Dergi Ara >>
Yıl:2008; Cilt: 21; Sayı: 1-4>> Özet
TAM METİN
Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2008;21(1-4):45-58
Normal Basınçlı Hidrosefali: Yeni Kavramlar
MM Taşkın
Bakırköy Ruh Sağlığı ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi
Normal basınçlı hidrosefali, idiyopatik veya sekonder nedenlerle olabilen, ileri yaşlarda görülen ve yürüme bozukluğu, demons ve inkontinans şeklinde bir klinik triadı bulunan, tedavi edilebilir bir ilerleyici psikomotor bozukluktur, ilk kez 1965 yılında, Hakim ve Adams tarafından tanımlandığı için, bu otörlerin adıyla da anılmaktadır. Tanısında CT ve MRI yanı sıra tedavi planlaması için de gereken, BOS drenajı yöntemlerinden yararlanılır. Klinik triadından en az ikisinin bulunduğu, ventrikülomegalisi bulunan ve BOS basıncı normal olan hastalardan, drenaj tedavisinden yarar görenleri, şant veya endoskopik üçüncü ventrikülostomi ameliyatı yapılarak tedavi edilebilmektedir. Ayırıcı tanıda, benzer klinik bulgulara yol açan diğer merkezi sinir sistemi dejeneratif hastalıkları ekarte edilmelidir. Cerrahi tedaviden en fazla yürüme bozukluğu yakınması ön planda olanlar ve semptomların süresi kısa olan hastalar yarar görmektedir.
Normal Pressure Hydrocephalus: New Concepts
Normal pressure hydrocephalus is a treatable syndrome seen in elderly patients who show the classical triad of gait disorder, dementia and urinary incontinence. It may be due to idiopathic or secondary causes and is a progressive psychomotor disorder. It was first described by Hakim and Adams in 1965, and sometimes referred as Hakim-Adams syndrome. Brain CT or MRI is used to diagnose this syndrome and cerebrospinal fluid (CSF) drainage gives the additional clue about the probable benefit from a shunt operation. Minimum requirements for the shunt replacement or endoscopic third ventriculostomy operations are, the presence of at least two components of the clinical triad, presence of ventriculomegaly, and normal opening pressure of CSF. In the differential diagnosis of this syndrome, other possible causes of degenerative CNS disorders must be ruled out. The patients whose main presenting symptom is gait disturbance and patients with a short duration of symptoms benefit mostly from these treatment modalities.

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