Hydrocephalus, normal-pressure

Drug-induced dopamine antagonists and depletors Hemiatrophy-hemiparkinsonism Hydrocephalus Normal pressure hydrocephalus Hypoxia... 

Brettschneider, J., el al. (2004). Meningeal derived cerebrospinal fluid proteins in different forms of dementia is a meningopathy involved in normal pressure hydrocephalus J. Neurot Neurosurg. Psychiatry 75, 1614-16. 

Mase, M., et al. (2003). Lipocalin-type prostaglandin D synthase (beta-trace) in cerebrospinal fluid a useful marker for the diagnosis of normal pressure hydrocephalus. Neurosci. Res. 47, 455-9. 

Normal pressure hydrocephalus Urinary incontinence, difficulty walking... 

Table 10.4 lists the various medications that can be stopped and medical illnesses that can be treated to reverse dementia. In some cases, such as hypothyroidism or dehydration, the reversal can be complete. More often, the dementia is only partially reversed or its further progression is halted. Examples of these partial improvements include normal pressure hydrocephalus and vitamin B12 deficiency. 

To deal with the different disorders included in this section would be excessive therefore, we focus on dementia in Alzheimer s disease (AD]. Nevertheless, the less specific treatment options for AD are also complementary options to the usual treatment approaches for other forms of dementia or cognitive deficits in which etiological or more specific treatments may be useful (e.g., dementia in normal pressure hydrocephalus). 

Other disorders that may kill cholinergic and other neurons, thus leading to memory loss. Vascular dementia, formerly multi-infarct dementia, is characterized by dementia that classically has a more stepwise downhill course as compared with Alzheimer s disease, which has a more smoothly progressive downhill course. Multi-infact dementia is caused by multiple strokes, which damage the brain sufficiently to cause dementia and often cause focal neurological signs and symptoms as well. Normal pressure hydrocephalus can cause dementia from dilated cerebral ventricles. Creutzfeldt-... 

Disorders with space-occupying effect Primary brain tumor Metastatic brain tumor Subdural hematoma (posttrauma) Normal-pressure hydrocephalus Neurosurgical management... 

Interstitial edema is seen in the periventricular regions in patients with hydrocephalus (Fig. 9). The widened extracellular space is the site of transependymal flow of CSF. The movement of ISF into the frontal white matter leads to difficulty walking and incontinence in the syndrome of normal pressure hydrocephalus. 

Marmarou A, Black P, Beigsneider M, KUnge P, Relkin N (2005) Guidelines for management of idiopathic normal pressure hydrocephalus progress to date. Acta Neurochir Suppl 95 237-240... 

In addition, other possible causes of dementia also need to be excluded, especially the treatable forms of cognitive impairment, such as that due to depression, chronic drug intoxication, chronic central nervous system infection, thyroid disease, vitamin deficiencies (i.e.. Bn and thiamine), central nervous system angitis, and normal-pressure hydrocephalus (Bird, 2008). Individuals who do not meet these criteria but have short-term memory loss and have only minimal impairment in other cognitive abilities and are not functionally impaired at work or at home are considered to have mild cognitive impairment (Petersen et al., 2001). 

Tsunoda A, Mitsuoka H, Bandai H, Endo T, Aral H, Sato K (2002) Lidacraiiial cerebrospinal fluid measurement studies in suspected idiopadnc normal pressure hydrocephalus, secondary normal pressure hydrocephalus, and brain atrophy. J Neurol Neurosurg Psychiatry 73 552—555. 

Increased intracranial pressure in normal pressure hydrocephalus patients has been described (SEDA-17, 79). An acute dystonic reaction has been reported in an untreated patient with Parkinson s disease (SEDA-16, 78). 

Neoplasms or strokes in the regions of the nigrostriatal pathways Traumatic lesions interrupting substantia nigra projections Normal-pressure hydrocephalus Parkinsonism with other neuronal system degenerations Wilson s disease (copper deposition in the brain)... 

Dementia due to other general medical condition (e.g, normal-pressure hydrocephalus, hypothyroidism, brain tumor, vitamin B12 deficiency, intracranial radiation)... 

Mixed Alzheimer s and vascular dementia Normal pressure hydrocephalus... 

Fig. 6.8 Statistical Images showing the F- FDGimagesof glucose utilization in the brains of patients with frontotemporal dementia (FTD) progressive supranuclear palsy (PSP) mild dementia of Alzheimertype (MID) and normal pressure hydrocephalus (NPH).

Many other possible causes of dialysis dementia have been proposed. These inclnde other trace element contaminants, normal pressure hydrocephalus, slow virus infection of the central nervous system, and regional alterations in cerebral blood flow (Arieff, 1990). Slow virus infection of the nervous system is a possible etiology for dialysis dementia. The clinical manifestations resemble those of other slow virus infections, such as Kuru or Creutzfeldt-Jakob disease (Selkoe, 1978 4714 Gajdusek, 1985 1662). 

Other central nervous system conditions that cause progressive deficiencies in memory and cognition (e.g., cerebrovascular disease, Parkinson s disease, Huntington s disease, subdural hematoma, normal-pressure hydrocephalus, brain tumour)... 

CT excludes gross problems, e.g. tumour, subdural haematoma, normal pressure hydrocephalus. Request specific features, e.g. atrophy excessive/regional/hippocanpal small vessel disease and extent of this... 

Single doses of [ F]flutemetamol injection were generally well tolerated in 15 patients with possible normal pressure hydrocephalus. Four of the 15 patients experienced a total of four adverse events (dizziness, headache, abdominal pain and throat irritation) [58 ]. Eleven subjects experienced a total of 14 adverse events, most were mild intensity with no severe events occurred in 52 patients with suspected normal pressure hydrocephalus underwent [ F]flute-metamol PET imaging for detection of cerebral cortical fibrillar amyloid 3. The most frequently reported adverse event was increased blood pressure, five events reported in five subjects [59 ]. 

Leinonen V, Rinne JO, Virtanen BCA, Eskola O, Rummukainen J, Huttunen J, et al. Positron emission tomography with [ F]flutemetamol and pCJPiB for in vivo detection of cerebral cortical amyloid in normal pressure hydrocephalus patients. Eur J Neurol official J Eur Fed Neurol Soc July 2013 20(7) 1043-52. 

Rinne JO, Wong DF, WoUc DA, Leinonen V, Arnold SE, Buckley C, et al. pFJFlutemetamol PET imaging and cortical biopsy histopathology for fibrillar amyloid beta detection in Uving subjects with normal pressure hydrocephalus pooled analysis of four studies. Acta neuropathol December 2012 124(6) 833-45. 

Brain disorders that cause imbalance and/or spasticity might be overlooked, for example, potentially treatable ones such as normal-pressure hydrocephalus, subdural hematoma (e.g. in a patient on anticoagulant therapy who has recently fallen), and early abscess or tumor. Other brain disorders affecting balance and gait are various. 

Frequent falls from loss of balance, memory impairment, and urinary incontinence are three common complaints in older patients, and should not be dismissed as "simply a part of aging." MRI of the head and cervical spine could reveal various treatable neurological/neurosurgical conditions. Normal-pressure hydrocephalus is important to be recognized, because treatment might dramatically benefit the patient s quality of life, including safety when walking, and perhaps improve the patient s memory. 

---