gms | German Medical Science

59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

Changes in aqueductal CSF stroke volume and the progression of symptoms in unshunted idiopathic NPH patients

Meeting Abstract

  • corresponding author A. Scollato - Department of Neurosurgery, University of Florence, Florence, Italy
  • R. Tenenbaum - Department of Neurosurgery, University of Florence, Florence, Italy
  • G. Bahl - Department of Radiology, University of California, San Diego, California, USA
  • M. Celerini - Department of Radiology, University of Florence, Florence, Italy
  • B. Salani - Geriatric Agency, Emergency Department, University of Florence, Florence, Italy
  • N. Di Lorenzo - Department of Neurosurgery, University of Florence, Florence, Italy

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.10.08

The electronic version of this article is the complete one and can be found online at:

Published: May 30, 2008

© 2008 Scollato et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Idiopathic normal pressure hydrocephalus (iNPH) represents a diagnostic challenge, given its variable presentation and progression, and Stroke Volume (SV), defined as the mean volume of Cerebro-Spinal Fluid (CSF) passing through the aqueduct during both systole and diastole, greater than or equal to 42 microliters serves as a selection criteria for patients with good probabilities of improvement after Ventriculo-Peritoneal Shunting (VPS). In our study we evaluated the SV changes during the progression of the clinical symptoms in patients with suspect of NPH.

Methods: Nine patients who presented with clinical and radiologic evidence of NPH, but refused treatment with VPS, were evaluated every six months for up to two years for progression in their clinical symptoms and changes in their SV, as measured by Phase Contrast Cine-MR (PCCMR).

Results: SV appears to increase between the onset of the symptoms and the following 18–20 months, then appears to plateau, following in the next 18–20 months by a slight decline to then drop more precipitously in the next 12 months. During this time, however, the patient’s clinical symptoms progressively worsen.

Conclusions: Patients with a low SV have not necessarily had brain atrophy and can show, in the following months, a progressive increase in SV which qualifies them as good candidates for VPS. The progressive reduction of the SV in untreated patients with worsening clinical symptoms may be a sign of a progressive cerebral ischemic injury which renders the NPH irreversible.