Pyrgelis Efstratios-Stylianos, Paraskevas George P, Constantinides Vasilios C, Boufidou Fotini, Velonakis Georgios, Stefanis Leonidas, Kapaki Elisabeth
1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece.
Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece.
J Clin Med. 2022 May 20;11(10):2898. doi: 10.3390/jcm11102898.
The aim of the present study was the implementation of the composite imaging "Radscale" in patients with idiopathic normal pressure hydrocephalus (iNPH) and the evaluation of its score, as well as absolute stroke volume and peak flow velocity of cerebrospinal fluid (CSF) in aqueduct as indicators of a positive response following a tap test. Forty-five patients with iNPH were included. Clinical evaluation involved the 10 m timed walk test before and every 24 h for 3 consecutive days after evacuative lumbar puncture (LP). Neuropsychological evaluation comprised a mini mental state examination (MMSE), frontal assessment battery (FAB), 5-word test (5WT) and CLOX drawing test 1 and 2, which were carried out before and 48 h after LP. The tap test's response was defined as a ≥20% improvement in gait and/or a ≥10% improvement in neuropsychological tests. All scores of neuropsychological and clinical variables, except for immediate 5WT and CLOX-1, differed significantly before and 48 h after LP. Improvement in time and steps of a 10 m timed walk test differed significantly between female and male patients. Out of 45 total patients, 19 were tap test responders and 26 non-responders. The total score of Radscale and CSF flow parameters did not differ between responders and non-responders. However, "Callosal angle" sub-score differed significantly between these two groups. A greater "callosal angle" sub-score, meaning more acute callosal angle, was associated with a positive tap test response, rendering it a useful measurement in the stratification of iNPH patients that will potentially respond to CSF shunting.
本研究的目的是在特发性正常压力脑积水（iNPH）患者中应用复合成像“Radscale”，并评估其评分以及中脑导水管脑脊液（CSF）的绝对卒中体积和峰值流速，作为腰穿试验后阳性反应的指标。纳入了45例iNPH患者。临床评估包括在减压性腰椎穿刺（LP）前以及之后连续3天每天24小时进行的10米定时步行测试。神经心理学评估包括简易精神状态检查（MMSE）、额叶评估量表（FAB）、5字测试（5WT）以及CLOX绘图测试1和2，这些测试在LP前和LP后48小时进行。腰穿试验的反应定义为步态改善≥20%和/或神经心理学测试改善≥10%。除了即时5WT和CLOX - 1外，所有神经心理学和临床变量的评分在LP前和LP后48小时均有显著差异。女性和男性患者在10米定时步行测试的时间和步数改善方面存在显著差异。在45例患者中，19例为腰穿试验反应者，26例为无反应者。反应者和无反应者之间Radscale总分和CSF流动参数没有差异。然而，这两组之间“胼胝体角”子评分存在显著差异。更大的“胼胝体角”子评分，即胼胝体角更尖锐，与腰穿试验阳性反应相关，使其成为iNPH患者分层中一个有用的测量指标，这些患者可能对CSF分流有反应。
