USING OF ROUTINE MRI SEQUENCES FOR EVALUATION OF IDIOPATHIC NORMAL PRESSURE HYDROCEPHALUS

Idiopathic normal pressure hydrocephalus (Hakim-Adams syndrome, iNPH) is a chronic neurodegenerative disease of elderly associated with ventricular expansion, and characterized by gait disturbance, mental deterioration, and urinary incontinence. It becomes more important with increasing of elderly part of population. Important feature of iNPH is it’s reversibility in case of early surgical treatment. One of the main problem is the differential diagnosis between iNPH and other neurodegenerative diseases and detection of patients which would be most benefit with shunting. In this purpose a number of radiological symptoms and signs have been proposed. Assessment of MR symptoms of iNPH increases the accuracy of diagnosis and allows in some cases to avoid the necessity of invasive diagnostic procedures (e.g. tap-test, infusion test, external lumbar drainage, ICP monitoring etc.) with lower risk of complications, less duration of treatment and minimizing negative personal experience. At the same time, assessing of most sensitive iNPH radiological symptoms allows to evolve candidates for shunting at prehospital stage and reduce the duration of treatment.

Background and purpose: systematization and synthesis of data on radiological symptoms of iNPH in order to identify most simple and at the same time significant diagnostic and prognostic criteria.

Matherials and methods. The search was performed in PubMed, Google Scholar and Cochrane Library by key words «normal pressure hydrocephalus», «neuroimaging», «magnetic resonance imaging», «computed tomography, radiological symptoms». In addition, data from references were used.

Results. Most specific and sensitive radiological criteria for diagnosis of iNPH are following: Evans index, DESH, temporal horns dilation, callosal angle, periventricular edema, perivascular spaces dilation and local sulci dilation. Complex assessment of this symptoms increases diagnostic accuracy and in some cases allows to avoid the necessity of invasive diagnostic procedures. 

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