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Neurofibrillary Tangles in the Dementia of “Normal Pressure” Hydrocephalus

Published online by Cambridge University Press:  18 September 2015

Melvyn J. Ball
Melvyn J. Ball*
Affiliation:
Departments of Clinical Neurological Sciences and Pathology, University of Western Ontario, London, Canada
*
Department of Pathology, University Hospital, 339 Windermere Rd., London, Ontario, Canada N6A 5A5
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Routine neuropathological examination could not explain the dramatic improvement exhibited by one patient with “normal pressure” hydrocephalus after shunting. The improved patient contrasted remarkably with the unchanged condition of four others also shunted successfully. The five brains were analysed by quantitative morphometry to determine the degree of neurofibrillary tangle formation in mesial temporal neurons. The density of tangle-bearing nerve cells in the four unimproved cases was markedly greater than in age-matched control brains from nineteen normal subjects, and fell in the same range as that of eight dements with neuropathologically confirmed Alzheimer's disease. The density of the one who recovered was within normal limits.

The duration of dementia before shunting, and the total duration of dementia in these five patients rank in the same order as their degree of neurofibrillary formation. Furthermore, a positive linear correlation exists between the Tangle Indices and the total duration of dementia. The data suggest that early diagnosis may improve the chances of reversing the dementia of normal pressure hydrocephalus before histological alterations prove too severe.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 3 , Issue 4 , November 1976 , pp. 227 - 235
Copyright
Copyright © Canadian Neurological Sciences Federation 1976

References

REFERENCES

Adams, R.D., Fisher, C.M., Hakim, S., Ojemann, R.G. and Sweet, W.H. (1965). Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. New England Journal of Medicine, 273, 117–126.CrossRefGoogle ScholarPubMed
Adapon, B.D., Braunstein, P., Lin, J.P. and Hochwald, G.M. (1974). Radiologic investigations of normal pressure hydrocephalus. Radiology Clinics of North America, 12, 353–369.CrossRefGoogle ScholarPubMed
Alzheimer, A. (1907). Uber eine eigenar-tige Erkrankung der Hirnrinde. Allgemein Zeitschrift fiir Psychiatrie. 64, 146–148.Google Scholar
Ball, M.J. (1976). Neurofibrillary tangles and the pathogenesis of dementia - a quantitative study. Neuropathology and Applied Neurobiology (in press).CrossRefGoogle Scholar
Bannister, C.M. (1972). A report of eight patients with low pressure hydrocephalus treated by CSF diversion with disappointing results. Acta neurochirurgica, 27, 11–15.CrossRefGoogle ScholarPubMed
Blessed, G., Tomlinson, B.E. and Roth, M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. British Journal of Psychiatry, 114, 797–811.CrossRefGoogle ScholarPubMed
Coblentz, J.M., Mattis, S., Zingesser, L.H., Kasoff, S.S., Wisniewski, H. and Katzman, R. (1973). Presenile dementia: clinical aspects and evaluation of CSF dynamics. Archives of Neurology, 29, 299–308.CrossRefGoogle Scholar
Dayan, A.D. and Ball, M.J. (1973). Histometric observations on the metabolism of tangle-bearing neurons. Journal of Neurological Sciences. 19, 433–436.CrossRefGoogle Scholar
Deland, F.H., James, A.E., Ladd, D.J. and Konigsmark, B.W. (1972). Normal pressure hydrocephalus: a histologic study. American Journal of Clinical Pathology, 58, 58–63.CrossRefGoogle ScholarPubMed
Earnest, M.P., Fahn, S., Karp, J.H. and Rowland, L.P. (1974). Normal pressure hydrocephalus and hypertensive cerebrovascular disease. Archives of Neurology, 31, 262–266.CrossRefGoogle ScholarPubMed
Fisher, C.M. (1965). Lacunes - small deep cerebral infarcts. Neurology (Min-neap.), 15, 774–784.CrossRefGoogle ScholarPubMed
Fisher, C.M. (1969). The arterial lesions underlying lacunes. Acta Neuropathologica (Berlin), 12, 1–15.CrossRefGoogle Scholar
Geschwind, N. (1968). The mechanism of normal pressure hydrocephalus. Journal of Neurological Sciences, 7, 481–493.CrossRefGoogle ScholarPubMed
Hachinski, V.C, Lassen, N.A. and Marshall, J. (1974). Multi-infarct Dementia. A cause of mental deterioration in the elderly. Lancet, 2, 207–210.CrossRefGoogle ScholarPubMed
Hakim, S. and Adams, R.D. (1965). The special clinical problem of symptomatic hydrocephalus with normal CSF pressure: Observations on CSF hydrodynamics. Journal of Neurological Sciences, 2. 307–327.CrossRefGoogle Scholar
Heinz, E.R., Davis, D.O. and Karp, H.R. (1970). Abnormal isotope cisternography in symptomatic hydrocephalus. Radiology, 95, 109–120.CrossRefGoogle Scholar
Hirano, A.. Dembitzer, H.M. and Kurland, L.T. (1968). The fine structure of some intraganglionic alterations. Journal of Neuropathology and Experimental Neurology, 27, 167–182.CrossRefGoogle ScholarPubMed
Jacobs, L., Conti, D., Kinkel, W.R. and Manning, E.J. (1976). “Normal-pressure” hydrocephalus: relationship of clinical and radiographic findings to improvement following shunt surgery. Journal of the American Medical Association. 235. 510–512.CrossRefGoogle ScholarPubMed
Järpe, S. (1970). Presenile dementia and hydrocephalus. Acta Neurologica Scandinavia 46. 43. 89.Google ScholarPubMed
Katzman, R. (1976). Cerebrospinal Fluid Physiology and Normal Pressure Hydrocephalus. In: Terry, R.D. and Gershon, S. (Ed.). Neurobiology of Aging. Raven Press. New York. pp. 139–153.Google Scholar
Lorenzo, A.V., Bresnan, M.J. and Barlow, C.F. (1974). Cerebrospinal fluid absorption deficit in normal pressure hydrocephalus. Archives of Neurology. 30, 387–393.CrossRefGoogle ScholarPubMed
McMenemey, W.H. (1971). Alzheimer’s disease. In: Blackwood, W., McMenemey, W.H.. Meyer, A.. Norman, R.M. and Russell, D.S. (Ed.). Greenfields’s Neuropathology. Edward Arnold Ltd.. London, pp. 529–546.Google Scholar
Messert, B and Wannamakkr, B.B. (1974). Reappraisal of the adult occult hydrocephalus syndrome. Neurology (Min-neap.). 24. 224–231.CrossRefGoogle ScholarPubMed
Ojemann, R.G.. Fisher, C.M., Adams, R.D., Sweet, W.H. and New, P.F.J. (1969). Further experience with the syndrome of “normal” pressure hydrocephalus. Journal of Neurology. Neurosurgery and Psychiatry. 31. 279–294.Google Scholar
Romanul, F. and Abramowicz, A. (1964). Changes in brain and pial vessels in arterial border zones. Archives of Neurology. 2. 40–65.CrossRefGoogle Scholar
Sohn, R.S.. Siegel, R.M.. Gado, M. and Torack, R. 4. (1973). Alzheimer’s disease with abnormal cerebrospinal fluid flow. Neurology (Minneap.), 23. 1058–1065.Google Scholar
Stein, S.C. and Langfitt, T.W. (1974). Normal pressure hydrocephalus. Predicting the results of cerebrospinal fluid shunting. Journal of Neurosurgery. 41. 463–470.CrossRefGoogle ScholarPubMed
Stokes, M. 1. and Trickey, R.J. (1973). Screening for neurofibrillary tangles and argyrophilic plaques with Congo red staining and polarized light. Journal of Clinical Pathology, 26, 241.CrossRefGoogle ScholarPubMed
Sugar, O. (1976). Editorial. Journal of the American Medical Association. 235. 534.CrossRefGoogle Scholar
Sypert, G.W., Leffman, H. and Ojemann, G.A. (1973). Occult normal pressure hydrocephalus manifested by parkinsonism-dementia complex. Neurology (Minneap.). 23. 234–238.CrossRefGoogle ScholarPubMed
Tomlinson, B.E., Blessed, G. and Roth, M. (1970). Observations on the brains of demented old people. Journal of Neurological Sciences, 2. 205–242.CrossRefGoogle Scholar
Tomlinson, B.E. and Kitchener, D. (1972). Granulovacuolar degeneration of hippocampal pyramidal cells. Journal of Pathology. 106, 165–185.CrossRefGoogle ScholarPubMed
Wolinsky, J.S., Barnes, B.D. and Margolis, M.T. (1973). Diagnostic tests in normal pressure hydrocephalus. Neurology (Minneap.). 23. 706–713.CrossRefGoogle ScholarPubMed