Shunt-responsive parkinsonism and reversible white matter lesions in patients with idiopathic NPH

被引:56
作者
Akiguchi, Ichiro [1 ,4 ]
Ishii, Mitsuaki [2 ]
Watanabe, Yuko [1 ]
Watanabe, Toshiyuki [1 ]
Kawasaki, Teruaki [1 ]
Yagi, Hideo [1 ]
Shiino, Akihiko [3 ]
Shirakashi, Yoshitomo [1 ,4 ]
Kawamoto, Yasuhiro [4 ]
机构
[1] Koseikai Takeda Hosp, Ctr Neurol & Cerebrovasc Dis, Shimogyo Ku, Kyoto 6008558, Japan
[2] Maizuru Municipal Hosp, Dept Physiotherapy, Kyoto, Japan
[3] Shiga Univ Med Sci, Dept Neurosurg, Shiga, Japan
[4] Kyoto Univ, Postgrad Med Sch, Dept Neurol, Kyoto, Japan
关键词
idiopathic NPH; Binswanger's disease; parkinsonisin;
D O I
10.1007/s00415-008-0928-1
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background Idiopathic normal pressure hydrocephalus (iNPH) is a potentially treatable dementia and gait disorder with abnormal CSF dynamics. Objective To investigate and characterize the changes in motor symptoms and CT and MRI features of iNPH before and after a shunt operation using specific evaluation criteria. Methods We studied 17 definitive iNPH patients, diagnosed according to the clinical guidelines of both the Japanese Society of NPH and the International NPH Consultant Group, with ventricular enlargement (Evan's index > 0.3) and narrowed CSF spaces at the high convexity on CT scan and /or MRI. The pre- and post-operative evaluation criteria for the gait and motor disturbances included the Japanese NPH Grading Scale-Revised (JNPHGSR), the Timed "Up and Go" test and the motor sections of the Unified Parkinson Disease Rating Scale. For cognitive impairments, the JNPHGSR, Mini Mental State Examination, Frontal Assessment Battery and Trail Making Test were used. White matter lesions were rated from the CT and/or MRI using a validated visual rating scale. Results All patients showed specific CT and MRI findings, consisting of diffusely-dilated Sylvian fissure, as well as narrowed CSF space at the high convexity. Fifteen patients (88 %) showed white matter lesions on their CT or MRI images. These signs were ameliorated in all patients after the shunt operation. Evan's index and the mean total scores on the visual scale for white matter lesions also improved significantly. Clinically, the patients had frequent parkinsonism (71 %), but relatively few had a history of either small-vessel diseases (29 %), hypertension (41 %) or diabetes (35 %). All patients showed gait disturbances, and these symptoms, including postural instability and body bradykinesia, improved significantly after the operation. Over half also showed signs of cognitive impairment and urinary incontinence, and all such symptoms and signs improved significantly. Conclusion iNPH often appears as a shunt-responsive type of Parkinsonism and reversible white matter lesions among the geriatric population.
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页码:1392 / 1399
页数:8
相关论文
共 41 条
[1]
SYMPTOMATIC OCCULT HYDROCEPHALUS WITH NORMAL CEREBROSPINAL-FLUID PRESSURE - A TREATABLE SYNDROME [J].
ADAMS, RD ;
FISHER, CM ;
HAKIM, S ;
OJEMANN, RG ;
SWEET, WH .
NEW ENGLAND JOURNAL OF MEDICINE, 1965, 273 (03) :117-&
[2]
Topographical and cytopathological lesion analysis of the white matter in Binswanger's disease brains [J].
Akiguchi, I ;
Tomimoto, H ;
Wakita, H ;
Kawamoto, Y ;
Matsuo, A ;
Ohnishi, K ;
Watanabe, T ;
Budka, H .
ACTA NEUROPATHOLOGICA, 2004, 107 (06) :563-570
[3]
Alterations in glia and axons in the brains of Binswanger's disease patients [J].
Akiguchi, I ;
Tomimoto, H ;
Suenaga, T ;
Wakita, H ;
Budka, H .
STROKE, 1997, 28 (07) :1423-1429
[4]
Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings [J].
Bech, RA ;
Waldemar, G ;
Gjerris, F ;
Klinken, L ;
Juhler, M .
ACTA NEUROCHIRURGICA, 1999, 141 (06) :633-639
[5]
Normal-pressure hydrocephalus: White matter lesions correlate negatively with gait improvement after lumbar puncture [J].
Bugalho, Paulo ;
Alves, Luisa .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2007, 109 (09) :774-778
[6]
PARKINSONIAN SYNDROMES ASSOCIATED WITH HYDROCEPHALUS - CASE-REPORTS, A REVIEW OF THE LITERATURE, AND PATHOPHYSIOLOGICAL HYPOTHESES [J].
CURRAN, T ;
LANG, AE .
MOVEMENT DISORDERS, 1994, 9 (05) :508-520
[7]
Post-surgical changes in brain metabolism detected by magnetic resonance spectroscopy in normal pressure hydrocephalus:: results of a pilot study [J].
del Mar Matarin, Maria ;
Pueyo, Roser ;
Poca, Maria Antonia ;
Falcon, Carles ;
Mataro, Maria ;
Bargallo, Nuria ;
Sahuquillo, Juan ;
Junque, Carme .
JOURNAL OF NEUROLOGY NEUROSURGERY AND PSYCHIATRY, 2007, 78 (07) :760-763
[8]
The FAB - A frontal assessment battery at bedside [J].
Dubois, B ;
Slachevsky, A ;
Litvan, I ;
Pillon, B .
NEUROLOGY, 2000, 55 (11) :1621-1626
[9]
TRAIL MAKING TEST AND VISUAL-SEARCH [J].
EHRENSTEIN, WH ;
HEISTER, G ;
COHEN, R .
ARCHIV FUR PSYCHIATRIE UND NERVENKRANKHEITEN, 1982, 231 (04) :333-338
[10]
Fahn S, 1987, Recent Dev. Park. Dis, P153