title: Bladder recovery relates with increased mid-cingulate perfusion after shunt surgery in idiopathic normal-pressure hydrocephalus: a single-photon emission tomography study.
abstract: OBJECTIVE
  It is reported that severe bladder disorder in idiopathic normal-pressure hydrocephalus (iNPH) is predicted by right frontal hypoperfusion. However, it is not known whether bladder recovery is predicted by brain perfusion change after shunt surgery. To address this issue, we compared bladder and brain function before and after shunt surgery in iNPH.
  
  
  METHODS
  We enrolled 75 patients in the study. Before and 12 months after shunt surgery, we analyzed brain perfusion by SPECT and bladder disorder by a specialized grading scale. The scale consisted of grade 0, none; grade 1, urinary urgency and frequency; grade 2, urinary incontinence 1-3 times a week; grade 3, urinary incontinence >daily; and grade 4, loss of bladder control. More than one grade improvement is defined as improvement, and more than one grade decrement as worsening; otherwise no changes.
  
  
  RESULTS
  Comparing before and after surgery, in the bladder-no-change group (32 cases) there was an increase in blood flow which is regarded as reversal of enlargement in the Sylvian fissure and lateral ventricles (served as control). In contrast, in the bladder-improved group (32 cases) there was an increase in bilateral mid-cingulate, parietal, and left frontal blood flow (p < 0.05). In the bladder-worsened group (11 cases) no significant blood flow change was observed.
  
  
  CONCLUSIONS
  The present study showed that after shunt surgery, bladder recovery is related with mid-cingulate perfusion increase in patients with iNPH. The underlying mechanism might be functional restoration of the mid-cingulate that normally inhibits the micturition reflex.
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan. sakakibara@sakura.med.toho-u.ac.jp.|Neurology, Chiba University, Chiba, Japan. sakakibara@sakura.med.toho-u.ac.jp.
authors.forename: Ryuji
authors.initials: R
authors.lastname: Sakakibara
authors.affiliation: Radiology, Sanno Hospital, Chiba, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Uchida
authors.affiliation: Center for Early Diagnosis of Dementia, Kinki University, Sayama, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Ishii
authors.affiliation: Neurosurgery, Kohritsu Noto Hospital, Ishikawa, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Neurosurgery, Kitano Hospital, Kyoto, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Psychiatry, Osaka University, Osaka, Japan.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kazui
authors.affiliation: Neurology, Chiba University, Chiba, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Continence Center, Dokkyo Medical College, Tochigi, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Uchiyama
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan.
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Tateno
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kishi
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tsuyusaki
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Aiba
authors.affiliation: Neurology Division, Department of Internal Medicine, Sakura Medical Center, Toho University, 564-1 Shimoshizu, Sakura, 285-8741, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Tateno
authors.affiliation: Neurosurgery, Sakura Medical Center, Toho University, Sakura, Japan.
authors.forename: Takeki
authors.initials: T
authors.lastname: Nagao
authors.affiliation: Radiology, Sakura Medical Center, Toho University, Sakura, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Terada
authors.affiliation: Radiology, Sakura Medical Center, Toho University, Sakura, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Inaoka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002557:Cerebrospinal Fluid Shunts / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D007427:Intracranial Pressure / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D001743:Urinary Bladder / Q000503:physiopathology*; D014549:Urinary Incontinence / Q000209:etiology / Q000503:physiopathology*; D014554:Urination / Q000502:physiology*
keywords: Autonomic nervous system; Frontal lobe; Idiopathic normal-pressure hydrocephalus (INPH); Single-photon emission computed tomography (SPECT); Urinary incontinence