Normal pressure
hydrocephalus (NPH) is a brain disorder
in which excess cerebrospinal fluid (CSF) accumulates in the brain’s ventricle,
while the pressure of the fluid is usually normal. It is usually characterized
by abnormal gait, urinary incontinence, and (potentially reversible) dementia.
It is most commonly seen in older adults, but it’s not easy to diagnose exactly
and to be treated. The usual treatment is surgical installation of a
ventriculoperitoneal shunt to drain excess CSF into the lining of the abdomen
where the CSF will eventually be absorbed.
To better understand
its pathophysiology, in this paper, in combination with many theories that have
been published in recent years and the experience of diagnosing and operating on
hydrocephalus patients, the authors presented a hypothesis, a model for
observable but unexplained facts, but also “progressive focusing”, a
qualitative method where some experimental facts were used in an effort to
understand a disease that was not fully charted. The hypothesis had
evolved during the search for a meaningful explanation to known problems
regarding the normal pressure hydrocephalus diagnosis. And the authors mainly
introduced the following parts: the ApoE3 theory, head size, arachnoid
granulations and the subpial theory.
And the conclusion
showed that the pathology regarding CSF absorption lied in the subpial spaces
in the basal cisternas and along the great vessels entering the brain. Here the
idiopathic NPH was caused by reduced pulse pressure, which was needed to press
the CSF into the venules. Here the ApoE3/3 genotype with the largest head
percentile seemed to be the most vulnerable. For the acquired type of NPH the
disruption of the subpial space reduced the entrance and subsequent resorption
of CSF. And the arachnoid granulations played no role in resorption of CSF, but
were rather most likely sensory and secretory organs necessary to control
intracranial venous pressure.
Full access: http://mrw.so/1cs7iB
Image by Finda TopDoc, from Flickr-cc.
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