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A BIOLOGICAL RHYTHM IN A PATIENT WITH NORMAL PRESSURE HYDROCEPHALUS:COMPARATIVE STUDIES IN PRE- AND POSTOPERATIVE PATIENTS BY A POLYGRAPHY Hiroji Kuchiwaki 1 , Naoki Kageyama 1 , Nagatoshi Hirai 1 , Sohshun Takada 1 , Suguru Inao 1 , Masayoshi Terashima 2 , Mitsuo Sugiura 3 1Department of Neurosurgery, Nagoya University, School of Medicine 2Division of Neurophysiology, Clinical Laboratory, Nagoya University Hospital 3Department of Neurosurgery, Okazaki Municipal Hospital pp.911-916
Published Date 1984/9/1
DOI https://doi.org/10.11477/mf.1406205382
  • Abstract
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The authors had studies the correlation between the appearance of the pressure waves and the level of the sleep in pre- and postoperative patients with normal pressure hydrocephalus (NPH). Thechanges from preoperative findings to postopera-tive ones were discussed in detail with the rela-tion of the pathophysiological state in these patients.

Seventeen patients were evaluated for the sus-pected diagnosis of the disease of NPH. Thirteen patients of them were treated with ventriculo-peritoneal shunts. Four representative cases among them were evaluated by pre- and postoperative polygraphic studies. A polygraphic overnight study includes a monitoring of an intracranial pressure (ICP), electroencephalography (EEG), electroocu-lography (EOG), respiratory movement and elect-romyography (EMG). Each data was recorded for the analysis on data recorder using a computer system.

A pressure waves (largely B type) appeared accompanied with an apnea at a resting state (so-called sleep) of each patients. An arousal response in EEG was also observed in the raising period of the pressure waves. At the peak respiration was resumed with transient activities in EMG and continued to the disappearance of the pressure wave. Pressure waves were observed frequently and contivally in hours in the resting state of these patients. As a result the level of sleep alter-nated frequently between an awake stage and a stage 1, including extremely rare appearance of stage 2.

In short, the level of sleep was frequently inter-rupted by the appearance of the pressure waves and apneas. Such pathological states of patient's sleeps were involved in the entity of the sleep apnea syndrome. After the operation, apneas were extremely rarely observed during the sleep. Then a sleep stage became stable and long period of the stage 2, including an increase in the time of the REM sleep. However, the stage 3 and 4 were hardly found in our follow up studies. These postoperative findings correlated with their impro-vements in the neurological states of the patients with NPH.

In conclusion, the abnormal sleep levels estima-ted by the scale of a biological rhythm seem to be important for the understanding the progres-sion and the diagnosis of normal pressure hydro-cephalus.


Copyright © 1984, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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