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Regional cerebral blood flow in normal pressure hydrocephalus: diagnostic and prognostic aspects

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Abstract

Relative regional cerebral blood flow (rrCBF) was measured by single-photon emission tomography (SPET), using technetium-99m-d,l-hexamethylpropylene amine oxime (HMPAO) as flow tracer, in 23 patients with normal pressure hydrocephalus (NPH). 1000 MBq 99mTc-HMPAO was given intravenously and the rrCBF calculated as regional/cerebellar count level ratios. The patients were examined before and 3–12 months after ventriculoperitoneal shunt surgery. rrCBF was also determined in ten healthy aged matched volunteers who served as controls. The NPH patients had decreased rrCBF in the hippocampal regions and in the frontal and parietal white matter as compared to the controls. The frontal/parietal rrCBF ratio correlated with both psychiatric disability and the preoperative degree of incontinence. Decreased flow in frontal white matter, frontoparietal and hippocampal grey matter and a low frontalparietal grey matter flow ratio preoperatively correlated with improvement in both Mini Mental State score and psychiatric disability after shunt surgery. After shunt surgery the rrCBF increased in the mesencephalon, frontal grey and white matter, parietal white matter and hippocampus. The flow increase in hippocampal regions and frontal white matter correlated with improvement in psychiatric symptomatology. The results of this study regarding the frontal and hippocampal rrCBF patterns, and the clinical correlation, support the hypothesis that CBF changes in these regions are of patohphysiological and prognostic importance in NPH.

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References

  1. Greitz TVB, Grepe AOL, Kalmer MSL, Lopez J. Pre- and postoperative evaluation of cerebral blood flow in low-pressure hydrocephalus. J Neurosurg 1969;31: 644–651

    Google Scholar 

  2. Graff-Radford NR, Rezai K, Godersky JC, Eslinger P, Damasio H, Kirchner PT. Regional cerebral blood flow in normal pressure hydrocephalus. J Neurol Neurosug Psychiatry 1987;50: 1589–1596

    Google Scholar 

  3. Mamo HL, Meric PC, Ponsin JC, Rey AC, Luft AG, Seylaz JA. Cerebral blood flow in normal pressure hydrocephalus. Stroke 1987;18:1074–1080

    Google Scholar 

  4. Ishikawa M, Kikuchi H, Taki W Kobayashi A, Nishizawa S, Yonekura Y, Konishi J. Regional cerebral blood flow and oxygen metabolism in normal pressure hydrocephalus after subarchnoid haemorrhage. Neurol Med Chir 1989;29: 382–388

    Google Scholar 

  5. Ingvar DH, Schwartz MS. The cerebral blood flow in low pressure hydrocephalus. In: Lundberg N, Ponten U, Brock M, eds. Intracranial pressure IT. New York: Springer; 1975: 153–159

    Google Scholar 

  6. Mathew NT, Meyer JS, Hartmann A, Ott EO. Abnormal cerebrospinal-blood flow dynamics. Implications in diagnosis, treatmant and prognosis in normal pressure hydrocephalus. Arch Neurol 1975;32: 657–664

    Google Scholar 

  7. Moretti JL, Sergent A, Louarn F, Rancurel G, le Percq M, Flavigny R, Degos J-D, Caron J-P, le Ponsin Lafitte M, Bardy A, Vigneron N. Cortical perfusion assessment with 123I-iso-propyl amphetamine (123I-IAMP) in normal pressure hydrocephalus (NPH). Eur J Nucl Med 1988;14: 73–79

    Google Scholar 

  8. Kamiya K, Yamashita N, Nagai H, Mizawa I. Investigation of normal pressure hydrocephalus by 123I-IMP SPECT. Neurol Med Chir 1991;31: 503–507

    Google Scholar 

  9. Kimura M, Tanaka A, Yoshinaga S. Significance of perventricular hemodynamics in normal pressure hydrocephalus. Neurosurgery 1992;30: 701–704

    Google Scholar 

  10. Graff-Radford NR, Godersky JC, Jones MP. Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology 1989;39: 1601–1604

    Google Scholar 

  11. Kushner M, Youkin D, Weinberger J, Hurtig H, Goldberg G, Reivich M. Cerebral hemodynamics in the diagnosis of normal pressure hydrocephalus. Neurology 1984;34: 96–99

    Google Scholar 

  12. Tamaki N, Kusunoki T, Wakabayashi T, Matsumoto s. Cerebral hemodynamics in normal-pressure hydrocephalus. Evaluation by 113Xe inhalation method and dynamic CT study. J Neurosurg 1984;61: 510–514

    Google Scholar 

  13. Meyer IS, Kitagawa Y, Tanahashi N, Tachibana H, Kandula P, Cech DA, Rose JE, Grossman RG. Pathogenesis of normal pressure hydrocephalus, preliminary observations. Surg Neurol 1985;23: 121–133

    Google Scholar 

  14. Burns A, Philpot MP, Costa DC, Ell PJ, Levy R. The investigation of Alzheimer's disease with single photon emission tomography. J Neural Neurosurg Psychiatry 1989;52: 248–253

    Google Scholar 

  15. Habert MO, Spampinato U, Mas JL, Piketty ML, Bourdel MC, de Recondo J, Rondot P, Askienazy S. A comparative technetium 99m hexamethylpropylene amine oxime SPET study in different types of dementia. Eur J Nucl Med 1991;18: 3–11

    Google Scholar 

  16. Costa DC, Ell PJ, Burns A, Philpot M, Levy R. CBF tomograms with 99mTc-HM-PAO in patients with dementia (Alzheimer type and HIV) and Parkinson's disease — initial results. J Cereb Blood Flow Menab 1988;8 (Suppl): 109–115

    Google Scholar 

  17. 17. Links JM. Optimization of acquisition parameters for brain SPECT. In: Weber DA, Devous MD, Tikofsky RS, Woodhead AD, Vivirito KJ, eds. Brain SPECT perfusion imaging: image acquisition, processing, display, and interpretion. Proceedings of Workshop Held at Brookhaven National Laboratory, 8–9, October 1991: 28–31

  18. Lycke J, Wikkelsö C, Bergh A-C, Jacobsson L, Andersen O. Regional cerebral blood flow in multiple sclerosis measured by single photon emission tomography with technetium-99m hexamethyl-propylenamine oxime. Ear Neurol 1993;33: 166–167

    Google Scholar 

  19. Larsson A, Moonen M, Bergh A-C, Lindberg S, Wikkelsö C. Predictive value of quantitative cisternography in normal pressure hydrocephalus. Acta Neural Scand 1990,1: 327–332

    Google Scholar 

  20. Wikkelsö C, Andersson H, Blomstrand C, Lindqvist G, Svendsen P. Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand 1986;73: 566–573

    Google Scholar 

  21. Larsson A, Wikkelsö C, Bilting M, Stephensen H. Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neural Scan 1991;84: 475–482

    Google Scholar 

  22. Dureman I. Sälde H. In: Psykometriska och experimentalpsykologiska metoder för klinisk tilldmpning. Uppsala: Almqvist och Wiksell, 1959

    Google Scholar 

  23. Gazzaniga M, ed. Handbook of behavioural neurobiology vol 2. Neuropsychology. New York: Plenum Press, 1979

    Google Scholar 

  24. Kolb B, Whishan JQ: In: Fundamentals of human neuropsychology, 2nd edn. New York: W.H. Freeman, 1985

    Google Scholar 

  25. Folstein M, Folstein S, McHugh P. Mini-Mental State — a practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 1975;12: 189–198

    Article  CAS  Google Scholar 

  26. Wikkelsö C, Andersson H, Lindberg S, Blomstrand C. Shuntography — a radiological scanning method for evaluation of cerebrospinal fluid shunt patency. Nucl Med Commun 1983;4: 88–93

    Google Scholar 

  27. Ahlberg J, Norlen L, Blomstrand C, Wikkelsö C. Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar pucture. J Neural Neurosurg Psychiatry 1988;51:105–108

    Google Scholar 

  28. Wikkelsö C, Andersson H, Blomstrand C, Matousek M, Svendsen P Computed tomography of the brain in the diagnosis of and prognosis in normal pressure hydrocephalus. Neuroradiology 1989;31: 160–165

    Google Scholar 

  29. Anderson B. Relief of akinetic mutism from obstructive hydrocephalus using bromocriptine and ephedrine. J Neurosurg 1992;76: 152–155

    Google Scholar 

  30. Pappada G, Poletti C, Guazzoni A, Sani R, Colli M. Normal pressure hydrocephalus: relationship among clinical picture, CT scan and intracranial pressure monitoring. Neurosurg Sci 1986;30: 115–121

    Google Scholar 

  31. Hashimoto K, Shibasaki H, Tabuchi K. Auditory brainstem responses before and after shunting in patients with suspected normal pressure hydrocephalus. Neural Med Chir 1990;30: 29–35

    Google Scholar 

  32. Andersen AR, Friberg HH, Schmidt JF, Hasselbalch SG. Quantitative measurements of cerebral blood flow using SPECT and [99mTc]-d,l-HM-PAO compared to xenon-133. J Cereb Blood Flow Menab 1988;8: 69–81

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurology, Sahlgren Hospital, S-413 45, Göteborg, Sweden

    Anders Larsson & Carsten Wikkelsö

  2. Department of Clinical Physiology, Section of Nuclear Medicine, Sahlgren Hospital, S-413 45, Göteborg, Sweden

    Ann-Christine Bergh

  3. Department of Radiation Physics, Sahlgren Hospital, S-413 45, Göteborg, Sweden

    Åsa Ärlig & Lars Jacobsson

  4. Department of Neurosurgery, Sahlgren Hospital, S-413 45, Göteborg, Sweden

    Marianne Bilting & Hannes Stephensen

Authors
  1. Anders Larsson
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  2. Ann-Christine Bergh
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  3. Marianne Bilting
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  4. Åsa Ärlig
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  5. Lars Jacobsson
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  6. Hannes Stephensen
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  7. Carsten Wikkelsö
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Correspondence to: A. Larsson

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Larsson, A., Bergh, AC., Bilting, M. et al. Regional cerebral blood flow in normal pressure hydrocephalus: diagnostic and prognostic aspects. Eur J Nucl Med 21, 118–123 (1994). https://doi.org/10.1007/BF00175758

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  • DOI: https://doi.org/10.1007/BF00175758

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