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. 2014 Aug;1(8):562-9.
doi: 10.1002/acn3.87. Epub 2014 Jul 28.

Disproportionate subarachnoid space hydrocephalus-outcome and perivascular space

Ichiro Akiguchi  1 , Yoshitomo Shirakashi  2 , Herbert Budka  3 , Yuko Watanabe  4 , Toshiyuki Watanabe  5 , Akihiko Shiino  5 , Mihoko Ogita  6 , Yasuhiro Kawamoto  6 , Susanne Jungwirth  7 , Wolfgang Krampla  8 , Peter Fischer  9
Affiliations

Disproportionate subarachnoid space hydrocephalus-outcome and perivascular space

Ichiro Akiguchi et al. Ann Clin Transl Neurol. 2014 Aug.

Abstract

Objective: We sought to identify the prevalence of MRI features of disproportionately enlarged subarachnoid space hydrocephalus in possible idiopathic normal pressure hydrocephalus (DESH-iNPH) and to describe the clinico-radiological features and outcomes of a community-based investigation (The Vienna Trans-Danube Aging study).

Methods: Of the 697 inhabitants (all 75 years old), 503 completed extensive neurological examinations at baseline and were followed up every 30 months thereafter with MRIs, mini-mental state examination (MMSE), and the Unified Parkinson Disease Rating Scale-Motor Section (UPDRSM). The DESH-iNPH participant data were compared with the data from participants with Evans index ratios >0.3 (ex vacuo hydrocephalus), cerebral small-vessel diseases, and normal MRIs. The widening of perivascular space was also evaluated by MRI in these groups.

Results: Eight participants with DESH-iNPH (1.6%) and 76 with ex vacuo hydrocephalus (16.1%) at baseline were identified. The mean MMSE in DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs was 26.4, 27.9, and 28.3, respectively, and the mean UPDRSM was 9.75, 2.96, and 1.87, respectively. After a 90-month follow-up, the mortality rates for DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs were 25.0%, 21.3%, and 10.9%, respectively. The perivascular-space widening scores were significantly smaller in the DESH-iNPH cases, particularly at the centrum semiovale, compared to cerebral small-vessel disease and ex vacuo hydrocephalus cases.

Interpretation: The prevalence of DESH-iNPH was 1.6% for participants aged 75 years and revealed significantly lower MMSE and higher UPDRSM scores compared to the ex vacuo hydrocephalus and controls. Moreover, it is suggested that perivascular-space narrowing is a morphological and pathophysiological marker of DESH-iNPH.

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Figures

Figure 1
Figure 1
T1-weighted MRI images from eight participants with DESH-iNPH at baseline. DESH-iNPH, MRI features of disproportionately enlarged subarachnoid space hydrocephalus in possible idiopathic normal pressure hydrocephalus.
See this image and copyright information in PMC

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