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 in | Neurourology and urodynamics Vol. 31; no. 1; pp. 50 - 55 |
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Main Authors | , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
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ISSN | 0733-2467 1520-6777 1520-6777 |
DOI | 10.1002/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. |
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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 |
Author_xml | – sequence: 1 givenname: Ryuji surname: Sakakibara fullname: Sakakibara, Ryuji email: sakakibara@sakura.med.toho-u.ac.jp organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan – sequence: 2 givenname: Yoshitaka surname: Uchida fullname: Uchida, Yoshitaka organization: Department of Radiology, Chiba University, Chiba, Japan – sequence: 3 givenname: Kazunari surname: Ishii fullname: Ishii, Kazunari organization: Department of Radiology, Himeji Cardiologic Disease Center, Himeji, Japan – sequence: 4 givenname: Hiromitsu surname: Kazui fullname: Kazui, Hiromitsu organization: Department of Psychiatry, Osaka University, Osaka, Japan – sequence: 5 givenname: Masaaki surname: Hashimoto fullname: Hashimoto, Masaaki organization: Department of Neurosurgery, Kohritsu Noto Hospital, Ishikawa, Japan – sequence: 6 givenname: Masaaki surname: Ishikawa fullname: Ishikawa, Masaaki organization: Department of Neurosurgery, Kitano Hospital, Kyoto, Japan – sequence: 7 givenname: Tatsuhiko surname: Yuasa fullname: Yuasa, Tatsuhiko organization: Department of Neurology, Kamagaya General Hospital, Kamagaya, Japan – sequence: 8 givenname: Masahiko surname: Kishi fullname: Kishi, Masahiko organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan – sequence: 9 givenname: Emina surname: Ogawa fullname: Ogawa, Emina organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan – sequence: 10 givenname: Fuyuki surname: Tateno fullname: Tateno, Fuyuki organization: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan – sequence: 11 givenname: Tomoyuki surname: Uchiyama fullname: Uchiyama, Tomoyuki organization: Department of Neurology, Chiba University, Chiba, Japan – sequence: 12 givenname: Tatsuya surname: Yamamoto fullname: Yamamoto, Tatsuya organization: Department of Neurology, Chiba University, Chiba, Japan – sequence: 13 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. ark:/67375/WNG-1XBHSKTJ-6 Imaging Statistical Analysis was made with a 3D-SSP software by Dr. Uchida. istex:9D31E24EAC7DED053B4DA4549D1E28A1CC84919A ArticleID:NAU21222 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. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
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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 |
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