Pathophysiology of idiopathic normal pressure hydrocephalus (part 2): cerebral blood flow and ischemia of the deep white matter

Abstract

In the development of the Idiopathic Normal Pressure Hydrocephalus (iNPH), there are multiple factors involved in the disease establishment, one of them that the literature most supports is the alteration in brain blood flow and the ischemia of the deep white matter, These changes can be caused by a previous events of cerebrovascular disease, amyloid angiopathy, and sclerotic medullary arteries (perforating arteries of the deep white matter). Looking carefully we will see that these changes are usually regional and emphasize mainly in the vessels of the basal ganglia and periventricular (Deep White Matter). In turn, these changes in regional flow will bring us consequences as edema, accumulation of waste products such as beta-amyloid (βa), contributing to chronic hypoxia. One of the questions that can be discussed in this issue is whether the changes in blood flow are the cause of these disorders or simply an epiphenomenon. Other authors refer to another simultaneous failure of toxic waste products such as βa factor are Neurovascular damage (NVU) Unit, this damage is often seen in Alzheimer’s Disease and hence one of the reasons why there comorbidity with iNPH.