[Idiopathic normal pressure hydrocephalus--overviews and pathogenesis].
[Idiopathic normal pressure hydrocephalus--overviews and pathogenesis].
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[特发性正常压力脑积水——概述和发病机制]。
DOI：
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
M. Ishikawa
中科院分区：
文献类型：
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作者：
M. Ishikawa
特发性正常压力脑积水（iNPH）是一种老年患者无任何前期疾病的步态障碍、痴呆和尿失禁综合征。日本老年人口的迅速增加促使我们制定 iNPH 的诊断和管理指南。日本指南于2004年发布，其特点总结如下： 1）简单且以治疗为导向，2）三个诊断级别：可能、可能和（确定）；分流手术仅适用于可能的 iNPH，3) 步态障碍作为最常见且可治疗的症状的临床意义，4) 脑脊液抽吸测试作为诊断的关键步骤，5) 建议使用可编程阀门来预防过度引流，以及 6) 诊断、分流适应症和预防分流并发症的流程图。 iNPH国际指南于2005年发布。它们是基于循证医学创建的，但也存在一些差异。主要差异在于 iNPH 的概念、年龄、脑脊液压力范围、MRI 结果以及脑脊液穿刺试验的评估、流出阻力测量和持续脑脊液引流。这种差异源于诊断测试的准确性、普及性和侵入性的权重。目前 iNPH 的发病机制尚不清楚。脑脊液主要被整个中枢神经系统的毛细血管吸收的新提议可能有助于阐明 iNPH 的发病机制。
Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome of gait disturbance, dementia and urinary incontinence without any preceding disorders in elderly patients. Rapid increase of elderly population in Japan prompted us to make guidelines for diagnosis and management of iNPH. The Japanese guidelines were published in 2004 and their characteristics were summarized as follows; 1) Simple and treatment-oriented, 2) Three diagnostic levels: possible, probable and (definite); Shunt surgery is indicated for probable iNPH only, 3) Clinical significance of gait disturbance as the most frequent and treatable symptom, 4) CSF tap test as a keystep of diagnosis, 5) Recommend the use of a programmable valve for prevention of overdrainage, and 6) Flow-charts for diagnosis, shunt indication and prevention of shunt complication. The International guidelines of iNPH were published in 2005. They were created based on evidence-based medicine, but there are some differences. Major differences were in the concept of iNPH, age, range of CSF pressure, MRI findings, and evaluation of CSF tap test, outflow resistance measurement and continuous CSF drainage. This difference would be derived from the weight of the accuracy, popularity and invasiveness of diagnostic tests. At present the pathogenesis of iNPH is not known. A new proposal in which CSF is mainly absorbed in the capillaries in all of the central nervous system may contribute to clarify the pathogenesis in iNPH.