光学相干断层扫描显示特发性正常压力脑积水的神经节细胞丢失。

Optical Coherence Tomography Revealing Ganglion Cell Loss in Idiopathic Normal Pressure Hydrocephalus.

机构信息

Department of Neurology, Division of Neurobiology, Linköping University, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Division of Neurobiology, Linköping University, Linköping, Sweden.

出版信息

World Neurosurg. 2021 May;149:e1061-e1066. doi: 10.1016/j.wneu.2021.01.003. Epub 2021 Jan 11.

DOI:10.1016/j.wneu.2021.01.003

PMID:33444824

Abstract

BACKGROUND

Although there may theoretically be a disturbance in the eye or the visual pathways due to abnormal cerebrospinal fluid (CSF) dynamics in idiopathic normal pressure hydrocephalus (iNPH), it has not been studied systemically. Optical coherence tomography (OCT) is a noninvasive, reproducible procedure for quantitative and qualitative analysis of retinal morphology.

METHODS

OCT was used to study the eye fundus before and after a CSF tap test in patients with iNPH compared with healthy individuals (HIs). Twelve patients with iNPH (6 females and 6 males) with a median age of 76 years (64-84 years) and 21 HIs (11 females and 10 males) with a median age of 73 years (64-79 years) were included. The patients underwent neurological, cognitive, and physiotherapeutic evaluation. Brain magnetic resonance imaging, CSF tap test via lumbar puncture, and subsequently CSF analysis were performed. OCT was performed before and after CSF removal. HIs underwent OCT once.

RESULTS

The patients had significantly reduced retinal ganglion cell layer thickness 71 μm (56-81 μm) compared with the HIs, 79.5 μm (72-90 μm) (P = 0.001), but no significant changes were observed before or after the CSF tap test. All patients improved in motor function in a 10-m walk test after the CSF tap test. The median CSF pressure was 15 and 1 cm HO, respectively, before and after lumbar puncture with removal of median 43.5 mL CSF.

CONCLUSIONS

This pilot study shows OCT findings that differ from HIs and implies a rational for becoming a valuable tool in the diagnosis of iNPH. Further studies are warranted to elucidate the pathology of the retina in iNPH.

摘要

背景

特发性正常压力脑积水（iNPH）患者可能因脑脊液（CSF）动力学异常而导致眼部或视觉通路出现理论上的紊乱，但这尚未得到系统研究。光学相干断层扫描（OCT）是一种非侵入性、可重复性的视网膜形态定量和定性分析方法。

方法

我们使用 OCT 比较 iNPH 患者与健康对照者（HCs）在 iNPH 患者行腰椎穿刺脑脊液引流术前后的眼底变化。12 例 iNPH 患者（6 名女性，6 名男性；年龄中位数为 76 岁，范围为 64-84 岁）和 21 例 HCs（11 名女性，10 名男性；年龄中位数为 73 岁，范围为 64-79 岁）纳入研究。患者接受了神经学、认知和物理治疗评估。所有患者均行脑磁共振成像（MRI）、腰椎穿刺脑脊液引流术，并随后进行脑脊液分析。所有患者在 CSF 引流前后均行 OCT 检查，HCs 仅行一次 OCT 检查。

结果

与 HCs 相比，患者的视网膜神经节细胞层厚度明显变薄（71μm，56-81μm），P=0.001，而在腰椎穿刺前后未观察到明显变化。所有患者在腰椎穿刺后行 CSF 引流后 10m 步行试验中运动功能均有改善。腰椎穿刺前、后 CSF 压力中位数分别为 15cmH₂O 和 1cmH₂O，CSF 引流中位数为 43.5mL。