Recovery Process of Gait Disturbance after Ventriculo-Peritoneal Shunt in Patients with Idiopathic Normal Pressure Hydrocephalus

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.

Download Full-text

A Case Report of Gait Disturbance in a Patient with Idiopathic Normal Pressure Hydrocephalus Induced by Secondary Parkinsonism Treated with Korean Medicine

The Journal of Internal Korean Medicine ◽

10.22246/jikm.2020.41.5.811 ◽

2020 ◽

Vol 41 (5) ◽

pp. 811-820

Author(s):

In-woo Choi ◽

Ji-hye Yang ◽

In-cheol Chae ◽

Chan-young Kim ◽

Ju-young Ryu ◽

...

Keyword(s):

Case Report ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Gait Disturbance ◽

Korean Medicine

Download Full-text

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

Journal of Neurosurgery ◽

10.3171/jns.2001.95.6.0970 ◽

2001 ◽

Vol 95 (6) ◽

pp. 970-973 ◽

Cited By ~ 96

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.

Download Full-text

Relationship Between Idiopathic Normal-Pressure Hydrocephalus and Lumbar Spinal Stenosis

10.21203/rs.3.rs-745054/v1 ◽

2021 ◽

Author(s):

Hiroyuki Tominaga ◽

Hiroto Tokumoto ◽

Ichiro Kawamura ◽

Masato Sanada ◽

Kazumasa Kawazoe ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Spinal Stenosis ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Urinary Dysfunction ◽

Gait Disturbance ◽

Symptom Improvement ◽

Lumbar Spinal ◽

The Relationship

Abstract Object: To evaluate the relationship between idiopathic normal-pressure hydrocephalus (iNPH) and lumbar spinal stenosis (LSS).Methods: With the aging of society, the numbers of patients with iNPH and LSS are likely to increase. iNPH and LSS have similar symptoms including gait disturbance and urinary dysfunction. The prevalence of dementia is higher in older adults with LSS. However, the relationship of LSS with iNPH and the prevalence of LSS in patients with iNPH are unknown. In our department between April 2011 and March 2017, 226 patients were diagnosed with iNPH and underwent shunt operation including lumboperitoneal shunts and ventriculoperitoneal shunts. Two spine surgeons evaluated LSS on magnetic resonance imaging of the lumbar spine. Age, sex, body mass index, Timed Up and Go test, Mini Mental State Examination score, and urinary dysfunction were examined before and after surgery for iNPH. Changes in these variables were compared between patients with iNPH without LSS and with iNPH and LSS.Results: In the overall cohort, the median patient age was 78 years and there were 121 males. Among 226 patients with iNPH, 73 (32.3%) had LSS. Neurological symptoms were improved in all patients at final follow-up. The rate of symptom improvement was lower for the iNPH and LSS group compared with the iNPH without LSS group.Conclusions: Surgery to improve gait disturbance might be difficult in patients with iNPH with LSS. When examining patients with iNPH, we should consider the possibility of concomitant LSS.

Download Full-text