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Reversibility of Anatomic, Metabolic, and Cognitive Deficits in Normal-Pressure Hydrocephalus Following Shunt Surgery

Jeffrey A. Kaye, MD; Cheryl L. Grady, PhD; James V. Haxby, PhD; Angela Moore, MSW; Robert P. Friedland, MD

Arch Neurol. 1990;47(12):1336-1341.

Abstract
• The course of idiopathic normal-pressure hydrocephalus was studied in a 78-year-old woman with a 4-year history of progressive dementia who underwent neuropsychologic testing, quantitative x-ray computed tomography, magnetic resonance imaging, and positron emission tomography with fludeoxyglucose F 18 to measure rates of regional cerebral glucose utilization. Preshunt cognitive testing demonstrated progressive deterioration during 2 years, and positron emission tomography showed significant reductions in regional cerebral glucose utilization of 34% to 49% as compared with age-and sex-matched control subjects in frontal, temporal, parietal, and whole brain regions. Periodic testing, carried out during a 2-year period after shunt surgery, showed steady improvement in clinical status. Parallel to the clinical changes, there was a significant reversal in neuropsychologic test scores with increased brain volume and increased regional cerebral glucose utilization in several brain regions. These results documented the considerable potential for recovery of compromised brain function in older subjects even after 4 years of progressive brain disease.

Author Affiliations
From the Laboratory of Neurosciences, Section on Brain Aging and Dementia, National Institute on Aging, National Institutes of Health, Bethesda, Md. Dr Kaye is now with the Department of Neurology, Oregon Health Sciences University, Portland, and Dr Friedland is now with the Alzheimer Center, University Hospitals of Cleveland (Ohio).

Footnotes
Accepted for publication April 30, 1990.

Presented at the Annual Meeting of the American Neurological Association, San Francisco, Calif, October 21, 1987.

Reprint requests to Alzheimer Center, University Hospitals of Cleveland, 2074 Abington Rd, Cleveland, OH 44106 (Dr Friedland).

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