Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement

Abstract Normal Pressure Hydrocephalus (NPH) is a syndrome in predominantly older adults, differential diagnoses include primary neurodegenerative diseases. The key radiological finding is ventricular enlargement, different from increased ventricular size associated with cerebral atrophy. After defi...

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Main Authors: Andrés Segura-Hernández, Diego F. Gómez-Amarillo, Isabella Mejía-Michelsen, María Paula Vargas-Osorio, Martina González, María T. Domínguez, Salvador M. Mattar, Daniela Volcinschi, Edgar G. Ordóñez-Rubiano, Alexandra Ramos-Márquez, Juan F. Ramón, Juan A. Mejía-Cordovez, Enrique Jiménez-Hakim, Fernando Hakim
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Language:English
Published: Nature Portfolio 2025-07-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-03158-6
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author Andrés Segura-Hernández
Diego F. Gómez-Amarillo
Isabella Mejía-Michelsen
María Paula Vargas-Osorio
Martina González
María T. Domínguez
Salvador M. Mattar
Daniela Volcinschi
Edgar G. Ordóñez-Rubiano
Alexandra Ramos-Márquez
Juan F. Ramón
Juan A. Mejía-Cordovez
Enrique Jiménez-Hakim
Fernando Hakim
author_facet Andrés Segura-Hernández
Diego F. Gómez-Amarillo
Isabella Mejía-Michelsen
María Paula Vargas-Osorio
Martina González
María T. Domínguez
Salvador M. Mattar
Daniela Volcinschi
Edgar G. Ordóñez-Rubiano
Alexandra Ramos-Márquez
Juan F. Ramón
Juan A. Mejía-Cordovez
Enrique Jiménez-Hakim
Fernando Hakim
author_sort Andrés Segura-Hernández
collection DOAJ
description Abstract Normal Pressure Hydrocephalus (NPH) is a syndrome in predominantly older adults, differential diagnoses include primary neurodegenerative diseases. The key radiological finding is ventricular enlargement, different from increased ventricular size associated with cerebral atrophy. After definitive surgical cerebrospinal fluid (CSF) shunting there appears to be increased brain tissue volume in patients’ follow-up images which could indicate that imaging findings usually interpreted as cerebral atrophy may be reversible with appropriate treatment. A cross-sectional study was performed comparing pre and postoperative brain volume in magnetic resonance imaging (MRI) studies of NPH patients who underwent ventriculoatrial shunting at our institution between April 2016 and February 2022. Brain volumes were obtained using volBrain and vol2Brain software. 30 patients were included, and 60 MRI studies reviewed. The average age was 80.4 years (54–92 years). 20 patients (66.6%) were men and 10 women. Following CSF shunting, patients had a statistically significant increase in white matter (p = 0.043), gray matter (p = 0.002), and total brain parenchyma (p = 0.032). The brain volume increased in postoperative MRI. We call this finding cerebral pseudoatrophy, which has not been previously described. Further studies are required to confirm this finding, which poses relevance for the accurate diagnosis of NPH.
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spelling doaj-art-e6c5fa39517d4c83896242d64ccb510e2025-08-20T03:42:31ZengNature PortfolioScientific Reports2045-23222025-07-011511910.1038/s41598-025-03158-6Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placementAndrés Segura-Hernández0Diego F. Gómez-Amarillo1Isabella Mejía-Michelsen2María Paula Vargas-Osorio3Martina González4María T. Domínguez5Salvador M. Mattar6Daniela Volcinschi7Edgar G. Ordóñez-Rubiano8Alexandra Ramos-Márquez9Juan F. Ramón10Juan A. Mejía-Cordovez11Enrique Jiménez-Hakim12Fernando Hakim13Department of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáDepartment of Neurosurgery, Hospital Universitario Fundación Santa Fe de BogotáAbstract Normal Pressure Hydrocephalus (NPH) is a syndrome in predominantly older adults, differential diagnoses include primary neurodegenerative diseases. The key radiological finding is ventricular enlargement, different from increased ventricular size associated with cerebral atrophy. After definitive surgical cerebrospinal fluid (CSF) shunting there appears to be increased brain tissue volume in patients’ follow-up images which could indicate that imaging findings usually interpreted as cerebral atrophy may be reversible with appropriate treatment. A cross-sectional study was performed comparing pre and postoperative brain volume in magnetic resonance imaging (MRI) studies of NPH patients who underwent ventriculoatrial shunting at our institution between April 2016 and February 2022. Brain volumes were obtained using volBrain and vol2Brain software. 30 patients were included, and 60 MRI studies reviewed. The average age was 80.4 years (54–92 years). 20 patients (66.6%) were men and 10 women. Following CSF shunting, patients had a statistically significant increase in white matter (p = 0.043), gray matter (p = 0.002), and total brain parenchyma (p = 0.032). The brain volume increased in postoperative MRI. We call this finding cerebral pseudoatrophy, which has not been previously described. Further studies are required to confirm this finding, which poses relevance for the accurate diagnosis of NPH.https://doi.org/10.1038/s41598-025-03158-6Normal pressure hydrocephalusCerebral pseudoatrophyHydrocephalusVentriculoatrial shuntVentriclesBrain volume
spellingShingle Andrés Segura-Hernández
Diego F. Gómez-Amarillo
Isabella Mejía-Michelsen
María Paula Vargas-Osorio
Martina González
María T. Domínguez
Salvador M. Mattar
Daniela Volcinschi
Edgar G. Ordóñez-Rubiano
Alexandra Ramos-Márquez
Juan F. Ramón
Juan A. Mejía-Cordovez
Enrique Jiménez-Hakim
Fernando Hakim
Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
Scientific Reports
Normal pressure hydrocephalus
Cerebral pseudoatrophy
Hydrocephalus
Ventriculoatrial shunt
Ventricles
Brain volume
title Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
title_full Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
title_fullStr Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
title_full_unstemmed Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
title_short Reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
title_sort reversal of cerebral pseudoatrophy in normal pressure hydrocephalus after ventriculoatrial shunt placement
topic Normal pressure hydrocephalus
Cerebral pseudoatrophy
Hydrocephalus
Ventriculoatrial shunt
Ventricles
Brain volume
url https://doi.org/10.1038/s41598-025-03158-6
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