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Ventricular cerebrospinal fluid neurofilament protein levels decrease in parallel with white matter pathology after shunt surgery in normal pressure hydrocephalus.

Artikel i vetenskaplig tidskrift
Författare Mats Tullberg
Kaj Blennow
Jan-Eric Månsson
Pam Fredman
Magnus Tisell
Carsten Wikkelsö
Publicerad i European journal of neurology : the official journal of the European Federation of Neurological Societies
Volym 14
Nummer/häfte 3
Sidor 248-54
ISSN 1468-1331
Publiceringsår 2007
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering
Institutionen för neurovetenskap och fysiologi, sektionen för psykiatri och neurokemi
Sidor 248-54
Språk en
Länkar www.ncbi.nlm.nih.gov/sites/entrez?D...
Ämnesord Adult, Aged, Aged, 80 and over, Axons, metabolism, pathology, Biological Markers, analysis, cerebrospinal fluid, Brain, metabolism, pathology, physiopathology, Cerebrospinal Fluid Pressure, physiology, Cerebrospinal Fluid Proteins, analysis, metabolism, Cerebrospinal Fluid Shunts, Down-Regulation, physiology, Female, Humans, Hydrocephalus, Normal Pressure, cerebrospinal fluid, physiopathology, surgery, Lateral Ventricles, pathology, physiopathology, surgery, Magnetic Resonance Imaging, Male, Middle Aged, Nerve Fibers, Myelinated, metabolism, pathology, Neurofilament Proteins, cerebrospinal fluid, Predictive Value of Tests, Treatment Outcome, Wallerian Degeneration, cerebrospinal fluid, diagnosis, physiopathology
Ämneskategorier Neurovetenskap, Neurofysiologi

Sammanfattning

Normal pressure hydrocephalus (NPH) is characterized by disturbed cerebrospinal fluid (CSF) dynamics and white matter lesions (WML). Although the morphology of these lesions is described, little is known about the biochemistry. Our aim was to explore the relationship between ventricular CSF markers, periventricular WML and postoperative clinical outcome in patients with NPH. We analysed lumbar and ventricular concentrations of 10 CSF markers, 12 clinical symptoms and signs, magnetic resonance imaging (MRI) periventricular white matter hyperintensities (PVH) and ventricular size before and 3 months after shunt surgery in 35 patients with NPH. Higher ventricular CSF neurofilament protein (NFL), an axonal marker, correlated with more extensive PVH. A larger postoperative reduction in NFL correlated with larger reduction in PVH and a more pronounced overall improvement. Albumin ratio, HMPG, NPY, VIP and GD3 increased postoperatively whereas NFL, tau and HVA decreased. Variations in ventricular size were not associated with CSF concentrations of any marker. We conclude that NPH is characterized by an ongoing periventricular neuronal dysfunction seen on MRI as PVH. Clinical improvement after shunt surgery is associated with CSF changes indicating a restitution of axonal function. Other biochemical effects of shunting may include increased monoaminergic and peptidergic neurotransmission, breakdown of blood brain barrier function, and gliosis.

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