Category: Neuroimaging (Non-PD)
Objective: We aimed to present two novel neuroimaging biomarkers based on enlarged perivascular spaces (ePVS) of the sub-insular territory: the Hedgehog and Hedgehog-Halo (H-H) sign to predict gait symptom severity and tap response in NPH.
Background: Reduced cerebrospinal fluid (CSF) clearance may play a vital role in the pathogenesis of normal pressure hydrocephalus (NPH), but the radiologic marker is yet to be elucidated.
Method: We retrospectively reviewed 203 patients with possible NPH with baseline magnetic resonance imaging and detailed gait analyses before and after lumbar puncture. The Hedgehog/H-H sign was scored using T2-weighted images. Gait was assessed using time-up-and-go test and objective gait analysis. The clinical severity at baseline and post-tap gait improvement was compared in patients with and without Hedgehog/H-H sign. The association between Hedgehog/H-H sign and post-tap gait outcomes was assessed using multivariate linear regression analysis.
Results: Patients with H-H showed higher modified Rankin Score (mRS) and more severe gait impairment than those without any signs. Following therapeutic lumbar puncture, patients with Hedgehog/H-H sign significantly improved in various gait parameters on objective gait analysis, unlike those without Hedgehog/H-H sign. Finally, the degree of alleged glymphatic dysfunction (H-H > Hedgehog > none) was significantly associated with post-tap gait improvement after adjusting for age, sex, disease duration, total basal ganglia-ePVS burden, and pre-tap mRS.
Conclusion: The Hedgehog/H-H sign is a useful neuroimaging biomarker related to the severity and tap response in NPH potentially implying glymphatic dysfunction. This biomarker can be readily applied in clinical practice, independent of conventional radiological signs.
To cite this abstract in AMA style:
J. Ha, S. Lee, S. Kim, JS. Lee, W. Kim, JH. Ahn, JW. Cho, A. Fasano, J. Youn. Sub-insular enlarged perivascular spaces are associated with gait symptom severity and tap response in normal pressure hydrocephalus [abstract]. Mov Disord. 2024; 39 (suppl 1). https://www.mdsabstracts.org/abstract/sub-insular-enlarged-perivascular-spaces-are-associated-with-gait-symptom-severity-and-tap-response-in-normal-pressure-hydrocephalus/. Accessed October 12, 2024.« Back to 2024 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/sub-insular-enlarged-perivascular-spaces-are-associated-with-gait-symptom-severity-and-tap-response-in-normal-pressure-hydrocephalus/