RESUMEN
Despite a variety of diagnostic methods, differentiation of symptoms of normal pressure hydrocephalus from those of atrophic processes of the brain is still a difficult task. In the present study an attempt of non-invasive differential diagnosis of normal pressure hydrocephalus (NPH) and brain atrophy (BA) was presented using volumetric analysis of CT images of the head by means of VisNow proprietary software. The analysis was based on the number of voxels converted to the amount of cerebrospinal fluid (CSF) in the subarachnoid space, skull base casters, and the ventricular system. The results demonstrate that the mean volumes of CSF in these compartments in patients with NPH differed significantly from those in BA. Similarly, the mean volumes of CSF in the subarachnoid space and skull base casters in patients with BA differed significantly from those in NPH. Volumetric assessment presented in the paper by application of VisNow software seems useful in the evaluation of NPH and brain BA.
Asunto(s)
Encefalopatías/diagnóstico por imagen , Hidrocéfalo Normotenso/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Programas Informáticos , Tomografía Computarizada por Rayos X/métodos , Anciano , Algoritmos , Atrofia/diagnóstico por imagen , Atrofia/patología , Encefalopatías/patología , Diagnóstico por Computador , Diagnóstico Diferencial , Humanos , Hidrocéfalo Normotenso/patología , Persona de Mediana Edad , Modelos Biológicos , Base del Cráneo/diagnóstico por imagen , Base del Cráneo/patología , Espacio Subaracnoideo/diagnóstico por imagen , Espacio Subaracnoideo/patologíaRESUMEN
Poor postural balance is one of the major risk factors for falling in normal pressure hydrocephalus (NPH). Postural instability in the clinic is commonly assessed based upon force platform posturography. In this study we focused on the identification of changes in sway characteristics while standing quiet in patients with NPH before and after shunt implantation. Postural sway area and sway radius were analyzed in a group of 9 patients and 46 controls of both genders. Subject's spontaneous sway was recorded while standing quiet on a force platform for 30-60 s, with eyes open and then closed. Both analyzed sway descriptors identified between-group differences and also an effect of shunt implantation in the NPH group. Sway radius and sway area in patients exhibited very high values compared with those in the control group. Importantly, the effect of eyesight in patients was not observed before shunt implantation and reappeared after the surgical treatment. The study documents that static force platform posturography may be a reliable measure of postural control improvement due to shunt surgery.
Asunto(s)
Hidrocéfalo Normotenso/cirugía , Equilibrio Postural , Derivación Ventriculoperitoneal , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hidrocéfalo Normotenso/fisiopatología , Masculino , Persona de Mediana Edad , Visión OcularRESUMEN
Gait and body balance disturbances are important clinical problems in patients with normal pressure hydrocephalus (NPH). They affect patients' locomotion and lead to a higher risk of falls. The gait pattern may be described as durations of the single and double support and of a stance phase. The aim of the present study was to apply the pattern recognition methods for the evaluation of gait disturbances in patients with NPH before and after neurosurgical treatment (shunt implantation). The results indicate that the parameters measured with a Computer DynoGraphy (CDG) system may effectively differentiate changes of gait in patients with NPH.