Correlation of right frontal hypoperfusion and urinary dysfunction in iNPH: A SPECT study

Objectives To elucidate the pathophysiology of urinary dysfunction in idiopathic normal‐pressure hydrocephalus (iNPH) by single‐photon emission computed tomography (SPECT) and statistical brain mapping. Methods Urinary symptoms were observed and N‐isopropyl‐p‐[123I]‐iodoamphetamine (IMP)‐SPECT imagi...

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Published inNeurourology and urodynamics Vol. 31; no. 1; pp. 50 - 55
Main Authors Sakakibara, Ryuji, Uchida, Yoshitaka, Ishii, Kazunari, Kazui, Hiromitsu, Hashimoto, Masaaki, Ishikawa, Masaaki, Yuasa, Tatsuhiko, Kishi, Masahiko, Ogawa, Emina, Tateno, Fuyuki, Uchiyama, Tomoyuki, Yamamoto, Tatsuya, Yamanishi, Tomonori, Terada, Hitoshi
Format Journal Article
LanguageEnglish
Published Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.01.2012
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ISSN0733-2467
1520-6777
1520-6777
DOI10.1002/nau.21222

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Abstract Objectives To elucidate the pathophysiology of urinary dysfunction in idiopathic normal‐pressure hydrocephalus (iNPH) by single‐photon emission computed tomography (SPECT) and statistical brain mapping. Methods Urinary symptoms were observed and N‐isopropyl‐p‐[123I]‐iodoamphetamine (IMP)‐SPECT imaging was performed in 97 patients with clinico‐radiologically definite iNPH. The patients included 56 men and 41 women; mean age, 74 years. The statistical difference in normalized mean tracer counts was calculated and visualized between patients with urinary dysfunction of severer degrees (>grade 2/4) and milder degrees (<grade 1/4) according to the urinary subscales of the iNPH grading scales. Results There was a significant decrease in tracer activity in the right‐side‐dominant bilateral frontal cortex and the left inferior temporal gyrus in the severe urinary dysfunction group (P < 0.05). In order to minimize the effects of gait and cognitive dysfunction, we performed similar analysis among subjects with little or no such dysfunction, and obtained the same results (P < 0.05) as described above. Conclusions Urinary dysfunction was found to be closely related with right frontal hypoperfusion in iNPH using [123I]‐IMP SPECT. This right frontal area is one of the critical areas for regulating micturition. While secondary incontinence can result from gait disturbance or dementia, there may also be a neurogenic mechanism underlying urinary dysfunction, which is a significant burden in patients with iNPH and their caregivers. Neurourol. Urodynam. 31:50–55, 2012. © 2011 Wiley Periodicals, Inc.
AbstractList To elucidate the pathophysiology of urinary dysfunction in idiopathic normal-pressure hydrocephalus (iNPH) by single-photon emission computed tomography (SPECT) and statistical brain mapping. Urinary symptoms were observed and N-isopropyl-p-[(123)I]-iodoamphetamine (IMP)-SPECT imaging was performed in 97 patients with clinico-radiologically definite iNPH. The patients included 56 men and 41 women; mean age, 74 years. The statistical difference in normalized mean tracer counts was calculated and visualized between patients with urinary dysfunction of severer degrees (>grade 2/4) and milder degrees (<grade 1/4) according to the urinary subscales of the iNPH grading scales. There was a significant decrease in tracer activity in the right-side-dominant bilateral frontal cortex and the left inferior temporal gyrus in the severe urinary dysfunction group (P < 0.05). In order to minimize the effects of gait and cognitive dysfunction, we performed similar analysis among subjects with little or no such dysfunction, and obtained the same results (P < 0.05) as described above. Urinary dysfunction was found to be closely related with right frontal hypoperfusion in iNPH using [(123) I]-IMP SPECT. This right frontal area is one of the critical areas for regulating micturition. While secondary incontinence can result from gait disturbance or dementia, there may also be a neurogenic mechanism underlying urinary dysfunction, which is a significant burden in patients with iNPH and their caregivers.
To elucidate the pathophysiology of urinary dysfunction in idiopathic normal-pressure hydrocephalus (iNPH) by single-photon emission computed tomography (SPECT) and statistical brain mapping.OBJECTIVESTo elucidate the pathophysiology of urinary dysfunction in idiopathic normal-pressure hydrocephalus (iNPH) by single-photon emission computed tomography (SPECT) and statistical brain mapping.Urinary symptoms were observed and N-isopropyl-p-[(123)I]-iodoamphetamine (IMP)-SPECT imaging was performed in 97 patients with clinico-radiologically definite iNPH. The patients included 56 men and 41 women; mean age, 74 years. The statistical difference in normalized mean tracer counts was calculated and visualized between patients with urinary dysfunction of severer degrees (>grade 2/4) and milder degrees (<grade 1/4) according to the urinary subscales of the iNPH grading scales.METHODSUrinary symptoms were observed and N-isopropyl-p-[(123)I]-iodoamphetamine (IMP)-SPECT imaging was performed in 97 patients with clinico-radiologically definite iNPH. The patients included 56 men and 41 women; mean age, 74 years. The statistical difference in normalized mean tracer counts was calculated and visualized between patients with urinary dysfunction of severer degrees (>grade 2/4) and milder degrees (<grade 1/4) according to the urinary subscales of the iNPH grading scales.There was a significant decrease in tracer activity in the right-side-dominant bilateral frontal cortex and the left inferior temporal gyrus in the severe urinary dysfunction group (P < 0.05). In order to minimize the effects of gait and cognitive dysfunction, we performed similar analysis among subjects with little or no such dysfunction, and obtained the same results (P < 0.05) as described above.RESULTSThere was a significant decrease in tracer activity in the right-side-dominant bilateral frontal cortex and the left inferior temporal gyrus in the severe urinary dysfunction group (P < 0.05). In order to minimize the effects of gait and cognitive dysfunction, we performed similar analysis among subjects with little or no such dysfunction, and obtained the same results (P < 0.05) as described above.Urinary dysfunction was found to be closely related with right frontal hypoperfusion in iNPH using [(123) I]-IMP SPECT. This right frontal area is one of the critical areas for regulating micturition. While secondary incontinence can result from gait disturbance or dementia, there may also be a neurogenic mechanism underlying urinary dysfunction, which is a significant burden in patients with iNPH and their caregivers.CONCLUSIONSUrinary dysfunction was found to be closely related with right frontal hypoperfusion in iNPH using [(123) I]-IMP SPECT. This right frontal area is one of the critical areas for regulating micturition. While secondary incontinence can result from gait disturbance or dementia, there may also be a neurogenic mechanism underlying urinary dysfunction, which is a significant burden in patients with iNPH and their caregivers.
Objectives To elucidate the pathophysiology of urinary dysfunction in idiopathic normal‐pressure hydrocephalus (iNPH) by single‐photon emission computed tomography (SPECT) and statistical brain mapping. Methods Urinary symptoms were observed and N‐isopropyl‐p‐[123I]‐iodoamphetamine (IMP)‐SPECT imaging was performed in 97 patients with clinico‐radiologically definite iNPH. The patients included 56 men and 41 women; mean age, 74 years. The statistical difference in normalized mean tracer counts was calculated and visualized between patients with urinary dysfunction of severer degrees (>grade 2/4) and milder degrees (<grade 1/4) according to the urinary subscales of the iNPH grading scales. Results There was a significant decrease in tracer activity in the right‐side‐dominant bilateral frontal cortex and the left inferior temporal gyrus in the severe urinary dysfunction group (P < 0.05). In order to minimize the effects of gait and cognitive dysfunction, we performed similar analysis among subjects with little or no such dysfunction, and obtained the same results (P < 0.05) as described above. Conclusions Urinary dysfunction was found to be closely related with right frontal hypoperfusion in iNPH using [123I]‐IMP SPECT. This right frontal area is one of the critical areas for regulating micturition. While secondary incontinence can result from gait disturbance or dementia, there may also be a neurogenic mechanism underlying urinary dysfunction, which is a significant burden in patients with iNPH and their caregivers. Neurourol. Urodynam. 31:50–55, 2012. © 2011 Wiley Periodicals, Inc.
Author Ishii, Kazunari
Yuasa, Tatsuhiko
Yamamoto, Tatsuya
Yamanishi, Tomonori
Sakakibara, Ryuji
Ishikawa, Masaaki
Uchiyama, Tomoyuki
Tateno, Fuyuki
Kishi, Masahiko
Hashimoto, Masaaki
Uchida, Yoshitaka
Ogawa, Emina
Kazui, Hiromitsu
Terada, Hitoshi
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  organization: Department of Neurology, Kamagaya General Hospital, Kamagaya, Japan
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  organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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  givenname: Emina
  surname: Ogawa
  fullname: Ogawa, Emina
  organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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  givenname: Fuyuki
  surname: Tateno
  fullname: Tateno, Fuyuki
  organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
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  givenname: Tomoyuki
  surname: Uchiyama
  fullname: Uchiyama, Tomoyuki
  organization: Department of Neurology, Chiba University, Chiba, Japan
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  givenname: Tatsuya
  surname: Yamamoto
  fullname: Yamamoto, Tatsuya
  organization: Department of Neurology, Chiba University, Chiba, Japan
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  givenname: Tomonori
  surname: Yamanishi
  fullname: Yamanishi, Tomonori
  organization: Department of Urology, Dokkyo Medical College, Tochigi, Japan
– sequence: 14
  givenname: Hitoshi
  surname: Terada
  fullname: Terada, Hitoshi
  organization: Department of Radiology, Sakura Medical Center, Toho University, Sakura, Japan
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Notes Eric Rovner led the review process.
Ethics: All patients gave informed consent before participating in the study. The present study was approved by the Ethics Committee at Sakura Medical Center, Toho University.
Disclosure information: None of the authors have financial support relevant to the study. All authors have no conflict of interests.
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Author Roles: Ryuji Sakakibara: Design, organization, analysis, and execution of the study. Yoshitaka Uchida: Statistical analysis of the study. Kazunari Ishii, Hiromitsu Kazui, Masaaki Hashimoto, Masaaki Ishikawa, Tatsuhiko Yuasa, Masahiko Kishi, Emina Ogawa, Fuyuki Tateno, Tomoyuki Uchiyama, Tatsuya Yamamoto, Tomonori Yamanishi, Hitoshi Terada: Execution of the study.
Imaging Statistical Analysis was made with a 3D‐SSP software by Dr. Uchida.
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Snippet Objectives To elucidate the pathophysiology of urinary dysfunction in idiopathic normal‐pressure hydrocephalus (iNPH) by single‐photon emission computed...
To elucidate the pathophysiology of urinary dysfunction in idiopathic normal-pressure hydrocephalus (iNPH) by single-photon emission computed tomography...
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SubjectTerms Aged
Aged, 80 and over
autonomic nervous system
Brain Mapping
Cognition Disorders - physiopathology
Female
frontal lobe
Frontal Lobe - blood supply
Frontal Lobe - diagnostic imaging
Frontal Lobe - physiopathology
Gait Disorders, Neurologic - physiopathology
Humans
Hydrocephalus, Normal Pressure - complications
Hydrocephalus, Normal Pressure - physiopathology
idiopathic normal-pressure hydrocephalus (iNPH)
Iodine Radioisotopes
Male
Middle Aged
Regional Blood Flow - physiology
Retrospective Studies
Severity of Illness Index
single-photon emission computed tomography (SPECT)
Tomography, Emission-Computed, Single-Photon
urinary incontinence
Urinary Incontinence - epidemiology
Urinary Incontinence - physiopathology
Urination Disorders - epidemiology
Urination Disorders - physiopathology
Title Correlation of right frontal hypoperfusion and urinary dysfunction in iNPH: A SPECT study
URI https://api.istex.fr/ark:/67375/WNG-1XBHSKTJ-6/fulltext.pdf
https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fnau.21222
https://www.ncbi.nlm.nih.gov/pubmed/22038765
https://www.proquest.com/docview/924963165
Volume 31
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