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Radiologie up2date 2017; 17(02): 119-136
DOI: 10.1055/s-0043-105737
Neuroradiologie
Georg Thieme Verlag KG Stuttgart · New York

Normaldruckhydrozephalus

Normal pressure hydrocephalus
Uwe Kehler
,
Elke Hattingen
Subject Editor: Prof. Elke Hattingen, Bonn
Further Information

Publication History

Publication Date:
03 August 2017 (online)

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Zusammenfassung

Für Diagnostik, Differenzialdiagnostik und Differenzialtherapie des Normaldruckhydrozephalus ist die Bildgebung entscheidend. Auch wenn die Therapie eines Normaldruckhydrozephalus nicht erfolgreich sein sollte, werden zahlreiche Fragen an den Radiologen gestellt. Der Artikel gibt eine Übersicht über das Krankheitsbild des Normaldruckhydrozephalus und die speziellen prä- und postchirurgischen Anforderungen an die Bildgebung.

Abstract

Normal pressure hydrocephalus is a very common disease in elderly people. It is a progressive disease. Patients untreated end bedridden, mortality is significantly higher. Normal pressure hydrocephalus is characterized by gait disturbance, incontinence and cognitive impairment. Typically ventriculomegaly and discrepancy of large basal and tight high convexity subarachnoid spaces are shown on MRI or CCT. Imaging helps also in differential indication for surgical treatment: Ventriculo-peritoneal shunting or endoscopic third ventriculostomy. Surgery is most effective with low complication rates. Postoperative imaging is needed if clinical improvement is missing and helps to detect causes of shunt malfunction.

Kernaussagen

  • Der Normaldruckhydrozephalus ist eine häufige Erkrankung des älteren Menschen, die ohne Behandlung in der Pflegebedürftigkeit endet.

  • Die Diagnostik des NPH stützt sich auf 3 Hauptsäulen: Klinik, Bildgebung und liquordynamische Untersuchung.

  • Die Bildgebung ist darüber hinaus entscheidend in der Therapiewahl: Shunt oder endoskopische Ventrikulozisternostomie.

  • Die Behandlung ist für die Patienten und ihre Angehörige segensreich.

  • Bei ausbleibendem Behandlungserfolg oder später erneut auftretender NPH-Symptomatik ist die Bildgebung von entscheidender Bedeutung in der Ursachenabklärung.

Schlüsselwörter

Normaldruckhydrozephalus - DESH - InfinoH - ventrikuloperitonealer Shunt - MRT - Gravitationsventil

Key words

normal pressure hydrocephalus - DESH - InfinoH - ventriculo-peritoneal shunt - MRI - hydrostatic valves
 

  • Literatur

  • 1 Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 1965; 2: 307-327
    CrossrefPubMedGoogle Scholar
  • 2 Dauch WA, Zimmermann R. Normal pressure hydrocephalus. An evaluation 25 years following the initial description. Fortschr Neurol Psychiatr 1990; 58: 178-190
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Andrén K, Wikkelsø C, Tisell M. et al. Natural course of idiopathic normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 2014; 85: 806-810
    CrossrefPubMedGoogle Scholar
  • 4 Hiraoka K, Meguro K, Mori E. Prevalence of idiopathic normal-pressure hydrocephalus in the elderly population of a Japanese rural community. Neurol Med Chir (Tokyo) 2008; 48: 197-199
    CrossrefPubMedGoogle Scholar
  • 5 Jaraj D, Rabiei K, Marlow T. et al. Prevalence of idiopathic normal-pressure hydrocephalus (the prevalence of probable iNPH was 0,2 % in those aged 70–79 years [n = 2] and 5,9 % [n = 24] in those aged 80 years). Neurology 2014; 82: 1449-1454
    CrossrefPubMedGoogle Scholar
  • 6 Fritsch M, Kehler U, Meier U. eds. Normal Pressure Hydrocephalus. Pathophysiology, Diagnosis, Treatment. Stuttgart: Thieme; 2014
    Google Scholar
  • 7 Greitz D. Paradigm shift in hydrocephalus research in legacy of Dandyʼs pioneering work: rationale for third ventriculostomy in communicating hydrocephalus. Childs Nerv Syst 2007; 23: 1229-1231
    CrossrefPubMedGoogle Scholar
  • 8 Silverberg GD, Mayo M, Saul T. et al. Alzheimerʼs disease, normal-pressure hydrocephalus, and senescent changes in CSF circulatory physiology: a hypothesis. Lancet Neurol 2003; 2: 506-511
    CrossrefPubMedGoogle Scholar
  • 9 Holodny AI, Waxman R, George AE. et al. MR differential diagnosis of normal-pressure hydrocephalus and Alzheimer disease: significance of perihippocampal fissures. Am J Neuroradiol 1998; 19: 813-819
    PubMedGoogle Scholar
  • 10 Wikkelsö C, Andersson H, Blomstrand C. et al. Computed tomography of the brain in the diagnosis of and prognosis in normal pressure hydrocephalus. Neuroradiology 1989; 31: 160-165
    CrossrefPubMedGoogle Scholar
  • 11 Evans WA. An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiat 1942; 47: 931-937
    CrossrefPubMedGoogle Scholar
  • 12 Missori P, Rughetti A, Peschillo S. et al. In normal aging ventricular system never attains pathological values of Evansʼ index. Oncotarget 2016; 7: 11860-11863
    CrossrefPubMedGoogle Scholar
  • 13 Toma AK, Holl E, Kitchen ND. et al. Evansʼ index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery 2011; 68: 939-944
    CrossrefPubMedGoogle Scholar
  • 14 Kitagaki H, Mori E, Ishii K. et al. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. Am J Neuroradiol 1998; 19: 1277-1284
    PubMedGoogle Scholar
  • 15 Craven CL, Toma AK, Mostafa T. et al. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci 2016; 34: 294-298
    CrossrefPubMedGoogle Scholar
  • 16 Sjaastad O, Nordvik A. The corpus callosal angle in the diagnosis of cerebral ventricular enlargement. Acta Neurol Scand 1973; 49: 396-406
    CrossrefPubMedGoogle Scholar
  • 17 Ishii K, Kanda T, Harada A. et al. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus. Eur Radiol 2008; 18: 2678-2683
    CrossrefPubMedGoogle Scholar
  • 18 Virhammar J, Laurell K, Cesarini KG. et al. The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus. J Neurosurg 2014; 120: 178-184
    CrossrefPubMedGoogle Scholar
  • 19 Bradley jr. WG, Whittemore AR, Watanabe AS. et al. Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal-pressure hydrocephalus. Am J Neuroradiol 1991; 12: 31-39
    PubMedGoogle Scholar
  • 20 Krauss JK, Regel JP, Vach W. et al. White matter lesions in patients with idiopathic normal pressure hydrocephalus and in an age-matched control group: a comparative study. Neurosurgery 1997; 40: 491-495
    PubMedGoogle Scholar
  • 21 Inatomi Y, Yonehara T, Hashimoto Y. et al. Correlation between ventricular enlargement and white matter changes. J Neurol Sci 2008; 269: 12-17
    CrossrefPubMedGoogle Scholar
  • 22 Tullberg M, Jensen C, Ekholm S. et al. Normal pressure hydrocephalus: vascular white matter changes on MR images must not exclude patients from shunt surgery. Am J Neuroradiol 2001; 22: 1665-1673
    PubMedGoogle Scholar
  • 23 Krauss JK, Droste DW, Vach W. et al. Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions. Neurosurgery 1996; 39: 292-299
    CrossrefPubMedGoogle Scholar
  • 24 Kehler U, Gliemroth J. Extraventricular intracisternal obstructive hydrocephalus – A hypothesis to explain successful 3rd ventriculostomy in communicating hydrocephalus. Pediatric Neurosurg 2003; 38: 98-101
    CrossrefPubMedGoogle Scholar
  • 25 Meese W, Kluge W, Grumme T. et al. CT evaluation of the cerebrospinal fluid spaces of healthy persons. Neuroradiology 1980; 19: 131-136
    CrossrefPubMedGoogle Scholar
  • 26 Jack jr. CR, Mokri B, Laws jr. ER. et al. MR findings in normal-pressure hydrocephalus: significance and comparison with other forms of dementia. J Comput Assist Tomogr 1987; 11: 923-931
    CrossrefPubMedGoogle Scholar
  • 27 Sherman JL, Citrin CM. Magnetic resonance demonstration of normal CSF flow. Am J Neuroradiol 1986; 7: 3-6
    PubMedGoogle Scholar
  • 28 Krauss JK, Regel JP, Vach W. et al. Flow void of cerebrospinal fluid in idiopathic normal pressure hydrocephalus of the elderly: can it predict outcome after shunting?. Neurosurgery 1997; 40: 67-73
    PubMedGoogle Scholar
  • 29 Bateman GA, Levi CR, Schofield P. et al. The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded?. Neuroradiology 2005; 47: 741-748
    CrossrefPubMedGoogle Scholar
  • 30 Kahlon B, Annertz M, Stahlberg F. et al. Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus?. Neurosurgery 2007; 60: 124-129
    CrossrefPubMedGoogle Scholar
  • 31 Dixon GR, Friedman JA, Luetmer PH. et al. Use of cerebrospinal fluid flow rates measured by phase-contrast MR to predict outcome of ventriculoperitoneal shunting for idiopathic normal-pressure hydrocephalus. Mayo Clin Proc 2002; 77: 509-514
    CrossrefPubMedGoogle Scholar
  • 32 Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int 2012; 109: 15-26
    PubMedGoogle Scholar
  • 33 Pomeraniec IJ, Bond AE, Lopes MB. et al. Concurrent Alzheimerʼs pathology in patients with clinical normal pressure hydrocephalus: correlation of high-volume lumbar puncture results, cortical brain biopsies, and outcomes. J Neurosurg 2016; 124: 382-388
    CrossrefPubMedGoogle Scholar
  • 34 Bech-Azeddine R, Hogh P, Juhler M. et al. Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting. J Neurol Neurosurg Psychiatry 2007; 78: 157-161
    CrossrefPubMedGoogle Scholar
  • 35 Silverberg GD, Mayo M, Saul T. et al. Continuous CSF drainage in AD – Results of a double-blind, randomized, placebo-controlled study. Neurology 2008; 71: 202-209
    CrossrefPubMedGoogle Scholar
  • 36 Lemcke J, Meier U, Müller C. et al. Safety and efficacy of gravitational shunt valves in patients with idiopathic normal pressure hydrocephalus: a pragmatic, randomised, open label, multicentre trial (SVASONA). J Neurol Neurosurg Psychiatry 2013; 84: 850-857
    CrossrefPubMedGoogle Scholar
  • 37 Gölz L, Ruppert FH, Meier U. et al. Outcome of modern shunt therapy in patients with idiopathic normal pressure hydrocephalus 6 years postoperatively (74 % Besserung). J Neurosurg 2014; 121: 771-775
    CrossrefPubMedGoogle Scholar
  • 38 Williams MA, Sharkey P, van Doren D. et al. Influence of shunt surgery on healthcare expenditures of elderly fee-for-service Medicare beneficiaries with hydrocephalus. J Neurosurg 2007; 107: 21-28
    CrossrefPubMedGoogle Scholar
  • 39 Kehler U, Langer N, Gliemroth J. et al. Reduction of shunt obstructions by using a peel-away sheath technique? A multicenter prospective randomized trial. Clin Neurol Neurosurg 2012; 114: 381-384
    CrossrefPubMedGoogle Scholar