脑脊液释放试验后脑血流变化对正常压力性脑积水患者临床症状改善的预测作用

目的 探讨经颅多普勒超声(Transcranial Doppler,TCD)评价正常压力性脑积水(normal pressure hydrocephalus,NPH)患者脑脊液释放试验对脑血流速度的影响及脑脊液释放试验的效果。方法 收集2015年5月1日-2017年6月1日于上海长征医院神经内科治疗的NPH患者25例,在脑脊液释放试验前及脑脊液释放试验24 h后评估患者NPH分级量表评分、运动功能及应用TCD测试大脑中动脉和大脑前动脉的血流速度; 根据NPH分级量表评分进行分组,降低≥1分者为改善组,否则为未改善组,观察2组动脉血流速度情况。结果 与脑脊液释放试验前比较,改善组患者脑脊液释放试验24 h后行走时间、行走步数均明显减少,TCD示左右两侧大脑中动脉最大流速、平均流速、最小流速均明显降低; 非改善组则无上述改变。结论 脑脊液释放试验NPH分级量表评分的改善可能与大脑中动脉血流速度有关,而TCD可有效地评测NPH患者脑脊液释放试验的效果。

Changing cerebral blood flow in normal pressure hydrocephalus after the cerebrospinal fluid tap test can predict clinical symptom improvement

ObjectiveTo evaluate the effect of cerebrospinal fluid tap test on cerebral blood flow in patients with normal pressure hydrocephalus and the effect of cerebrospinal fluid tap test.Methods Twenty-five NPH patients treated in the department of neurology, shanghai changzheng hospital from May 1, 2015 to June 1, 2017 were collected. NPH grading scale, motor disorders and blood flow velocities of middle cerebral artery and anterior cerebral artery were evaluated before and 24 hours after CSF tap test. Improvement was defined by at least one point reduction in INPH grading scale, the blood flow of the two groups was compared.Results Walking time and walking steps were significantly reduced in the improved group 24 hours after CSF tap test, and the maximum, average and minimum flow velocities of middle cerebral artery on both sides were significantly decreased.Conclusion The improvement of NPH grading scale in CSF tap test might be related to middle cerebral artery blood flow velocity, while TCD could effectively evaluate the effect of CSF release test in patients with NPH.