Paradigm-shift: radiological changes in the asymptomatic iNPH-patient to be: an observational study.
Paradigm-shift: radiological changes in the asymptomatic iNPH-patient to be: an observational study.
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DOI：
10.1186/s12987-018-0090-9
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发表时间：
2018-02-09
影响因子：
7.3
通讯作者：
Brendle C
中科院分区：
文献类型：
--
作者：
Engel DC;Adib SD;Schuhmann MU;Brendle C
已知许多放射学体征可用于诊断特发性正常压力脑积水 (iNPH)。然而，关于症状前阶段这些症状的信息很少。出于病理生理学研究的目的，我们对出现症状的患者进行了描述性图像分析研究。包括在 2010 年至 2016 年期间与图宾根大学医院神经科或神经外科有过接触且在症状出现前 3 年以上使用磁共振图像的患者。记录症状出现的日期和严重程度、第一次成像的日期和出生日期。在症状出现之前和前后的图像中评估埃文指数（EI）、第三脑室宽度（3VW）、紧高凸度（THC）、侧裂、白质高信号程度和导水管血流。其中包括十名患者。所有十名患者的首发症状都是步态障碍。十张症状前图像中有九张显示了 iNPH 的典型症状。 EI 显示症状前阶段和症状阶段之间显着增加。 3VW呈上升趋势，但不显着。随着时间的推移，某些患者体内的 THC 会发生来回变化。根据现有的稀缺文献，放射学变化至少在 iNPH 症状出现前 3 年出现。 EI 似乎是症状前放射学变化的有力衡量标准。根据数据推断，iNPH 典型变化的发展可能是一个阴险的过程，而 THC 的发展可能是一个可变的非线性过程。有必要进行更大样本量的进一步研究，以将这些发现纳入 iNPH 发展的病理生理学角度。
Many radiological signs are known for the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). However, there is little information about these signs in the pre-symptomatic phase. For pathophysiological investigative purposes we conducted a descriptive image analysis study on pre-symptomatic patients. Patients that had contact with either the neurological or neurosurgical department of the university hospital Tuebingen from 2010 through 2016 with magnetic resonance images > 3 years before onset of symptoms, were included. The date of onset and severity of symptoms, date of first imaging and birth date were recorded. Evan’s index (EI), width of the third ventricle (3VW), tight high convexity (THC), Sylvian fissure, extent of white matter hyperintensities and aqueductal flow were assessed in images before and around symptom onset. Ten patients were included. In all ten patients the first symptom was gait disturbance. Nine of ten pre-symptomatic images showed classic signs for iNPH. EI showed a significant increase between the pre-symptomatic and symptomatic phase. 3VW showed a trend for increase without significance. THC changed back and forth over time within some patients. In accordance with the scarce literature available, radiological changes are present at least 3 years before onset of iNPH-symptoms. EI seems to be a robust measure for pre-symptomatic radiological changes. Extrapolating the data, the development of iNPH typical changes might be an insidious process and the development of THC might be a variable and non-linear process. Further studies with larger sample sizes are necessary to put these findings into the pathophysiological perspective for the development of iNPH.
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影响因子：
11.2
作者：
Kuriyama, Nagato;Tokuda, Takahiko;Nakagawa, Masanori
通讯作者：
Nakagawa, Masanori
影响因子：
9.9
作者：
Alperin, Noam;Oliu, Carlos J.;Relkin, Norman
通讯作者：
Relkin, Norman
影响因子：
4.4
作者：
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通讯作者：
Leinonen, Ville
影响因子：
3
作者：
Cusimano, M. D.;Rewilak, D.;Freedman, M.
通讯作者：
Freedman, M.
影响因子：
2.4
作者：
Bech, RA;Waldemar, G;Juhler, M
通讯作者：
Juhler, M