解决内部的魔鬼:正常压力脑积水-叙述性回顾

IF 0.3 Q4 SURGERY Indian Journal of Neurosurgery Pub Date : 2022-07-10 DOI:10.1055/s-0042-1753475
D. Garg, N. Chaudhry
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引用次数: 0

摘要

常压性脑积水(NPH)是成人中最常见的脑积水形式。它的临床特征是经典的三联征,称为哈基姆三联征,包括步态问题,认知障碍和泌尿系统问题。NPH可以是原发性、特发性(iNPH)或继发性。出现特征性的神经影像学特征,这对诊断至关重要。以日本指南和2005年神经外科医生大会指南形式制定的诊断标准,大体上是基于与脑脊液(CSF)测试相关的一系列临床和神经影像学特征。脑脊液穿刺试验、腰椎延伸引流试验和脑脊液输注试验均为侵入性诊断试验。脑脊液穿刺试验和延长腰椎引流用于证明脑脊液引流的临床可逆性,证明这一点的患者可考虑进行脑脊液分流。然而,由于这些试验的阴性预测值较低,不能否定对脑脊液引流无反应的患者对分流的潜在反应。各种分流手术用于治疗,包括脑室腹腔分流、腰腹腔分流和脑室心房分流。内镜下第三脑室造口术也曾尝试过,但成功率有限。在临床特征中,步态异常对分流最敏感。对分流持续的长期反应已被报道。分流术后需要对患者进行细致的随访,以评估临床和神经影像学反应,并发现可能的分流术相关并发症,特别是脑脊液过度引流。早期治疗与更好的预后相关,在出现严重症状之前识别和治疗这种情况至关重要。
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Addressing the Devil Within: Normal Pressure Hydrocephalus—A Narrative Review
Abstract Normal pressure hydrocephalus (NPH) is the most frequently occurring form of hydrocephalus among adults. It is characterized clinically by the classical triad, called Hakim's triad, comprising gait issues, cognitive impairment, and urinary problems. NPH may be primary or idiopathic (iNPH) or secondary. Characteristic neuroimaging features occur, which are vital to diagnosis. Diagnostic criteria in the form of Japanese guideline and Congress of Neurological Surgeons 2005 guidelines have been devised, and broadly, are based on a constellation of clinical and neuroimaging features, in association with cerebrospinal fluid (CSF) testing. CSF tap test, extended lumbar drainage, and CSF infusion tests are invasive diagnostic tests. CSF tap test and extended lumbar drainage are used to demonstrate clinical reversibility with CSF drainage, and patients who demonstrate this are candidates for CSF shunting. However, due to the low negative predictive value of these tests, potential response to shunting cannot be negated among patients who do not respond to CSF drainage. Various shunting procedures are used for treatment, including ventriculoperitoneal, lumboperitoneal, and ventriculoatrial shunts. Endoscopic third ventriculostomy has also been attempted with limited success. Among the clinical features, gait abnormalities are most responsive to shunting. Persistent long-term response to shunting has been reported. Patients need to be meticulously followed up after the shunting procedure, to assess clinical and neuroimaging response, and detect possible shunt-related complications, especially CSF over-drainage. Early treatment is associated with better prognosis, and it is crucial to recognize and treat this condition before the development of severe symptoms.
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CiteScore
0.40
自引率
0.00%
发文量
52
审稿时长
12 weeks
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