常压脑积水的病理生理学在多大程度上得到了澄清?

Mori, Mima
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引用次数: 17

摘要

特发性常压脑积水(NPH)的病因和病理生理学仍然知之甚少。我们回顾了最近3年(1994- 1996)关于NPH的相关文献[Crit Rev neurosurgery(1997):263-275],并回顾了主要出现在1997年的进一步手稿。最近的研究表明特发性NPH可能是一种原发性脑实质疾病,而不是脑脊液(CSF)吸收障碍。特发性NPH的病理生理学范围很广,从脑脊液吸收缺陷引起的纯粹流体动力学问题到缺血性血管危险因素引起的血流动力学问题引起的实质改变。NPH的磁共振成像(MRI)常显示缺血性血管性脑病。NPH可能与皮层下白质血管性脑病共存,因为Binswanger脑病和特发性NPH具有共同的临床症状。大多数疑似NPH的患者可能同时遭受这两种问题。由于MRI显示疑似NPH,血管病变引起的缺血性实质改变已受到重视。疑似NPH的脑活检结果提示存在血管病变引起的实质改变,如动脉硬化。脑活检发现阿尔茨海默病的患者可能受益于分流术。脑活检所见的病理改变并不是NPH的特异性。迄今积累的有关NPH的信息显示其具有广泛的临床谱和多因素病因。因此,NPH患者是不均匀的,这给分流患者的诊断和选择带来了困难。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
To what extent has the pathophysiology of normal-pressure hydrocephalus been clarified?

The causes and pathophysiology of idiopathic normal-pressure hydrocephalus (NPH) still remain poorly understood. We reviewed the recent pertinent literature on NPH from the past 3 years (1994- 1996) in this journal [Crit Rev Neurosurg (1997) 7:263-275] and here review further manuscripts that appeared mainly in 1997. Recent investigations suggest that idiopathic NPH may be a primary cerebral parenchymal disease rather than a disorder of cerebrospinal fluid (CSF) absorption. The pathophysiology of idiopathic NPH has a wide spectrum ranging from purely hydrodynamic problems owing to a CSF absorption defect to parenchymal changes caused by hemodynamic problems owing to ischemic vascular risk factors. Magnetic resonance imaging (MRI) of NPH frequently shows ischemic vas-cular encephalopathy. NPH may coexist with subcortical white matter vascular encephalopathy, because Binswanger's encephalopathy and idiopathic NPH share common clinical symptoms. Most patients with suspected NPH may suffer from both problems. Because of MRI findings of suspected NPH, ischemic parenchymal changes caused by vasculopathy have been receiving attention. Brain biopsy findings of suspected NPH suggest the presence of parenchymal changes caused by vasculopathy such as arteriosclerosis. Patients with brain biopsy findings of Alzheimer's disease may benefit from shunting. Pathological changes seen by brain biopsy are not specific for NPH. The information accumulated so far about NPH shows a wide clinical spectrum and multifactorial etiology. Therefore, patients with NPH are inhomogeneous, and this makes it difficult to diagnose and select patients for shunting.

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