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Neurological Surgery No Shinkei Geka Volume 21, Issue 5 （May 1993）

Neurological Surgery 脳神経外科 21巻5号（1993年5月発行）

Japanese English

研究

高齢者の特発性正常圧水頭症の病態および診断 Idiopathic Normal Pressure Hydrocephalus in Elderly Patients:Its pathophysiology and diagnosis 田中公人 ^1,2 , 米川泰弘 ¹ , 三宅英則 ¹ , 小林映 ¹ , 塚原徹也 ¹ , 新島京 ¹ , 緒方伸好 ¹ , 郭泰彦 ¹ , 風川清 ¹ , 竹田誠 ¹ , 小室太郎 ¹ , 深尾繁治 ¹ Kimito TANAKA ^1,2 , Yasuhiro YONEKAWA ¹ , Hidenori MIYAKE ¹ , Akira KOBAYASHI ¹ , Tetsuya TSUKAHARA ¹ , Kyou NIIJIMA ¹ , Nobuyoshi OGATA ¹ , Yasunori KAKU ¹ , Kiyosi KAZEKAWA ¹ , Makoto TAKEDA ¹ , Tarou KOMURO ¹ , Shigeharu FUKAO ¹ ¹国立循環器病センター脳神経外科 ²三重大学脳神経外科 ¹Department of Neurosurgery, National Cardiovascular Center キーワード： Normal pressure hydrocephalus , Acetazolamide , Cerebrospinal fluid pressure , Flow void , Deep white matter ischemia Keyword: Normal pressure hydrocephalus , Acetazolamide , Cerebrospinal fluid pressure , Flow void , Deep white matter ischemia pp.403-409

発行日 1993年5月10日 Published Date 1993/5/10

DOI https://doi.org/10.11477/mf.1436900641

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Abstract 文献概要
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I．はじめに

　痴呆症に対する治療の多くは病態進行の抑制を主目的とする姑息的な内科的治療であるが，正常圧水頭症（NPH）は外科的治療により治癒可能な原因疾患の1つである．くも膜下出血や髄膜炎など原因の明らかなNPHの外科適応は容易であるが，原因不明の高齢者NPHは，診断および手術適応が困難となることが多く，手術の合併症等を考えると外科治療に躊躇することがある．今回，われわれは原因不明の脳室拡大とともにNPH症状をきたした高齢患者全例（11例）に外科的治療を施行し，そのうち10例と高頻度に治療効果を得たが，1例はshuntのpatencyであるにもかかわらず症状の改善は得られなかった。これらの結果より，原因不明の高齢者NPHの病態，診断および治療の問題点について文献的考察を加えて報告する．

We described 10 cases of idiopathic normal pressure hydrocephalus (NPH) in elderly patients who had good results after shunting. Retrospective analysis of our cases offers the following results which indicate the pathogenesis and surgical selection of idiopathic NPH. 1) Most of the patients had risk factors of ischemic cerebrovascular disease and had multiple small ische-mic lesions such as lacunae. 2) Cerebrospinal fluid (CSF) pressure is below 20mmHg in all cases and its response to acetazolamide loading was suppressed or almost lost in most of cases.3) The volume of the later-al ventricle was slightly reduced after the effective op-eration. 4) Some of the patients showed clinical nn-provement even if they had symptoms for more than 2 years before treatment. Two primary theories exist con-cerning the cause of NPH. One is extraventricular ob-struction to CSF flow at the level of the arachnoid villi or the basal cistern. The other is periventricular white matter ischemic damage which decreases the tensile strength of the ventricular walls and leads to ventricu- lar dilatation. Tangential periventricular shearing force due to ventricular dilatation produces the symptom of NPH. Our results support these descriptions as the causes of idiopathic NPH in elderly patients. We noticed, firstly, involvement of the ischemic risk factor. Other findings implied decreased elasticity or com-pliance of the brain and the loss of the autoregulatory properties of cerebral circulation which accelerate the ischemic damage to the periventricular white matter. Inunderstanding the etiology, it is important to know the fragility of the aged brain and the mechanical and hemodynamic stress to which it is subjected.

We think that neuronal images by MRI and CT can help us to diagnose the NPH, but more invasive phy-siological examinations such as CSF pressure monitor-ing offer no benefit to the patients.