Bräutigam Konstantin, Vakis Antonis, Tsitsipanis Christos
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology, Charitéplatz 1, 10117 Berlin, Germany.
Department of Neurosurgery, University of Crete, Panepistimiou, 71500 Iraklio, Greece.
J Clin Neurosci. 2019 Mar;61:10-13. doi: 10.1016/j.jocn.2018.10.147. Epub 2018 Nov 6.
Idiopathic Normal Pressure Hydrocephalus (iNPH) is a frequent neuropsychiatric entity. Clinically it is characterised by Hakim's triad: Dementia, gait disturbance and urinary incontinence. While its symptomatology is typical, the etiology and thereby physiopathology of iNPH still remain enigmatic. This review summarizes and synthesizes different etiologic conceptions and physiopathologic aspects of iNPH. A research of literature via the PubMed/MEDLINE and the Cochrane database was conducted. Only English language articles clearly outlining a reasonable concept of physiopathology were included. Most authors advocate that iNPH is a result of chronically altered cerebrospinal fluid (CSF) dynamics, i.e. deranged CSF production, kinetics and reabsorption. In addition, there are vascular, metabolo-neurodegenerative and hereditary factors. Neuroinflammation does not seem to play a significant role in the etiology of iNPH. All in all, iNPH seems to combine several pathogenetic factors leading to a self-reinforcing vicious circle. The majority of studies hint at CSF disturbances on grounds of altered hemodynamics.
特发性正常压力脑积水（iNPH）是一种常见的神经精神疾病。临床上，它以哈基姆三联征为特征：痴呆、步态障碍和尿失禁。虽然其症状学具有典型性，但iNPH的病因及由此产生的病理生理学仍然不明。本综述总结并综合了iNPH的不同病因学概念和病理生理学方面。通过PubMed/MEDLINE和Cochrane数据库进行了文献检索。仅纳入了清晰阐述合理病理生理学概念的英文文章。大多数作者主张iNPH是慢性脑脊液（CSF）动力学改变的结果，即脑脊液生成、流动和重吸收紊乱。此外，还存在血管、代谢 - 神经退行性和遗传因素。神经炎症似乎在iNPH的病因中不起重要作用。总而言之，iNPH似乎是多种致病因素共同作用导致了一个自我强化的恶性循环。大多数研究表明，由于血流动力学改变导致脑脊液紊乱。
