The aim of the study is to inform professionals about a serious complication--the liquor malabsorption--developing in relation to the routinely performed roentgen-contrastive examination (PMG). It also demonstrates advantages of the lumbal infusion test (LIT) as a part of the algorithm of the shunt operation in patients with supposed pathology of liquor malabsorption.

• MeSH
• jopamidol škodlivé účinky   MeSH
• kontrastní látky škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• myelografie škodlivé účinky   MeSH
• normotenzní hydrocefalus chemicky indukované   diagnostické zobrazování   MeSH
• páteř diagnostické zobrazování   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• Názvy látek
• jopamidol MeSH
• kontrastní látky MeSH

• MeSH
• anizotropie * MeSH
• hydrocefalus * MeSH
• lidé MeSH
• normotenzní hydrocefalus MeSH
• subarachnoidální prostor MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• komentáře MeSH
• úvodníky MeSH

Normal pressure hydrocephalus (NPH) is an important differential diagnosis of neurodegenerative diseases. The prevalence of dementia is increasing in line with the worldwide increase in life expectancy. NPH can be divided into idiopathic (iNPH) and secondary (sNPH) which is important in terms of clinical symptoms, future progress, and the outcome of possible treatment. The full clinical triad is not prevalent in all of the cases and the pathophysiology of iNPH remains unclear. Diagnosis is based on the evaluation of clinical symptoms (Hakim's triad) combined with an MRI assessment, evaluation of CSF dynamic parameters by different methods such as a tap test, lumbar infusion test (LIT), and external lumbar drainage (ELD). Despite the development of diagnostic techniques and strategies in management, NPH remains to be a challenge for the specialists despite more than 50 years of research. However, results of this research have brought new opportunities in the diagnosis, therapy, and quality of life as well as survival time of NPH patients with improved symptoms. The aim of this article is to present the pathophysiological hypotheses of NPH and an overview of the diagnostic techniques used for the evaluation of NPH patients.

• Klíčová slova
• Diagnostic procedures, Hydrocephalus, Idiopathic NPH, NPH pathophysiology, Normal pressure hydrocephalus,
• MeSH
• lidé MeSH
• normotenzní hydrocefalus diagnóza   epidemiologie   patofyziologie   terapie   MeSH
• prevalence MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

• MeSH
• dospělí MeSH
• hydrocefalus chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• normotenzní hydrocefalus diagnóza   chirurgie   MeSH
• předškolní dítě MeSH
• shunty pro odvod mozkomíšního moku MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH
• kazuistiky MeSH

BACKGROUND: Machine learning (ML) approaches can significantly improve the classical Rout-based evaluation of the lumbar infusion test (LIT) and the clinical management of the normal pressure hydrocephalus. OBJECTIVE: To develop a ML model that accurately identifies patients as candidates for permanent cerebral spinal fluid shunt implantation using only intracranial pressure and electrocardiogram signals recorded throughout LIT. METHODS: This was a single-center cohort study of prospectively collected data of 96 patients who underwent LIT and 5-day external lumbar cerebral spinal fluid drainage (external lumbar drainage) as a reference diagnostic method. A set of selected 48 intracranial pressure/electrocardiogram complex signal waveform features describing nonlinear behavior, wavelet transform spectral signatures, or recurrent map patterns were calculated for each patient. After applying a leave-one-out cross-validation training-testing split of the data set, we trained and evaluated the performance of various state-of-the-art ML algorithms. RESULTS: The highest performing ML algorithm was the eXtreme Gradient Boosting. This model showed a good calibration and discrimination on the testing data, with an area under the receiver operating characteristic curve of 0.891 (accuracy: 82.3%, sensitivity: 86.1%, and specificity: 73.9%) obtained for 8 selected features. Our ML model clearly outperforms the classical Rout-based manual classification commonly used in clinical practice with an accuracy of 62.5%. CONCLUSION: This study successfully used the ML approach to predict the outcome of a 5-day external lumbar drainage and hence which patients are likely to benefit from permanent shunt implantation. Our automated ML model thus enhances the diagnostic utility of LIT in management.

• MeSH
• intrakraniální tlak MeSH
• kohortové studie MeSH
• lidé MeSH
• normotenzní hydrocefalus * diagnóza   chirurgie   MeSH
• shunty pro odvod mozkomíšního moku metody   MeSH
• strojové učení MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• 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.

• Klíčová slova
• CSF tap test, Gait analysis, Hydrocephalus, Shunt,
• 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

UNLABELLED: PURPOSE : Phase contrast magnetic resonance imaging (PC-MRI) represents an opportunity to non-invasively investigate cerebral spinal fluid (CSF) flow in patients with idiopathic normal pressure hydrocephalus (iNPH). Studies in recent years have explored the diagnostic and prognostic value of PC-MRI derived parameters. This review aims to identify all PC-MRI studies of iNPH published since 2010, synthesise a review based on collated results, and analyse specific flow parameters identified in the selected studies. METHODS: Our protocol was prospectively registered on PROSPERO [CRD42020180826]. We systematically searched four databases: Pubmed, Web of Science, Ovid, and Cochrane library to identify all eligible studies. Quality assessment was performed using a modified Newcastle-Ottawa Scale [19]. Systematic review was conducted according to Prisma guidelines. A random-effects model was used to perform meta-analysis on the available flow parameters. RESULTS: Eighteen records were identified for inclusion. Five studies were eligible for meta-analysis, representing 107 iNPH patients and 82 controls. CSF flow parameters available for analysis were stroke volume and peak velocity. Both were significantly higher than controls (p = 0.0007 and p = 0.0045 respectively) according to our random-effects analysis, consistent with a model of hyper-dynamic CSF in iNPH. Our systematic review revealed average stroke volumes in iNPH ranging from 43uL to over 200uL. Peak velocity values ranged from 5.9 cm/s to 12.8 cm/s. CONCLUSION: Significant increases in stroke volume and peak velocity values in iNPH patients suggest a place for PC-MRI as supplementary evidence in the diagnostic work-up of iNPH. Although shunting reduces aqueductal stroke volume and peak velocity, the ability of pre-shunt values to reliably predict treatment response remains complicated. We suggest that it may be more appropriate to consider a range of values that reflect varying probabilities of shunt success. We recommend that future studies should prioritise standardising PC-MRI protocols, and before then PC-MRI findings should be considered supportive rather than determinative.

• Klíčová slova
• Cerebrospinal fluid, Neuroimaging, Normal pressure hydrocephalus, Peak velocity, Phase contrast magnetic resonance imaging, Stroke volume,
• MeSH
• lidé MeSH
• magnetická rezonanční tomografie * metody   MeSH
• normotenzní hydrocefalus * diagnostické zobrazování   patofyziologie   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• přehledy MeSH
• systematický přehled MeSH

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.

• Klíčová slova
• Gravitational valve, Normal pressure hydrocephalus, Shunting, Ventriculoperitoneal shunt,
• 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.

• Klíčová slova
• DTI, Diffusion tensor imaging, Normal pressure hydrocephalus, iNPH,
• 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

OBJECTIVE: Phase-contrast MRI allows detailed measurements of various parameters of CSF motion. This examination is technically demanding and machine dependent. The literature on this topic is ambiguous. Machine learning (ML) approaches have already been successfully utilized in medical research, but none have yet been applied to enhance the results of CSF flowmetry. The aim of this study was to evaluate the possible contribution of ML algorithms in enhancing the utilization and results of MRI flowmetry in idiopathic normal pressure hydrocephalus (iNPH) diagnostics. METHODS: The study cohort consisted of 30 iNPH patients and 15 healthy controls examined on one MRI machine. All major phase-contrast parameters were inspected: peak positive, peak negative, and average velocities; peak amplitude; positive, negative, and average flow rates; and aqueductal area. The authors applied ML algorithms to 85 complex features calculated from a phase-contrast study. RESULTS: The most distinctive parameters with p < 0.005 were the peak negative velocity, peak amplitude, and negative flow. From the ML algorithms, the Adaptive Boosting classifier showed the highest specificity and best discrimination potential overall, with 80.4% ± 2.9% accuracy, 72.0% ± 5.6% sensitivity, 84.7% ± 3.8% specificity, and 0.812 ± 0.047 area under the receiver operating characteristic curve (AUC). The highest sensitivity was 85.7% ± 5.6%, reached by the Gaussian Naive Bayes model, and the best AUC was 0.854 ± 0.028 by the Extra Trees classifier. CONCLUSIONS: Feature extraction algorithms combined with ML approaches simplify the utilization of phase-contrast MRI. The highest-performing ML algorithm was Adaptive Boosting, which showed good calibration and discrimination on the testing data, with 80.4% accuracy, 72.0% sensitivity, 84.7% specificity, and 0.812 AUC. Phase-contrast MRI boosted by the ML approach can help to determine shunt-responsive iNPH patients.

• Klíčová slova
• iNPH, idiopathic normal pressure hydrocephalus, machine learning, phase-contrast MRI,
• MeSH
• aquaeductus cerebri MeSH
• Bayesova věta MeSH
• lidé MeSH
• magnetická rezonanční tomografie metody   MeSH
• normotenzní hydrocefalus * diagnostické zobrazování   MeSH
• strojové učení MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH