Mechanisms in hydrocephalus revealed by neuroimaging

More documents

Recommendations

Info

An analogy: Clinico-radiological paradox Don’t treat the scan!
Neurology. 2012 Jul 3. [Epub ahead of print] Three-day CSF drainage barely reduces ventricular size in normal pressure hydrocephalus. Lenfeldt N, Hansson W, Larsson A, Birgander R, Eklund A, Malm J. RESULTS: • Drain volume was 415 mL (median 470 mL, range 160-510 mL). Ventricular size was reduced in all patients, averaging 3.7 mL (SD 2.2 mL, p < 0.001), which corresponded to a 4.2% contraction. The ratio of volume contraction to drain volume was only 0.9%. Seven patients improved in gait and 6 in attention. Ventricular reduction and total drain volume correlated neither with improvement nor with each other. The 7 patients with the largest drain volumes (close to 500 mL), had ventricular changes varying from 1.3 to 7.5 mL. CONCLUSIONS: • Clinical improvement occurs in patients with NPH after ELD despite unaltered ventricles, suggesting that ventricular size is of little relevance for postshunt improvement or determining shunt function. The clinical effect provided by ELD, mimicking shunting, is probably related to the recurring CSF extractions rather than to the cumulative effect of the drainage on ventricular volume.
Page 1: Neuroimaging approaches for elucida
Page 5 and 6: CSF flow Techniques • Cine phase
Page 7 and 8: There is abundant literature on the
Page 9 and 10: Toward mechanisms - Relationship be
Page 11 and 12: Changes Is there a in relationship
Page 13 and 14: Possible confounds - Physiological
Page 15 and 16: 4D phase contrast imaging - but wha
Page 17 and 18: time Real-time CSF flow during phys
Page 19 and 20: How is Compliance Measured Invasive
Page 21 and 22: The Physiologic Basis of MR-ICP IC
Page 23 and 24: How is dP Measured? • The pressur
Page 25 and 26: MR Elastography Freimann et al, Neu
Page 27 and 28: … but no change in compliance wit
Page 29 and 30: CBF Techniques - 133 Xe-CT - 15 O
Page 31 and 32: CBF by PET (NPH) CBF decreased, glo
Page 33 and 34: CBF by PCMRI • Increased with shu
Page 35 and 36: CBF by SPECT CBF marginally changed
Page 37 and 38: Diffusion Techniques • MRI - Dif
Page 39 and 40: Why would diffusion NOT be isotropi
Page 41 and 42: First demonstration of DTI changes
Page 43 and 44: ↓ FA increased, ↑MD in iNPH not
Page 45 and 46: FA/MD in corticospinal tract Correl
Page 47 and 48: Increased FA in caudate … improve
Page 49 and 50: Liliefeld et al, JNSPeds 2009
Page 51 and 52: Functional MRI ???
Page 53:
Acknowledgements Pat McAllister, Ph
show all

Mechanisms in hydrocephalus revealed by neuroimaging

Create successful ePaper yourself

Delete template?

Save as template?