Graff-Radford N R, Rezai K, Godersky J C, Eslinger P, Damasio H, Kirchner P T
Department of Neurology, University of Iowa College of Medicine, Iowa City.
J Neurol Neurosurg Psychiatry. 1987 Dec;50(12):1589-96. doi: 10.1136/jnnp.50.12.1589.
Regional cerebral blood flow (rcbf) was studied preoperatively and at 2 and 6 months postoperatively in 22 normal pressure hydrocephalus patients using xenon-133 inhalation and single photon emission computed tomography. Sixteen of the 22 patients improved (improved group) and six did not (unimproved group). The following comparisons were made: (1) preoperative rcbf in the improved group, to 14 normal elderly volunteers and to that in 59 SDAT (senile dementia of the Alzheimer type) patients; (2) preoperative rcbf in the improved and unimproved groups to determine if rcbf could predict surgical outcome; (3) pre- to postoperative rcbf in the improved group to see if increased cbf accounted for clinical improvement. The findings were: (1) preoperative rcbf in the improved group was lower than that in normal controls but was the same as that in SDAT; however, the ratios of rcbf values in anterior and posterior brain regions were significantly different between improved group and SDAT (p = 0.02); (2) an anterior/posterior ratio of 1.05 correctly classified surgical outcome in 19/22 patients; five of six in the unimproved group were above this cut off while 14/16 in the improved group were below; (3) in the improved group rcbf increased at 2 but not at 6 months after surgery without a corresponding reduction of clinical signs, supporting the notion that increase in cbf probably does not account for clinical improvement in normal pressure hydrocephalus.
采用氙-133吸入法和单光子发射计算机断层扫描技术，对22例正常压力脑积水患者在术前、术后2个月和6个月进行了局部脑血流量（rcbf）研究。22例患者中16例病情改善（改善组），6例未改善（未改善组）。进行了以下比较：（1）改善组术前rcbf与14名正常老年志愿者以及59名阿尔茨海默型老年痴呆（SDAT）患者的rcbf进行比较；（2）改善组和未改善组术前rcbf，以确定rcbf是否能预测手术结果；（3）改善组术前至术后rcbf，以观察脑血流量增加是否与临床改善有关。结果如下：（1）改善组术前rcbf低于正常对照组，但与SDAT患者相同；然而，改善组与SDAT患者脑前后区域rcbf值的比率有显著差异（p = 0.02）；（2）前后比率为1.05时，可正确分类22例患者中的19例手术结果；未改善组6例中有5例高于此临界值，而改善组16例中有14例低于此临界值；（3）改善组术后2个月rcbf增加，但6个月时未增加，且临床体征无相应减轻，这支持了脑血流量增加可能与正常压力脑积水临床改善无关的观点。
