Abstract
Background: Virchow-Robin spaces (VRSs) surround perforating cerebral arteries and are reported to be found with increasing frequency with advancing age. In addition, some studies indicate an association between VRSs and vascular dementias. The present study examined the incidence of VRSs in patients with idiopathic normal pressure hydrocephalus (INPH) and considered their use as a potential surrogate imaging marker of coexisting microvascular disease in patients with this condition.
Methods: The MRI incidence of VRS in the centrum semiovale (CS), basal ganglia (BG), mesencephalon (MES), and the subinsular (SI) region was measured in 12 patients with INPH and in 12 control subjects, using the scoring system proposed by Patankar et al. (Am J Neuroradiology 26:1512, 2005). Historical control data were also used for further comparison.
Results: All 12 INPH patients had clearly visible VRSs, distributed in the CS (all 12), basal ganglia (11/12), SI region (9/12), and MES region (6/12). The mean Patankar scores of the INPH group were BG 2.25, CS 1.66, SI 0.91, and ME 0.5. The respective scores for our control group were 1.41, 1.5, 1.16, and 0.16, and for historical controls were 1.46, 0.51, 0.96, and 0.51. There were, however, no statistically significant differences between the INPH patients and either of the control groups. No correlation was found between age and the overall incidence of VRS.
Conclusion: This preliminary study suggests that there may be a higher incidence of VRSs in patients with INPH, when compared with normal patients of similar age, but our small numbers prevent us from demonstrating statistical significance, and larger studies are clearly required.
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References
Abbott NJ (2004) Evidence for bulk flow of brain interstitial fluid: significance for physiology and pathology. Neurochem Int 45:545–552
Bateman G (2002) Pulse-wave encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus. Neuroradiology 44:740–748
Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Hermans J (1999) Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg 90:221–226
Bradley WG Jr, Whittemore AR, Watanabe AS, Davis SJ, Teresi LM, Homyak M (1991) Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal-pressure hydrocephalus. AJNR Am J Neuroradiol 12:31–39
Corkill RG, Garnett MR, Blamire AM, Rajagopalan B, Cadoux-Hudson TA, Styles P (2003) Multi-modal MRI in normal pressure hydrocephalus identifies pre-operative haemodynamic and diffusion coefficient changes in normal appearing white matter correlating with surgical outcome. Clin Neurol Neurosurg 105:193–202
Davson H (ed) (1956) Physiology of the ocular and cerebrospinal fluids. Churchill, London
Kondziella D, Sonnewald U, Tullberg M, Wikkelso C (2008) Brain metabolism in adult chronic hydrocephalus. J Neurochem 106:1515–1524
Krauss JK, Droste DW, Vach W, Regel JP, Orszagh M, Borremans JJ, Tietz A, Seeger W (1996) Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions. Neurosurgery 39:292–299; discussion 299–300
Krauss JK, Regel JP, Vach W, Orszagh M, Jungling FD, Bohus M, Droste DW (1997) White matter lesions in patients with idiopathic normal pressure hydrocephalus and in an age-matched control group: a comparative study. Neurosurgery 40:491–495; discussion 495–496
Kristensen B, Malm J, Fagerland M, Hietala SO, Johansson B, Ekstedt J, Karlsson T (1996) Regional cerebral blood flow, white matter abnormalities, and cerebrospinal fluid hydrodynamics in patients with idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 60:282–288
MacLullich AMJ, Wardlaw JM, Ferguson KJ, Starr JM, Seckl JR, Deary IJ (2004) Enlarged perivascular spaces are associated with cognitive function in healthy elderly men. J Neurol Neurosurg Psychiatry 75:1519
Momjian S, Owler BK, Czosnyka Z, Czosnyka M, Pena A, Pickard JD (2004) Pattern of white matter regional cerebral blood flow and autoregulation in normal pressure hydrocephalus. Brain 127:965–972
Panczel G, Bönöczk P, Voko Z, Spiegel D, Nagy Z (2000) Impaired vasoreactivity of the basilar artery system in patients with brainstem lacunar infarcts. Cerebrovasc Dis 9:218–223
Patankar TF, Mitra D, Varma A, Snowden J, Neary D, Jackson A (2005) Dilatation of the Virchow-Robin space is a sensitive indicator of cerebral microvascular disease: study in elderly patients with dementia. AJNR Am J Neuroradiol 26:1512
Proescholdt MG, Hutto B, Brady LS, Herkenham M (1999) Studies of cerebrospinal fluid flow and penetration into brain following lateral ventricle and cisterna magna injections of the tracer [14C] inulin in rat. Neuroscience 95:577–592
Pullen RGL, Cserr HF (1984) Pressure dependent penetration of CSF into brain. Federation Proc 43:2521
Rennels ML, Blaumanis OR, Grady PA (1990) Rapid solute transport throughout the brain via paravascular fluid pathways. Adv Neurol 52:431
Silverberg GD (2004) Normal pressure hydrocephalus (NPH): ischaemia, CSF stagnation or both. Brain 127:947–948
Symon L, Dorsch NWC (1975) Use of long-term intracranial pressure measurement to assess hydrocephalic patients prior to shunt surgery. J Neurosurg 42:258–273
Tarnaris A, Toma AK, Kitchen ND, Watkins LD (2009) Ongoing search for diagnostic biomarkers in idiopathic normal pressure hydrocephalus. Biomarkers 3:787–805
Vorstrup S, Christensen J, Gjerris F, Sorensen PS, Thomsen AM, Paulson OB (1987) Cerebral blood flow in patients with normal-pressure hydrocephalus before and after shunting. J Neurosurg 66:379–387
Weller RO (1998) Pathology of cerebrospinal fluid and interstitial fluid of the CNS: significance for Alzheimer disease, prion disorders and multiple sclerosis. J Neuropathol Exp Neurol 57:885
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Tarnaris, A. et al. (2012). Virchow-Robin Spaces in Idiopathic Normal Pressure Hydrocephalus: A Surrogate Imaging Marker for Coexisting Microvascular Disease?. In: Aygok, G., Rekate, H. (eds) Hydrocephalus. Acta Neurochirurgica Supplementum, vol 113. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0923-6_7
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