{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:25:45Z","timestamp":1785432345158,"version":"3.56.0"},"reference-count":44,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T00:00:00Z","timestamp":1730851200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003653","name":"Korea National Institute of Health","doi-asserted-by":"publisher","award":["RS\u20102023\u201000266288"],"award-info":[{"award-number":["RS\u20102023\u201000266288"]}],"id":[{"id":"10.13039\/501100003653","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disord Clin Pract"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Reduced cerebrospinal fluid (CSF) clearance may play a vital role in the pathogenesis of normal pressure hydrocephalus (NPH), but the radiologic marker is yet to be elucidated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>This open\u2010label study presents two novel neuroimaging biomarkers based on enlarged perivascular spaces (ePVS) of the sub\u2010insular territory: the Hedgehog and Hedgehog\u2010Halo (H\u2010H) sign, designed to predict gait symptom severity and tap response in NPH.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed 203 patients with possible NPH with baseline magnetic resonance imaging and gait analyses before and after lumbar puncture (LP). The Hedgehog\/H\u2010H sign was scored using T2\u2010weighted images. The clinical severity at baseline and post\u2010tap gait improvement was compared in patients with and without Hedgehog\/H\u2010H sign. The association between Hedgehog\/H\u2010H sign and post\u2010tap gait outcomes was assessed using multivariate regression. The diagnostic performance of Hedgehog\/H\u2010H sign was compared with conventional radiological markers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with H\u2010H showed higher global disability and more severe gait impairment than those without any signs. Following LP, patients with Hedgehog\/H\u2010H sign significantly improved in various gait parameters, unlike those with neither sign. Additionally, sub\u2010insular ePVS was significantly associated with post\u2010tap gait improvement after adjusting covariates. Finally, the Hedgehog\/H\u2010H sign showed a higher performance than conventional markers in predicting post\u2010tap gait response.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The Hedgehog\/H\u2010H sign is a useful neuroimaging biomarker related to the severity and tap response in NPH. This biomarker can be readily applied in clinical practice before undergoing LP, independent of conventional radiological signs. Further research is warranted to determine applicability in predicting post\u2010shunt gait response.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mdc3.14255","type":"journal-article","created":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T06:26:00Z","timestamp":1730874360000},"page":"21-33","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The \u201cHedgehog\u2010Halo Sign\u201d Is Associated with Gait Symptom Severity and Tap Response in Normal Pressure Hydrocephalus"],"prefix":"10.1002","volume":"12","author":[{"given":"Jongmok","family":"Ha","sequence":"first","affiliation":[{"name":"Department of Neurology Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Neuroscience Center, Samsung Medical Center  Seoul Korea"},{"name":"Department of Neurology Emory School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suin","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Neuroscience Center, Samsung Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seongmi","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Neuroscience Center, Samsung Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun Seok","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Neurology Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Neuroscience Center, Samsung Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6415-2316","authenticated-orcid":false,"given":"Jong Hyeon","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurology Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Neuroscience Center, Samsung Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin Whan","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Neurology Samsung Medical Center, Sungkyunkwan University School of Medicine  Seoul Korea"},{"name":"Neuroscience Center, Samsung Medical Center  Seoul Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5346-0180","authenticated-orcid":false,"given":"Alfonso","family":"Fasano","sequence":"additional","affiliation":[{"name":"Edmond J. 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