Is normal pressure hydrocephalus (NPH) over-diagnosed? YES. When appropriately diagnosed and treated can some symptoms improve w/ shunting. YES. Nice article by Akter and colleagues to help clinicians on their journey to sort this out.
Key points:
- NPH: think ventriculomegaly in the absence of structural blockage of the CSF.
- Famous triad of cognitive impairment, gait disturbance and urinary incontinence.
- A detailed cognitive assessment, neurologic examination and brain imaging should be carefully performed to exclude alternative causes and confirm the diagnosis. The key word is multidisciplinary.
- Many experts recommend high-volume lumbar puncture or a lumbar drain. Watching gait pre- and post LP can be tricky and watch out for placebo effects.
My take: Any clinician who is overconfident on the diagnosis of NPH will be humbled and burned at some point. Workup's should be slow and deliberate and there should be shared decision making if a shunt is considered as there are both complications and also concerns over longevity of response. Levodopa treatment may be appropriate in some cases. Nice recent articles by @AlbertoEspay@DrAlfonsoFasano and Bluett. and others go deep on thinking about the complexities of NPH.
https://t.co/9a4fcMJqNB
https://t.co/uLJ7qvOfz0
https://t.co/qRUaWftDGD #NPH #Parkinson
📍Last chance to register for the fourth #IshenTranslational presentation series:
📅When: Tuesday, 7th of December 2023, at 10am EST (3pm UK time).
⬇️Click here to register⬇️
https://t.co/XwdOPBjTk9
This study found that individuals with rare NOTCH3 variants have a distinct pattern of brain parenchymal damage related to cerebral small vessel disease. Learn more: https://t.co/j4DDfeFm9p
#NeuroTwitter#Genetics
🩸🧠CAA and Alzheimer's disease spectrum
(CAA=Cerebral Amyloid Angiopathy)
📒 Notes:
-Most patients with AD have mild/moderate CAA and not the advanced "bleeding" CAA subtype.
-AD and CAA have different dominant Aβ species:
🧶AD - Aβ42 predominant (less soluble, stick together in neuritic plaques)
⭕️CAA - Aβ40 and Aβ38 dominate in vessels (more soluble, cleared along perivascular paths)
#neurotwitter #NeuroTwitter #NeuroRad #Neurology #Neurosurgery #stroke #MedStudentTwitter #FOAMncc #MedTwitter #amyloidangiopathy #FOAMncc #neuroscience #brain #Alzheimers #Alzheimer
Excited to share our work on autoantibodies against CXCR3 and their relation to cardiovascular disease - out now 🎯
Many thanks to all the fantastic contributors for making this collaborative effort possible! 🧵
@cardiogenetics@RheumaImmu_HL
🔗https://t.co/7Rv8mIe6CU
Happy to share our current review on the evidence in treatment of ischemic stroke (in German)
https://t.co/iZWuFuWtan
@MHH_life @SpringerMedizin @Johanna_Ernst_ @kai_schmidt_ott@PRACTIS_MHH
The TENSION trial shows that thrombectomy reduces disability and mortality in pts. with large infarct core in the ext. time window and that sophisticated imaging methods are not strictly mandatory to guide this therapy.
@TENSIONstudy@ESOstroke@CSI_Lab
https://t.co/VQ4mAsv4Gd
Driveline infection in patients under LVAD therapy increases the risk for vessel wall inflammation, stroke and mortality: https://t.co/TfhjDWLoN7 #lvad#fdgpet#nature#artificialhearts
🌊🩸MRI features of ARIA
(Amyloid-Related Imaging Abnormalities)
🧠Associated with the use of monoclonal antibodies that target Aβ for Alzheimer's disease
💡ARIA=iatrogenic CAA-related inflammation
#neurotwitter#NeuroTwitter#NeuroRad#MedTwitter#MedStudentTwitter#MedEd #EndNeurophobia #Neurology #Neurosurgery #RadEd #stroke #Alzheimers #dementia #lecanemab #amyloidangiopathy
We are ending our morning session with two great and informative talks by @alena_eh3 on diagnosing mHE: comparison of 6 frequently used tests and Julius Egge on the impact of alcohol etiology of liver cirrhosis upon mHE diagnosis #ishen2023
The ISHEN 2023 Symposium provides an outstanding update on research and clinical implications of HE and a fantastic social program in the beautiful landscape of Bad Zwischenahn! Register now at:
https://t.co/E0UA8vW9dj
@ISHENliver
@MHH_life
@idw_online_de
@dgn_ev
@KarinWeissenb
People are talking about: As it becomes increasingly clear just how central the neurovasculature is in clearance of amyloid and other proteins, a new term, “neurovasculome,” has entered the lexicon: https://t.co/BI7UkEKP53
#NeuroTwitter@AANMember
We present a 48-year-old woman suffering two spontaneous intracranial lobar hemorrhages. Do you consider recently proposed diagnostic criteria for iatrogenic CAA in your diagnostic routine? #CAA#amyloid@BenStorti @MHH_life #EJoN
https://t.co/5cjYfkxITo
Just published in @JAHA_AHA: https://t.co/TwcWkZotYZ
In this systematic literature review, we provide an overview on the current evidence on how genetic variants may help to elucidate the actual mechanism of cryptogenic #stroke. @Johanna_Ernst_ @MHH_life @PRACTIS_MHH@dfg_public
The clinical spectrum of cerebral amyloid angiopathy (CAA) is increasingly expanding. Proud to keep the track with Fondazione IRCCS Istituto Neurologico Carlo Besta @BenStorti@frontiers https://t.co/aidKsynYey
The first analysis of the multicenter PRODAST study is now online OA! Early application of dabigatran after stroke ist likely safer than vit. K antagonists with regards to hemorrhagic complications, especially ICH. @unidue @MHH_life @IntJStroke@WorldStrokeOrg@ESOstroke
Un unforgetable and exciting 4-month stage at the Cerebrovascular Disease Unit of IRCCS Foundation C Besta in Milan is over. Can’t express all my gratitude to Dr.Anna Bersano, her amazing team (@BenStorti) and @ESOstroke for the support! Check my report on https://t.co/eHC1sKVU2r