Department of Neurosurgery, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
Department of Neuroradiology, University Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany.
Fluids Barriers CNS. 2018 Feb 9;15(1):5. doi: 10.1186/s12987-018-0090-9.
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.
许多放射学征象可用于诊断特发性正常压力脑积水（iNPH）。然而，在疾病的前驱期，这些征象的相关信息却很少。出于对病理生理学研究的目的，我们对前驱期患者进行了描述性影像学分析研究。
纳入 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 年以上有磁共振成像的患者。记录发病日期和症状严重程度、首次影像学检查日期和出生日期。评估症状出现前和前后的 Evans 指数（EI）、第三脑室宽度（3VW）、高凸紧束带（THC）、大脑外侧裂、脑白质高信号范围和导水管流率。
共纳入 10 例患者。所有患者的首发症状均为步态障碍。10 例患者中有 9 例在前驱期图像上出现了典型的 iNPH 征象。EI 在前驱期和症状期之间显著增加。3VW 虽有增加趋势，但无统计学意义。一些患者的 THC 随时间来回变化。
与现有文献稀缺的情况相符，放射学改变至少在 iNPH 症状出现前 3 年就已存在。EI 似乎是前驱期放射学改变的一个可靠指标。根据数据推断，iNPH 典型改变的发展可能是一个隐匿的过程，而 THC 的发展可能是一个可变的非线性过程。需要进一步扩大样本量的研究，以将这些发现置于 iNPH 发展的病理生理学视角中。
