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Pathophysiology of cerebral circulatory disorders in idiopathic normal pressure hydrocephalus

Totaro Takeuchi1, Hiromi Goto, Kenji Izaki

  • 1Department of Neurosurgery, The Gyoda General Hospital, Saitama, Japan. t.takeuchi@gyoda-hp.or.jp

Neurologia Medico-Chirurgica
|July 27, 2007
PubMed

Insights

Idiopathic normal pressure hydrocephalus (iNPH) involves cerebral circulatory disorders, primarily affecting the cerebral cortex or thalamus-basal ganglia region. Shunt surgery significantly improved cerebral blood flow in iNPH patients, highlighting distinct pathophysiological patterns.

Area of Science:

  • Neurology
  • Radiology
  • Neurosurgery

Background:

  • Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia, and urinary incontinence.
  • The underlying pathophysiological mechanisms, particularly cerebral circulatory disorders, require further elucidation.

Purpose of the Study:

  • To investigate the pathologic conditions of cerebral circulatory disorders in iNPH patients.
  • To evaluate the impact of shunt surgery on cerebral blood flow (CBF) and perfusion patterns.

Main Methods:

  • Forty iNPH patients underwent shunt surgery and were assessed using N-isopropyl-((123)I)-P-iodo-amphetamine single photon emission computed tomography (SPECT) for cerebral blood flow (CBF) and three-dimensional stereotactic surface projection (3D-SSP) for perfusion patterns.
  • Measurements were taken before and one month after surgery.

Main Results:

  • Mean CBF significantly increased post-surgery (p < 0.03).
  • Cerebral circulatory disorders manifested as either cortical or thalamus-basal ganglia region involvement, or both.
  • Shunt surgery led to improved blood flow in a majority of patients, with distinct patterns of hypoperfusion observed pre-surgery.

Conclusions:

  • Cerebral circulatory disorders in iNPH present with specific patterns affecting either the cerebral cortex or thalamus-basal ganglia region.
  • Shunt surgery can effectively improve cerebral blood flow and alleviate symptoms in iNPH patients.
  • The findings provide insights into the heterogeneous pathophysiology of iNPH.

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