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J Neurol Neurosurg Psychiatry 2004;75:1141-1148 doi:10.1136/jnnp.2003.019943
  • Paper

Magnetic resonance spectroscopic determination of a neuronal and axonal marker in white matter predicts reversibility of deficits in secondary normal pressure hydrocephalus

  1. A Shiino1,
  2. Y Nishida2,
  3. H Yasuda3,
  4. M Suzuki4,
  5. M Matsuda1,
  6. T Inubushi5
  1. 1Department of Neurosurgery, Shiga University of Medical Science, Shiga, Japan
  2. 2Department of Ophthalmology, Shiga University of Medical Science
  3. 3Department of Neurology, Shiga University of Medical Science
  4. 4Department of Otolaryngology, Shiga University of Medical Science
  5. 5Department of Molecular Neuroscience Research Centre, Shiga University of Medical Science
  1. Correspondence to:
 Dr A Shiino
 Department of Neurosurgery, Shiga University of Medical Science, Seta, Ohtsu, Shiga 520-2192, Japan; shiinobelle.shiga-med.ac.jp
  • Received 30 May 2003
  • Accepted 26 October 2003
  • Revised 26 September 2003

Abstract

Background: Normal pressure hydrocephalus (NPH) is considered to be a treatable form of dementia, because cerebrospinal fluid (CSF) shunting can lessen symptoms. However, neuroimaging has failed to predict when shunting will be effective.

Objective: To investigate whether 1H (proton) magnetic resonance (MR) spectroscopy could predict functional outcome in patients after shunting.

Methods: Neurological state including Hasegawa’s dementia scale, gait, continence, and the modified Rankin scale were evaluated in 21 patients with secondary NPH who underwent ventriculo-peritoneal shunting. Outcomes were measured postoperatively at one and 12 months and were classified as excellent, fair, or poor. MR spectra were obtained from left hemispheric white matter.

Results: Significant preoperative differences in N-acetyl aspartate (NAA)/creatine (Cr) and NAA/choline (Cho) were noted between patients with excellent and poor outcome at one month (p = 0.0014 and 0.0036, respectively). Multiple regression analysis linked higher preoperative NAA/Cr ratio, gait score, and modified Rankin scale to better one month outcome. Predictive value, sensitivity, and specificity for excellent outcome following shunting were 95.2%, 100%, and 87.5%. Multiple regression analysis indicated that NAA/Cho had the best predictive value for one year outcome (p = 0.0032); predictive value, sensitivity, and specificity were 89.5%, 90.0%, and 88.9%.

Conclusions: MR spectroscopy predicted long term post-shunting outcomes in patients with secondary NPH, and it would be a useful assessment tool before lumbar drainage.

Footnotes

  • Competing interests: none declared

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