Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting
Idiopathic normal-pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting
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DOI：
10.1136/jnnp.2006.095117
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发表时间：
2007-02-01
影响因子：
11
通讯作者：
Waldemar, G.
中科院分区：
文献类型：
--
作者：
Bech-Azeddine, R.;Hogh, P.;Waldemar, G.
目的：阐明临床诊断的脑合并症在特发性常压脑积水（INPH）中的重要性及其对分流术后改善的影响，以及与额叶脑活检标本中描述的实质病理变化的一致性。研究方法：在28例诊断为INPH并根据临床、放射学和脑脊液动力学标准分流的连续患者中，仔细登记伴随疾病，特别强调脑血管疾病（CVD）和可能的阿尔茨海默病。在分流手术期间，获得额叶脑活检标本，随后分析病理变化。结果如下：89%的患者中存在一种或多种并发疾病，最常见的是CVD（n=17）和可能的阿尔茨海默病（n=12），其中8例患者同时存在这两种疾病，根据国家神经和交流疾病和中风研究所以及阿尔茨海默病和相关疾病协会的标准进行诊断。分流成功率为33%。与分流手术后改善的患者相比，在无改善或临床恶化的亚组中发现CVD或阿尔茨海默病患病率明显增加的趋势。CVD的存在倾向于不利的分流结局。病理实质变化反映了合并症的临床诊断，并在大约一半的活检标本中进行了描述，阿尔茨海默病（n=7）和血管变化（n=7）是最常见的结果。但与阿尔茨海默病和心血管病的临床诊断无显著相关性。无论是临床诊断还是脑活检，脑合并症的存在并不妨碍分流术后的临床改善。结论：在因INPH分流的患者中发现CVD和阿尔茨海默病的高患病率，这反映了相似的神经病理学活检结果，尽管不太常见。合并症的存在与分流结果之间没有显著相关性。研究结果支持INPH作为多病因临床实体的看法，可能与CVD和阿尔茨海默病在病理生理学上重叠。
Objectives: To elucidate the importance of clinically diagnosed cerebral comorbidity in idiopathic normal-pressure hydrocephalus (INPH) and its effect on improvement after shunt surgery as well as concordance with parenchymal pathological changes described in frontal cerebral biopsy specimens. Methods: In 28 consecutive patients diagnosed with INPH and shunted according to clinical, radiological and cerebrospinal fluid dynamic criteria, concomitant disorders were carefully registered, with special emphasis on cerebrovascular disease (CVD) and possible Alzheimer's disease. During shunt surgery, a frontal cerebral biopsy specimen was obtained and subsequently analysed for pathological changes. Results: One or several concurrent disorders were present in 89% of the patients, most often CVD (n=17) and possible Alzheimer's disease (n=12), of which eight patients presented both, diagnosed according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. The shunt success rate was 33%. A clear tendency towards increasing prevalence of CVD or Alzheimer's disease was found in the subgroups with no improvement or clinical deterioration compared with the patients improving after shunt surgery. The presence of CVD tended towards an unfavourable shunt outcome. The pathological parenchymal changes reflected the clinical diagnoses of comorbidity, and were described in about half of the biopsy specimens, with Alzheimer's disease (n=7) and vascular changes (n=7) being the most common findings. However, no significant correlation was found with the clinical diagnoses of Alzheimer's disease and CVD. The presence of cerebral comorbidity, whether diagnosed clinically or by brain biopsy, did not preclude clinical improvement after shunt operation. Conclusions: A high prevalence of CVD and Alzheimer's disease was found in patients shunted for INPH, which was reflected, although less commonly, by similar neuropathological biopsy findings. No significant correlation was found between the presence of comorbidity and shunt outcome. The findings support the perception of INPH as a multiaetiological clinical entity, possibly overlapping pathophysiologically with CVD and Alzheimer's disease.