Theoretical considerations on the pathophysiology of normal pressure hydrocephalus (NPH) and NPH-related dementia

Medical Hypotheses
Abderrahmane HamlatEdouardo Pasqualini

Abstract

Normal pressure hydrocephalus (NPH) is considered to be an example of reversible dementia although clinical improvement after shunting varies from subject to subject, and recent studies have pointed to a possible link with other dementia. The authors consider that the craniospinal compartment is a partially closed sphere with control device systems represented by the spinal axis and the sagittal sinus-arachnoid villi complex which interact with each other in the clinical patient setting. We hypothesise that changing spinal compliance by altering the flow process and CSF dynamics lead to hydrocephalus. Therefore four NPH types have been distinguished according to the alterations in spinal compliance, decrease in CSF absorption at the sagittal sinus or both occurrences. The authors consider that NPH and NPH-related diseases (NPH-RD) are initiated by the same common final pathway and demonstrate that NPH could represent an initial stage of NPH-RD. Progression of clinical signs can be explained as damage to the cerebral tissue by both intermittent increased intracranial pressure and pulse pressure waves leading to periventricular ischaemia. In addition, they believe that both volume equilibrium and spinal compliance are restored in...Continue Reading

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Citations

Jun 8, 2012·European Journal of Neurology : the Official Journal of the European Federation of Neurological Societies·M MiyajimaH Arai
Nov 7, 2015·AJNR. American Journal of Neuroradiology·N FattahiJ Huston
Jan 22, 2018·Journal of Neural Transmission·Tommaso SchirinziAntonio Pisani
Nov 12, 2015·International Psychogeriatrics·Yuta YoshinoShu-ichi Ueno

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