The literature on hydrocephalus treatment shows support for adjustable valves and devices which prevent the so-called "siphon effect". In our study, 21 probable iNPH patients were indicated to shunt surgery with the Miethke M.blue® adjustable gravitational valve. Outcomes at three months were measured using the following tests: Dutch Gait Scale, International Consortium on Incontinence Questionnaire (ICIQ-UI SF), SF12V2-Health Survey, Kiefer Scale, 3T MRI, and a neuropsychological testing battery. Preoperative parameters were studied for any signs of overdrainage risk. Valves were set according to the manufacturer's recommendations. Significant improvement at three months was seen in the Dutch Gait Scale, ICIQ-UI SF, Kiefer Scale, Mental Health Component of the SF12V2-Health Survey (MCS-12) and three neuropsychological tests: Rey-Osterrieth complex figure test (ROCFT 30 min), auditory verbal learning test (AVLT I-V) and the NKP version of verbal fluency test. Seven patients needed more than one adjustment of the valve. This subgroup significantly improved only in Walking Score and Step Score but the trend was toward significant improvement in other variables. Eight patients had subdural effusions that were completely managed with adjustments until the 3-month control. BMI was significantly lower in patients with ≥2 adjustments compared to those with a maximum of one adjustment. Implantation had low complication rates and no mortality. Initial results are promising however more studies are needed to provide rationale for gravitational valves in iNPH. We recommend increasing the initial valve setting by 2-4 cm H2O above manufacturer's recommendation, especially in lean patients.

• MeSH
• gravitace MeSH
• lidé MeSH
• následné studie MeSH
• normotenzní hydrocefalus * diagnóza   chirurgie   MeSH
• ventrikuloperitoneální zkrat metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

The aim of this study was to investigate whether white matter changes as measured by diffusion tensor imaging (DTI) can help differentiate shunt-responsive idiopathic normal pressure hydrocephalus (iNPH) patients from patients with other causes of gait disturbances and/or cognitive decline with ventriculomegaly whose clinical symptoms do not improve significantly after cerebrospinal fluid derivation (non-iNPH). Between 2017 and 2022, 85 patients with probable iNPH underwent prospective preoperative magnetic resonance imaging (MRI) and comprehensive clinical workup. Patients with clinical symptoms of iNPH, positive result on lumbar infusion test, and gait improvement after 120-h lumbar drainage were diagnosed with iNPH and underwent shunt-placement surgery. Fractional anisotropy (FA) and mean diffusivity (MD) values for individual regions of interest were extracted from preoperative MRI, using the TBSS pipeline of FSL toolkit. These FA and MD values were then compared to results of clinical workup and established diagnosis of iNPH. An identical MRI protocol was performed on 13 age- and sex-matched healthy volunteers. Statistically significant differences in FA values of several white matter structures were found not only between iNPH patients and healthy controls but also between iNPH and non-iNPH patients. ROI that showed best diagnostic ability when differentiating iNPH among probable iNPH cohort was uncinate fasciculus, with AUC of 0.74 (p < 0.001). DTI methods of white matter analysis using standardised methods of ROI extraction can help in differentiation of iNPH patients not only from healthy patients but also from patients with other causes of gait disturbances with cognitive decline and ventriculomegaly.

• MeSH
• difuzní magnetická rezonance metody   MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• normotenzní hydrocefalus * diagnostické zobrazování   chirurgie   MeSH
• prospektivní studie MeSH
• zobrazování difuzních tenzorů metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Primary endpoint of this single-centre, prospective consecutive cohort study was to evaluate DESH score, CA, CSS and Evans index of suspected iNPH patients against the reference standard of lumbar infusion test (LIT) and external lumbar drainage (ELD) in prediction of gait response after VP shunt implantation in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients were assigned to NPH and non-NPH groups based on LIT and ELD results. Age-matched controls were added for group comparison. 32 NPH, 46 non-NPH and 15 control subjects were enrolled in the study. There were significant differences in mean preoperative DESH scores of NPH, non-NPH and control groups (6.3 ± 2.3 ([±SD]) (range 2-10) vs 4.5 ± 2.4 (range 0-10) vs 1.0 ± 1.2 (range 0-4)). Differences in mean CA and Evans index were not significant between NPH and non-NPH groups. CSS showed 62.5% sensitivity, 60.87% specificity, 52.63% PPV and 70% NPV for differentiation of NPH and non-NPH groups. A CA of 68 degrees had 48.49% sensitivity, 76.09% specificity, 59.26% PPV 67.31% NPV and DESH score of 4 had 93.75% sensitivity, 41.30% specificity, 52.63% PPV and 90.48% NPV for differentiation between NPH and non-NPH groups. The groups of probable iNPH patients with gait impairment diagnosed by high DESH score or positive functional testing did not overlap and DESH score did not correlate with gait improvement after ELD. DESH score should not be used as a simple diagnostic or prognostic marker of iNPH and we could not confirm the benefit of measurement of callosal angle and cingulate sulcus sign.

• MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• neurologické poruchy chůze etiologie   chirurgie   MeSH
• neurozobrazování metody   MeSH
• normotenzní hydrocefalus diagnostické zobrazování   patologie   chirurgie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• ventrikuloperitoneální zkrat metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• Publikační typ
• abstrakty MeSH

Úvod: V diagnostice idiopatického normotenzního hydrocefalu (iNPH) chybí spolehlivý nástroj. Perspektivu má magnetická rezonance (MR). Jednou z modalit MR je zobrazení difuzních tenzorů (DTI). Cílem bylo porovnat parametry DTI u pacientů před operací a po ní a u zdravých dobrovolníků. Metodika a materiál: Pacientům byla provedena MR mozku před operací a 1 rok po operaci. Dále byli vyšetřeni zdraví dobrovolníci. Parametry DTI (frakční anizotropie; FA; průměrná difuzivita; MD) byly měřeny v předním a zadním raménku capsula interna a v corpus callosum (ALIC, PLIC, CC). Do studie bylo zahrnuto 27 pacientů s iNPH a 24 zdravých dobrovolníků. Výsledky: U iNPH pacientů byla MD vyšší ve všech měřených oblastech než u zdravých dobrovolníků (p < 0,05). FA byla u pacientů vyšší jen v PLIC (p < 0,001). Jeden rok po operaci byl patrný pokles hodnoty FA v PLIC (p < 0,001). V jiných oblastech k poklesu FA či MD nedošlo. Hodnota FA v PLIC ani po operaci nedosáhla hodnot zdravých dobrovolníků (0,63 po operaci vs. 0,58 u kontrol). Závěr: Hodnota FA v PLIC je u pacientů s iNPH signifikantně vyšší než u zdravých. Po operaci klesá. Hodnoty MD byly vyšší v ALIC, PLIC i CC. Po operaci pokles nenastává, což odráží stupeň degenerace bílé hmoty u pacientů s iNPH.

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a disease with many unanswered questions. General effort is to find a simple and non-invasive diagnostic tool. Magnetic resonance imaging (MRI) is a topic for intensive research. Diffusion tensor imaging (DTI) is one of the MRI modalities. This examination can detect microstructural changes of the cerebral white matter. The aim of this study was to compare the DTI parameters in iNPH patients before and after a surgery and with healthy volunteers. Material and methods: MRI was performed in patients before surgery and 1 year after. We also examined age-matched healthy volunteers. The DTI parameters (fractional anisotropy; FA and mean diffusivity; MD) were measured in the anterior and posterior limb of the internal capsule and in the corpus callosum (ALIC, PLIC, CC). Acquired data were statistically analysed. We enrolled 27 patients with iNPH and 24 healthy volunteers. Results: MD was higher in all measured regions comparing iNPH and healthy volunteers (p < 0.05). FA was higher in the PLIC only (p < 0.001). Comparing our data before surgery and one year after, we found significant decrease of FA in the PLIC (p < 0.001) but FA in this region did not reached the FA level in the healthy volunteers group (0.63 after the surgery vs. 0.58 in volunteers). No other significant change in FA or MD was noticed. Conclusion: This study proved, that the FA in the PLIC is significantly higher in iNPH patients than in healthy volunteers. After the surgery, FA decreased. MD values were significantly higher in iNPH patients in the ALIC, PLIC and CC with no decrease after the surgery. It reflects degeneration of the white matter in iNPH patients.

• MeSH
• capsula interna diagnostické zobrazování   MeSH
• corpus callosum diagnostické zobrazování   MeSH
• difuzní magnetická rezonance * MeSH
• intrakraniální tlak fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• normotenzní hydrocefalus * diagnostické zobrazování   diagnóza   chirurgie   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ventrikuloperitoneální zkrat MeSH
• výsledek terapie MeSH
• zobrazování difuzních tenzorů * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a progressive disease characterized by disproportionate ventricular enlargement at brain imaging with gait disturbance and an increased risk of falling. Gait assessment is a key feature in the diagnosis of iNPH and characterization of post-surgical outcomes. RESEARCH QUESTION: How do gait parameters change 24 h after CSF tap test (CSFTT) and after ventriculoperitoneal shunt surgery? METHODS: The PRISMA guidelines were used to perform the systematic review. We conducted a search of the following electronic databases: PubMed, Medline, Web of Science and EBSCO. We included studies focusing on gait changes occurring 24 h after a CSFTT or after ventriculoperitoneal shunt surgery in patients with iNPH. All articles were assessed for methodological quality using an adapted version of The Standard Quality Assessment Criteria for Evaluating Primary Research Papers checklist. RESULTS: Twenty-seven studies were included in the systematic review. Studies were highly heterogeneous due to lack of standardization of CSFTT or shunt surgery methodology, with varying amounts of CSF removed during the tap test (20-50 ml) and varying time of outcome assessment after shunt surgery. Dynamic equilibrium measurements are generally used to assess preoperative levels of cardinal symptoms and postoperative outcomes in iNPH. The most sensitive spatio-temporal parameter assessed 24 h after CSFTT was self-selected walking speed followed by stride length, which increased significantly. Cadence is hence not suitable to consider in the evaluation of effect of CSFTT and shunt surgery. Changes in balance-related gait parameters after CSFTT and shunt surgery are still a controversial area of research. CONCLUSION: Gait assessment is a key feature in the diagnosis of iNPH and characterization of post-surgical outcomes. Dynamic equilibrium measurements are generally used to assess preoperative levels of cardinal symptoms and postoperative outcomes in iNPH, but quantitative and standardized gait analysis procedures are missing. Changes in balance-related gait parameters after CSFTT might be useful in deciding whether to perform shunt surgery in iNPH patients who hope for improvement in gait ability. The dual-task paradigm after CSFTT could improve the clinical evaluation of higher level frontal gait disturbances in patients with suspected iNPH before shunting.

• MeSH
• chůze (způsob) * fyziologie   MeSH
• lidé MeSH
• normotenzní hydrocefalus * chirurgie   patofyziologie   mozkomíšní mok   diagnóza   MeSH
• shunty pro odvod mozkomíšního moku MeSH
• spinální punkce metody   MeSH
• ventrikuloperitoneální zkrat MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH
• systematický přehled MeSH

BACKGROUND AND PURPOSE: White matter changes assessed by DTI typically reflect tract functionality. This study aimed to investigate DTI parameter alterations in important regions pre- and postshunt implantation in patients with idiopathic normal pressure hydrocephalus (iNPH), alongside assessing the relationship between DTI parameters and clinical improvement. MATERIALS AND METHODS: Patients with probable iNPH underwent prospective preoperative MRI and comprehensive clinical work-up between 2017-2022. Patients with clinical symptoms of iNPH, positive result on a lumbar infusion test, and/or gait improvement after 120-hour lumbar drainage were diagnosed with iNPH and underwent shunt-placement surgery. Fractional anisotropy and mean diffusivity values for individual regions of interest were extracted from preoperative and postoperative MRI. These values were correlated with the clinical picture of individual patients. RESULTS: A total of 32 patients (73.59 ± 4.59 years) with definite iNPH were analyzed. Preoperative DTI characteristics of internal capsule and corona radiata correlated with the 1-year improvement in the Dutch Gait Scale postoperatively (all P < .036). Cognitive domain improvement after surgery in memory and psychomotor speed correlated with preoperative DTI values of cingulate gyrus (P = .050), uncinate fasciculus (P = .029), superior longitudinal fasciculus (P = .020), or corpus callosum (P < .045). CONCLUSIONS: DTI characteristics of white matter regions reflect clinical improvement after shunt surgery in patients with iNPH. They tend to improve toward physiologic DTI values, thus further accentuating the benefit of shunt surgery in both clinical and radiologic pictures.

• MeSH
• anizotropie MeSH
• bílá hmota diagnostické zobrazování   MeSH
• lidé středního věku MeSH
• lidé MeSH
• normotenzní hydrocefalus * chirurgie   diagnostické zobrazování   MeSH
• prospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• shunty pro odvod mozkomíšního moku * MeSH
• výsledek terapie MeSH
• zobrazování difuzních tenzorů * metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: Numerous radiological measures have been proposed as imaging biomarkers of idiopathic normal pressure hydrocephalus (iNPH), however, the number of studies systematically comparing their diagnostic values remains limited. The study objective was to compare the diagnostic performance of fifteen cross-sectional imaging iNPH biomarkers. MATERIALS AND METHODS: Eighty subjects were prospectively enrolled in the study: 35 subjects with clinically confirmed iNPH and 45 matched healthy controls (HC). Values of linear, angular and index measurements including three newly proposed biomarkers were obtained from 3T brain MRI studies by two independent readers. Diagnostic performance of biomarkers was studied by using receiver operating characteristic (ROC) analysis and t-statistic. RESULTS: All biomarkers studied were able to reliably differentiate iNPH subjects from HC (p < .001) except for cella media-to-temporal horn ratio. Z-Evans index, vertical cella media and vertical frontal horn diameters showed the highest discriminatory power between iNPH and HC groups (area under curve >0.99). Simple linear measurements of vertical (0.99) or horizontal (0.95) frontal horn diameters showed results comparable to calculated ratios, i.e. z-Evans (0.99) and Evans (0.96) indexes, respectively. CONCLUSION: The best diagnostic performance among fifteen radiological iNPH biomarkers was found in linear measurements referring to caudocranial alterations of the ventricular geometry, outweighing those referring to laterolateral ventricular enlargement (as e.g. commonly used Evans index). Simple linear measurements of vertical or horizontal frontal horn diameters showed comparable results to calculated, more time-consuming z-Evans or Evans indexes, respectively.

• MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   normy   MeSH
• normotenzní hydrocefalus diagnostické zobrazování   patofyziologie   MeSH
• prospektivní studie MeSH
• průřezové studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Disproportionately enlarged subarachnoid space hydrocephalus (DESH) findings on MRI were described as a prognostic factor for responsiveness to the treatment of idiopathic normal pressure hydrocephalus (iNPH). Our premise is that DESH could be associated with compression of the cerebral white matter. Microstructural changes can be identified using diffusion tensor imaging (DTI), specifically fractional anisotropy (FA). The aim of this study is to compare FA in iNPH patients with and without DESH and healthy controls. METHODS: We analysed 1.5-T MRI scans of patients fulfilling the criteria of probable or possible iNPH and positive supplementary tests before and after surgery (ventriculo-peritoneal shunt). FA was measured in the anterior and posterior limb of the internal capsule (PLIC) and in the corpus callosum. Patients were divided into the DESH and non-DESH group. These data were also compared to FA values in the control group. RESULTS: Twenty-seven patients and 24 healthy controls were enrolled. DESH was present in 15 patients and lacking in 12. Twenty-three iNPH patients were shunt responders (85.2 %), and 4 were non-responders (14.8 %). All patients in the DESH group were shunt responders. In the non-DESH group, eight patients were responders (66.7 %). A significant difference between the DESH and non-DESH group was found in the FA of the PLIC. The mean value of FA in the PLIC was 0.72 in the DESH group and 0.66 in the non-DESH group. After the surgery FA decreased in both groups. In the DESH iNPH group FA PLIC decreased to 0.65 and in the non-DESH iNPH group to 0.60. In the healthy controls, the mean FA in the PLIC was 0.58. CONCLUSION: DESH on MRI scans is related to a higher FA in the PLIC with a decrease after the surgery. It reflects a more severe compression of the white matter than in non-DESH patients or healthy volunteers. DESH patients had better outcome than non-DESH patients. This study confirmed the importance of DESH as a supportive sign for iNPH.

• MeSH
• anizotropie MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• normotenzní hydrocefalus diagnostické zobrazování   chirurgie   MeSH
• senioři MeSH
• ventrikuloperitoneální zkrat MeSH
• zobrazování difuzních tenzorů metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

We sought to describe the cognitive profile of patients with Idiopathic Normal Pressure Hydrocephalus (iNPH) using a comprehensive neuropsychological battery. Based on age and education correlated norms, we aimed to compare performance in each measured cognitive domain: executive functions (EFs), verbal memory (VM), non-verbal memory (nVM), visuoconstructional abilities (VA) and attention/psychomotor speed (A/PS). Patients diagnosed with iNPH underwent comprehensive neuropsychological evaluation before shunting. Their performance was compared to the age and education correlated norms. Correlation of different cognitive domains in iNPH profile was performed. A total of 53 iNPH patients (73.21 ± 5.48 years) were included in the study. All of the measured cognitive domains were significantly damaged. The most affected domains were EFs and VM (p<0.001 and p<0.001, respectively). A/PS domain was affected milder than EFs and VM (p<0.001). The least affected domains were nVM (p<0.001) and VA (p<0.001). Patients with iNPH are affected in all cognitive domains and the cognitive decline is uneven across these domains. The impairment of memory was shown to depend on the presented material. VM was shown to be much more severely affected than nVM and along with VM, EFs were shown to be the most affected. A/PS speed was shown to be less affected than VM and EFs and the least affected domains were nVM and VA.

• MeSH
• exekutivní funkce MeSH
• kognice MeSH
• kognitivní dysfunkce * MeSH
• lidé MeSH
• neuropsychologické testy MeSH
• normotenzní hydrocefalus * diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH