臨床神経学

第51回日本神経学会総会

<シンポジウム15―1>特発性正常圧水頭症(iNPH):病態研究最近の進歩
診断法の進歩(症候・画像・tap test)

森 悦朗

東北大学大学院医学系研究科高次機能障害学〔〒980―8575 仙台市青葉区星陵町2―1〕

The symptoms of idiopathic normal pressure hydrocephalus (iNPH) are generally seen in aged, and iNPH has been overlooked or misdiagnosed. In Japan, since the Clinical Guidelines were published, remarkable progress are noted in the recognition of it and clinical researches for it. In this paper, recent progress diagnostic measures for iNPH is discussed, focusing on the key role of clinical features, neuroimagings, and tap test. As for clinical symptoms, in particular the distinctive features of cognitive and behavioral symptoms have been delineated. The clinical significance of MRI features of iNPH, i.e., ventriculomegary with tight high convexty/midline subarachnoid spaces and enlarged Sylvian fissures, have been validated in a prospective cohort study, Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement ( SINPHONI ) . Disproportionately enlarged subarachnoid-space hydrocephalus (DESH) has been proposed to designate iNPH with these MRI features consisting of a major proportion of iNPH. Although tap test is useful in diagnosis and in making decision of shunt surgery, the results of SINPHONI suggest that its procedure needs to be refined to increase the diagnostic accuracy.
Full Text of this Article in Japanese PDF (183K)

(臨床神経, 50:960−962, 2010)
key words:特発性正常圧水頭症,症状,MRI,disproportionately enlarged subarachnoid-space hydrocephalus,tap test

(受付日:2010年5月22日)