![]() In patients with NPH, the corpus callosum can be found elevated upwards, serving as another structural marker for the diagnosis of NPH ( 14). The corpus callosum is a bundle of C-shaped nerve fibers that sits beneath the cerebral cortex, connecting the left and right cerebral hemispheres. The widening of the horns indicates dilated lateral ventricles and a width of 6 mm or more can be seen in iNPH patients ( 13). The temporal horns, or the inferior horns of the lateral ventricles, project anteriorly and inferiorly into the temporal lobe of the brain. Wider Temporal Horns of Lateral Ventricles This morphological change is also useful in diagnosing iNPH ( 12). In addition to the lateral ventricles, the third ventricle also dilates such that on the coronal panels, its wall bows outward rather than concaved (as in normal people). Similar to ordinary individuals, the CSF in iNPH patients flows back and forth through the aqueduct due to cardiac pulse, while a net direction toward the fourth ventricle can be observed. Normal-pressure hydrocephalus, as a special form of communicating hydrocephalus, possesses no obstruction in the flow of CSF. Similar findings also exist in Sylvian fissures and focal sulci, that disproportional widening suggests NPH. Disproportionate enlarged subarachnoid space hydrocephalus is a promising sign for iNPH diagnosis as well as shunting responsiveness ( 9– 11). ![]() It is characterized by more crowded sulci near the superior cortex while larger spaces are seen inferiorly, where CSF accumulates. According to the Japanese guideline, a feature termed DESH can help with the distinguishment. ![]() In addition, clinicians need to first rule out the possibility of cerebral atrophy, which is commonly found in the elder population. Some researchers choose to use the coronal plane at the level of the posterior commissure and discovered that patients with NPH usually have smaller angles (0.3 is not unique to iNPH (i.e., low specificity). The specific measurement of CA depends on the level of the coronal plane selected (perpendicular to the bi-commissural line). Callosal Angle (CA)Ĭallosal angle is another radiological feature that can distinguish NPH and atrophy and eliminate non-hydrocephalus patients. Although the index is not precise and informative enough to help with neither differential diagnosis nor prognostication, it is easy to utilize as it can be performed on ordinary CT or MRI scans without instrumental assistance. Normal-pressure hydrocephalus is a concept first raised by Hakim and Adams in 1965, who defined the disease with two elementary ideas-symptomatic ventriculomegaly and cerebrospinal fluid (CSF) pressure within a normal range (0.3 implies the existence of hydrocephalus. ![]()
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