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Rev Med Interne 2021 Jun 15. Epub 2021 Jun 15.

Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Université de Bordeaux, CNRS UMR 5287, INCIA, Zone nord, Bat 2, 2e étage, 146, rue Léo-Saignat, 33076 Bordeaux cedex, France.

Formerly called normal pressure hydrocephalus, communicating chronic hydrocephalus (CCH) is a condition affecting 0.1 to 0.5% of patients over 60years of age. Read More

J Neurol Surg Rep 2021 Jan 14;82(2):e17-e20. Epub 2021 Jun 14.

Department of Neurosurgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.

Shunt failure requiring reintervention remains a common complication of hydrocephalus treatment. Here, we report a novel cause of mechanical shunt obstruction in an adult patient: position-dependent intermittent occlusion via an infusion port catheter. A 51-year-old woman with a grade II oligodendroglioma presented in a delayed fashion following surgery with a pseudomeningocele. Read More

CNS Spectr 2021 Apr;26(2):160-161

University of Florida College of Medicine, Department of Psychiatry, Gainesville, FL, USA.

Background: Othello syndrome, also known as morbid jealousy, pathological jealousy, and conjugal paranoia, is a rare delusional disorder related to partner's infidelity. There are no large scale or comprehensive studies on delusional jealousy, and only few case reports and cases series leave delusional disorder jealous type (DDJT) largely unknown. Herein, we report a case of DDJT, its possible etiology and describe its characteristics, comorbidities, and interventions. Read More

Clin Radiol 2021 Jun 4. Epub 2021 Jun 4.

Neurology Department, Bolu İzzet Baysal State Hospital, Bolu, Turkey.

Aim: To investigate changes in olfactory bulb (OB) volume in patients with idiopathic normal-pressure hydrocephalus (NPH).

Materials And Methods: This multicentric retrospective study included a test group of 23 patients with NPH (10 male and 13 female patients) and a control group of 27 healthy participants without hydrocephalus. The OB volume in all participants had been measured using cranial magnetic resonance imaging (MRI). Read More

AJNR Am J Neuroradiol 2021 May 27. Epub 2021 May 27.

From the Departments of Radiology and Research Institute of Radiology (H.Y.P., C.H.S., M.J.K., W.H.S., S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Background: Disproportionately enlarged subarachnoid space hydrocephalus is a specific radiologic marker for idiopathic normal pressure hydrocephalus. However, controversy exists regarding the prognostic utility of disproportionately enlarged subarachnoid space hydrocephalus.

Purpose: Our aim was to evaluate the prevalence of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus and its predictive utility regarding prognosis in patients treated with ventriculoperitoneal shunt surgery. Read More

Heliyon 2021 May 7;7(5):e06982. Epub 2021 May 7.

Department of Medical Imaging, School of Medical Sciences, College of Health and Allied Sciences, University of Cape Coast, P.M.B University of Cape Coast, Cape Coast, Ghana.

Introduction: Normal-Pressure Hydrocephalus (NPH) is a neurological condition which is made up of a clinical triad of gait disturbance, dementia and urinary incontinence and can be reversed by ventricular shunting. Currently, some guidelines suggest the use of Evans' index (EI) for diagnosis of hydrocephalus radiologically. Most of the studies are based on the Western population data. Read More

Eur Radiol 2021 May 15. Epub 2021 May 15.

Duke-NUS Medical School, Singapore, Singapore.

Objectives: To evaluate the utility of the splenial angle (SA), an axial angular index of lateral ventriculomegaly measured on diffusion tensor MRI color fractional anisotropy maps, in differentiating NPH from Alzheimer's disease (AD), Parkinson's disease (PD), and healthy controls (HC), and post-shunt changes in NPH, compared to Evans' index and callosal angle.

Methods: Evans' index, callosal angle, and SA were measured on brain MRI of 76 subjects comprising equal numbers of age- and sex-matched subjects from each cohort of NPH, AD, PD, and HC by two raters. Receiver operating characteristics (ROC) and multivariable analysis were used to assess the screening performance of each measure in differentiating and predicting NPH from non-NPH groups respectively. Read More

J Neurosci Rural Pract 2021 Apr 23;12(2):412-418. Epub 2021 Apr 23.

Division of Neuroradiology, Department of Neuroimaging and interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, India.

 Overlap of normal pressure hydrocephalus (NPH) and pathology proven cases of dementia is known. The objective of this paper is to correlate both the clinical and multimodality imaging findings in patients with imaging diagnosis NPH and give a hypothesis for association of clinical findings.  This is a retrospective observational analysis of 13 cases patients who were referred to molecular imaging center for imaging in 2016 to 2019, and they were divided into four groups based on structural imaging findings. Read More

World Neurosurg 2021 Apr 22. Epub 2021 Apr 22.

Department of Neurosurgery, Nayoro General Hospital, Nayoro City, Japan.

Background: Surgical treatment of idiopathic normal pressure hydrocephalus (iNPH) by ventriculoperitoneal (VP) or lumboperitoneal (LP) shunting can achieve long-term recovery of activities of daily living; however, in a subset of patients, maintenance of independence lasted for <6 months. This study examined positive preoperative predictive factors of short-term outcome for shunted iNPH patients.

Methods: Over a 9-year period, consecutive patients from multiple centers diagnosed with probable iNPH underwent either VP or LP shunt surgery. Read More

AJNR Am J Neuroradiol 2021 Apr 22. Epub 2021 Apr 22.

Imaging and Functional Medicine (J.Z.), University Hospital of Umeå, Umeå, Sweden

Background And Purpose: Systematic analysis of angulation-related variability of idiopathic normal pressure hydrocephalus imaging biomarkers has not been published yet. Our aim was to evaluate the variability of these radiologic biomarkers with respect to imaging plane angulation.

Materials And Methods: Eighty subjects (35 with clinically confirmed idiopathic normal pressure hydrocephalus and 45 age- and sex-matched healthy controls) were prospectively enrolled in a 3T brain MR imaging study. Read More

Zhonghua Yi Xue Za Zhi 2021 Apr;101(15):1093-1096

Department of Neurology, the First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou 510080, China.

Three cases with age-related cerebral small vessel disease and normal pressure hydrocephalus in the Department of Neurology of Sun Yat-sen University were retrospectively reviewed. All the patients exhibited gait disturbance, cognitive impairment and urinary incontinence. Meanwhile, the Craniocerebral imaging demonstrated cerebral small vessel disease and communicating hydrocephalus. Read More

World Neurosurg 2021 Apr 13. Epub 2021 Apr 13.

Department of Neurosurgery, Yale University School of Medicine, New Haven, CT; Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT. Electronic address:

Objective: For idiopathic normal pressure hydrocephalus (iNPH), risk stratifying patients and identifying those who are likely to fare well after ventriculoperitoneal shunt (VP) surgery may help improve quality of care and reduce unplanned readmissions. The aim of this study was to investigate the drivers of 30- and 90-day readmissions following VP shunt surgery for iNPH in elderly patients.

Methods: The Nationwide Readmission Database years 2013 - 2015 was queried. Read More

Acta Neurochir Suppl 2021 ;131:343-347

Division of Neurosurgery, Department of Clinical Neuroscience, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.

Introduction: Challenges in diagnosing post-traumatic hydrocephalus (PTH) have created a need for an accurate diagnostic tool. We aim to report CSF dynamics in PTH and atrophy, along with differences before and after cranioplasty.

Methods: We retrospectively analyzed traumatic brain injury patients with ventriculomegaly who had infusion studies. Read More

Acta Neurochir Suppl 2021 ;131:307-309

Academic Neurosurgery, Cambridge University Hospital, Cambridge, UK.

The relationship between intracranial pulse amplitude (AMP) and mean intracranial pressure (ICP) has been previously described. Generally, AMP increases proportionally to rises in ICP. However, at low ICP a lower breakpoint (LB) of amplitude-pressure relationship can be observed, below which pulse amplitude stays constant when ICP varies. Read More

N Engl J Med 2021 Apr;384(14):1350-1358

From the Departments of Psychiatry (F.M., B.W.), Radiology (M.G.), and Neurosurgery (W.T.C.), Massachusetts General Hospital, and the Departments of Psychiatry (F.M., B.W.), Radiology (M.G.), and Neurosurgery (W.T.C.), Harvard Medical School - both in Boston.

No Shinkei Geka 2021 Mar;49(2):317-327

Department of Neurosurgery, Shiga University of Medical Science.

Hydrocephalus is caused by excessive accumulation of cerebrospinal fluid(CSF)in the ventricles or the skull. Unlike acute hydrocephalus presenting with elevated intracranial pressure, chronic hydrocephalus is called normal-pressure hydrocephalus(NPH). Because the CSF volume increases slowly, the brain compressively deforms without increasing intracranial pressure. Read More

BMC Surg 2021 Mar 21;21(1):154. Epub 2021 Mar 21.

Department of Neurosurgery, Li Hui Li Hospital of Medical Centre of Ningbo, No. 1111 Jiangnan Road, Yinzhou District, Ningbo, 315041, China.

Background: Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon but important complication of ventriculoperitoneal (VP) shunts. While individual articles have reported many cases of abdominal CSF pseudocyst following VP shunts, no case of a hemorrhagic abdominal pseudocyst after VP shunts has been reported so far.

Case Presentation: This article reports a 68-year-old woman with a 4-month history of progressive abdominal pain and distention. Read More

J Neurol Surg B Skull Base 2021 Feb 26;82(Suppl 1):S45-S47. Epub 2020 Nov 26.

Department of Neurosurgery, Tuen Mun Hospital, Hong Kong Special Administrative Region, Tuen Mun, Hong Kong.

We report a case of craniocervical junction dural arteriovenous fistula (dAVF) presented with myelopathy and normal pressure hydrocephalus, and was treated with hybrid approach of embolization and surgical disconnection. A 68-year-old gentleman presented with 1 year history of unsteady gait and sphincter disturbance. Magnetic resonance imaging (MRI) showed abnormally enlarged and tortuous vessels over right cerebellomedullary cistern. Read More

Front Neurol 2021 25;12:636518. Epub 2021 Feb 25.

Department of Radiology, Health Science Center, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.

The purpose of this study was to measure the diffusion spectrum imaging (DSI) parameters of corticospinal tracts (CSTs) and evaluate diffusional changes in CSTs in patients with idiopathic normal pressure hydrocephalus (iNPH) by DSI. Twenty-three iNPH patients and twenty-one healthy controls (HCs) were involved in this study. Brain DSI data for all participants were collected through the same MR scanning procedure. Read More

World Neurosurg 2021 May 1;149:e1-e10. Epub 2021 Mar 1.

Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA. Electronic address:

Objective: It is difficult to predict which patients with idiopathic normal pressure hydrocephalus (iNPH) will improve after shunt surgery. This study investigated the association between preoperative imaging parameters in patients with iNPH and long-term outcome after shunt placement.

Methods: Patients with iNPH who showed a response to large-volume cerebrospinal fluid drainage and subsequently underwent ventriculoperitoneal shunt surgery were reviewed. Read More

J Neurol Sci 2021 04 29;423:117329. Epub 2021 Jan 29.

Department of Neurology, Yozgat City Hospital, Yozgat, Turkey. Electronic address:

Ann Indian Acad Neurol 2020 Sep-Oct;23(5):625-631. Epub 2020 Dec 8.

Radiology Clinic, Yozgat City Hospital, Yozgat, Turkey.

Objective: To investigate the frequency of previously defined neuroimaging signs of normal pressure hydrocephalus in our NPH patient group with positive cerebrospinal fluid (CSF) tap test response.

Methods: Twenty-two patients with probable NPH and 33 healthy control individuals were enrolled in this study. Previously defined 9 parameters including Evan's index, narrow high convexity sulci, dilation of the Sylvian fissures, focally enlarged sulci, enlargement of the temporal horns, callosal angle, periventricular hyperintensities, bulging of the lateral ventricular roof, and disproportionately enlarged subarachnoid space hydrocephalus were evaluated on conventional magnetic resonance imaging. Read More

Front Neurol 2021 1;12:596294. Epub 2021 Feb 1.

Department of Medical Imaging, Soroka Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.

Benign external hydrocephalus (BEH) is defined by rapid increase in head circumference in infancy, with neuroimaging evidence of enlarged cerebrospinal fluid (CSF) spaces. BEH was postulated to predispose to subdural hematoma, neurocognitive impairments, and autism. There is currently no consensus on BEH diagnostic criteria and no biomarkers to predict neurological sequalae. Read More

Neurosurg Rev 2021 Feb 15. Epub 2021 Feb 15.

Institute of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy.

Objective: In a previous work, we found that an Intracranial Elastance Index (IEI) ≥0.3 at ventricular infusion test had a high accuracy in predicting shunt response at 6 and 12 months in idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to verify the accuracy of IEI to predict response to shunt at both short- and long-term follow-up. Read More

Clin Neuroradiol 2021 Jan 26. Epub 2021 Jan 26.

Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.

Background And Purpose: As magnetic resonance imaging (MRI) signs of normal pressure hydrocephalus (NPH) may precede clinical symptoms we sought to evaluate an algorithm that automatically detects this pattern.

Methods: A support vector machine (SVM) was trained in 30 NPH patients treated with ventriculoperitoneal shunts and 30 healthy controls. For comparison, four neuroradiologists visually assessed sagittal MPRAGE images and graded them as no NPH pattern, possible NPH pattern, or definite NPH pattern. Read More

Clin Interv Aging 2021 15;16:139-153. Epub 2021 Jan 15.

Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan 410008, People's Republic of China.

Idiopathic normal pressure hydrocephalus (iNPH) is a rare neurological disorder with no clear prevalence factors and is a significant danger to the elderly. The intracranial glymphatic system is the internal environment that maintains brain survival and metabolism, and thus fluid exchange changes in the glymphatic system under various pathological conditions can provide important insights into the pathogenesis and differential diagnosis of many neurodegenerative diseases such as iNPH. iNPH can be diagnosed using a combination of clinical symptoms, imaging findings and history, and cerebrospinal fluid biomarkers due to the glymphatic system disorder. Read More

Parkinsonism Relat Disord 2021 01 13;82:158-159. Epub 2021 Jan 13.

Center for Neurological Restoration and Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA. Electronic address:

AJNR Am J Neuroradiol 2021 03 21;42(3):479-486. Epub 2021 Jan 21.

From the Department of Neurosurgery (S.Y., K.N.), Shiga University of Medical Science, Shiga, Japan.

Background And Purpose: Oscillatory shear stress could not be directly measured in consideration of direction, although cerebrospinal fluid has repetitive movements synchronized with heartbeat. Our aim was to evaluate the important of oscillatory shear stress in the cerebral aqueduct and foramen magnum in idiopathic normal pressure hydrocephalus by comparing it with wall shear stress and the oscillatory shear index in patients with idiopathic normal pressure hydrocephalus.

Materials And Methods: By means of the 4D flow application, oscillatory shear stress, wall shear stress, and the oscillatory shear index were measured in 41 patients with idiopathic normal pressure hydrocephalus, 23 with co-occurrence of idiopathic normal pressure hydrocephalus and Alzheimer-type dementia, and 9 age-matched controls. Read More

Neurosurgery 2021 03;88(4):812-818

Department of Neurosurgery, University of Texas Southwestern Medical School, Dallas, Texas.

Background: Placement of the distal shunt catheter into the peritoneum during ventriculoperitoneal shunt (VPS) surgery can be done with either laparoscopic assistance or laparotomy.

Objective: To compare outcomes in laparoscopic-assisted vs laparotomy for placement of VPS in the Medicare population.

Methods: Patients undergoing VPS placement, between 2004 and 2014, were identified by International Classification of Disease, Ninth Revision and Current Procedural Terminology codes in the Medicare database. Read More

Mov Disord 2020 11;35(11):2121

Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.