{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:27:17Z","timestamp":1791890837341,"version":"4.3.4"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2006,9,6]],"date-time":"2006-09-06T00:00:00Z","timestamp":1157500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Magnetic Resonance Imaging"],"published-print":{"date-parts":[[2006,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To determine if normal pressure hydrocephalus (NPH) could result from decreased resorption of cerebrospinal fluid (CSF) by the arachnoidal villi, leading to benign external hydrocephalus [BEH] in infancy, followed by deep white matter ischemia (DWMI) in late adulthood (the more hydrophilic environment increasing resistance to CSF flow through the extracellular space (ECS) of the brain).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>CSF outflow via the fourth ventricle and the ECS of the brain was mathematically modeled using a parallel electrical circuit analog. The apparent diffusion coefficient (ADC) was measured as a surrogate of the amount of water in the ECS in normals, patients with symptomatic NPH, and patients with dilated ventricles without symptoms of NPH (\u201cpre\u2010NPH\u201d).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The electrical circuit model demonstrates increasing ventricular volume with increasing resistance to flow through the ECS of the brain. ADC measurements performed in the centrum semiovale are significantly higher in patients with NPH and \u201cpre\u2010NPH\u201d than in age\u2010matched controls (<jats:italic>P<\/jats:italic> &lt; 0.05), controlling for the same degree of DWMI indicating increased fluid in the ECS of the brain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The electrical circuit analog and finding of increased periventricular ADC support the theory that NPH is a \u201ctwo hit\u201d disease. J. Magn. Reson. Imaging 2006. \u00a9 2006 Wiley\u2010Liss, Inc.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmri.20684","type":"journal-article","created":{"date-parts":[[2006,9,6]],"date-time":"2006-09-06T17:35:37Z","timestamp":1157564137000},"page":"747-755","source":"Crossref","is-referenced-by-count":62,"title":["Idiopathic normal pressure hydrocephalus may be a \u201cTwo Hit\u201d disease: Benign external hydrocephalus in infancy followed by deep white matter ischemia in late adulthood"],"prefix":"10.1002","volume":"24","author":[{"suffix":"Jr.","given":"William G.","family":"Bradley","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gautam","family":"Bahl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John F.","family":"Alksne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2006,9,6]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(65)90016-X"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196507152730301"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196602242740817"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1984.61.2.0322"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/neurosurgery\/24.CN_suppl_1.270"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1984.61.3.0501"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1042-3680(18)30024-X"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.4065\/77.6.507"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00342987"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00588027"},{"key":"e_1_2_6_12_2","first-page":"1479","article-title":"Increased intracranial volume in normal pressure hydrocephalus: a clue to the etiology of \u201didiopathic\u201c NPH?","volume":"25","author":"Bradley WG","year":"2004","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.20.6.534"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.20.7.665"},{"key":"e_1_2_6_15_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.198.2.8596861"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.178.2.1987609"},{"key":"e_1_2_6_17_2","first-page":"31","article-title":"Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normal pressure hydrocephalus","volume":"12","author":"Bradley WG","year":"1991","journal-title":"AJNR Am J Neuroradiology"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199608000-00011"},{"key":"e_1_2_6_19_2","first-page":"868","article-title":"Idiopathic normal pressure hydrocephalus and systemic hypertension","volume":"37","author":"Graff\u2010Radford NR","year":"1987","journal-title":"Neuroradiology"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.40.1.73"},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.27.1.24"},{"key":"e_1_2_6_22_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199703000-00011"},{"key":"e_1_2_6_23_2","first-page":"606","volume-title":"Pediatric neuroradiology","author":"Barkovich, AJ","year":"2000"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/105.1.65"},{"key":"e_1_2_6_25_2","first-page":"331","article-title":"Does CSF outflow resistance predict the response to shunting in patients with normal pressure hydrocephalus?","volume":"71","author":"Boon AJW","year":"1998","journal-title":"Acta Neurochir (Wein)"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/58.1.58"},{"key":"e_1_2_6_27_2","first-page":"1638","article-title":"NPH and deep white matter ischemia: which is the chicken and which is the egg?","volume":"22","author":"Bradley WG","year":"2001","journal-title":"AJNR Am J Neuroradiol"},{"key":"e_1_2_6_28_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.52.7.847"},{"key":"e_1_2_6_29_2","first-page":"31262","article-title":"Normal pressure hydrocephalus and hypertensive cerebrovascular disease","author":"Earnest MP","year":"1974","journal-title":"Arch Neurol"},{"key":"e_1_2_6_30_2","doi-asserted-by":"publisher","DOI":"10.1007\/s007010050417"},{"key":"e_1_2_6_31_2","doi-asserted-by":"publisher","DOI":"10.1097\/00006123-199706000-00009"},{"key":"e_1_2_6_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410190306"},{"key":"e_1_2_6_33_2","unstructured":"GideonP ThomsenC GjerrisF et al.Increased self diffusion of brain water in hydrocephalus measured by MR imaging. Acta Radiol"},{"key":"e_1_2_6_34_2","doi-asserted-by":"publisher","DOI":"10.1159\/000120367"},{"key":"e_1_2_6_34_3","first-page":"514","article-title":"Ventricular volume regulation: a mathematical model and computer simulation","volume":"6","author":"Rekate HL","year":"1994","journal-title":"Pediatric Neurosci"},{"key":"e_1_2_6_35_2","first-page":"1","volume":"19","author":"Spetzler RF","year":"2003","journal-title":"Barrow Quarterly"}],"container-title":["Journal of Magnetic Resonance Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjmri.20684","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jmri.20684","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T23:04:35Z","timestamp":1697151875000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jmri.20684"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,9,6]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2006,10]]}},"alternative-id":["10.1002\/jmri.20684"],"URL":"https:\/\/doi.org\/10.1002\/jmri.20684","archive":["Portico"],"relation":{},"ISSN":["1053-1807","1522-2586"],"issn-type":[{"value":"1053-1807","type":"print"},{"value":"1522-2586","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,9,6]]}}}