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AJNR Awards, New Junior Editors, and more. Read the latest AJNR updates

Research ArticleAdult Brain

Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus?

A.K. Ahmed, M. Luciano, A. Moghekar, J. Shin, N. Aygun, H.I. Sair, D. Rigamonti and A.M. Blitz
American Journal of Neuroradiology November 2018, 39 (11) 2022-2026; DOI: https://doi.org/10.3174/ajnr.A5820
A.K. Ahmed
aFrom the Departments of Neurosurgery (A.K.A., M.L., D.R.)
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M. Luciano
aFrom the Departments of Neurosurgery (A.K.A., M.L., D.R.)
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A. Moghekar
bNeurology (A.M.)
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J. Shin
dDepartment of Radiology (J.S.), University of California, San Francisco, School of Medicine, San Francisco, California.
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N. Aygun
cRadiology and Radiological Sciences (N.A., H.I.S., A.M.B.), Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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H.I. Sair
cRadiology and Radiological Sciences (N.A., H.I.S., A.M.B.), Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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D. Rigamonti
aFrom the Departments of Neurosurgery (A.K.A., M.L., D.R.)
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A.M. Blitz
cRadiology and Radiological Sciences (N.A., H.I.S., A.M.B.), Division of Neuroradiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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    FIGURE.

    Characteristic imaging and classification for patients with adult hydrocephalus. A, Absence of DESH. B, DESH present: Sylvian fissure enlargement and tight high-convexity effacement are present. Both patients were treated with ventricular shunting and had improvement in symptoms. A scaled measurement of the Sylvian fissure is provided to illustrate the extent of fissure enlargement in this representative case. However, consistent with the defining features of DESH in the literature,3–5 quantitative measurement was not used as scoring criterion during blinded neuroradiologist review.

Tables

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    Table 1:

    Demographics and baseline characteristics

    Demographics and Characteristics
    Mean age (range) (yr)71.7 (53–80)
    Sex68.4% Male, 32.6% female
    Hydrocephalus classification (n = 133)
        No DESH (No.) (%)96 (72.2%)
        DESH (No.) (%)37 (27.8%)
    • View popup
    Table 2:

    Preoperative clinical presentation

    OverallNo DESHDESHP Value (No DESH vs DESH)
    Gait (No.)1339637
    Normal gait14131>.05
        Gait abnormality with uneven surfaces or pace18153>.05
        History of falls544014>.05
        Assisted gait (ie, walker)392316>.05
        Wheelchair-bound853>.05
    Urinary dysfunction (No.)1319437
        No dysfunction433112>.05
        Urgency, anxiety, or ambiguous symptoms not otherwise classified19163>.05
        Rare or intermittent symptoms433013>.05
        Urinary symptoms often16115>.05
        Urinary incontinence (requiring adult diapers)1064>.05
    Dementia (No.)1339637
        No dementia22166>.05
        Forgetfulness33285>.05
        Mild dementia473314>.05
        Moderate dementia21147>.05
        Severe dementia1055>.05
    MMSEa (mean) (95% CI)26.5 (7–30)27.1 (16–30)21.3 (7–28)>.05
    Tinetti (proportion)21.4 (6–28)21.63 (6–28)21.3 (7–28)>.05
    TUG (mean) (95% CI)19.07 (4.5–82)18.63 (4.5–60)19.5 (9.7–82)>.05
    Depression (proportion)52/94 (55.3%)40/73 (54.8%)12/21 (57.1%)>.05
    Headache (proportion)44/78 (56.4%)36/62 (58.1%)8/16 (50%)>.05
    • ↵a The MMSE score was available for 26/96 patients with preoperative findings without DESH and 34/37 patients with DESH.

    • View popup
    Table 3:

    Outcomes following treatment for adult hydrocephalus at last known follow-up (1248.3 ± 103.3 days following surgery)a

    OverallNo DESHDESHP Valueb (No DESH vs DESH)
    Gait (No.)1138429
        Improvement896524>.05
        No improvement1385>.05
        Worse431>.05
        Normal findings at baseline761>.05
        P valueb<.05<.05<.05
    Improvement compared with baseline
        Urinary dysfunction (No.) (%)1198435
            Improvement715021>.05
            No improvement633>.05
            Worse220>.05
            Normal findings at baseline402911>.05
        P valueb<.05<.05<.05
    Improvement compared with baseline
        Dementia (No.) (%)
            Improvement30246>.05
            No improvement743>.05
            Worse330>.05
            Normal findings at baseline743>.05
        P valueb<.05<.05<.05
    Improvement compared with baseline
        MMSE27.5 (17–30)27.7 (16–30)27.4 (17–30)>.05
        Tinetti25 (8–28)24.9 (5–28)25 (15–28)>.05
        TUG13.5 (6–25.7)14.6 (7.5–57)12.9 (10.9–19)>.05
    • ↵a Columns compare the proportion improved among a cohort (ie, overall, DESH, No DESH); rows compare proportional improvement between those with and without DESH.

    • ↵b The Fisher exact test was performed for those with preoperative symptoms, excluding those with normal findings at baseline. Findings are significant.

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American Journal of Neuroradiology: 39 (11)
American Journal of Neuroradiology
Vol. 39, Issue 11
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Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus?
A.K. Ahmed, M. Luciano, A. Moghekar, J. Shin, N. Aygun, H.I. Sair, D. Rigamonti, A.M. Blitz
American Journal of Neuroradiology Nov 2018, 39 (11) 2022-2026; DOI: 10.3174/ajnr.A5820
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A.K. Ahmed, M. Luciano, A. Moghekar, J. Shin, N. Aygun, H.I. Sair, D. Rigamonti, A.M. Blitz
Does the Presence or Absence of DESH Predict Outcomes in Adult Hydrocephalus?
American Journal of Neuroradiology Nov 2018, 39 (11) 2022-2026; DOI: 10.3174/ajnr.A5820

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