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Improvement after cerebrospinal fluid drainage is related to levels of N-acetyl-aspartate in idiopathic normal pressure hydrocephalus
Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap. Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF). Neurologi.
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Diagnostisk radiologi.
Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF).
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2008 (Engelska)Ingår i: Neurosurgery, ISSN 0148-396X, E-ISSN 1524-4040, Vol. 62, nr 1, s. 135-142Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: This study uses proton magnetic resonance spectroscopy to investigate whether or not idiopathic normal pressure hydrocephalus is associated with neuronal dysfunction or ischemia in the brain. We evaluate whether or not proton magnetic resonance spectroscopy is useful for predicting improvement after long-term external lumbar drainage (ELD) of cerebrospinal fluid.

METHODS: Eighteen patients (mean age, 73 yr; six women) and 10 matching controls participated. Participants were characterized by clinical features, cognitive and motor function tests, and cerebrospinal fluid hydrodynamics (patients only). Signals from N-acetyl-aspartate (NAA), choline, lactate, and creatine (Cr) (reference) were sampled once in controls and twice in patients (before and after a 3-day ELD of approximately 135 mL/24 h) by proton magnetic resonance spectroscopy (1.5 T) from a 7.2-mL volume in the frontal white matter. Improvement was defined by video recordings of the patients' gait.

RESULTS: Sixteen patients finished the ELD (one patient had meningitis, and one patient had catheter insertion failure) with a mean drain volume of 395 mL. NAA/Cr ratios were lower in patients than in controls (1.60 versus 1.84, P = 0.02), but no difference was found for choline/Cr ratios. No lactate signals were detected. Fifty percent of patients improved after ELD. They had higher NAA/Cr ratios than nonimproved patients (1.70 versus 1.51, P = 0.01), but no differences were found in choline/Cr ratios or drain volume.

CONCLUSION: NAA/Cr ratios were decreased in patients with idiopathic normal pressure hydrocephalus, which is consistent with neuronal dysfunction in the frontal white matter. Improved patients had NAA/Cr ratios close to normal, indicating that enough functional neurons are a prerequisite for the cerebrospinal fluid drainage to have an effect.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2008. Vol. 62, nr 1, s. 135-142
Nyckelord [en]
ischemia, lactate, lumbar puncture, N-acetyl-aspartate, neuronal integrity, periventricular white matter lesions, spectroscopy
Nationell ämneskategori
Neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-9380DOI: 10.1227/01.NEU.0000311070.25992.05PubMedID: 18300900OAI: oai:DiVA.org:umu-9380DiVA, id: diva2:149051
Tillgänglig från: 2008-03-28 Skapad: 2008-03-28 Senast uppdaterad: 2019-08-07Bibliografiskt granskad

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Lenfeldt, NiklasHauksson, JónBirgander, RichardEklund, AndersMalm, Jan

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Lenfeldt, NiklasHauksson, JónBirgander, RichardEklund, AndersMalm, Jan
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Klinisk neurovetenskapCentrum för medicinsk teknik och fysik (CMTF)RadiofysikDiagnostisk radiologi
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