Profile of cognitive dysfunction and relation with gait disturbance in Normal Pressure Hydrocephalus

2014 ◽  
Vol 118 ◽  
pp. 83-88 ◽  
Author(s):  
Paulo Bugalho ◽  
Luísa Alves ◽  
Rita Miguel ◽  
Olga Ribeiro
Keyword(s):  
Cognitive Dysfunction ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Gait Disturbance

Endoscopic Third Ventriculostomy in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 129-134 ◽  
Author(s):  
Michelangelo Gangemi ◽  
Francesco Maiuri ◽  
Simona Buonamassa ◽  
Giuseppe Colella ◽  
Enrico de Divitiis
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Endoscopic Third Ventriculostomy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Gait Disturbance ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Duration Of Symptoms ◽  
Cerebrospinal Fluid Flow

Abstract OBJECTIVE: To define the role and indications for an endoscopic third ventriculostomy (ETV) in patients with idiopathic normal pressure hydrocephalus (INPH). A series of 25 patients treated by endoscopic technique was analyzed, and the results were compared with those of 14 studies reporting patients treated by shunting. METHODS: Twenty-five patients with INPH were treated by ETV from January 1994 through December 2000. All were younger than 75 years of age, had a preoperative clinical history of 1 year or less, had prevalence of gait disturbance with scarce or mild dementia, had marked ventricular enlargement on magnetic resonance imaging (MRI), and had intracranial pressure values ranging from 8 to 12 mm Hg. All were studied by a phase-contrast MRI flow study 1 month after ETV. The 14 reviewed series of patients treated by shunting (all published after 1980) each include more than 25 patients, for a total of 777 patients. RESULTS: The overall rate of neurological improvement after ETV in our series was 72% (including two patients reoperated on because of absence of flow in the MRI scan); this percentage is slightly higher than that found in the 14 series of shunted patients (66%). Gait disturbance showed a high rate of improvement when compared with other symptoms, both in our ETV study and in other shunting series. Postoperative complications occurred only in one patient (4%) with an intracerebral frontal hemorrhage and in 37.9% of patients from the series including shunted patients. CONCLUSION: In patients with INPH showing short duration of symptoms, prevalence of gait disturbance, and slight mental impairment, ETV provides similar results to those of shunting. We suggest performing ETV in these patients and reserving shunting only for those who do not improve after ETV, despite the presence of cerebrospinal fluid flow through the ventriculostomy on MRI flow studies. The good results after ETV in our series indirectly confirm that the cerebrospinal fluid absorption is good or at least sufficient in selected patients with INPH.

Disability risk or unimproved symptoms following shunt surgery in patients with idiopathic normal-pressure hydrocephalus: post hoc analysis of SINPHONI-2

2016 ◽  
Vol 126 (6) ◽  
pp. 2002-2009 ◽  
Author(s):  
Shigeki Yamada ◽  
Teruo Kimura ◽  
Naoto Jingami ◽  
Masamichi Atsuchi ◽  
Osamu Hirai ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Normal Pressure Hydrocephalus ◽  
Symptom Severity ◽  
Disease Duration ◽  
Normal Pressure ◽  
Gait Disturbance ◽  
Shunt Surgery ◽  
Tap Test ◽  
Relative Risks

OBJECTIVEThe study aim was to assess the influence of presurgical clinical symptom severity and disease duration on outcomes of shunt surgery in patients with idiopathic normal-pressure hydrocephalus (iNPH). The authors also evaluated the cerebrospinal fluid tap test as a predictor of improvements following shunt surgery.METHODSEighty-three patients (45 men and 38 women, mean age 76.4 years) underwent lumboperitoneal shunt surgery, and outcomes were evaluated until 12 months following surgery. Risks for poor quality of life (Score 3 or 4 on the modified Rankin Scale [mRS]) and severe gait disturbance were evaluated at 3 and 12 months following shunt surgery, and the tap test was also conducted. Age-adjusted and multivariate relative risks were calculated using Cox proportional-hazards regression.RESULTSOf 83 patients with iNPH, 45 (54%) improved by 1 point on the mRS and 6 patients (7%) improved by ≥ 2 points at 3 months following surgery. At 12 months after surgery, 39 patients (47%) improved by 1 point on the mRS and 13 patients (16%) improved by ≥ 2 points. On the gait domain of the iNPH grading scale (iNPHGS), 36 patients (43%) improved by 1 point and 13 patients (16%) improved by ≥ 2 points at 3 months following surgery. Additionally, 32 patients (38%) improved by 1 point and 14 patients (17%) by ≥ 2 points at 12 months following surgery. In contrast, 3 patients (4%) and 2 patients (2%) had worse symptoms according to the mRS or the gait domain of the iNPHGS, respectively, at 3 months following surgery, and 5 patients (6%) and 3 patients (4%) had worse mRS scores and gait domain scores, respectively, at 12 months after surgery. Patients with severe preoperative mRS scores had a 4.7 times higher multivariate relative risk (RR) for severe mRS scores at 12 months following surgery. Moreover, patients with severe gait disturbance prior to shunt surgery had a 46.5 times greater multivariate RR for severe gait disturbance at the 12-month follow-up. Patients without improved gait following the tap test had multivariate RRs for unimproved gait disturbance of 7.54 and 11.2 at 3 and 12 months following surgery, respectively. Disease duration from onset to shunt surgery was not significantly associated with postoperative symptom severity or unimproved symptoms.CONCLUSIONSPatients with iNPH should receive treatment before their symptoms become severe in order to achieve an improved quality of life. However, the progression of symptoms varies between patients so specific timeframes are not meaningful. The authors also found that tap test scores accurately predicted shunt efficacy. Therefore, indications for shunt surgery should be carefully assessed in each patient with iNPH, considering the relative risks and benefits for that person, including healthy life expectancy.

scholarly journals Case Report: Lesson Learned from Rehabilitation Medicine Point of View for an Elderly with Normal Pressure Hydrocephalus

2021 ◽  
Vol 9 (C) ◽  
pp. 133-135
Author(s):  
Irma Ruslina Defi ◽  
Andre Andre ◽  
Sunaryo Barki Sastradimadja ◽  
Ahmad Faried
Keyword(s):  
Elderly Patient ◽  
Case Report ◽  
Normal Pressure Hydrocephalus ◽  
Motor Vehicle ◽  
Motor Vehicle Accident ◽  
Normal Pressure ◽  
Gait Disturbance ◽  
Physical Medicine ◽  
Rehabilitation Intervention ◽  
Physical Medicine And Rehabilitation

BACKGROUND: Normal pressure hydrocephalus (NPH) is characterized by an abnormal buildup of cerebrospinal fluid in the ventricles or cavities of the brain. The objective of the case report was to define the importance of physical medicine and rehabilitation intervention as an approach for an elderly patient with NPH. CASE REPORT: A 75-year-old woman presented with a balance and gait disturbance after injury from a motor vehicle accident. The patient experience Hakim’s triad (gait disturbance, urinary frequency, and mild cognitive impairment), and her computed tomography scan of the head revealed ventriculomegaly, multiple lacunar infarctions on the paraventricle, and cerebral atrophy, which could indicate NPH. Balance and gait training, cardiopulmonary training, and environment modification were interventions from physical medicine and rehabilitation provided to this patient. CONCLUSION: An elderly patient with NPH should receive physical medicine and rehabilitation intervention to prevent falls, improve functional ability, and improve quality of life.

Management of idiopathic normal-pressure hydrocephalus: a multi-institutional study conducted in Japan

2001 ◽  
Vol 95 (6) ◽  
pp. 970-973 ◽  
Author(s):  
Koreaki Mori
Keyword(s):  
Lumbar Puncture ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Gait Disturbance ◽  
Early Assessment ◽  
Content Type ◽  
Programmable Valve ◽  
Csf Diversion ◽  
Fine Print

Object. A cooperative study was undertaken to identify factors that could be used to predict a favorable outcome after extracranial cerebrospinal fluid (CSF) diversion (shunting) in patients with suspected idiopathic normal-pressure hydrocephalus (NPH). Methods. Questionnaires concerning patients with suspected idiopathic NPH were sent to 14 members of the Committee for Scientific Research on Intractable Hydrocephalus, sponsored by the Ministry of Health and Welfare of Japan. After the questionnaires were returned, a retrospective analysis of the responses was undertaken. To be included in the study, patients had to be 65 years of age or older and had to have undergone surgery between October 1995 and October 1998. Clinical measures included degrees of gait disturbance, dementia, and urinary incontinence as evaluated before, 3 months after, and 3 years after shunt placement. Diagnostic tests in various combinations included lumbar puncture in which CSF was withdrawn; intracranial pressure monitoring; measurements of CSF outflow resistance, level of serum α-1-antichymotrypsin, cerebral arteriovenous differences of oxygen content, and cerebral blood flow; and computerized tomography cisternography. In this study, 120 patients were identified as having idiopathic NPH and these patients underwent placement of shunts. A ventriculoperitoneal shunt with a programmable valve was used in two thirds of the patients. At the end of 3 months (early assessment), there was an 80% overall rate of clinical improvement, which dropped to 73.3% of the 105 patients who could be evaluated at the end of the 3-year study. Of the three variables, gait disturbance was most improved, both at early and late testing periods. Shunt complications occurred in 22 (18.3%) of the patients. Conclusions. Patients suspected of having idiopathic NPH did not form a homogeneous group, making it difficult to select those who would most likely respond to CSF diversion. Of the diagnostic studies, the most reliable result was improvement in clinical symptoms following a lumbar puncture in which CSF was withdrawn. The use of a programmable valve is recommended because it offers advantages in preventing problems of over- and underdrainage.

scholarly journals Two cases of normal pressure hydrocephalus caused by ependymoma of the cauda equina

2021 ◽  
Vol 12 ◽  
pp. 8
Author(s):  
Isamu Miura ◽  
Motoo Kubota ◽  
Nobuhiko Momozaki ◽  
Masahito Yuzurihara
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Cauda Equina ◽  
Normal Pressure ◽  
Gait Disturbance ◽  
Myxopapillary Ependymoma ◽  
Tumor Excision ◽  
Vp Shunt ◽  
Brain Ct ◽  
First Case ◽  
Intradural Tumor

Background: Normal pressure hydrocephalus (NPH) associated with tumors of the cauda equina is rare. Here, we report two cases of NPH attributed to cauda equina ependymomas. Case Description: A 63-year-old male presented with progressive gait disturbance, dementia, and urinary incontinence. When the lumbar MR documented an intradural tumor involving the cauda equina at the L2-L3 level; the tumor was excised; pathologically, it proved to be a myxopapillary ependymoma. Postoperatively, however, the patient’s continued gait disturbance led to a brain CT that documented ventricular dilation consistent with NPH; following ventriculoperitoneal (VP) shunt placement his symptoms improved. A 65-year-old female also presented with gait disturbance, dementia, and urinary retention. Here, procedures were performed in reverse. When a brain CT showed hydrocephalus, a VP shunt was placed. When symptoms persisted, a lumbar MR demonstrated a T12-L2 intradural tumor; following a lumbar laminectomy for tumor excision, symptoms stabilized. The pathological diagnosis was also consistent with a conus/cauda equina ependymoma. Over the next 10 years, the patient had residual bladder dysfunction (e.g., requiring straight catheterization), but had no shunt dysfunction. Conclusion: We observed two cases of ependymomas of the cauda equina and brain CTs documenting NPH that was successfully surgically managed with stabilization of neurological deficit. In the first case, L2-L3 laminectomy for tumor removal was succeeded by shunting for NPH, while in the second case, initial VP shunting for NPH was followed by a T12-L2 laminectomy for tumor excision.

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