Department "G.F. Ingrassia", Section of Neurosciences, University of Catania, Via S. Sofia 78, 95123, Catania, Italy.
Neurol Sci. 2017 Dec;38(12):2209-2212. doi: 10.1007/s10072-017-3093-4. Epub 2017 Aug 22.
Differential diagnosis between vascular parkinsonism (VP) and idiopathic normal pressure hydrocephalus (iNPH) is particularly challenging due to similar clinical and neuroradiological features. The objective of this study is to differentiate VP with radiological evidence of ventricular enlargement (REVE) from iNPH on the basis of cerebrospinal fluid (CSF) hydrodynamics. CSF pressure components were investigated in patients with a clinical diagnosis of VP and REVE. Data of eight patients (seven men; age 76 ± 3.9 years; disease duration 26.5 ± 15.6 months) were evaluated. CSF opening pressure values were normal in all patients. Also, mean CSF pressure values during short-term monitoring were normal, except in one patient. Four out of the eight patients had raised values of pulse wave amplitude (PWA) during the opening phase (mean ± SD 57.1 ± 19.9 mmHO), meanwhile during short-term monitoring, seven out of the eight patients showed raised values of mean PWA (76.8 ± 23 mmHO). We found that most of patients with clinical characteristics of VP and REVE showed elevated PWA during the short-term monitoring of CSF pressure as observed in iNPH patients. Patients clinically identified as VP may be part of the clinical spectrum of iNPH.
血管性帕金森病（VP）和特发性正常压力脑积水（iNPH）之间的鉴别诊断特别具有挑战性，因为它们具有相似的临床和神经影像学特征。本研究的目的是基于脑脊液（CSF）动力学来区分具有脑室扩大（REVE）的放射学证据的 VP 与 iNPH。研究人员调查了临床诊断为 VP 和 REVE 的患者的 CSF 压力成分。评估了 8 名患者（7 名男性；年龄 76±3.9 岁；病程 26.5±15.6 个月）的数据。所有患者的 CSF 开口压力值均正常。此外，除了一名患者外，短期监测期间的平均 CSF 压力值也正常。在打开阶段，8 名患者中有 4 名患者的脉动波幅度（PWA）值升高（平均值±标准差 57.1±19.9mmHO），而在短期监测期间，8 名患者中有 7 名患者的平均 PWA 值升高（76.8±23mmHO）。研究人员发现，大多数具有 VP 和 REVE 临床特征的患者在 CSF 压力的短期监测中表现出升高的 PWA，这与 iNPH 患者的观察结果一致。临床上被识别为 VP 的患者可能是 iNPH 临床谱的一部分。
