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1. Neuropsychiatric Symptoms of Moyamoya Disease: Considerations for the Clinician

Author

Oakley CI, Lanzino G, and Klaas JP

Subjects
moyamoya disease, moyamoya angiopathy-associated cognitive dysfunction, neuropsychological outcomes, neuropsychiatric comorbidity, revascularization, neurocognitive recovery, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429
Abstract

Carlee I Oakley,1 Giuseppe Lanzino,2 James P Klaas1 1Department of Neurology, Mayo Clinic, Rochester, MN, USA; 2Department of Neurosurgery, Mayo Clinic, Rochester, MN, USACorrespondence: Carlee I Oakley, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA, Tel +1 507 284 2120, Fax +1 507 538 6012, Email oakley.carlee@mayo.eduAbstract: Neurocognitive impairment in moyamoya disease is common, under recognized, and potentially devastating. The purpose of this paper is to provide an updated overview on this topic for the practicing clinician. We searched PubMed for keywords including cognitive impairment, neurocognitive dysfunction, and neuropsychological recovery in moyamoya disease. We summarized the literature to provide a concise review of the treatment and management of neuropsychiatric symptoms associated with moyamoya disease. Neuropsychiatric sequelae have conventionally been attributed to chronic cerebral hypoperfusion and/or stroke. Cognitive dysfunction in adults with moyamoya disease is most commonly in the form of impaired executive function, whereas intelligence is the predominant impairment in children with moyamoya disease. Pharmacotherapy for treatment of the neuropsychiatric symptoms associated with moyamoya disease is appropriate and can improve quality of life; however, careful consideration is needed to avoid adverse cerebrovascular events. It remains unclear as to whether surgical revascularization improves or stabilizes cognitive performance and outcomes. Additional prospective studies are warranted to better understand the long-term impact of revascularization on cognitive functioning in moyamoya disease.Keywords: moyamoya disease, moyamoya angiopathy-associated cognitive dysfunction, neuropsychological outcomes, neuropsychiatric comorbidity, revascularization, neurocognitive recovery

Published
2024

2. Cervical Artery Dissections: Etiopathogenesis and Management

Author

Keser Z, Chiang CC, Benson JC, Pezzini A, and Lanzino G

Subjects
cervical artery dissection, genetics, stroke, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Zafer Keser,1 Chia-Chun Chiang,1 John C Benson,2 Alessandro Pezzini,3 Giuseppe Lanzino4 1Department of Neurology, Mayo Clinic, Rochester, MN, USA; 2Department of Radiology, Mayo Clinic, Rochester, MN, USA; 3Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy; 4Department of Neurosurgery, Mayo Clinic, Rochester, MN, USACorrespondence: Zafer Keser, Department of Neurology – Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, Email keser.zafer@mayo.eduAbstract: Cervical Artery Dissection (CeAD) is a frequent stroke etiology for patients younger than 50 years old. The most common immediate complications related to CeAD are headache and neck pain (65– 95%), TIA/ischemic stroke (> 50%), and partial Horner’s syndrome (25%). The prevailing hypothesis regarding the pathogenesis of sCeAD is that the underlying constitutional vessel wall weakness of patients with sCeAD is genetically determined and that environmental factors could act as triggers. The stroke prevention treatment of CeAD remains controversial, involving anticoagulation or antiplatelet therapy and potentially emergent stenting and/or thrombectomy or angioplasty for selected cases of carotid artery dissection with occlusion. The treatment of headache associated with CeAD depends on the headache phenotype and comorbidities. Radiographically, more than 75% of CeAD cases present with occlusion or non-occlusive stenosis. Many patients demonstrate partial and complete healing, more commonly in the carotid arteries. One-fifth of the patients develop dissecting pseudoaneurysm, but this is a benign clinical entity with an extremely low rupture and stroke recurrence risk. Good recovery is achieved in many CeAD cases, and mortality remains low. Family history of CeAD, connective tissue disorders like Ehlers-Danlos syndrome type IV, and fibromuscular dysplasia are risk factors for recurrent CeAD, which can occur in 3– 9% of the cases. This review serves as a comprehensive, updated overview of CeAD, emphasizing etiopathogenesis and management.Keywords: cervical artery dissection, genetics, stroke

Published
2022

5. Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement

Author

Saba, L, Brinjikji, W, Spence, JD, Wintermark, M, Castillo, M, Borst, GJD, Yang, Q, Yuan, C, Buckler, A, Edjlali, M, Saam, T, Saloner, D, Lal, BK, Capodanno, D, Sun, J, Balu, N, Naylor, R, Lugt, AVD, Wasserman, BA, Kooi, ME, Wardlaw, J, Gillard, J, Lanzino, G, Hedin, U, Mikulis, D, Gupta, A, DeMarco, JK, Hess, C, Goethem, JV, Hatsukami, T, Rothwell, P, Brown, MM, and Moody, AR

Subjects
Biomedical and Clinical Sciences, Neurosciences, Clinical Sciences, Atherosclerosis, Aging, Clinical Research, Cardiovascular, Patient Safety, Stroke, Health Services, Carotid Arteries, Carotid Artery Diseases, Carotid Stenosis, Consensus, Humans, Plaque, Atherosclerotic, Nuclear Medicine & Medical Imaging, Clinical sciences, Physical chemistry
Abstract

Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.

Published
2021

9. Treatment of large and giant posterior communicating artery aneurysms with the Surpass streamline flow diverter: results from the SCENT trial

Author

Kan, P., Mohanty, A., Meyers, P.M., Coon, A.L., Wakhloo, A.K., Marosfoi, M., Bain, M., Vries, J. de, Ebersole, K., Lanzino, G., Taussky, P., Hanel, R.A., Kan, P., Mohanty, A., Meyers, P.M., Coon, A.L., Wakhloo, A.K., Marosfoi, M., Bain, M., Vries, J. de, Ebersole, K., Lanzino, G., Taussky, P., and Hanel, R.A.

Abstract

Item does not contain fulltext, BACKGROUND: The Surpass flow diverter was developed to treat intracranial aneurysms not amenable to standard treatment. Indications for use allow placement in the internal carotid artery to the terminus, including the communicating artery segment. METHODS: The Surpass Intracranial Aneurysm Embolization System Pivotal Trial to Treat Large or Giant Wide Neck Aneurysms (SCENT) trial is an international, multicenter, prospective, non-randomized trial comparing the outcomes of Surpass flow diverter treatment with historic control designed to evaluate the effectiveness and safety of Surpass for the treatment of wide neck (≥4 mm) large or giant intracranial aneurysms ≥10 mm. The primary effectiveness endpoint is the percentage of subjects with 100% aneurysm occlusion without significant stenosis of the parent artery and without retreatment of the target aneurysm at 12 months. The primary safety endpoint is the percentage of subjects experiencing neurologic death or major ipsilateral stroke at 12 months. We report the effectiveness and safety of flow diversion in the subgroup of posterior communicating artery (PComA) aneurysms. RESULTS: Of the 180 patients treated, 38 harbored a PComA aneurysm. Mean aneurysm size was 12.2 mm and mean neck width was 4.8 mm. The mean number of Surpass devices used was 1.1 per procedure, with 94.7% of aneurysms treated with one flow diverter. The 12 month primary effectiveness rate was 73.7% (28/38). At 36 months, 68.4% (26/38) of aneurysms remained completely occluded. The 12 month major ipsilateral stroke or neurological death rate was 10.5%. No patients with PComA occlusion after flow diverter placement (54.5%) had clinical sequelae. CONCLUSIONS: SCENT demonstrated acceptable 12 month effectiveness of flow diversion in PComA aneurysms. Despite associated PComA occlusions in many cases, arterial occlusions were clinically silent. TRIAL REGISTRATION NUMBER: URL: https://www. CLINICALTRIALS: gov. Unique identifier: NCT01716117.

Published
2023

14. Learning Curve for Flow Diversion of Posterior Circulation Aneurysms: A Long-Term International Multicenter Cohort Study

Author

Adeeb, N., primary, Dibas, M., additional, Griessenauer, C.J., additional, Cuellar, H.H., additional, Salem, M.M., additional, Xiang, S., additional, Enriquez-Marulanda, A., additional, Hong, T., additional, Zhang, H., additional, Taussky, P., additional, Grandhi, R., additional, Waqas, M., additional, Aldine, A.S., additional, Tutino, V.M., additional, Aslan, A., additional, Siddiqui, A.H., additional, Levy, E.I., additional, Ogilvy, C.S., additional, Thomas, A.J., additional, Ulfert, C., additional, Möhlenbruch, M.A., additional, Renieri, L., additional, Bengzon Diestro, J.D., additional, Lanzino, G., additional, Brinjikji, W., additional, Spears, J., additional, Vranic, J.E., additional, Regenhardt, R.W., additional, Rabinov, J.D., additional, Harker, P., additional, Müller-Thies-Broussalis, E., additional, Killer-Oberpfalzer, M., additional, Islak, C., additional, Kocer, N., additional, Sonnberger, M., additional, Engelhorn, T., additional, Kapadia, A., additional, Yang, V.X.D, additional, Salehani, A., additional, Harrigan, M.R., additional, Krings, T., additional, Matouk, C.C., additional, Mirshahi, S., additional, Chen, K.S., additional, Aziz-Sultan, M.A., additional, Ghorbani, M., additional, Schirmer, C.M., additional, Goren, O., additional, Dalal, S.S., additional, Finkenzeller, T., additional, Holtmannspötter, M., additional, Buhk, J.-H., additional, Foreman, P.M., additional, Cress, M.C., additional, Hirschl, R.A., additional, Reith, W., additional, Simgen, A., additional, Janssen, H., additional, Marotta, T.R., additional, Stapleton, C.J., additional, Patel, A.B., additional, and Dmytriw, A.A., additional

Published
2022
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16. List of Contributors

Author

Abbatemarco, J.A., primary, Adams, R.J., additional, Adkins, D.L., additional, Akamatsu, Y., additional, Akyol, O., additional, Alexandrov, A.V., additional, Alim, I., additional, Alkhachroum, A.M., additional, Amin-Hanjani, S., additional, Andjelkovic, A.V., additional, Anrather, J., additional, Applegate, R., additional, Arai, K., additional, Ayata, C., additional, Aziz-Sultan, M.A., additional, Ballesteros, I., additional, Bar, B., additional, Barone, F.C., additional, Barrow, D.L., additional, Başkaya, M.K., additional, Bateman, K., additional, Bazan, N.G., additional, Beecher, J.S., additional, Beer-Furlan, A., additional, Belayev, L., additional, Bhattacharya, P., additional, Bhole, R., additional, Biller, J., additional, Biousse, V., additional, Borlongan, C.V., additional, Bouts, M.J.R.J., additional, Brey, R.L., additional, Bronstein, R., additional, Bryer, A., additional, Bulsara, K.R., additional, Can, A., additional, Canhão, P., additional, Caplan, L.R., additional, Carmichael, S.T., additional, Carrau, R., additional, Castaldo, J., additional, Catanese, L., additional, Chabriat, H., additional, Chaturvedi, S., additional, Chaudhary, N., additional, Chen, Jieli, additional, Chen, S., additional, Chen, Jun, additional, Choi, D.W., additional, Choi, B., additional, Chopp, M., additional, Chung, D.Y., additional, Chung, C.-P., additional, Cipolla, M.J., additional, Colbourne, F., additional, Colburn, Q., additional, Cord, B.J., additional, Coull, B.M., additional, Cuartero, M.I., additional, Cummings, J.L., additional, Dafer, R.M., additional, Dalkara, T., additional, Daou, B., additional, Dave, K.R., additional, Davis, T.P., additional, De Georgia, M., additional, De Silva, T.M., additional, Dharap, A., additional, Di Tullio, M.R., additional, Dietrich, W.D., additional, Dijkhuizen, R.M., additional, Dobkin, B.H., additional, Du, R., additional, Ducruet, A.F., additional, Duncan, K.R., additional, Edvinsson, L., additional, Edwards, M.J., additional, Egemen, E., additional, El-Hunjul, M., additional, Emanuele, M., additional, Emanuele, N., additional, Erdman, M.K., additional, Ergul, A., additional, Fagan, S.C., additional, Faraci, F.M., additional, Federau, C., additional, Ferro, J.M., additional, Fisher, M., additional, Flemming, K.D., additional, Foerch, C., additional, Freitas, R.S., additional, Friedlander, R.M., additional, Gaberel, T., additional, Gakuba, C., additional, Giffard, R.G., additional, Goldberg, M.P., additional, González, R.G., additional, Gopinath, S., additional, Gorelick, P.B., additional, Goshgarian, C., additional, Greenberg, D.A., additional, Griessenauer, C.J., additional, Groshans, K.A., additional, Gupta, R., additional, Hachem, R.A., additional, Hage, Z.A., additional, Hall, E.D., additional, Hamel, E., additional, Hao, Q., additional, Haqqani, A.S., additional, Hariman, R., additional, Hasan, D., additional, Haussen, D.C., additional, He, L., additional, Heiferman, D.M., additional, Herndon, J.M., additional, Ho, W.M., additional, Hoffmann, S., additional, Howard, B.M., additional, Hu, B.R., additional, Huber, J.D., additional, Huisa, B., additional, Hurn, P.D., additional, Iliff, J.J., additional, Jabbour, P., additional, Jamshidi, A.O., additional, Jankowitz, B., additional, Jickling, G.C., additional, Johansen, M., additional, Jovin, T.G., additional, Karuppagounder, S.S., additional, Kasper, E.M., additional, Keep, R.F., additional, Kim, H.-H., additional, Kim, D.E., additional, Kim, J.S., additional, Kim, J.Y., additional, Klahr, A.C., additional, Koch, M.J., additional, Kole, M., additional, Koleilat, S.M., additional, Kozan, A., additional, Kuroda, S., additional, Lamy, C., additional, Lanzino, G., additional, Larsen, A.G., additional, Laviv, Y., additional, Lawton, M.T., additional, Leary, M.C., additional, Leira, E.C., additional, Li, L., additional, Li, Q., additional, Liebeskind, D.S., additional, Lin, L., additional, Lioutas, V.A., additional, Lippert, T., additional, Liu, R., additional, Liu, J., additional, Liu, C.L., additional, Lizasoain, I., additional, Lo, E.H., additional, Loftus, C.M., additional, Logsdon, A.F., additional, Lucke-Wold, B.P., additional, Madhavan, S., additional, Madhugiri, V., additional, Malhotra, K., additional, Manning, W.J., additional, Marcell, S.J., additional, Mas, J.-L., additional, Masamoto, K., additional, Matute, C., additional, McCullough, L.D., additional, McDowell, M.M., additional, Mehdiratta, M., additional, Mehta, D., additional, Meisel, A., additional, Messegee, J., additional, Miller, B., additional, Mirza, S., additional, Modak, J.M., additional, Moro, M.A., additional, Nagel, M.A., additional, Namura, S., additional, Nedergaard, M., additional, Newell, D.W., additional, Newman, N.J., additional, Ng, K.L., additional, Nguyen, D., additional, Nguyen, H., additional, Nielsen, G., additional, Nishijima, Y., additional, Nishimura, N., additional, Nogueira, R.G., additional, Ogilvy, C.S., additional, Orbach, D.B., additional, Ostendorf, A.P., additional, Otto, B., additional, Ozpinar, A., additional, Panczykowski, D.M., additional, Patel, A.B., additional, Perez, Y., additional, Perez-Pinzon, M.A., additional, Potey, C., additional, Pradillo, J.M., additional, Prevedello, D.M., additional, Rajamani, K., additional, Rangel-Castilla, L., additional, Rao, N.M., additional, Ratan, R.R., additional, Raval, A.P., additional, Reddy, G.D., additional, Reis, C., additional, Roach, E.S., additional, Ronaldson, P.T., additional, Rosen, C.L., additional, Rosenberg, G.A., additional, Rutledge, W.C., additional, Sabzwari, R., additional, Salzano, G., additional, Santucci, P.A., additional, Saver, J.L., additional, Schallert, T., additional, Schermerhorn, M.L., additional, Schneck, M.J., additional, See, A.P., additional, Shakir, H.J., additional, Sharp, F.R., additional, Shuja, F., additional, Siddiqui, A.H., additional, Silva, M.A., additional, Singhal, A.B., additional, Sivakumar, K., additional, Slade, D.H., additional, Smith, E.R., additional, Sohrabji, F., additional, Solaroglu, I., additional, Sriraman, S.K., additional, Stamova, B., additional, Stanimirovic, D.B., additional, Stapleton, C.J., additional, Stary, C.M., additional, Steinberg, G.K., additional, Stephen, C., additional, Stetler, R.A., additional, Stone, J., additional, Sumbria, R., additional, Sweis, R., additional, Tahir, R., additional, Tarawneh, R., additional, Tarsia, J., additional, Tehrani, R., additional, Teo, M.K., additional, Testai, F.D., additional, Thrane, A.S., additional, Tobin, M.K., additional, Tome, M.E., additional, Topcuoglu, M.A., additional, Topel, C.H., additional, Torchilin, V., additional, Traystman, R.J., additional, Tsirka, S.E., additional, Turan, Y., additional, Tymianski, M., additional, van Leyen, K., additional, Varade, P., additional, Veluz, J.S., additional, Vemuganti, R., additional, Venkat, P., additional, Vexler, Z.S., additional, Vial, C.M., additional, Vinters, H.V., additional, Vosko, M.R., additional, Waeber, C., additional, Walcott, B.P., additional, Wang, J., additional, Wang, X., additional, Wang, Y.T., additional, Wei, Z.Z., additional, Wei, L., additional, Welch, B.G., additional, Winn, H.R., additional, Wintermark, M., additional, Wityk, R.J., additional, Wu, O., additional, Wu, K.C., additional, Xi, G., additional, Yacoub, H.A., additional, Yakhkind, A., additional, Yamamoto, Y., additional, Yang, S.-H., additional, Yenari, M., additional, Yigitkanli, K., additional, Yonas, H., additional, Yu, Z., additional, Zettervall, S.L., additional, Zhang, J., additional, Zhang, W., additional, and Zhao, H., additional

Published
2017
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19. O05 Flow diversion for recurrent aneurysms after stent-assisted coiling: multicenter experience

Author

Salem, M, primary, Fargen, K, additional, Lanzino, G, additional, Tanweer, O, additional, Spiotta, A, additional, Shapiro, M, additional, Tjoumakaris, SI, additional, Kim, L, additional, Levitt, MR, additional, Kan, P, additional, Hassan, A, additional, Ducruet, A, additional, Wolfe, SC, additional, Albuquerque, F, additional, Colby, G, additional, Ogilvy, C, additional, Thomas, A, additional, Levy, E, additional, Nelson, PK, additional, Siddiqui, A, additional, Riina, H, additional, Raz, E, additional, Starke, R, additional, Jabbour, P, additional, Jankowitz, B, additional, and Burkhardt, J-K, additional

Published
2022
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21. P-009 Natural history, angiographic presentation and outcomes of anterior cranial fossa dural arteriovenous fistulas

Author

Sanchez, S, primary, Raghuram, A, additional, Wendt, L, additional, Hayakawa, M, additional, Chen, C, additional, Sheehan, J, additional, Kim, L, additional, Abecassis, I, additional, Levitt, M, additional, Jayaraman, K, additional, Guniganti, R, additional, Kansagra, A, additional, Lanzino, G, additional, Giordan, E, additional, Brinjikji, W, additional, Bulters, D, additional, Durnford, A, additional, Fox, C, additional, Polifka, A, additional, Gross, B, additional, Amin-Hanjani, S, additional, Alaraj, A, additional, Kwasnicki, A, additional, Starke, R, additional, Sur, S, additional, van Dijk, M, additional, Potgieser, A, additional, Satomi, J, additional, Tada, Y, additional, Abla, A, additional, Winkler, E, additional, Du, R, additional, Rosalind Lai, P, additional, Zipfel, G, additional, Derdeyn, C, additional, and Samaniego, E, additional

Published
2022
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22. O-057 Salvage flow diversion for persistent/recanalized aneurysms after stent-assisted coiling: multicenter experience

Author

Salem, M, primary, Naamani, K, additional, Levine, A, additional, Srinivasan, V, additional, Baig, A, additional, Abbas, R, additional, Desai, S, additional, Burks, J, additional, Sinai, V, additional, Saber, H, additional, Borg, N, additional, Al Kasab, S, additional, Fargen, K, additional, Lanzino, G, additional, Tanweer, O, additional, Spiotta, A, additional, Shapiro, M, additional, Kan, P, additional, Tjoumakaris, S, additional, Kim, L, additional, Levitt, M, additional, Hassan, A, additional, Wolfe, S, additional, Albuquerque, F, additional, Colby, G, additional, Ogilvy, C, additional, Thomas, A, additional, Levy, E, additional, Nelson, P, additional, Siddiqui, A, additional, Riina, H, additional, Starke, R, additional, Jabbour, P, additional, Jankowitz, B, additional, and Burkhardt, J, additional

Published
2022
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37. Roadmap consensus on carotid artery plaque imaging and impact on therapy strategies and guidelines:An international, multispecialty, expert review and position statement

Author

Saba, L., Brinjikji, W., Spence, J. D., Wintermark, M., Castillo, M., Borst, G. J.D., Yang, Q., Yuan, C., Buckler, A., Edjlali, M., Saam, T., Saloner, D., Lal, B. K., Capodanno, D., Sun, J., Balu, N., Naylor, R., Lugt, A. V.D., Wasserman, B. A., Kooi, M. E., Wardlaw, J., Gillard, J., Lanzino, G., Hedin, U., Mikulis, D., Gupta, A., DeMarco, J. K., Hess, C., Goethem, J. V., Hatsukami, T., Rothwell, P., Brown, M. M., Moody, A. R., Saba, L., Brinjikji, W., Spence, J. D., Wintermark, M., Castillo, M., Borst, G. J.D., Yang, Q., Yuan, C., Buckler, A., Edjlali, M., Saam, T., Saloner, D., Lal, B. K., Capodanno, D., Sun, J., Balu, N., Naylor, R., Lugt, A. V.D., Wasserman, B. A., Kooi, M. E., Wardlaw, J., Gillard, J., Lanzino, G., Hedin, U., Mikulis, D., Gupta, A., DeMarco, J. K., Hess, C., Goethem, J. V., Hatsukami, T., Rothwell, P., Brown, M. M., and Moody, A. R.

Abstract

Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.

Published
2021

38. Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement

Author

Regenerative Medicine and Stem Cells, Brain, Zorgeenheid Vaatchirurgie Medisch, Circulatory Health, CDL Nanomedicine, Saba, L., Brinjikji, W., Spence, J. D., Wintermark, M., Castillo, M., de Borst, G. J. D., Yang, Q., Yuan, C., Buckler, A., Edjlali, M., Saam, T., Saloner, D., Lal, B. K., Capodanno, D., Sun, J., Balu, N., Naylor, R., Lugt, A. V. D., Wasserman, B. A., Kooi, M. E., Wardlaw, J., Gillard, J., Lanzino, G., Hedin, U., Mikulis, D., Gupta, A., DeMarco, J. K., Hess, C., Goethem, J., V, Hatsukami, T., Rothwell, P., Brown, M. M., Moody, A. R., Regenerative Medicine and Stem Cells, Brain, Zorgeenheid Vaatchirurgie Medisch, Circulatory Health, CDL Nanomedicine, Saba, L., Brinjikji, W., Spence, J. D., Wintermark, M., Castillo, M., de Borst, G. J. D., Yang, Q., Yuan, C., Buckler, A., Edjlali, M., Saam, T., Saloner, D., Lal, B. K., Capodanno, D., Sun, J., Balu, N., Naylor, R., Lugt, A. V. D., Wasserman, B. A., Kooi, M. E., Wardlaw, J., Gillard, J., Lanzino, G., Hedin, U., Mikulis, D., Gupta, A., DeMarco, J. K., Hess, C., Goethem, J., V, Hatsukami, T., Rothwell, P., Brown, M. M., and Moody, A. R.

Published
2021

40. Anterior callosal angle correlates with gait impairment and fall risk in iNPH patients

Author

Mantovani, P., Giannini, G., Milletti, D., Cevoli, S., Valsecchi, N., Gramegna, L. L., Albini-Riccioli, L., Sturiale, C., Cortelli, P., Lanzino, G., Elder, B. D., Palandri, G., Agati, R., Aspide, R., Calandra-Buonaura, G., Capellari, S., Chiari, L., Ferrari, A., Magelli, E., Merola, M., Oppi, F., Parchi, P., Pirina, A., Piserchia, V. A., Sambati, L., Mantovani, Paolo, Giannini, Giulia, Milletti, David, Cevoli, Sabina, Valsecchi, Nicola, Gramegna, Laura Ludovica, Albini-Riccioli, Luca, Sturiale, Carmelo, Cortelli, Pietro, Lanzino, Giuseppe, Elder, Benjamin D, and Palandri, Giorgio

Subjects
Male, medicine.medical_specialty, Neurology, Idiopathic normal pressure hydrocephalu, Corpus callosum, Ventriculoperitoneal Shunt, 030218 nuclear medicine & medical imaging, Corpus Callosum, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Idiopathic normal pressure hydrocephalus, Internal medicine, medicine, Humans, Anterior callosal angle, Gait impairment, Tinetti POMA scale, Accidental Falls, Aged, Female, Hydrocephalus, Normal Pressure, Magnetic Resonance Imaging, Middle Aged, Gait, Normal Pressure, Neuroradiology, medicine.diagnostic_test, business.industry, Tinetti test, Interventional radiology, Magnetic resonance imaging, eye diseases, stomatognathic diseases, Cardiology, Surgery, Neurology (clinical), Neurosurgery, business, 030217 neurology & neurosurgery, Hydrocephalus
Abstract

Background In idiopathic normal pressure hydrocephalus (iNPH), gait and balance impairment is the most frequent symptom, and it is often associated with a higher fall risk. In a prior study, the anterior callosal angle (ACA) was validated as a reliable marker to discriminate iNPH from Alzheimer's disease and healthy controls. However, the potential correlation between the ACA with clinical symptoms and functional outcomes has not been assessed. The objective of this study is to determine the utility of the ACA in predicting gait improvement after ventriculoperitoneal (VP) shunting.Methods Patients with probable iNPH who underwent shunt placement at a single institution were prospectively enrolled from May 2015 to May 2019. Patients were assessed preoperatively and at 6 months postoperatively following a standard clinical and MRI protocol. Callosal angle (CA) and ACA were calculated from 3 T MRI preoperatively and at 6 months postoperatively. CA and ACA were tested for correlation with clinical scores.Results Forty-seven patients with probable INPH who completed 6-month postoperative follow-up were enrolled in the study. Baseline ACA was significantly correlated with preoperative fall risk, gait, and balance impairment assessed with Tinetti POMA scale. Additionally, baseline ACA differentiated patients who experienced improvement at Tinetti POMA scale after surgery.Conclusions The baseline ACA is a useful neuroradiological marker to differentiate patients by fall risk and has significant correlation with the improvement in gait and balance impairment following surgery. This study demonstrated that the ACA may be a complementary tool to the CA in predicting shunt responsiveness in iNPH.

Published
2020

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