Paired CSF and plasma metabolomics reveals a robust CSF-centered metabolic phenotype in idiopathic normal-pressure hydrocephalus: an exploratory case-control study

The study examined metabolic changes in patients with idiopathic normal-pressure hydrocephalus (iNPH) by comparing cerebrospinal fluid and blood plasma samples. Samples from 10 iNPH patients and 10 controls were analyzed using mass spectrometry. In cerebrospinal fluid, 56 altered metabolites were identified, with 34 increased and 22 decreased. Changes involved energy metabolism, carnitine metabolism, redox metabolism, and tryptophan-kynurenine metabolism. Elevated levels included succinate, 3-hydroxybutyrate, and kynurenine, while decreased levels included carnitine and methionine. In blood plasma, only 5 metabolites showed consistent changes. The results suggest that iNPH is associated with more extensive metabolic alterations in cerebrospinal fluid than in peripheral blood.