正常压力脑积水腰穿放液试验及脑室腹腔分流术疗效的初步临床分析
|
摘要
目的探讨正常压力脑积水(Normal Pressure Hydrocephalus,NPH)患者行腰穿放液试验(The Cerebrospinal Fluid Tap Test,CSFTT)及脑室腹腔分流术后步态障碍、认知障碍及影像学改善情况和变化特点。方法回顾性分析2017年12月～2018年9月就诊于中国医科大学神经内科的5例经CSFTT及脑室腹腔分流术证实的NPH患者的临床资料及影像学资料,并进行对比分析。结果 5例患者CSFTT结果均阳性,其中最长为发病3 y后行CSFTT。5例患者步态障碍、简易精神状态检查(Mini-mental State Examination,MMSE)及蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA量表)评分在CSFTT后8 h及24 h改善最显著(最多达85%),Rey听觉词语学习测验(Rey auditory verbal learning test,RAVLT)及日常生活能力量表(Activity of daily living,ADL)评分在CSFTT后无明显变化,在脑室腹腔分流术后逐渐改善;连线测验、排尿功能及影像学在CSFTT及脑室腹腔分流术后均无明显变化。结论正常压力脑积水患者在发病后3 y行CSFTT及脑室腹腔分流术仍有效; MMSE、Mo CA可作为正常压力脑积水患者CSFTT后首选的认知功能改善评价指标,RAVLT及ADL评分可有效用于脑室腹腔分流术的疗效评估。
Objective To explore the characteristics of gait disorder,cognitive impairment and imaging improvement after the cerebrospinal fluid tap test and ventricular peritoneal shunt in patients with normal pressure hydrocephalus. Methods The clinical data and imaging data of 5 patients with normal pressure hydrocephalus confirmed by cerebrospinal fluid tap test and ventricular peritoneal shunt in the Department of Neurology of China Medical University from December 2017 to September 2018 were analyzed and compared retrospectively. Results The longest onset time of the 5 patients was 3 years before taking the cerebrospinal fluid tap test,and the cerebrospinal fluid tap test results of 5 patients were all positive; The 5 patients' B gait disorder,MMSE and MoCA improved most obviously 8 h and 24 h after the cerebrospinal fluid tap test( up to85%). The RAVLT and ADL scores did not change obviously after the cerebrospinal fluid tap test,but gradually improved after the ventricular peritoneal shunt. The connection test,urination function and imaging were not significantly changed after the cerebrospinal fluid tap test and ventricular peritoneal shunt. Conclusions The patients with normal pressure hydrocephalus undergoing the cerebrospinal fluid tap test and ventricular peritoneal shunt in 3 years after the onset are still effective. For patients of normal pressure hydrocephalus,MMSE and MoCA can be used as the first evaluation of cognitive function improvement after the cerebrospinal fluid tap test; RAVLT and ADL may be used as effective evaluation indicators for ventricular peritoneal shunt.
Objective To explore the characteristics of gait disorder,cognitive impairment and imaging improvement after the cerebrospinal fluid tap test and ventricular peritoneal shunt in patients with normal pressure hydrocephalus. Methods The clinical data and imaging data of 5 patients with normal pressure hydrocephalus confirmed by cerebrospinal fluid tap test and ventricular peritoneal shunt in the Department of Neurology of China Medical University from December 2017 to September 2018 were analyzed and compared retrospectively. Results The longest onset time of the 5 patients was 3 years before taking the cerebrospinal fluid tap test,and the cerebrospinal fluid tap test results of 5 patients were all positive; The 5 patients' B gait disorder,MMSE and MoCA improved most obviously 8 h and 24 h after the cerebrospinal fluid tap test( up to85%). The RAVLT and ADL scores did not change obviously after the cerebrospinal fluid tap test,but gradually improved after the ventricular peritoneal shunt. The connection test,urination function and imaging were not significantly changed after the cerebrospinal fluid tap test and ventricular peritoneal shunt. Conclusions The patients with normal pressure hydrocephalus undergoing the cerebrospinal fluid tap test and ventricular peritoneal shunt in 3 years after the onset are still effective. For patients of normal pressure hydrocephalus,MMSE and MoCA can be used as the first evaluation of cognitive function improvement after the cerebrospinal fluid tap test; RAVLT and ADL may be used as effective evaluation indicators for ventricular peritoneal shunt.
引文
[1]Hakim S,Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics[J]. J Neurol Sci,1965,2(4):307-327.
[2]中华医学会神经外科学分会.中国特发性正常压力脑积水诊治专家共识(2016)[J].中华医学杂志,2016,96(21):1635-1638.
[3]Ringstad G,Vatnehol S,Eide PK. Glymphatic MRI in idiopathic normal pressure hydrocephalus[J]. Brain,2017,140(10):2691-2705.
[4]Baird G,Montine TJ,Chang JJ,et al. Cerebrospinal Fluid Total Tau is Increased in Normal Pressure Hydrocephalus Patients who Undergo Successful Lumbar Drain Trials[J]. Cureus,2017,9(5):e1265.
[5]中国痴呆与认知障碍指南写作组. 2018中国痴呆与认知障碍诊治指南[J].中华医学杂志,2018,98(13):965-1142.
[6]Miyajima M,Kazui H,Mori E,et al. One-year outcome in patients with idiopathic normal-pressure hydrocephalus:comparison of lumboperitoneal shunt to ventriculoperitoneal shunt[J]. J Neurosurg,2016,125(6):1483-1492.
[7]Ishikawa M,Yamada S,Yamamoto K. Early and delayed assessments of quantitative gait measures to improve the tap test as a predictor of shunt effectiveness in idiopathic normal pressure hydrocephalus[J].Fluids Barriers CNS,2016,13(1):20.
[8]Matsuoka T,Iida JI,Kawahara M,et al. Investigation and clinical applications of muscle strength change in cerebrospinal fluid tap test in cases of idiopathic normal pressure hydrocephalus:A retrospective study[J]. J Neurol Sci,2016,371:18-23.
[9]Sakka L,Chomicki A,Gabrillargues J,et al. Validation of a noninvasive test routinely used in otology for the diagnosis of cerebrospinal fluid shunt malfunction in patients with normal pressure hydrocephalus[J]. J Neurosurg,2016,124(2):342-349.
[10]Schniepp R,Trabold R,Romagna A,et al. Walking assessment after lumbar puncture in normal-pressure hydrocephalus:a delayed improvement over 3 days[J]. J Neurosurg,2017,126(1):1-10.
[11]Scully AE,Ecw L,Teow PP,et al. A systematic review of the diagnostic utility of simple tests of change after trial removal of cerebrospinal fluid in adults with normal pressure hydrocephalus[J]. Clin Rehabil,2018,32(7):942-953.
[12]Shaw R,Everingham E,Mahant N,et al. Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus[J]. J Clin Neurosci,2016,29(1):81-86.
[13]Vakili S,Moran D,Hung A,et al. Timing of surgical treatment for idiopathic normal pressure hydrocephalus:association between treatment delay and reduced short-term benefit[J]. Neurosurg Focus,2016,41(3):2.
[14]Brix M K,Westman E,Simmons A,et al. The Evans’Index revisited:New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly[J]. Eur J Radiol,2017,95(6):28-32.
[15]Narita W,Nishio Y,Baba T,et al. High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus[J]. Am J Neuroradiol,2016,37(10):1831-1837.
[16]Yamada S,Ishikawa M,Yamamoto K. Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease[J]. AJNR Am J Neuroradiol,2016,37(7):1249-1255.
[2]中华医学会神经外科学分会.中国特发性正常压力脑积水诊治专家共识(2016)[J].中华医学杂志,2016,96(21):1635-1638.
[3]Ringstad G,Vatnehol S,Eide PK. Glymphatic MRI in idiopathic normal pressure hydrocephalus[J]. Brain,2017,140(10):2691-2705.
[4]Baird G,Montine TJ,Chang JJ,et al. Cerebrospinal Fluid Total Tau is Increased in Normal Pressure Hydrocephalus Patients who Undergo Successful Lumbar Drain Trials[J]. Cureus,2017,9(5):e1265.
[5]中国痴呆与认知障碍指南写作组. 2018中国痴呆与认知障碍诊治指南[J].中华医学杂志,2018,98(13):965-1142.
[6]Miyajima M,Kazui H,Mori E,et al. One-year outcome in patients with idiopathic normal-pressure hydrocephalus:comparison of lumboperitoneal shunt to ventriculoperitoneal shunt[J]. J Neurosurg,2016,125(6):1483-1492.
[7]Ishikawa M,Yamada S,Yamamoto K. Early and delayed assessments of quantitative gait measures to improve the tap test as a predictor of shunt effectiveness in idiopathic normal pressure hydrocephalus[J].Fluids Barriers CNS,2016,13(1):20.
[8]Matsuoka T,Iida JI,Kawahara M,et al. Investigation and clinical applications of muscle strength change in cerebrospinal fluid tap test in cases of idiopathic normal pressure hydrocephalus:A retrospective study[J]. J Neurol Sci,2016,371:18-23.
[9]Sakka L,Chomicki A,Gabrillargues J,et al. Validation of a noninvasive test routinely used in otology for the diagnosis of cerebrospinal fluid shunt malfunction in patients with normal pressure hydrocephalus[J]. J Neurosurg,2016,124(2):342-349.
[10]Schniepp R,Trabold R,Romagna A,et al. Walking assessment after lumbar puncture in normal-pressure hydrocephalus:a delayed improvement over 3 days[J]. J Neurosurg,2017,126(1):1-10.
[11]Scully AE,Ecw L,Teow PP,et al. A systematic review of the diagnostic utility of simple tests of change after trial removal of cerebrospinal fluid in adults with normal pressure hydrocephalus[J]. Clin Rehabil,2018,32(7):942-953.
[12]Shaw R,Everingham E,Mahant N,et al. Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus[J]. J Clin Neurosci,2016,29(1):81-86.
[13]Vakili S,Moran D,Hung A,et al. Timing of surgical treatment for idiopathic normal pressure hydrocephalus:association between treatment delay and reduced short-term benefit[J]. Neurosurg Focus,2016,41(3):2.
[14]Brix M K,Westman E,Simmons A,et al. The Evans’Index revisited:New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly[J]. Eur J Radiol,2017,95(6):28-32.
[15]Narita W,Nishio Y,Baba T,et al. High-Convexity Tightness Predicts the Shunt Response in Idiopathic Normal Pressure Hydrocephalus[J]. Am J Neuroradiol,2016,37(10):1831-1837.
[16]Yamada S,Ishikawa M,Yamamoto K. Comparison of CSF Distribution between Idiopathic Normal Pressure Hydrocephalus and Alzheimer Disease[J]. AJNR Am J Neuroradiol,2016,37(7):1249-1255.