Cerebrospinal fluid markers before and after shunting in patients with secondary and idiopathic normal pressure hydrocephalus

被引：26
作者：
Tullberg M. [1 ]
Blennow K. [1 ]
Månsson J.-E. [1 ]
Fredman P. [1 ]
Tisell M. [1 ]
Wikkelsö C. [1 ]
机构：
[1] Institute of Neuroscience and Physiology, Göteborg University, Sahlgrenska University Hospital
来源：
Cerebrospinal Fluid Research | / 5卷 / 1期
关键词：
Vasoactive Intestinal Peptide; Gamma Amino Butyric Acid; Normal Pressure Hydrocephalus; Normal Pressure Hydrocephalus; Idiopathic Normal Pressure Hydrocephalus;
D O I：
10.1186/1743-8454-5-9
中图分类号：
学科分类号：
摘要：
Background: The aim of this study was to explore biochemical changes in the cerebrospinal fluid (CSF) induced by shunt surgery and the relationship between these changes and clinical improvement. Methods: We measured clinical symptoms and analysed lumbar CSF for protein content, neurodegeneration and neurotransmission markers in patients with secondary (SNPH, n = 17) and idiopathic NPH (INPH, n = 18) before and 3 months after shunt surgery. Patients were divided into groups according to whether or not there was improvement in clinical symptoms after surgery. Results: Preoperatively, the only pathological findings were elevated neurofilament protein (NFL), significantly more so in the SNPH patients than in the INPH patients, and elevated albumin content. Higher levels of NFL correlated with worse gait, balance, wakefulness and neuropsychological performance. Preoperatively, no differences were seen in any of the CSF biomarkers between patients that improved after surgery and those that did not improve. Postoperatively, a greater improvement in gait and balance performance correlated with a more pronounced reduction in NFL. Levels of albumin, albumin ratio, neuropeptide Y, vasoactive intestinal peptide and ganglioside GD3 increased significantly after shunting in both groups. In addition, Gamma amino butyric acid increased significantly in SNPH and tau in INPH. Conclusion: We conclude that a number of biochemical changes occur after shunt surgery, but there are no marked differences between the SNPH and INPH patients. The results indicate that NFL may be a marker that can predict a surgically reversible state in NPH. © 2008 Tullberg et al; licensee BioMed Central Ltd.
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  • [1] Hoglund M(2000)Incidence of surgery for hydrocephalus in adults surveyed: same number afflicted by hydrocephalus as by multiple sclerosis. Lakartidningen 98 1681-1685
  • [2] Tisell M(1994)Regional cerebral blood flow in normal pressure hydrocephalus: diagnostic and prognostic aspects Eur J Nucl Med 21 118-123
  • [3] Wikkelso C(2004)Impaired wakefulness is associated with reduced anterior cingulate CBF in patients with normal pressure hydrocephalus Acta Neurol Scand 110 322-330
  • [4] Larsson A(2004)Changes in cerebral blood flow during cerebrospinal fluid pressure manipulation in patients with normal pressure hydrocephalus: a methodological study J Cereb Blood Flow Metab 24 579-587
  • [5] Bergh AC(1999)Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease J Neurosurg 90 221-226
  • [6] Bilting M(2003)Intracerebral microdialysis and CSF hydrodynamics in idiopathic adult hydrocephalus syndrome J Neurol Neurosurg Psychiatry 74 217-221
  • [7] Arlig A(1991)Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal- pressure hydrocephalus [see comments] AJNR Am J Neuroradiol 12 31-39
  • [8] Jacobsson L(2001)Normal pressure hydrocephalus:Vascular white matter changes on MRI must not exclude patients from shunt surgery Am J Neuroradiol 22 1665-1673
  • [9] Stephensen H(2002)White matter changes in normal pressure hydrocephalus and Binswanger disease: specificity, predictive value and correlations to axonal degeneration and demyelination Acta Neurol Scand 105 417-426
  • [10] Wikkelso C(1985)High cerebrospinal fluid concentration of glial fibrillary acidic protein (GFAP) in patients with normal pressure hydrocephalus J Neurol Sci 70 269-274
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