Magnetic Resonance Imaging of Normal Pressure Hydrocephalus

Publication date: April 2016 Source:Seminars in Ultrasound, CT and MRI, Volume 37, Issue 2 Author(s): William G. Bradley Normal pressure hydrocephalus (NPH) is a syndrome found in the elderly, which is characterized by ventriculomegaly and deep white matter ischemia (DWMI) on magnetic resonance imaging (MRI) and the clinical triad of gait disturbance, dementia, and urinary incontinence. NPH has been estimated to account for up to 10% of cases of dementia and is significant because it is treatable by ventriculoperitoneal shunting. Patients with a known cause of chronic communicating hydrocephalus, that is, meningitis or hemorrhage, tend to respond better than patients with the so-called “idiopathic” form, most likely because of poor selection criteria in the past. Good response to shunting has been associated with hyperdynamic cerebrospinal fluid (CSF) flow through the aqueduct. In the early days of MRI, patients with a large CSF flow void extending from the foramen of Monro through the aqueduct to the fourth ventricle had an excellent chance of responding to ventriculoperitoneal shunting (P < 0.003). Today, we use phase-contrast MRI to measure the volume of CSF flowing through the aqueduct in either direction over a cardiac cycle. When this aqueductal CSF stroke volume is sufficiently elevated, there is an excellent chance of shunt responsiveness (100% positive predictive value in 1 study). Idiopathic NPH appears to be a “two-hit” disease—benign externa...
Source: Seminars in Ultrasound, CT and MRI - Category: Radiology Source Type: research