Department of Radiology, Baoji Center Hospital, Baoji, Shaanxi, China.
Department of Pharmaceutics, Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Selangor, Puncak Alam Campus, Bandar Puncak Alam 42300, Selangor, Malaysia.
Curr Drug Targets. 2019;20(10):1041-1057. doi: 10.2174/1389450120666190214121342.
Normal pressure hydrocephalus (NPH) is a critical brain disorder in which excess Cerebrospinal Fluid (CSF) is accumulated in the brain's ventricles causing damage or disruption of the brain tissues. Amongst various signs and symptoms, difficulty in walking, slurred speech, impaired decision making and critical thinking, and loss of bladder and bowl control are considered the hallmark features of NPH.
The current review was aimed to present a comprehensive overview and critical appraisal of majorly employed neuroimaging techniques for rational diagnosis and effective monitoring of the effectiveness of the employed therapeutic intervention for NPH. Moreover, a critical overview of recent developments and utilization of pharmacological agents for the treatment of hydrocephalus has also been appraised.
Considering the complications associated with the shunt-based surgical operations, consistent monitoring of shunting via neuroimaging techniques hold greater clinical significance. Despite having extensive applicability of MRI and CT scan, these conventional neuroimaging techniques are associated with misdiagnosis or several health risks to patients. Recent advances in MRI (i.e., Sagittal-MRI, coronal-MRI, Time-SLIP (time-spatial-labeling-inversion-pulse), PC-MRI and diffusion-tensor-imaging (DTI)) have shown promising applicability in the diagnosis of NPH. Having associated with several adverse effects with surgical interventions, non-invasive approaches (pharmacological agents) have earned greater interest of scientists, medical professional, and healthcare providers. Amongst pharmacological agents, diuretics, isosorbide, osmotic agents, carbonic anhydrase inhibitors, glucocorticoids, NSAIDs, digoxin, and gold-198 have been employed for the management of NPH and prevention of secondary sensory/intellectual complications.
Employment of rational diagnostic tool and therapeutic modalities avoids misleading diagnosis and sophisticated management of hydrocephalus by efficient reduction of Cerebrospinal Fluid (CSF) production, reduction of fibrotic and inflammatory cascades secondary to meningitis and hemorrhage, and protection of brain from further deterioration.
正常压力脑积水（NPH）是一种严重的脑部疾病，脑室内积聚了过多的脑脊液，导致脑组织受损或破坏。在各种症状和体征中，行走困难、言语不清、决策和思维能力受损以及膀胱和肠道控制丧失被认为是 NPH 的主要特征。
本综述旨在全面概述和批判性评估主要用于 NPH 的神经影像学技术，以进行合理诊断和有效监测所采用治疗干预的效果。此外，还对治疗脑积水的药理学制剂的最新发展和应用进行了批判性评估。
考虑到与分流手术相关的并发症，通过神经影像学技术对分流进行持续监测具有更大的临床意义。尽管 MRI 和 CT 扫描具有广泛的适用性，但这些常规神经影像学技术与误诊或对患者的若干健康风险相关。MRI 的最新进展（即矢状位 MRI、冠状位 MRI、时间-时空标记反转脉冲（Time-SLIP）、PC-MRI 和弥散张量成像（DTI））在 NPH 的诊断中显示出有前途的适用性。由于与手术干预相关的多种不良反应，非侵入性方法（药理学制剂）引起了科学家、医疗专业人员和医疗保健提供者的更大兴趣。在药理学制剂中，利尿剂、异山梨酯、渗透剂、碳酸酐酶抑制剂、糖皮质激素、非甾体抗炎药、地高辛和金 198 已被用于治疗 NPH 和预防继发性感觉/智力并发症。
合理诊断工具和治疗方式的应用可避免误导性诊断和对脑积水进行复杂管理，方法是通过有效减少脑脊液（CSF）的产生、减少脑膜炎和出血引起的纤维化和炎症级联反应，以及保护大脑免受进一步恶化。
