|
|
Normal pressure hydrocephalus- Complex approach to diagnosis and treatment
Skalický, Petr ; Bradáč, Ondřej (advisor) ; Haninec, Pavel (referee) ; Keller, Jiří (referee)
Normal pressure hydrocephalus (NPH) is an important part of the differential dia- gnosis of the causes of cognitive deficit, gait disorder and incontinence in elderly patients. This is especially true for idiopathic normal pressure hydrocephalus (iNPH), to which this thesis is dominantly devoted. A number of factors contribute to the course of the disease, therefore a comprehensive approach evaluating multiple variables accompanying the disease, comorbid diseases or considered diseases in the differential diagnosis, as well as a comprehensive approach to therapy, which contains much more than just the im- plantation of a derivation system for the drainage of cerebrospinal fluid, can improve, not only, the quality of life of these patients. The mainstay of the dissertation thesis are two first-author articles. The first study deals with morphological parameters obtained during MRI examination and their ability to predict improvement in gait after shunt implantation in iNPH patients. We evaluated the predictive performance of score for evaulating disproportionately enlarged subarachnoid space hydrocephalus (DESH score), callosal angle and cingulate sulcus sign against the reference standard in the form of functional testing - lumbar infusion test (LIT) and external lumbar drainage (ELD). In the...
|
|
|
Deriving predictive pathophysiological markers from ICP analysis
Mládek, Arnošt ; Bradáč, Ondřej (advisor) ; Haninec, Pavel (referee) ; Mraček, Jan (referee)
Deriving predictive pathophysiological markers from ICP analysis RNDr. Arnošt Mládek, Ph.D. December 13, 2021 Abstract Intracranial pressure (ICP) is an irreplaceable neurointensive care parameter and is an area under intensive research. The great diagnostic importance of ICP is underlied by two factors: (1) the central nervous system (CNS) is placed in a rigid cranial vault and even small local expansive processes (e.g. tumors, abscesses, bleeding) may lead to intracranial hypertension; (2) a specific property of the CNS is a rather uniform response to various pathological events since many etiologically heterogeneous diffuse injuries of neural tissue lead to oedema elevating ICP. The complexity of ICP monitoring stems from the neurosurgical insertion of the pressure sensor into the intracranial space and the associated risks of bleeding, neuroinfection and brain tissue damage. Intracranial pressure is more than just a number on a bedside monitor, even though in clinical practice this simplification is rather common. Similarly to electrocardiogram (ECG) signals whose information content goes well beyond heart rate calculation, understanding of ICP dynamics can provide us with insight into the current clinical status as well as prediction of further evolution. The mainstay of the dissertation thesis are...
|
|
|
The use of experimental MR imaging in neurosurgery, diagnostic markers in expansive brain processes. Diagnostic markers of patients with normal pressure hydrocephalus
Vlasák, Aleš ; Bradáč, Ondřej (advisor) ; Hejčl, Aleš (referee) ; Krahulík, David (referee)
Despite decades of research of normal pressure hydrocephalus (NPH), a clear pathophysiological mechanism of the disease is sill unknown. This results in the absence of a unambiguous diagnostic biomarker. Moreover, NPH in contrast to similar neurodegenerative diseases is curable by insertion of a ventrikulo-peritoneal shunt. Now the diagnostics is based on invasive functional testing, on the contrary, imaging methods play only a supporting role. This work is processed with an effort to find a sufficiently sensitive and specific biomarker of MRI imaging using advanced analytical methods. For this reason, the structural volumetry and the phase contrast method were tested. The individual partial results of both of these modalities have already been described in the literature, but the conclusions were controversial. The main contribution of this work is the range of tested parameters and their to date untested advanced analysis - accurate automatic segmentation in volumetric study and machine learning algorithms in phase contrast study. In a volumetric study, we segmented a total of 26 structures in 74 patients (29 with diagnosed NPH, 45 without NPH). In the case of preoperative examination, we demonstrated statistically significant differences in the size of the left hippocampus, corpus callosum, left...
|
|
|
Structural Patterns of Cognitive Deficits in MR Imaging.
Buksakowska, Irena ; Hořínek, Daniel (advisor) ; Rulseh, Aaron (referee) ; Dušek, Petr (referee)
Structural and diffusion imaging patterns that can be evaluated using MRI in patients with cognitive deficits are the central theme of the proposed work. First, the clinical and neuroimaging background of dementias has been reviewed in a broader context, with a special focus on Alzheimer's disease (AD) and differential diagnoses. The second part of this thesis contains four consecutive experimental studies. The primary objective of the first two studies was to obtain structural and microstructural information on the neurodegenerative processes characteristic for AD on global and regional levels. For this purpose, several complementary approaches were used and the focus was shifted from grey to white matter (GM/WM). The following two studies focused on the differential context of WM microstructural alterations in normal pressure hydrocephalus (NPH) and distinctive patterns of WM disintegrity in temporal lobe epilepsy (TLE). The most important conclusion of our studies is that structural and diffusion imaging proved to be useful in identifying regionally specific and disproportionate loss of brain volume and microstructure in several pathological processes underlying cognitive deterioration. The use of distinctive morphometric methods yielded complementary information on AD-related atrophy patterns,...
|
guest ::
