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Cerebral Microbleeds-Long-Term Outcome After Cerebrospinal Fluid Shunting in Idiopathic Normal Pressure Hydrocephalus

William Hansson1, Elias Johansson1, Richard Birgander2

  • 1Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden.

Neurosurgery
|February 28, 2023
PubMed
Abstract

Insights

Cerebral microbleeds (CMBs) in idiopathic normal pressure hydrocephalus (INPH) patients are linked to increased mortality and hemorrhagic stroke risk. However, CMBs do not negatively impact gait improvement after shunt surgery.

Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Cerebral microbleeds (CMBs) are frequent in idiopathic normal pressure hydrocephalus (INPH).
  • CMBs may indicate a predisposition to bleeding and influence shunt surgery decisions.

Purpose of the Study:

  • To determine if CMBs increase long-term risks of hemorrhagic complications and mortality in INPH patients.
  • To assess the impact of CMBs on outcomes after cerebrospinal fluid shunt surgery.

Main Methods:

  • 149 INPH patients underwent preoperative MRI to identify CMBs.
  • Patients were followed for a mean of 6.5 years post-shunt surgery.
  • Hemorrhagic events, mortality, and gait improvement were recorded.

Main Results:

  • 50% of patients had CMBs at baseline.
  • CMBs were associated with increased mortality (P=.02).
  • Extensive CMBs (≥50) correlated with hemorrhagic stroke (P=.03), but overall CMBs did not increase subdural hematoma/hygroma risk.

Conclusions:

  • CMBs are associated with increased mortality and hemorrhagic stroke risk in INPH patients.
  • CMBs do not appear to hinder gait improvement after shunt surgery.
  • CMBs do not significantly increase the risk of subdural hematoma or hygroma post-surgery.

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