Researchers at Cedars-Sinai have conducted a study and found that some patients diagnosed with behavioral-variant frontotemporal dementia (bvFTD) may have a treatable cerebrospinal fluid (CSF) leak.
Behavioral-variant frontotemporal dementia is a disease that causes patients to lose control of their behavior and their ability to carry out daily activities.
Cerebrospinal fluid is a clear fluid that surrounds the brain and spinal cord to protect them from injury. When this fluid leaks into the body, it can cause the brain to sag, leading to dementia-like symptoms.
According to the study, many patients with brain sagging caused by a CSF leak go undiagnosed.
Therefore, the researchers suggest that clinicians should take a second look at patients with telltale symptoms and ask about a history of severe headaches that improve when the patient lies down, significant sleepiness even after adequate nighttime sleep, and whether the patient has ever been diagnosed with a Chiari brain malformation.
Even when brain sagging is detected, the source of a CSF leak can be difficult to locate.
When the fluid leaks through a tear or cyst in the surrounding membrane, it is visible on CT myelogram imaging with the aid of a contrast medium.
However, the team discovered an additional cause of CSF leak in which the fluid leaks into a vein, making it difficult to see on a routine CT myelogram.
To detect these leaks, technicians must use a specialized CT scan and observe the contrast medium in motion as it flows through the cerebrospinal fluid.
In the study, the researchers used this imaging technique on 21 patients with brain sagging and symptoms of bvFTD, and they discovered CSF-venous fistulas in nine of those patients.
All nine patients had their fistulas surgically closed, and their brain sagging and accompanying symptoms were completely reversed.
The remaining 12 study participants, whose leaks could not be identified, were treated with nontargeted therapies designed to relieve brain sagging, such as implantable systems for infusing the patient with CSF.
However, only three of these patients experienced relief from their symptoms.
This research shows that some patients diagnosed with bvFTD may actually have a treatable condition caused by a CSF leak.
If clinicians take a second look at patients with telltale symptoms and use specialized imaging techniques to detect CSF leaks, patients may be able to receive treatment that could reverse their symptoms.
The study was conducted by Wouter Schievink et al and published in Alzheimer’s & Dementia: Translational Research and Clinical Interventions.
If you care about dementia, please read studies that diabetes drug metformin may slow down cognitive decline, and scientists find deep cause of cognitive decline in Alzheimer’s.
For more information about brain health, please see recent studies that cranberries could help boost memory, and how alcohol, coffee and tea intake influence cognitive decline.
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