國立臺灣大學醫學院外科杜永光Tu, Yong-KwangYong-KwangTu2006-07-262018-07-112006-07-262018-07-112003-12-31http://ntur.lib.ntu.edu.tw//handle/246246/24509Normal pressure hydrocephalus (NPH) resulted from cerebrovascular accidents, head injury or other causes is a common disease among aged patients. This disease is characterized by the presence of symptoms of diffused brain dysfunction without those of intracranial hypertension. Deterioration of mental function, manifested initially as impairment of memory, insidiously progresses to confusion and severe deterioration of intellectual function, associate with disturbance of gait and bladder control. Because of the similar clinical manifestation and imaging finding on CT or MR, it is very difficult to differentiate this disease from brain atrophy or Alzheimer’s disease. Shunting procedure to drain cerebrospinal fluid (CSF) in NPH patients may effectively reverse these clinical problems, however, if the differential diagnosis is not properly made this surgery sometimes become unnecessary or even harmful. Various tests have been investigated for the differentiation of these conditions, yet none was proven to be ideal. Demonstration of CSF circulation dynamics by cisternography with isotope intrathecal injection or employing CT and MR technique was tried but the results were equivocal. One recent study of regional blood flow measurement showed that both conditions caused the reduction of flow over the periventricular areas of the brain but the results of cerebrovascular reactivity are different between NPH and brain atrophy. Thus, we hypothesize that in a reversible clinical condition such as NPH, although rCBF is depleted due to the pressure effect from dilated ventricles, neuronal metabolic activity should remain normal or suboptimal. On the contrary, both rCBF and neuronal metabolic activity should be very low in the irreversible condition of brain atrophy. In vivo proton magnetic resonance spectroscopy allows noninvasive evaluation of brain metabolism on patients with neurological disease. During the past 3 years, we conducted two studies to evaluate the biochemical changes of the brain parenchyma with proton magnetic resonance spectroscopy (H-MRS) and the changes of regional cerebral blood flow (rCBF) in patients with moderate head injury and intracerebral hemorrhage. We demonstrate a good correlation among H-MRS, rCBF and patients clinical outcome in these two diseases. Recently, we are able to apply imaging software to reconstruct proton single voxel spectroscopy into chemical shifting imaging (CSI). With this technique, rCBF mapping can be superimposed with CSI and MR imaging for analysis.application/pdf97705 bytesapplication/pdfzh-TW國立臺灣大學醫學院外科Normal Pressure HydrocephalusRegional Cerebral Blood FlowChemical Shifting ImagingMagnetic Resonance SpectroscopyVentriculo-peritoneal Shuntingreporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/24509/1/912314B002341.pdf