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Computerized axial transverse tomography in normal pressure hydrocephalus.

L Jacobs, W Kinkel

    Neurology
    |June 1, 1976
    PubMed
    Summary

    Computerized axial transverse tomographic (CT) scans revealed cortical atrophy in normal pressure hydrocephalus patients, challenging current concepts. Ventricular size post-surgery did not correlate with clinical outcomes.

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    Area of Science:

    • Neurology
    • Neurosurgery
    • Radiology

    Background:

    • Normal pressure hydrocephalus (NPH) is a condition characterized by enlarged ventricles, impaired cerebrospinal fluid (CSF) absorption, and neurological symptoms.
    • Traditional diagnostic methods for NPH include pneumoencephalography (PEG) and clinical assessment of response to CSF shunting.

    Purpose of the Study:

    • To evaluate the utility of computerized axial transverse tomographic (CT) scanning in assessing normal pressure hydrocephalus.
    • To compare CT findings with pneumoencephalographic results and clinical outcomes after ventricular shunting.

    Main Methods:

    • Twenty patients diagnosed with normal pressure hydrocephalus underwent CT scanning.
    • CT findings were correlated with pre-existing pneumoencephalographic data and patient responses to ventricular shunting.

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    Main Results:

    • CT scans identified significant cortical atrophy in seven patients, which was not evident on pneumoencephalograms.
    • Autopsy confirmed cortical atrophy in one case.
    • Enlarged ventricles (25-40% of intracranial volume) were observed in eight patients up to four years post-ventricular shunting.
    • No correlation was found between cortical atrophy, postoperative ventricular size, and clinical improvement following shunting.

    Conclusions:

    • CT scanning offers valuable insights into brain morphology in NPH, potentially revealing cortical atrophy missed by PEG.
    • The findings suggest a need to revise current understandings of normal pressure hydrocephalus pathophysiology and diagnostic criteria.
    • Clinical outcomes after shunting may not be directly predictable by the presence of cortical atrophy or postoperative ventricular size.