Is the midbrain involved in the manifestation of gait disturbance in idiopathic normal-pressure hydrocephalus?

Kotaro Hiraoka, Hiroshi Yamasaki, Masahito Takagi, Makoto Saito, Yoshiyuki Nishio, Osamu Iizuka, Shigenori Kanno, Hirokazu Kikuchi, Etsuro Mori

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

Gait disturbance is the most common symptom in idiopathic normal-pressure hydrocephalus (iNPH). However, its pathophysiology in iNPH has not been clarified. Some researchers have hypothesized that the mesencephalic locomotor region, which is a functionally defined area in the brainstem playing an important role in locomotion, is involved in the development of gait disturbance in iNPH. The purpose of the study was to investigate whether the midbrain is involved in the manifestation of gait disturbance in iNPH. Twenty-one iNPH patients who showed clinical improvements after shunt surgery were studied. Brain magnetic resonance imaging (MRI) was performed and clinical symptoms were assessed before and 1 year after surgery. Gait disturbance was assessed by the Timed Up and Go test and gait subcategory of the iNPH Grading Scale, a validated assessment tool for iNPH symptoms. Anteroposterior, left-to-right diameter and cross-sectional areas of the midbrain were measured at the inferior collicular level of axial images in MRI. The diameters and cross-sectional area of the midbrain at baseline did not show significant correlation with gait assessments at baseline (Spearman's correlation). The midbrain measurement did not show significant difference between the baseline and postoperative values (paired t test), and its change rates did not show significant correlation with the change (rates) of the gait assessments. In this study there were no findings to suggest involvement of the midbrain in the manifestation of gait disturbance in iNPH. The hypothesis that the mesencephalic locomotor region is involved in the manifestation of gait disturbance in iNPH needs to be reconsidered.

Original languageEnglish
Pages (from-to)820-825
Number of pages6
JournalJournal of neurology
Volume258
Issue number5
DOIs
Publication statusPublished - 2011 May

Keywords

  • Gait disturbance
  • Idiopathic normal-pressure hydrocephalus
  • Magnetic resonance imaging
  • Mesencephalic locomotor region
  • Midbrain
  • Pedunculopontine nucleus
  • Shunt surgery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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