Normal Pressure Hydrocephalus

Slides:



Advertisements
Similar presentations
Central Nervous System Disorders Unit II Syllabus
Advertisements

Treatment of hydrocephalus at the Wessex Neurological Centre
Cerebrospinal fluid Definition; It is the water clear fluid surrounding the brain and spinal cord. Formation; The cerebrospinal fluid is formed as an ultra.
Dr. VASHDEV KHIMANI ASSISTANT PROFESSOR DEPT. OF NEUROSURGERY LUMHS JAMSHORO.
Intracranial Pressure Monitoring Definition: pressure exerted by intracranial volume of: 1- Brain 2- Blood 3- CSF Normal ICP: mm Hg. Increased.
ANSYS FLUENT for Brain Research: Cranio-spinal system
Class grades 3 Quizzes Clinical Notebooks Due: 2 Exams
Noninvasive Measurement of Intracranial Pressure by MRI (MR-ICP) Overview Noam Alperin, PhD Physiologic Imaging and Modeling Lab Department of Radiology.
Support for Creation of an ICD-9 Code for Normal Pressure Hydrocephalus (NPH) Michael A. Williams, M.D. Adult Hydrocephalus Program Departments of Neurology.
CEREBROSPINAL FLUID AND INTRACRANIAL PRESSURE DR IFRA ASHRAF.
Hydrocephalus From Greek hydrokephalos, from hydr- + kephalE head
Diseases of CNS By Dr. Abdelaty Shawky Dr. Gehan Abdel-Monem.
Assistant Professor Department of Paediatrics ANMC.
Care of Children Experiencing Alterations in Neurologic Function Marydelle Polk, Ph.D., ARNP-CS Florida Gulf Coast University.
HYDROCEPH ALUS NEIL BARRY 11/0537/1159 MEDICAL AND SURGICALCONDITIONS.
Surgical Department of Renhe Hospital of the Three Gorges University
Cerebrospinal fluid.
Blood supply.
Online Module: Hydrocephalus
Hydrocephalus. Definition Hydrocephalus is the result of buildup of CSF in the ventricles of the brain Fig Hydrocephalus and Ventriculoperitoneal Shunts.
1 Chapter 9 Cerebrospinal Fluid Professor A. S. Alhomida Disclaimer The texts, tables, figures and images contained in this course presentation (BCH 376)
Review Normal Pressure Hydrocephalus
IST8A Fall 2008 Introduction to the Brain. Outline of Topics 1.Imaging: postmortem and MRI 2.Brain Macro anatomy – lobes, tissues, cortex, hippocampus,
Barak Bar M.D. UCSF Department of Neurology
Discovering the Origin of Syrinx Fluid. Syringomyelia Fluid collection within the center of the spinal cord that expands the diameter of the spinal cord.
INCREASED INTRACRANIAL PRESSURE Patrick C.J. Ward, M.D. Professor & Head Dept. of Anatomy, Microbiology & Pathology January, 2008.
Exercise Management Aneurysms Chapter 16. Exercise Management Pathophysiology Aneurysms can be caused by congenital or acquired diseases, are usually.
Dr Mohamed El Safwany. MD.
Resident Categorical Course
Meninges ,ventricles & CSF
Ventricular System, Meninges, and CSF Study suggestion: Read the selected pages from Chapter 2 first, then read Chapter 8.
NEUROANATOMY Lecture : 6 The Ventricles and Meninges of the Brain,
Alzheimer’s Disease. Alzheimer's is a the most common form of dementia. Nearly 50-80% of all dementia patients have Alzheimer's. It is a progressive fatal.
conflicts of interest to report.
Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus
Aiding Diagnosis of Normal Pressure Hydrocephalus with Enhanced Gait Feature Separability Shanshan Chen, Adam T. Barth, Maïté Brandt-Pearce, John Lach.
White Matter Structural Integrity in Healthy Aging Adults and Patients With Alzheimer Disease: A Magnetic Resonance Imaging Study Bartzokis, et al. UCLA.
Laboratory for Product and Process Design Computer Assisted Design of Transport Processes in the Human Brain Laboratory for Product and Process Design,
INTRAVENTRICULAR HEMORRHAGE IN THE NEONATE YURIDIA, KENNEDY RT-29 NEONATAL.
Diseases of Nervous System Fatima Obeidat, MD Pathologist/Neuropathologist The University of Jordan Lecture 2.
HYDROCEPHALUS. Definition: Hydrocephalus is defined as abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles and subarachnoid spaces.
Methods, Results and Limitations of Studies of Brain Iron in RLS in the Living Christopher J Earley MB, BCh, PhD, FRCP(I) Professor Department of Neurology.
Sirasa Iambamrung Intern/Mentor GT Advisor: Dr. Edward Ahn Dr. Kiehl.
The under drainage problems of Low-Pressure Hydrocephalus Patients: A clinical study Vaner Köksal /Recep Tayyip Erdoğan University Introduction; font size.
Case presentation in normal pressure hydrocephalus 中國醫藥大學附設醫院神經部 楊玉婉.
Department of Clinical Radiotherapy, Royal Marsden Hospital, Sutton, Surrey SM2 5PT, UK R4 한재준 1.
Hydrocephalus. Hydrocephalus also known as "water on the brain", is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid.
Sponge: Set up Cornell Notes on pg. 19 Topic: 11.2: Ventricles- CSF and TBI Essential Question: None. 2.1 Atoms, Ions, and Molecules 11.2:Ventricles-CSF-
Normal Pressure Hydrocephalus (NPH)
Meninges & CSF and Ventricular system
HYDROCEPHALUS.
Ventriculostomy N451 Clinical Presentation
Hydrocephalus.
Differentiating Normal Pressure Hydrocephalus from Alzheimer Disease and Healthy Controls: Sulcal Depth Alexander M. Le, M.S., Benjamin Ades-Aron, M.S.,
Image Challenge Q: A 70-year-old woman presented to the neurology clinic with a 2-year history of gait disturbance, cognitive impairment, and urinary incontinence.
Increased Intracranial Pressure
Get out work from yesterday
The Ventricular System
HYDROCEPHALUS.
Cerebrospinal fluid.
Diagrammatic representation of syringomyelia and the “presyrinx” hypothesis in the setting of obstruction to CSF flow. Diagrammatic representation of syringomyelia.
9-year-old girl with hydrocephalus and hydromyelia
Dr Rajesh Umap Asso Prof Dept of Radiodiagnosis
Patient 1. Patient 1. A, Sagittal T1-weighted image (600/8/2) shows a Chiari I malformation, with tonsillar herniation to the mid-C2 level and a pointed.
Ventricles Ventricles irregularly shaped spaces deep within the brain
65-year old woman with multiple cerebral metastases and hydrocephalus probably secondary to carcinomatous meningitis.A, Contrast-enhanced CT scan of the.
Detecting and Diagnosing Alzheimer’s Disease
Atrophied Brain T2 Lesion Volume at MRI Is Associated with Disability Progression and Conversion to Secondary Progressive Multiple Sclerosis The rate.
Presentation transcript:

Normal Pressure Hydrocephalus 23/11 2015 Erika Lindstrøm

Outline Characteristics of NPH Overview of Cerebrospinal fluid flow Stages of NPH Ventricle enlargement Diagnostics, W. Bradley Diagnostics, Rikshospitalet New findings Image source: Alz.com

Characteristics of NPH A form of dementia. First symptom is gait disturbance, followed by dementia and urinary incontinence. First described by Hakim and Adams and Adams et al. in 1965. Today, up to 10% of people suffering from dementia may have NPH. Can occur in people of any age, but most common in the elderly. To be diagnosed, enlarged ventricles and at least a portion of the clinical triad (gait disturbance, dementia, urinary continence) . Differs between idiopathic and secondary (may be caused by subarachnoid hemorrhage, head trauma, tumor etc.). Treatable by surgical CSF shunting.

Cerebrospinal fluid (CSF) CSF production 500 ml/day, mainly by the choroid plexus, recently suggested also that production occur in the brain parenchyma. Transportation: Bulk flow of CSF passes from lateral ventricles through the foramen of Monro into the third ventricle, through the aqueduct and fourth ventricle and out into the subarachnoid space via the foramina Lushka and Magendie. Image source: humanphysiology.academy

Stages of NPH Early stage of NPH display enlarged ventricles, and minimal, if any, atrophy. When the brain expands during systole in healthy elderly patients, it expands outward toward the subarachnoid space (SAS) and inward toward the ventricles. In patients with early NPH, the brain is already expanded outwards, so all systolic expansion is directed inward to the enlarged ventricles. This larger drumhead of the enlarged ventricles leads to hyperdynamic CSF flow through the Aqueduct. If these patients are not shunted, they will eventually develop atrophy and the amount of systolic expansion will be reduced. Thus, hyperdynamic CSF flow indicates that atrophy has not yet taken place. While the mean intraventricular pressure may be normal, the pulse pressure is often 6-8 times normal.

Ventricle enlargement Upper images A & B: Healthy person with normal ventricles Lower images C & D: NPH patient with dilated ventricles For NPH patients, the tissue surrounding ventricles may not be may not appear shrunken. Patients suffering from Alzheimer’s disease also have enlarged ventricles, caused by tissue shrinkage. Image source: neuropsychconsulting.wordpress.com

Diagnostics, William Bradley Bradley et al. suggested in Normal-Pressure Hydrocephalus: Evaluation with Cerebrospinal Fluid Flow Measurements at MR Imaging (1996) that the stroke volume of CSF recorded in the aqueduct could be used for diagnostic NPH. They reported that if the stroke volume were greater than 42 µL, the patients were considered to suffer from hyperdynamic CSF flow and should be treated by shunting. Their study involved 18 patients, where 12 patients had a stroke volume larger than the critical 42 µL and were treated successfully. The patients with stroke volume smaller than the critical displayed a success rate of 50%. In a review article CSF flow in the brain in the context of Normal Pressure Hydrocephalus (2015) Bradley adjusted the number and suggested that the critical value should be at least twice the value of normal stroke volume, found from a test group measured with the same MRI system. Patients in early stage may not have developed hyperdynamic CSF flow, and patients that already have developed atrophy will not display volumes twice the normal.

Diagnostics, Rikshospitalet Eide reported a study of 39 NPH patients in his article Intracranial pressure parameters in idiopathic normal pressure hydrocephalus treated with ventriculo-peritoneal shunts (2005) where he analyzed both mean and pulse pressure of the patients in terms of intracranial pressure measurements. Mean ICP: sum of pressure levels divided by the number of samples, fig. b: 7.6mmHg. Mean ICP wave amplitude: balanced positions of occurrences single wave amplitudes, fig b: 1.8mmHg. Mean ICP wave amplitudes were significantly higher in NPH patients improving clinically after shunt treatment, while no difference in mean ICP was documented. Pressure parameters were computed in time windows of 6 seconds.

MRI, NPH vs. healthy subjects MRI method is not associated with any risk while ICP method is a surgical method. Region of interest for aqueduct is narrow, usually 10-20 pixels. Comparison between 4 healthy subjects (20 measurements) and 23 NPH patients display that both pressure gradients, mean velocities and flow rates are in the same regime. Velocities were extracted just below the Foramen Magnum, region of interest typically 400-700 pixels. No correlation between intracranial pulse pressure amplitude and pressure gradients recorded at Foramen Magnum.

New findings One difference detected is bilateral flow, NPH patients display bilateral flow throughout the cycle.

New findings Subject Delta V Subject Delta V 2 0.263 4 0.286 9 0.092 10 0.177 11 0.148 12 0.102 14 0.342 16 0.257 17 0.198 18 0.071 19 0.076 20 0.131 22 0.113 23 0.216 25 0.215 28 29 0.044 41 0.024 46 0.020 47 -0.048 51 0.012 Subject Delta V ErikaPPU1T1 0.0446 ErikaPPU2T2 -0.0362 ErikaECGT1 -0.0314 ErikaPPU1T2 0.0374 -0.0322 KentPPU1T1 0.0319 KentPPU2T2 0.0437 KentECGT1 0.0210 KentPPU1T2 0.0118 0.0780 JacobPPU1T1 0.0646 JacobPPU2T2 0.3077 JacobECGT1 0.0160 JacobPPU1T2 0.1158 JacobPPU1T3 0.1288 VegardPPU1T1 0.1832 VegardPPU2T2 0.1810 VegardECGT1 0.0708 VegardPPU1T2 0.1886 0.1873 Measurements during one cycle display that a positive net flux is dominating. Mean value: 0.1049 ml

Thank you