Ryuji Sakakibara1,2, Yoshitaka Uchida3, Kazunari Ishii4, Masaaki Hashimoto5, Masaaki Ishikawa6, Hiromitsu Kazui7, Tatsuya Yamamoto8, Tomoyuki Uchiyama9, Fuyuki Tateno10, Masahiko Kishi10, Yohei Tsuyusaki10, Yosuke Aiba10, Hiromi Tateno10, Takeki Nagao11, Hitoshi Terada12, Tsutomu Inaoka12. 1. Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan. sakakibara@sakura.med.toho-u.ac.jp. 2. Neurology, Chiba University, Chiba, Japan. sakakibara@sakura.med.toho-u.ac.jp. 3. Radiology, Sanno Hospital, Chiba, Japan. 4. Center for Early Diagnosis of Dementia, Kinki University, Sayama, Japan. 5. Neurosurgery, Kohritsu Noto Hospital, Ishikawa, Japan. 6. Neurosurgery, Kitano Hospital, Kyoto, Japan. 7. Psychiatry, Osaka University, Osaka, Japan. 8. Neurology, Chiba University, Chiba, Japan. 9. Continence Center, Dokkyo Medical College, Tochigi, Japan. 10. Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan. 11. Neurosurgery, Sakura Medical Center, Toho University, Sakura, Japan. 12. Radiology, Sakura Medical Center, Toho University, Sakura, Japan.
Abstract
AIMS OF STUDY: It is reported that severe bladder disorder in idiopathic normal-pressure hydrocephalus (iNPH) is predicted by right frontal hypoperfusion. However, it is not known whether bladder recovery is predicted by brain perfusion change after shunt surgery. To address this issue, we compared bladder and brain function before and after shunt surgery in iNPH. METHODS: We enrolled 75 patients in the study. Before and 12 months after shunt surgery, we analyzed brain perfusion by SPECT and bladder disorder by a specialized grading scale. The scale consisted of grade 0, none; grade 1, urinary urgency and frequency; grade 2, urinary incontinence 1-3 times a week; grade 3, urinary incontinence >daily; and grade 4, loss of bladder control. More than one grade improvement is defined as improvement, and more than one grade decrement as worsening; otherwise no changes. RESULTS: Comparing before and after surgery, in the bladder-no-change group (32 cases) there was an increase in blood flow which is regarded as reversal of enlargement in the Sylvian fissure and lateral ventricles (served as control). In contrast, in the bladder-improved group (32 cases) there was an increase in bilateral mid-cingulate, parietal, and left frontal blood flow (p < 0.05). In the bladder-worsened group (11 cases) no significant blood flow change was observed. CONCLUSION: The present study showed that after shunt surgery, bladder recovery is related with mid-cingulate perfusion increase in patients with iNPH. The underlying mechanism might be functional restoration of the mid-cingulate that normally inhibits the micturition reflex.
AIMS OF STUDY: It is reported that severe bladder disorder in idiopathic normal-pressure hydrocephalus (iNPH) is predicted by right frontal hypoperfusion. However, it is not known whether bladder recovery is predicted by brain perfusion change after shunt surgery. To address this issue, we compared bladder and brain function before and after shunt surgery in iNPH. METHODS: We enrolled 75 patients in the study. Before and 12 months after shunt surgery, we analyzed brain perfusion by SPECT and bladder disorder by a specialized grading scale. The scale consisted of grade 0, none; grade 1, urinary urgency and frequency; grade 2, urinary incontinence 1-3 times a week; grade 3, urinary incontinence >daily; and grade 4, loss of bladder control. More than one grade improvement is defined as improvement, and more than one grade decrement as worsening; otherwise no changes. RESULTS: Comparing before and after surgery, in the bladder-no-change group (32 cases) there was an increase in blood flow which is regarded as reversal of enlargement in the Sylvian fissure and lateral ventricles (served as control). In contrast, in the bladder-improved group (32 cases) there was an increase in bilateral mid-cingulate, parietal, and left frontal blood flow (p < 0.05). In the bladder-worsened group (11 cases) no significant blood flow change was observed. CONCLUSION: The present study showed that after shunt surgery, bladder recovery is related with mid-cingulate perfusion increase in patients with iNPH. The underlying mechanism might be functional restoration of the mid-cingulate that normally inhibits the micturition reflex.
Authors: Otto Lilja-Lund; Karin Kockum; Per Hellström; Lars Söderström; Lars Nyberg; Katarina Laurell Journal: Sci Rep Date: 2020-10-23 Impact factor: 4.379