• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.151-160
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• 2022

Continuous monitoring of intracranial pressure is a well established medical procedure. Still, little is known about long-term behavior of intracranial pressure in normal pressure hydrocephalus. The present study is designed to evaluate periodicity of intracranial pressure over long-time scales using intraventricular pressure monitoring in patients with normal pressure hydrocephalus. In addition, the circadian and diurnal patterns of blood pressure and body temperature in those patients are studied. Four patients, selected with "probable" normal pressure hydrocephalus, were monitored for several dozen hours. Intracranial pressure, blood pressure, and body temperature were recorded hourly. Autocorrelation functions were calculated and cross-correlation analysis were carried out to study all the time-series data. Autocorrelation results show that intracranial pressure, blood pressure, and body temperature values follow bimodal (positive and negative) curves over a day. The cross-correlation functions demonstrate causal relationships between intracranial pressure, blood pressure, and body temperature. The results show that long-term fluctuations in intracranial pressure exhibit cyclical patterns with periods of about 24 hours. Continuous intracranial pressure recording in "probable" normal pressure hydrocephalus patients reveals circadian fluctuations not related to the day and night cycle. These fluctuations are causally related to changes in blood pressure and body temperature. The present study reveals the complete loss of the diurnal blood pressure and body temperature rhythmicities in patients with "probable" normal pressure hydrocephalus.

• The Journal of Internal Korean Medicine
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• v.25 no.2
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• pp.314-319
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• 2004

Objective : This study was designed to evaluate the effects of oriental medicine therapy on a normal pressure hydrocephalus patient. Methods : The clinical data was analyzed on a patient with normal pressure hydrocephalus whose main symptoms were dementia, gait disturbance and urinary incontinence. The patient was admitted to the internal medicine department of Dong-shin University Oriental Hospital from December 7, 2002, and remaind until January 20, 2003. He was treated with herbal medicine(Yukmijiwhangtang), acupuncture and moxa therapy. Results : After treatment, improvement was seen in dementia, gait disturbance, and urinary incontinence. Conclusions : The study suggests that oriental medicine therapy is significantly effective on the treatment or normal pressure hydrocephalus.

• The Journal of Internal Korean Medicine
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• v.25 no.4
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• pp.221-226
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• 2004

Objective : This study was designed to evaluate the effects of oriental medicine therapy on a normal pressure hydrocephalus patient Methods : The clinical data was analyzed on a patient with normal pressure hydrocephalus whose main symptoms were gait apraxia, dementia and urinary incontinence, The patient was admitted to the internal medicine department of KyungWon university In-cheon Oriental Medical Hospital, on April 19, 2004 and remained until Apri 30, 2004. He was treated with herbal medicine(Oryung-San), acupuncture and moxa therapy. Results : After treatment, improvement was seen in gait apraxia, dementia and urinary disturbance. Conclusion : The study suggests that oriental medicine therapy is significantly effective in the treatment of normal pressure hydrocephalus.

• Journal of Korean Neurosurgical Society
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• v.46 no.4
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• pp.370-377
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• 2009

Objective : There is no definite adjustment protocol for patients shunted with programmable valves. Therefore, we attempted to find an appropriate method to adjust the valve, initial valve-opening pressure, adjustment scale, adjustment time interval, and final valve-opening pressure of a programmable valve. Methods : Seventy patients with hydrocephalus of various etiologies were shunted with programmable shunting devices (Micro Valve with $RICKHAM^{(R)}$ Reservoir). The most common initial diseases were subarachnoid hemorrhage (SAH) and head trauma. Sixty-six patients had a communicating type of hydrocephalus, and 4 had an obstructive type of hydrocephalus. Fifty-one patients had normal pressure-type hydrocephalus and 19 patients had high pressure-type hydrocephalus. We set the initial valve pressure to $10-30\;mmH_2O$, which is lower than the preoperative lumbar tapping pressure or the intraoperative ventricular tapping pressure, conducted brain computerized tomographic (CT) scans every 2 to 3 weeks, correlated results with clinical symptoms, and reset valve-opening pressures. Results : Initial valve-opening pressures varied from 30 to $180\;mmH_2O$ (mean, $102{\pm}27.5\;mmH_2O$). In high pressure-type hydrocephalus patients, we have set the initial valve-opening pressure from 100 to $180\;mmH_2O$. We decreased the valve-opening pressure $20-30\;mmH_2O$ at every 2- or 3-week interval, until hydrocephalus-related symptoms improved and the size of the ventricle was normalized. There were 154 adjustments in 81 operations (mean, 1.9 times). In 19 high pressure-type patients, final valve-opening pressures were $30-160\;mmH_2O$, and 16 (84%) patients' symptoms had nearly improved completely. However, in 51 normal pressure-type patients, only 31 (61%) had improved. Surprisingly, in 22 of the 31 normal pressure-type improved patients, final valve-opening pressures were $30\;mmH_2O$ (16 patients) and $40\;mmH_2O$ (6 patients). Furthermore, when final valve-opening pressures were adjusted to $30\;mmH_2O$, 14 patients symptom was improved just at the point. There were 18 (22%) major complications : 7 subdural hygroma, 6 shunt obstructions, and 5 shunt infections. Conclusion : In normal pressure-type hydrocephalus, most patients improved when the final valve-opening pressure was $30\;mmH_2O$. We suggest that all normal pressure-type hydrocephalus patients be shunted with programmable valves, and their initial valve-opening pressures set to $10-30\;mmH_2O$ below their preoperative cerebrospinal fluid (CSF) pressures. If final valve-opening pressures are lowered in 20 or $30\;mmH_2O$ scale at 2- or 3-week intervals, reaching a final pressure of $30\;mmH_2O$, we believe that there is a low risk of overdrainage syndromes.

• The Journal of Internal Korean Medicine
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• v.41 no.5
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• pp.811-820
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• 2020

Objective: The aim of this study was to report the effectiveness of traditional Korean medicine treatment of a gait disturbance in a patient with idiopathic normal pressure hydrocephalus induced by secondary Parkinsonism. Methods: The patient was treated with Korean herbal medicine (Yukmijihwang-tang-gami), acupuncture, moxibustion, and rehabilitation exercise. The gait of the patient was evaluated by the 10 m Walk Test, Timed Up and Go (TUG) test, 360° turning test, Functional Ambulatory Category (FAC), and GAITRite. Results: After 20 days of traditional Korean medicine treatment, we observed improvement in the symptoms of the gait disturbance. Conclusion: Traditional Korean medicine treatment might be effective in the treatment of gait disturbance in patients with idiopathic normal pressure hydrocephalus induced by secondary Parkinsonism.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.437-440
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• 2013

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.

• Journal of Biomedical Engineering Research
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• v.40 no.5
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• pp.189-196
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• 2019

We investigated differences in ventricular and hippocampal volumes between CSF tap test (CSFTT) responders and non-responders in idiopathic normal-pressure hydrocephalus (INPH) patients and compared these parameters in INPH patients with that of age- and gender-matched healthy controls. We also evaluated relationships between ventricular and hippocampal volumes and clinical profiles in INPH patients. We enrolled 48 patients with INPH and 29 healthy controls. Ventricular and hippocampal volumes were measured on MRI, including 3-dimensional volumetric images. INPH patients, when compared to healthy controls, had significantly larger ventricular and smaller hippocampal volumes. No difference in ventricular and hippocampal volumes was found between CSFTT responders and non-responders in INPH patients. And hippocampal volumes showed significant negative correlations with Clinical Dementia Rating Scale scores, INPH grading scale cognitive scores, Timed Up and Go Test scores, and Unified Parkinson's Disease Rating Scale motor scores in INPH patients. Volumetric assessment of ventricular and hippocampal regions may have no predictive value in differentiating between CSFTT responders and non-responders in INPH patients. Our findings may help us understand the potential pathophysiology of unique symptoms associated with INPH.

• The Journal of the Society of Stroke on Korean Medicine
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• v.17 no.1
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• pp.45-54
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• 2016

A case of a 75-year-old Korean female with gait disturbance due to Normal pressure hydrocephalus (NPH) is presented. She was treated with acupuncture, electroacupuncture and herbal medicine - 柴苓湯(Shirhyung-Tang, Chai-ling-tang, Sairei-to) We used iNPH grading scale, and specified further the grade of gait disturbance category. After Korean medical treatment, there was notable improvement in gait disturbance on our specified scale. Cognitive impairment, tremor and rigidity were improved on each scale alongside. Korean medical treatment may be effective in treating NPH patients.

• Phonetics and Speech Sciences
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• v.16 no.1
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• pp.57-65
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• 2024

Normal pressure hydrocephalus (NPH) is a condition wherein the cerebrospinal pressure in the brain is within the normal range, but the cerebrospinal fluid increases above the normal level, causing ventriculomegaly. In patients with NPH, the articulatory system exhibits reduced mobility and range, which may affect diadochokinesis (DDK) and speech intelligibility. In this study, we investigated the characteristics of DDK, including accurate-token DDK and all-token DDK including inaccurate tokens, in patients with NPH and healthy elderly adults (HE). We also examined the classification accuracy of DDK between the two groups. Finally, we investigated whether there was a correlation between speech intelligibility and DDKs in the NPH group. The results showed that NPH and HE groups differed significantly in both accurate-token DDK and all-token DDK, and their classification accuracy was relatively high. However, there was no correlation between speech intelligibility and DDK. The findings suggest that the DDK is a useful method for sensitively assessing speech motor performance in patients with NPH.

• Journal of Korean Neurosurgical Society
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• v.39 no.1
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• pp.20-25
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• 2006

Objective : The authors analyze prospectively the result of transcranial doppler[TCD] in normal pressure hydrocephalus and compared its cerebral blood flow parameters to radionuclide cerebrospinal fluid[CSF] flow study, postoperative brain computed tomography[CT] findings and clinical outcome, and studied the relationship between cerebral hemodynamics and clinical performance. Methods : Twenty five patients with hydrocephalus undertook pre- and post-operative TCD but only preoperative CSF flow study was performed. Mean flow velocity[Vm], pulsatility index[PI] and resistance index[RI] were assessed through TCD and changes in ventricle size and cortical gyral atrophy were checked through brain CT. Results : Postoperative hydrocephalus showed an increase in Vm[ACA P=0.037, MCA P=0.034], decrease in PI[ACA P=0.019, MCA P=0.017] and decrease in RI [ACA P=0.017, MCA P=0.021] compared to preoperative TCD parameters in the postoperative improvement group. In the postoperative improvement group, postoperative TCD parameters correlated with CSF flow study grade [Vm : $R^2=-0.75$, PI : $R^2=0.86$, RI : $R^2=0.78$] and ventriculocranial ratio change correlated with PI change [$R^2=0.73$]. The convexity gyral atrophy and initial TCD parameters showed close relationship to outcome. Conclusion : PI and RI can be used as an indicator of post operative prognosis, and with the addition of CSF flow study values, can also be used as a tool to predict pre-op and post-op patient status and successful shunt surgery.