title: Disproportionate subarachnoid space hydrocephalus-outcome and perivascular space.
abstract: OBJECTIVE
  We sought to identify the prevalence of MRI features of disproportionately enlarged subarachnoid space hydrocephalus in possible idiopathic normal pressure hydrocephalus (DESH-iNPH) and to describe the clinico-radiological features and outcomes of a community-based investigation (The Vienna Trans-Danube Aging study).
  
  
  METHODS
  Of the 697 inhabitants (all 75 years old), 503 completed extensive neurological examinations at baseline and were followed up every 30 months thereafter with MRIs, mini-mental state examination (MMSE), and the Unified Parkinson Disease Rating Scale-Motor Section (UPDRSM). The DESH-iNPH participant data were compared with the data from participants with Evans index ratios >0.3 (ex vacuo hydrocephalus), cerebral small-vessel diseases, and normal MRIs. The widening of perivascular space was also evaluated by MRI in these groups.
  
  
  RESULTS
  Eight participants with DESH-iNPH (1.6%) and 76 with ex vacuo hydrocephalus (16.1%) at baseline were identified. The mean MMSE in DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs was 26.4, 27.9, and 28.3, respectively, and the mean UPDRSM was 9.75, 2.96, and 1.87, respectively. After a 90-month follow-up, the mortality rates for DESH-iNPH, ex vacuo hydrocephalus, and normal MRIs were 25.0%, 21.3%, and 10.9%, respectively. The perivascular-space widening scores were significantly smaller in the DESH-iNPH cases, particularly at the centrum semiovale, compared to cerebral small-vessel disease and ex vacuo hydrocephalus cases.
  
  
  CONCLUSIONS
  The prevalence of DESH-iNPH was 1.6% for participants aged 75 years and revealed significantly lower MMSE and higher UPDRSM scores compared to the ex vacuo hydrocephalus and controls. Moreover, it is suggested that perivascular-space narrowing is a morphological and pathophysiological marker of DESH-iNPH.
authors.affiliation: Center of Neurological and Cerebrovascular Diseases, Takeda Hospital Kyoto, Japan ; Department of Health Science, Kyoto Koka Women's University Kyoto, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Akiguchi
authors.affiliation: Center of Neurological and Cerebrovascular Diseases, Takeda Hospital Kyoto, Japan ; Biomedical MR Science Center, Shiga University of Medical Science Otsu, Japan.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Shirakashi
authors.affiliation: Institute of Neurology, Medical University of Vienna Vienna, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Budka
authors.affiliation: Center of Neurological and Cerebrovascular Diseases, Takeda Hospital Kyoto, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Health Science, Kyoto Koka Women's University Kyoto, Japan ; Biomedical MR Science Center, Shiga University of Medical Science Otsu, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Health Science, Kyoto Koka Women's University Kyoto, Japan ; Biomedical MR Science Center, Shiga University of Medical Science Otsu, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Shiino
authors.affiliation: Department of Health Science, Kyoto Koka Women's University Kyoto, Japan.
authors.forename: Mihoko
authors.initials: M
authors.lastname: Ogita
authors.affiliation: Department of Health Science, Kyoto Koka Women's University Kyoto, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kawamoto
authors.affiliation: Ludwig Boltzmann Institute of Aging Research Vienna, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Jungwirth
authors.affiliation: Ludwig Boltzmann Institute of Digital Radiography and Intervention Radiology Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Krampla
authors.affiliation: Ludwig Boltzmann Institute of Aging Research Vienna, Austria ; Psychiatric Department, Danube Hospital Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Fischer