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Normal-Pressure Hydrocephalus

Wei-Jen Shih, MD; Phillip A. Tibbs, MD
JAMA. 1990;264(3):336. doi:10.1001/jama.1990.03450030052023.
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To the Editor.—  Dr Friedland1 presents impressive positron emission tomographic images made before and after the placement of a shunt in a patient with normal-pressure hydrocephalus. The images show postoperative recovery in cerebral glucose metabolism, especially pronounced in the temporal and parietal cortices. Positron emission tomography using fludeoxyglucose F 18 may become a routine procedure for evaluation before and after operation in patients with normal-pressure hydrocephalus.While the study by Dr Friedland used computed tomography, magnetic resonance imaging, and positron emission tomography for diagnostic imaging and postoperative evaluation, he made no mention of radionuclide (indium 111-labeled pentetic acid or ytterbium 169-labeled pentetate) cisternography for the diagnosis of normal-pressure hydrocephalus. We believe that radionuclide cisternography can provide information on the status of the cerebrospinal circulation. Images of the head taken at 3 to 6, 24, and 48 hours following the intrathecal injection of 0.5 to 1.0 mCi of111 Inlabeled


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