A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy
A case report of nonsurgical idiopathic normal pressure hydrocephalus differentiated from Alzheimer's dementia: Levetiracetam was effective in symptomatic epilepsy
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非手术性特发性常压脑积水与阿尔茨海默病相鉴别一例报告：左乙拉西坦治疗症状性癫痫有效
DOI：
10.1002/pcn5.43
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Kobayashi Seiju
中科院分区：
文献类型：
--
作者：
Ishida Tetsuro;Murayama Tomonori;Kobayashi Seiju
背景特发性正常压力脑积水（iNPH）是一种常见的痴呆症，会导致步态障碍、认知障碍和尿失禁。 iNPH 是一种“可治疗的痴呆症”，可以通过分流手术治疗，但在某些情况下可能无效，并且可能伴有并发症。因此，许多 iNPH 患者不接受手术。然而，除了手术治疗之外，没有足够的证据证明有效的治疗方法。病例介绍一位75岁的女性来我院就诊，主诉为认知能力下降。她表现出动力减弱和不活动。脑磁共振成像显示埃文斯指数（双侧侧脑室前角之间的最大宽度/同一切片中的最大颅内腔）得分较高。蛛网膜下腔在外侧裂处和下方扩大，在较高弓形区域变窄。她被诊断患有 iNPH。然而，没有进行分流手术； 11个月后，她出现全身痉挛并失去知觉。脑电图显示全身性癫痫放电。她的 iNPH 手术的可能性被排除。左乙拉西坦可预防癫痫复发，并改善自发性和动机等认知功能。结论通常认为手术是 iNPH 患者唯一有效的治疗方法。然而，正如本例一样，有症状的癫痫发作可能是痴呆症的一个因素。即使在没有手术治疗的情况下，我们也应该检查 iNPH 患者痴呆的原因，并考虑药物治疗，包括抗癫痫药物。
BackgroundIdiopathic normal pressure hydrocephalus (iNPH) is a common form of dementia that causes gait disturbance, cognitive impairment, and urinary incontinence. iNPH is a “treatable dementia” that can be treated with shunt surgery, but this can be ineffective in some cases and can be accompanied by complications. As a result, many patients with iNPH do not undergo surgery. However, there is insufficient evidence on effective treatments other than surgical therapy.Case PresentationA 75‐year‐old woman presented to our hospital with a chief complaint of cognitive decline. She showed reduced motivation and inactivity. Brain magnetic resonance imaging showed a high score on the Evans Index (maximum width between bilateral lateral ventricular anterior horns/maximum intracranial cavity in the same slice). The subarachnoid space was enlarged at and below the Sylvian fissure, and narrowed at the higher arcuate region. She was diagnosed with iNPH. However, no shunt surgery was performed; 11 months later, she had a generalized convulsive seizure with loss of consciousness. An electroencephalogram showed generalized epileptic discharges. The possibility of surgery for her iNPH was ruled out. Levetiracetam prevented seizure recurrence and cognitive functions such as spontaneity and motivation were improved.ConclusionIt is often assumed that surgery is the only effective treatment for patients with iNPH. However, as in the present case, symptomatic epileptic seizures may be a factor in dementia. Even in the absence of surgical treatment, we should examine the cause of dementia in patients with iNPH and consider pharmacological treatment, including antiepileptic drugs.
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影响因子：
2.8
作者：
Sasaki, Makoto;Honda, Satoshi;Ohba, Hideki
通讯作者：
Ohba, Hideki
影响因子：
4.1
作者：
Mori, K
通讯作者：
Mori, K
影响因子：
1.9
作者：
Pomeraniec, I. Jonathan;Ksendzovsky, Alexander;Jane, John A., Jr.
通讯作者：
Jane, John A., Jr.
影响因子：
2
作者：
Shaw, Richard;Everingham, Emma;Owler, Brian
通讯作者：
Owler, Brian
特发性正常压力脑积水的脑脊液空间：形态和体积。
DOI：
--
发表时间：
1998
期刊：
AJNR. American journal of neuroradiology
影响因子：
--
作者：
H. Kitagaki;E. Mori;Kazunari Ishii;S. Yamaji;N. Hirono;T. Imamura
通讯作者：
T. Imamura