Diagnostic importance of disproportionately enlarged subarachnoid space hydrocephalus and Callosal Angle measurements in the context of normal pressure hydrocephalus: A useful tool for clinicians

Hydrocephalus is a clinical and neurologic condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF). Currently, idiopathic Normal Pressure Hydrocephalus (iNPH) is recognized as a late-onset neurologic disorder defined by a clinical triad of gait disturbance, urinary incontine...

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Bibliographic Details
Published in:Journal of the neurological sciences 2024-11, Vol.466, p.123250, Article 123250
Main Authors: Petersen, Gabriela, Ortega-Matute, Eduardo, Perez-Nieto, Daniela, Inzunza, Andrés, Garcia Navarro, Victor
Format: Article
Language:English
Subjects:
Cerebrospinal fluid
Diagnosis
Hydrocephalus
MRI
NPH
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Summary:Hydrocephalus is a clinical and neurologic condition characterized by an abnormal accumulation of cerebrospinal fluid (CSF). Currently, idiopathic Normal Pressure Hydrocephalus (iNPH) is recognized as a late-onset neurologic disorder defined by a clinical triad of gait disturbance, urinary incontinence, and dementia. Imaging studies often reveal a disproportionate increase in subarachnoid space and ventricular size relative to brain volume, with normal CSF pressure during lumbar puncture. Recent developments in neuroimaging have led to the establishment of criteria for diagnosing and managing iNPH, incorporating the concept of Disproportionately Enlarged Subarachnoid-space Hydrocephalus (DESH). Distinguishing iNPH from the natural neurological aging process and other forms of dementia, wherein brain atrophy and hydrocephalus ex vacuo can be observed, can present challenges for both neurologists and neuroradiologists. Despite DESH becoming a radiologic criterion for diagnosing iNPH in some guidelines, its recognition remains limited. •iNPH is characterized by alterations in gait, cognition, and urinari incontinence.•Diagnosing iNPH requires a combination of a detailed clinical history, phyisical examination, CSF.OP measurement, and brain imaging findings, particularly DESH.•DESH has been associated with adequate diagnosis and patient selection for definitive treatment and has an important prognostic role.•Despite its importance in refining the diagnostic criteria for iNPH, DESH remains underrecognized.
ISSN:0022-510X
1878-5883
1878-5883
DOI:10.1016/j.jns.2024.123250