Cerebral hemodynamics in normal-pressure hydrocephalus

Evaluation by 133Xe inhalation method and dynamic CT study

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✓ Cerebral hemodynamics in 31 patients with suspected normal-pressure hydrocephalus were studied by means of the xenon-133 (133Xe) inhalation method and on dynamic computerized tomography (CT) scanning. Cerebral blood flow (CBF) is reduced in all patients with dementia. Hypoperfusion was noted in a frontal distribution in these patients compared with normal individuals. There was no difference in CBF patterns between patients with good and those with poor outcome. The CBF was increased following cerebrospinal fluid (CSF) shunting in patients who responded to that procedure: increase in flow correlated with clinical improvement, frontal and temporal lobe CBF was most markedly increased, and the CBF pattern became normal. In contrast, CBF was decreased after shunt placement in patients who were considered to have suffered from degenerative dementia, as evidenced by non-response to shunting.

Dynamic computerized tomography studies demonstrated that patients with a good outcome showed a postoperative reduction in mean transit time of contrast material, most prominent in the frontal and temporal gray matter, and slight in the deep frontal structures, but not in the major cerebral vessels. Patients with poor outcome after shunting, however, had an increase in transit time in all regions. This corresponded well with the results as determined by the 133Xe inhalation method.

Article Information

Address reprint requests to: Norihiko Tamaki, M.D., Department of Neurosurgery, Kobe University School of Medicine, 5-1 Kusunoki-cho, 7-chome, Chuo-ku, Kobe 650, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Mean preoperative cerebral blood flow (CBF) from both hemispheres of the patients with suspected normal-pressure hydrocephalus. Patients are grouped according to the quality of response to cerebrospinal fluid shunting. ISI = initial slope index; NS = not significant.

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    Pattern of regional cerebral blood flow (CBF) distribution in normal individuals and in patients with suspected normal-pressure hydrocephalus. ISI = initial slope index.

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    Correlation of increase in cerebral blood flow (CBF) with clinical outcome of cerebrospinal fluid shunting. ISI = initial slope index.

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    Correlation of percentage increase in regional cerebral blood flow with the clinical result of shunt placement. Cross-hatched boxes: excellent and good results; black boxes: excellent results; dotted boxes: good results; white boxes: poor results.

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    Effect of cerebrospinal fluid shunting on regional cerebral blood flow (CBF). ISI = initial slope index. *** = p < 0.001; * = p < 0.05; open circle = excellent and good results; cross = poor results.

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    Change of mean transit time (m.T.T.) after cerebrospinal fluid shunting. Measurements are taken preoperatively and twice during the postoperative phase.

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    Functional computerized tomography brain image of mean transit time in a patient who responded to cerebrospinal fluid shunting (left) and in a patient who did not respond to shunting (right). The white areas indicate slow transit time; black areas indicate rapid transit time.

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