Advertisement

Neuroradiology

, Volume 47, Issue 10, pp 741–748 | Cite as

The pathophysiology of the aqueduct stroke volume in normal pressure hydrocephalus: can co-morbidity with other forms of dementia be excluded?

  • Grant A. BatemanEmail author
  • Christopher R. Levi
  • Peter Schofield
  • Yang Wang
  • Elizabeth C. Lovett
Diagnostic Neuroradiology

Abstract

Variable results are obtained from the treatment of normal pressure hydrocephalus (NPH) by shunt insertion. There is a high correlation between NPH and the pathology of Alzheimer’s disease (AD) on brain biopsy. There is an overlap between AD and vascular dementia (VaD), suggesting that a correlation exists between NPH and other forms of dementia. This study seeks to (1) understand the physiological factors behind, and (2) define the ability of, the aqueduct stroke volume to exclude dementia co-morbidity. Twenty-four patients from a dementia clinic were classified as having either early AD or VaD on the basis of clinical features, Hachinski score and neuropsychological testing. They were compared with 16 subjects with classical clinical findings of NPH and 12 aged-matched non-cognitively impaired subjects. MRI flow quantification was used to measure aqueduct stroke volume and arterial pulse volume. An arterio-cerebral compliance ratio was calculated from the two volumes in each patient. The aqueduct stroke volume was elevated in all three forms of dementia, with no significant difference noted between the groups. The arterial pulse volume was elevated by 24% in VaD and reduced by 35% in NPH, compared to normal (P=0.05 and P=0.002, respectively), and was normal in AD. There was a spectrum of relative compliance with normal compliance in VaD and reduced compliance in AD and NPH. The aqueduct stroke volume depends on the arterial pulse volume and the relative compliance between the arterial tree and brain. The aqueduct stroke volume cannot exclude significant co-morbidity in NPH.

Keywords

Normal pressure hydrocephalus Vascular dementia Alzheimer’s disease Aqueduct stroke volume Compliance 

Notes

Acknowledgements

We thank the Australian Brain Foundation and the John Hunter Hospital Research Committee for granting funding for this research.

References

  1. 1.
    Krauss JK, Regel JP, Vach W, Jungling FD, Droste DW, Wakhloo AK (1997) Flow void of cerebrospinal fluid in idiopathic normal pressure hydrocephalus of the elderly: can it predict outcome after shunting?. Neurosurgery 40:67–73Google Scholar
  2. 2.
    Vanneste J, Augustijn P, Dirven C, Tan WF, Goedhart ZD (1992) Shunting normal pressure hydrocephalus: do the benefits outweigh the risks? A multicentre study and literature review. Neurology 42:54–59Google Scholar
  3. 3.
    Bradley WG Jr, Scalzo D, Queralt J, Nitz WN, Atkinson DJ, Wong P (1996) Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology 198:523–529Google Scholar
  4. 4.
    Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27:147–165Google Scholar
  5. 5.
    Egnor M, Zheng L, Rosiello A, Gutman F, Davis R (2002) A model of pulsations in communicating hydrocephalus. Pediatr Neurosurg 36:281–303Google Scholar
  6. 6.
    Savolainen S, Paljarvi L, Valpalahti M (1999) Prevalence of Alzheimer’s disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir (Wein) 141:849–853Google Scholar
  7. 7.
    Bradley WG Jr, Whittemore AR, Watanabe AS, Davis SJ, Teresi LM, Homyak M (1991) Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal pressure hydrocephalus. AJNR Am J Neuroradiol 12:31–39Google Scholar
  8. 8.
    Krauss JK, Regel JP, Vach W, et al (1997) White matter lesions in patients with idiopathic normal pressure hydrocephalus and in an age-matched control group: a comparative study. Neurosurgery 40:491–495Google Scholar
  9. 9.
    Skoog I (1991) Vascular factors in dementia. Alzheimer Dis Assoc Disord 13:106–114Google Scholar
  10. 10.
    Bateman GA (2002) Pulse-wave encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus. Neuroradiology 44:740–748Google Scholar
  11. 11.
    Dixon GR, Friedman JA, Luetmer PH, et al (2002) Use of cerebrospinal fluid flow rates measured by phase-contrast MR to predict outcome of ventriculoperitoneal shunting for idiopathic normal-pressure hydrocephalus. Mayo Clin Proc 77:509–514Google Scholar
  12. 12.
    Bradley WG (2002) Cerebrospinal fluid dynamics and shunt responsiveness in patients with normal-pressure hydrocephalus. Mayo Clin Proc 77:507–508Google Scholar
  13. 13.
    Mase M, Yamada K, Banno T, Miyachi T, Ohara S, Matsumoto T (1998) Quantitative analysis of CSF flow dynamics using MRI in normal pressure hydrocephalus. Acta Neurochir 71 [Suppl]:350–353Google Scholar
  14. 14.
    Barkhof F, Kouwenhonen M, Scheltens P, Sprenger M, Algra P, Valk J (1994) Phase contrast cine MR imaging of normal aqueductal CSF flow: effect of aging and relation to CSF void on modulus MR. Acta Radiol 35:123–130Google Scholar
  15. 15.
    Stollman AL, George AE, Pinto RS, de Leon MJ (1986) Periventricular high signal lesions in a single void on magnetic resonance imaging in hydrocephalus. Acta Radiol 369 [Suppl]:388–391Google Scholar
  16. 16.
    Turner MS, Goodman JM (1998) Comment on “correlation between lumbo-ventricular perfusion and MRI-CSF flow studies in idiopathic normal pressure hydrocephalus”. Surg Neurol 49:20Google Scholar
  17. 17.
    Greitz D, Wirestam R, Frank A, Nordell B, Thomsen C, Stahlberg F (1992) Pulsatile brain movement and associated hydrodynamics studied by magnetic resonance phase imaging. The Monro–Kellie doctrine revisited. Neuroradiology 34:370–380Google Scholar
  18. 18.
    Du Boulay GH, O’Connell J, Currie J, Bostick T, Verity P (1972) Further investigations on pulsatile movements in the cerebrospinal fluid pathways. Acta Radiol 13:496–523Google Scholar
  19. 19.
    Bateman GA (2001) Toward a better understanding of normal pressure hydrocephalus. AJNR Am J Neuroradiol 22:596Google Scholar
  20. 20.
    Cordoso ER, Rowan JO, Galbrath S (1983) Analysis of the cerebrospinal fluid pulse wave in intracranial pressure. J Neurosurg 59:817–821Google Scholar
  21. 21.
    Ohara S, Nagai H, Matsumoto T (1988) MR imaging of CSF pulsatory flow and its relation to intracranial pressure. J Neurosurg 69:675–682Google Scholar
  22. 22.
    Luetmer PH, Huston J, Friedman JA, et al (2002) Measurement of cerebrospinal fluid flow at the cerebral aqueduct by use of phase contrast magnetic resonance imaging: technique validation and utility in diagnosing idiopathic normal pressure hydrocephalus. Neurosurgery 50:534–542Google Scholar
  23. 23.
    Black PM, Ojemann RG, Tzouras A (1985) CSF shunts for dementia, incontinence and gait disturbance. Clin Neurosurg 32:632–651Google Scholar
  24. 24.
    Bateman GA (2000) Vascular compliance in normal pressure hydrocephalus. AJNR Am J Neuroradiol 21:1574–1585Google Scholar
  25. 25.
    Uftring SJ, Chu D, Alperin N, Levin DN (2000) The mechanical state of intracranial tissues in elderly subjects studied by imaging CSF and brain pulsations. Magn Reson Imaging 18:991–996Google Scholar
  26. 26.
    Bateman GA (2004) Pulse wave encephalopathy: a spectrum hypothesis incorporating Alzheimer’s disease, vascular dementia and normal pressure hydrocephalus. Med Hypotheses 62:182–187Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Grant A. Bateman
    • 1
    Email author
  • Christopher R. Levi
    • 2
  • Peter Schofield
    • 3
  • Yang Wang
    • 2
  • Elizabeth C. Lovett
    • 2
  1. 1.Department of Medical ImagingJohn Hunter HospitalNewcastleAustralia
  2. 2.Clinical Neurosciences ProgramHunter Medical Research InstituteNewcastleAustralia
  3. 3.Neuropsychiatry UnitJames Fletcher HospitalNewcastleAustralia

Personalised recommendations