İdiopatik Normal Basınçlı Hidrosefali Hastalarında Kraniyal MR Bulguları

Year 2019, Volume: 5 Issue: 2, 194 - 200, 01.01.2019

Muhammet Bahadır Yılmaz

Abstract

Amaç: Bu makalenin amacı, normal basınçlı hidrosefalide az bilinen veya göz ardı edilen kraniyal MRG bulgularının vurgulanmasıdır. Gereç ve Yöntemler: 2014-2017 yılları arasında, nöroloji tarafından idiopatik normal basınçlı hidrosefali tanısı konmuş hastalardan; yapılan boşaltıcı lomber ponksiyonda pozitif sonuç elde edilip ventriküloperitoneal şant takılan 9 hasta, boşaltıcı lomber ponksiyonda anlamlı klinik düzelme elde edilememesi üzerine şant takılmasından vazgeçilen 3 hasta ve boşaltıcı lombar ponksiyonu kabul etmeyen 4 hastanın preoperatif kraniyal MRI bulguları retrospektif olarak incelendi. Bulgular: İdiopatik normal basınçlı hidrosefali tanısı konan 8 erkek, 8 kadın toplam 16 hastaincelendi. Ortalama yaş 73,6 olarak saptandı. Hastaların %68,75’inde çok belirgin serebral atrofi, %100’ünde temporal hornlarda genişleme, %75’inde silvian fissürde genişleme vardı. Korpus kallozum incelmesi %100, ventrikül çatısında dalgalanma bulging %68,75 oranında saptandı. Ortalama kallozal açı 83,4 derece, şant takılıp fayda gören hastalarda ise 71,6 dereceydi. Evans indeksi ortalama 0.4, 3.ventrikül ortalama çapı 1,49 cm, aquaduct çapı ortalama 2,66 mm olarak ölçüldü. Periventriküler hiperintensite %81,25, beyaz cevher hiperintensitesi %62,5 oranında saptandı. Singulat sulkus bulgusu %37,5, mezensefalon bulgusu %81,25, hidrosefaliyle orantısız subaraknoid alan genişlemesi %81,25 oranında saptandı. Sonuç: Literatürde farklı görüşler olmakla birlikte; preoperatif MR’da 40-90 derecelik kallozal açı, temporal hornların dilatasyonu, hidrosefaliyle orantısız genişlemiş bazal subaraknoid alanlar, periventriküler hiperintensite ve boşaltıcı lombar ponksiyondan fayda görülmesi, şanttan faydalanım açısından pozitif belirteçtir

Keywords

İdiopatik normal basınçlı hidrosefali, ventriküloperitoneal şant, kraniyal MRG

Hydrocephalus Cranial MRI Findings in Idiopathic Normal Pressure

Abstract

Objective: The aim of this article is to emphasize the findings of minimally known or ignored cranial MRI in normal pressure hydrocephalus. Material and Methods: We retrospectively evaluated the preoperative cranial MRI findings of 9 patients where a ventriculoperitoneal shunt was inserted after a positive result withthe lumbar tap test performed by the author, 3 patients where it was decided not to place a shunt as there was no significant clinical improvement on the lumbar tap test performed by the author, and 4 patients who did not accept a lumbar tap test, among our patients diagnosed with idiopathic normal pressure hydrocephalusby the Neurology Department between 2014 and 2017. Results: A total of 16 patients consisting of 8 males and 8 females with a diagnosis of normal pressure hydrocephalus were evaluated. The mean age was 73.6 years. Marked cerebral atrophy was found in 68.75% of the patients, temporal horn dilatation in 100% and Sylvian fissure dilatation in 75%. Corpus callosum thinning was found at a rate of 100% and ventricular roof bulging at 68.75%. The mean callosal angle was 83.4 degrees, decreasing to 71.6 degrees in patients who had benefited from a shunt. The mean Evans index was 0.4, mean 3rd ventricle diameter 1.49 cm, and the mean aqueduct diameter 2.66 mm. Periventricular hyperintensity was present in 81.25% and white matter hyperintensity in 62.5%. A cingulate sulcus finding was observed in 37.5%, a mesencephalon finding in 81.25%, and disproportionate subarachnoid area enlargement in 81.25%. Conclusion: Despite the various views in the literature a 40-90 degree preoperative callosal angle, dilated temporal horns, disproportionately enlarged basal subarachnoid areas, periventricular hyperintensity and benefit from lumbar puncture drainage are positive indicators of benefiting from a shunt

Keywords

Idiopathic normal pressure hydrocephalus, ventriculoperitoneal shunt, cranial magnetic resonance imaging

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