Advertisement

Communicating Hydrocephalus. Normal Pressure Hydrocephalus

  • Alex RoviraEmail author
Living reference work entry

Abstract

Communicating hydrocephalus is defined as a CSF flow circulation abnormality outside the ventricular system that produces an increase in the ventricular size. Most cases are secondary to obstruction of CSF flow between the basal cisterns and brain convexity and include common conditions such as subarachnoid hemorrhage and meningitis (infectious and neoplastic). In a subset of communicating hydrocephalus, no CSF obstruction can be demonstrated as occurs in normal pressure hydrocephalus (NPH), a complex entity with poorly understood CSF dynamics. Clinical neuroradiology plays an essential role in the diagnosis of communicating hydrocephalus and in distinguishing this condition from other causes of ventriculomegaly (central atrophy, non-communicating hydrocephalus).

NPH is a syndrome characterized by the triad of gait disturbance, mental deterioration, and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. Although NPH represents a major cause for reversible and treatable dementia, this syndrome is frequently underdiagnosed. The clinical presentation (triad) may be atypical or incomplete or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, including different radiological techniques such as computed tomography (CT) or magnetic resonance imaging (MRI). According to international guidelines, CT or MRI is decisive for NPH diagnosis and selection of shunt-responsive patients. These techniques provide essential morphological findings: ventricular enlargement associated with tight high convexity and medial subarachnoid sulci and enlarged Sylvian fissures (disproportionally enlarged subarachnoid space hydrocephalus [DESH]), ballooning of frontal horns, reduction of the callosal angle, corpus callosum thinning, and widening of temporal horns not explained by hippocampal atrophy. Other imaging methods such as radionuclide cisternography or cardiac-gated flow-sensitive phase-contrast cine MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases. In summary, morphological MRI features still play an essential role in the diagnosis of NPH and also in predicting a positive clinical outcome after shunting.

Keywords

Hydrocephalus Normal pressure hydrocephalus Cerebrospinal fluid disorders Dementia MRI CT 

Abbreviations

AD

Alzheimer’s disease

CA

Callosal angle

CISS

Constructive interference steady state

CSF

Cerebrospinal fluid

CT

Computed tomography

DESH

Disproportionally enlarged subarachnoid space hydrocephalus

EI

Evans’ index

ELD

External lumbar drainage

FIESTA

Fast imaging employing steady-state acquisition

FLAIR

Fluid attenuated inversion recovery

ICP

Intracranial pressure

iNPH

Idiopathic normal pressure hydrocephalus

MRI

Magnetic resonance imaging

NPH

Normal pressure hydrocephalus

PC-MRI

Phase-contrast flow-sensitive MRI

SAS

Subarachnoid hemorrhage

sNPH

Secondary normal pressure hydrocephalus

SPACE

Sampling perfection with application optimized contrast

Time-SLIP

Time-spatial labeling inversion pulse

VISTA

Volume isotropic turbo spin-echo acquisition

References

  1. Agarwal A, Bathla G, Kanekar S. Imaging of communicating hydrocephalus. Semin Ultrasound CT MR. 2016;37(2):100–8.CrossRefGoogle Scholar
  2. Bradley WG Jr. CSF flow in the brain in the context of normal pressure hydrocephalus. AJNR Am J Neuroradiol. 2015;36(5):831–8.CrossRefGoogle Scholar
  3. Bradley WG Jr. Magnetic resonance imaging of normal pressure hydrocephalus. Semin Ultrasound CT MR. 2016;37(2):120–8.CrossRefGoogle Scholar
  4. Ghosh S, Lippa C. Diagnosis and prognosis in idiopathic normal pressure hydrocephalus. Am J Alzheimers Dis Other Demen. 2014; 29:583–9.CrossRefGoogle Scholar
  5. Ishii K, Kanda T, Harada A, et al. Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus. Eur Radiol. 2008;18(11):2678–83.CrossRefGoogle Scholar
  6. Mori E, Ishikawa M, Kato T, Japanese Society of Normal Pressure Hydrocephalus, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo). 2012;52(11):775–809.CrossRefGoogle Scholar
  7. Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(3 Suppl):S4–16; discussion ii–vPubMedGoogle Scholar
  8. Shinoda N, Hirai O, Hori S, et al. Utility of MRI-based disproportionately enlarged subarachnoid space hydrocephalus scoring for predicting prognosis after surgery for idiopathic normal pressure hydrocephalus: clinical research. J Neurosurg. 2017;127(6):1436–42.CrossRefGoogle Scholar
  9. Tanaka N, Yamaguchi S, Ishikawa H, Ishii H, Megura K. Prevalence of possible idiopathic normal-pressure hydrocephalus in Japan: the Osaki-Tajiri project. Neuroepidemiology. 2009;32:171–5.CrossRefGoogle Scholar
  10. Ucar M, Guryildirim M, Tokgoz N, et al. Evaluation of aqueductal patency in patients with hydrocephalus: three-dimensional high-sampling-efficiency technique (SPACE) versus two-dimensional turbo spin echo at 3 Tesla. Korean J Radiol. 2014;15(6):827–35.CrossRefGoogle Scholar
  11. Williams MA, Malm J. Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn). 2016;22(2 Dementia):579–99.Google Scholar

Further Readings

  1. Iseki C, Kawanami T, Nagasawa H, et al. Asymptomatic ventriculomegaly with features of idiopathic normal pressure hydrocephalus on MRI (AVIM) in the elderly: a prospective study in a Japanese population. J Neurol Sci. 2009;277(1–2):54–7.CrossRefGoogle Scholar
  2. Marmarou A, Black P, Bergsneider M, Klinge P, Relkin N, International NPH Consultant Group. Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date. Acta Neurochir Suppl. 2005;95:237–40.CrossRefGoogle Scholar
  3. Miskin N, Patel H, Franceschi AM, Alzheimer’s Disease Neuroimaging Initiative, et al. Diagnosis of normal-pressure hydrocephalus: use of traditional measures in the era of volumetric MR imaging. Radiology. 2017;285(1):197–205.CrossRefGoogle Scholar
  4. Poca MA, Solana E, Martínez-Ricarte FR, Romero M, Gándara D, Sahuquillo J. Idiopathic normal pressure hydrocephalus: results of a prospective cohort of 236 shunted patients. Acta Neurochir Suppl. 2012;114:247–53.CrossRefGoogle Scholar
  5. Ringstad G, Vatnehol SAS, Eide PK. Glymphatic MRI in idiopathic normal pressure hydrocephalus. Brain. 2017;140(10):2691–705.CrossRefGoogle Scholar
  6. Virhammar J, Laurell K, Cesarini KG, Larsson EM. The callosal angle measured on MRI as a predictor of outcome in idiopathic normal-pressure hydrocephalus. J Neurosurg. 2014a;120(1):178–84.CrossRefGoogle Scholar
  7. Virhammar J, Laurell K, Cesarini KG, Larsson EM. Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol. 2014b;35(12):2311–8.CrossRefGoogle Scholar
  8. Virhammar J, Laurell K, Cesarini KG, Larsson EM. Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus. J Neurosurg. 2018;1:1–6.  https://doi.org/10.3171/2017.8.JNS17547. [Epub ahead of print].CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of RadiologyHospital Universitari Vall d’HebronBarcelonaSpain

Section editors and affiliations

  • Charles Anthony Józef Romanowski
    • 1
  1. 1.Department of NeuroradiologySheffield Teaching Hospitals NHS Foundation TrustSheffieldUK

Personalised recommendations