Objective: We aimed to investigate detailed analysis for striatal dopaminergic depletion in idiopathic normal pressure hydrocephalus (iNPH) with visual assessment.

Background: Variable degree of parkinsonism including gait disturbance could be seen in patients with iNPH [1]. Accordingly, in the real clinical field, differentiation of iNPH from other parkinsonian disorders is crucial. Dopamine transporter imaging has been regarded as a diagnostic tool for the differential diagnosis of various parkinsonism [2]. However, it remains little known about characteristic patterns of striatal dopaminergic depletion in iNPH.

Method: We reviewed medical records of twenty-four patients diagnosed with iNPH and performed dopamine transporter imaging in movement disorders clinic at our hospital between 2017 and 2018. To increase the diagnostic accuracy, not only America-Europe guideline but also Japanese guideline were retrospectively applied to the current study. In addition, this study limited inclusion to patients with iNPH who underwent ventriculoperotoneal shunt. Finally Visual analyses by a consensus of two experienced neurologists were performed for dopamine transporter PET scans.

Results: All patients (100%) with iNPH revealed slight reduction in bilateral caudate nucleus. Six out of 8 patients with iNPH (75%) showed mild striatal depletion in bilateral putamen without a rostrocaudal gradient, and those putaminal uptake were heterogeneously decreased.

Conclusion: We demonstrated characteristic patters of striatal dopaminergic depletion in patients with iNPH. Our findings will help clinicians diagnose patients with parkinsonism. Further well-designed studies are required to validate our results.

References: [1] Allali G, Garibotto V, Assal F. Parkinsonism Differentiates Idiopathic Normal Pressure Hydrocephalus from Its Mimics. J Alzheimers Dis. 2016 Jul 27;54(1):123-7. [2] Oh M, Kim JS, Kim JY, Shin KH, Park SH, Kim HO, Moon DH, Oh SJ, Chung SJ, Lee CS. Subregional patterns of preferential striatal dopamine transporter loss differ in Parkinson disease, progressive supranuclear palsy, and multiple-system atrophy. J Nucl Med. 2012 Mar;53(3):399-406.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/visual-assessment-of-dopamine-transporter-imaging-in-normal-pressure-hydrocephalus/