role. METHODS We evaluated two iNPH cohorts: "evaluation" (cohort-1) with 32 patients and "validation" (cohort-2) with 13 patients. Comparison cohorts included: 27 neurologically healthy controls (HCs), and 16 AD, 15 Parkinson's disease (PD), and 14 progressive supranuclear palsy (PSP) patients. We assessed for all cohorts CSF AβO10-20 levels and their comprehensive clinical data. iNPH cohort-1 pre-shunting data were compared with those of comparison cohorts, using cohort-2 for validation. Next, we compared cohort-1's clinical and CSF data: 1) before and after CSF shunting, and 2) increased versus decreased AβO10-20 levels at baseline, 1 and 3 years after shunting. RESULTS Cohort-1 had higher CSF AβO10-20 levels than the HCs, PD, and PSP cohorts. This result was validated with data from cohort-2. CSF AβO10-20 levels differentiated cohort-1 from the PD and PSP groups, with an area under receiver operating characteristic curve of 0.94. AβO10-20 levels in cohort-1 decreased after CSF shunting. Patients with AβO10-20 decrease showed better cognitive outcome than those without. CONCLUSION AβO10-20 accumulates in patients with iNPH and is eliminated by CSF shunting. AβO10-20 can be an applicable diagnostic and prognostic biomarker.
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Affiliation(s)
- Kaito Kawamura
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Masakazu Miyajima
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Shinsuna Koto-ku, Tokyo, Japan
| | - Madoka Nakajima
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Mitsuyasu Kanai
- Department of Neurology, Mihara Memorial Hospital, Ota-cho, Isesaki-shi, Gunma, Japan
| | - Yumiko Motoi
- Department of Neurology, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Chihiro Akiba
- Department of Neurosurgery, Juntendo Tokyo Koto Geriatric Medical Centre, Shinsuna Koto-ku, Tokyo, Japan
| | - Ikuko Ogino
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Hanbing Xu
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Chihiro Kamohara
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Shinya Yamada
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan.,Department of Neurosurgery, Kugayama Hospital, Kita-Karasuyama, Setagaya-ku, Tokyo, Japan
| | - Kostadin Karagiozov
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Takeshi Ikeuchi
- Department of Molecular Genetics, Brain Research Institute, Niigata University, Asahimachi, Niigata, Japan
| | - Akihide Kondo
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
| | - Hajime Arai
- Department of Neurosurgery, Juntendo University, Hongo Bunkyo-ku, Tokyo, Japan
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Bommarito G, Van De Ville D, Frisoni GB, Garibotto V, Ribaldi F, Stampacchia S, Assal F, Allali G, Griffa A. Alzheimer's Disease Biomarkers in Idiopathic Normal Pressure Hydrocephalus: Linking Functional Connectivity and Clinical Outcome. J Alzheimers Dis 2021; 83:1717-1728. [PMID: 34459399 DOI: 10.3233/jad-210534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Alzheimer's disease (AD) pathology impacts the response to treatment in patients with idiopathic normal pressure hydrocephalus (iNPH), possibly through changes in resting-state functional connectivity (rs-FC). OBJECTIVE To explore the relationship between cerebrospinal fluid biomarkers of AD and the default mode network (DMN)/hippocampal rs-FC in iNPH patients, based on their outcome after cerebrospinal fluid tap test (CSFTT), and in patients with AD. METHODS Twenty-six iNPH patients (mean age: 79.9±5.9 years; 12 females) underwent MRI and clinical assessment before and after CSFTT and were classified as responders (Resp) or not (NResp), based on the improvement at the timed up and go test and walking speed. Eleven AD patients (mean age: 70.91±5.2 years; 5 females), matched to iNPH for cognitive status, were also included. DMN and hippocampal rs-FC was related to amyloid-β42 and phosphorylated tau (pTau) levels. RESULTS Lower amyloid-β42 levels were associated with reduced inter- and intra-network rs-FC in NResp, and the interaction between amyloid-β42 and rs-FC was a predictor of outcome after CSFTT. The rs-FC between DMN and salience networks positively correlated to amyloid-β42 levels in both NResp and AD patients. The increase in the inter-network rs-FC after CSFTT was associated with higher pTau and lower amyloid-β42 levels in NResp, and to lower pTau levels in Resp. CONCLUSION Amyloid-β42 and pTau impact on rs-FC and its changes after CSFTT in iNPH patients. The interaction between AD biomarkers and rs-FC might explain the responder status in iNPH.
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Affiliation(s)
- Giulia Bommarito
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dimitri Van De Ville
- Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland.,Department of Radiology and Medical Informatics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Giovanni B Frisoni
- Memory Clinic, Department of Rehabilitation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Federica Ribaldi
- Memory Clinic, Department of Rehabilitation and Geriatrics, Geneva University and University Hospitals, Geneva, Switzerland
| | - Sara Stampacchia
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospitals and NIMTlab, Geneva University, Geneva, Switzerland
| | - Frédéric Assal
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Neurology, Division of Cognitive & Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
| | - Alessandra Griffa
- Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Institute of Bioengineering, Center of Neuroprosthetics, Ecole Polytechnique Fédérale De Lausanne (EPFL), Lausanne, Switzerland
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50
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Yang D, Yang H, Luiselli G, Ogagan C, Dai H, Chiu L, Carroll RS, Johnson MD. Increased plasmin-mediated proteolysis of L1CAM in a mouse model of idiopathic normal pressure hydrocephalus. Proc Natl Acad Sci U S A 2021; 118:e2010528118. [PMID: 34380733 DOI: 10.1073/pnas.2010528118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is the most common form of adult-onset hydrocephalus, but its etiology is poorly understood. Symptoms develop in previously normal individuals and include gait difficulty, incontinence, and dementia. We recently reported that 15% of iNPH patients harbor heterozygous loss-of-function deletions in CWH43, which encodes a protein that modifies other cell membrane proteins. Mice harboring CWH43 deletions develop hydrocephalus and gait dysfunction. Mutations affecting the L1CAM adhesion protein cause developmental brain abnormalities and hydrocephalus from birth. Here, we show that CWH43 deletion leads to L1CAM hypoglycosylation, decreased L1CAM association with lipid microdomains, increased plasmin-mediated L1CAM cleavage, and decreased L1CAM expression. Thus, decreased L1CAM expression appears to occur in adult-onset iNPH and congenital hydrocephalus. Idiopathic normal pressure hydrocephalus (iNPH) is a common neurological disorder that is characterized by enlarged cerebral ventricles, gait difficulty, incontinence, and dementia. iNPH usually develops after the sixth decade of life in previously asymptomatic individuals. We recently reported that loss-of-function deletions in CWH43 lead to the development of iNPH in a subgroup of patients, but how this occurs is poorly understood. Here, we show that deletions in CWH43 decrease expression of the cell adhesion molecule, L1CAM, in the brains of CWH43 mutant mice and in human HeLa cells harboring a CWH43 deletion. Loss-of-function mutations in L1CAM are a common cause of severe neurodevelopmental defects that include congenital X-linked hydrocephalus. Mechanistically, we find that CWH43 deletion leads to decreased N-glycosylation of L1CAM, decreased association of L1CAM with cell membrane lipid microdomains, increased L1CAM cleavage by plasmin, and increased shedding of cleaved L1CAM in the cerebrospinal fluid. CWH43 deletion also decreased L1CAM nuclear translocation, suggesting decreased L1CAM intracellular signaling. Importantly, the increase in L1CAM cleavage occurred primarily in the ventricular and subventricular zones where brain CWH43 is most highly expressed. Thus, CWH43 deletions may contribute to adult-onset iNPH by selectively downregulating L1CAM in the ventricular and subventricular zone.
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