scholarly journals Normal pressure hydrocephalus: Diagnostic and predictive evaluation

2009 ◽  
Vol 3 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Benito Pereira Damasceno
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
Recording Time ◽  
Patient Will ◽  
Diagnostic Difficulties ◽  
Prognostic Tests ◽  
The One ◽  
Low Sensitivity ◽  
Icp Recording

Abstract In typical cases, normal pressure hydrocephalus (NPH) manifests itself with the triad of gait disturbance, which begins first, followed by mental deterioration and urinary incontinence associated with ventriculomegaly (on CT or MRI) and normal cerebrospinal fluid (CSF) pressure. These cases present minor diagnostic difficulties and are the most likely to improve after shunting. Problems arise when NPH shows atypical or incomplete clinical manifestations (25-50% of cases) or is mimicked by other diseases. In this scenario, other complementary tests have to be used, preferentially those that can best predict surgical outcome. Radionuclide cisternography, intracranial pressure monitoring (ICP) and lumbar infusion tests can show CSF dynamics malfunction, but none are able to confirm whether the patient will benefit from surgery. The CSF tap test (CSF-TT) is the only procedure that can temporarily simulate the effect of definitive shunt. Since the one tap CSF-TT has low sensitivity, it cannot be used to exclude patients from surgery. In such cases, we have to resort to a repeated CSF-TT (RTT) or continuous lumbar external drainage (LED). The most reliable prediction would be achieved if RTT or LED proved positive, in addition to the occurrence of B-waves during more than 50% of ICP recording time. This review was based on a PubMed literature search from 1966 to date. It focuses on clinical presentation, neuroimaging, complementary prognostic tests, and differential diagnosis of NPH, particularly on the problem of selecting appropriate candidates for shunt.

scholarly journals Prevalence of Cervical Stenosis and Myelopathy in Patients With Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ryan M Naylor ◽  
Karina Lenartowicz ◽  
Jonathan Graff-Radford ◽  
Jeremy Cutsforth-Gregory ◽  
Benjamin D Elder
Keyword(s):  
Cervical Spine ◽  
Normal Pressure Hydrocephalus ◽  
Cervical Myelopathy ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Decompression Surgery ◽  
Consecutive Series ◽  
Cervical Stenosis ◽  
Shunt Placement

Abstract INTRODUCTION Both idiopathic normal pressure hydrocephalus (iNPH) and cervical myelopathy may result in progressive gait impairment. It is possible that some of the patients who do not respond to shunting despite a positive tap test may have gait dysfunction from cervical myelopathy. The objective of this study was to determine the prevalence of cervical stenosis with or without myelopathy in patients with iNPH. METHODS We screened a consecutive series of patients who underwent shunt placement for iNPH for comorbid cervical stenosis. Clinical manifestations of iNPH and cervical myelopathy, grade of cervical stenosis based on previously published criteria, cervical spine surgical intervention, timing of intervention, and outcomes were recorded. RESULTS A total of 42 patients with iNPH were included for analysis. Slightly more patients were male (65%), with a mean age of 75 yr (SD 7 yr) for the entire cohort. All patients presented with gait disturbances and underwent cervical spine MRI. 30/42 (71%) had at least cervical stenosis, while 7/42 (17%) had significant (grade 2-3) cervical stenosis with myelopathy requiring surgical decompression. All patients with grade 2-3 cervical stenosis and symptoms of cervical myelopathy in addition to iNPH underwent cervical decompression surgery. CONCLUSION Clinically significant cervical stenosis is highly prevalent in patients with iNPH, though this finding requires validation in a larger population. Based on these results, cervical imaging should be considered preoperatively or in patients whose gait does not improve after shunt placement.

scholarly journals Neurofibrillary Tangles in the Dementia of “Normal Pressure” Hydrocephalus

1976 ◽  
Vol 3 (4) ◽  
pp. 227-235 ◽  
Author(s):  
Melvyn J. Ball
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Matched Control ◽  
Neurofibrillary Tangle ◽  
Total Duration ◽  
Normal Pressure ◽  
Normal Subjects ◽  
Dramatic Improvement ◽  
Normal Limits ◽  
Positive Linear Correlation ◽  
The One

SUMMARY:Routine neuropathological examination could not explain the dramatic improvement exhibited by one patient with “normal pressure” hydrocephalus after shunting. The improved patient contrasted remarkably with the unchanged condition of four others also shunted successfully. The five brains were analysed by quantitative morphometry to determine the degree of neurofibrillary tangle formation in mesial temporal neurons. The density of tangle-bearing nerve cells in the four unimproved cases was markedly greater than in age-matched control brains from nineteen normal subjects, and fell in the same range as that of eight dements with neuropathologically confirmed Alzheimer's disease. The density of the one who recovered was within normal limits.The duration of dementia before shunting, and the total duration of dementia in these five patients rank in the same order as their degree of neurofibrillary formation. Furthermore, a positive linear correlation exists between the Tangle Indices and the total duration of dementia. The data suggest that early diagnosis may improve the chances of reversing the dementia of normal pressure hydrocephalus before histological alterations prove too severe.

scholarly journals Normal pressure hydrocephalus secondary to Lyme disease, a case report and review of seven reported cases

BMC Neurology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Louise Nørreslet Gimsing ◽  
Anne-Mette Hejl
Keyword(s):  
Lyme Disease ◽  
Borrelia Burgdorferi ◽  
Normal Pressure Hydrocephalus ◽  
Chronic Phase ◽  
Normal Pressure ◽  
Ventricular System ◽  
One Year ◽  
The One ◽  
The Right ◽  
Balance Problems

Abstract Background Infection with tick borne Borrelia Burgdorferi (Lyme disease) can without treatment rarely develop into a chronic phase. Secondary Normal Pressure Hydrocephalus (sNPH) based on chronic infection with Borrelia Burgdorferi (Bb) is an even rarer entity, that with the right treatment is potentially curable. Case presentation A 67-year-old male with a slow onset of progressive balance problems, also presented unspecified dizziness, urge feeling, neck soreness and discrete cognitive complaints. An MRI scan revealed an enlarged ventricular system compatible with NPH. After further liquor dynamic procedures, cerebrospinal fluid (CSF) was analysed with the surprising results of lymphocytic pleocytosis, and signs of increased antibody production. Microbiology revealed chronic neuroborreliosis and the patient was treated with antibiotics accordingly. At the one-year follow-up no symptoms remained and the ventricular system almost normalized. Conclusions We describe the 7th published case of sNPH secondary to chronic Borreliosis in a previous healthy adult. Existing published literature has been reviewed and previous cases showed similarly nearly full clinical recovery. Primary/idiopathic NPH (iNPH) is treated with the surgical intervention of ventriculoperitoneal shunt and can be mistaken for a sNPH. The awareness of rare causes of sNPH like chronic Borreliosis is important as it is easily treated non surgically.

scholarly journals Normal pressure hydrocephalus and cerebral amyloid angiopathy: a set of diseases or the unity of pathogenesis?

2020 ◽  
Vol 12 (6) ◽  
pp. 104-109
Author(s):  
E. G. Mendelevich
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Bypass Surgery ◽  
Normal Pressure ◽  
Cerebrovascular Diseases ◽  
Amyloid Angiopathy ◽  
Controversial Issues ◽  
Resonance Imaging ◽  
Diagnostic Features ◽  
Wide Range ◽  
Diagnostic Difficulties

Idiopathic normal pressure hydrocephalus (NPH) is cerebral ventriculomegaly characterized by a wide range of controversial issues related to the prevalence of the disease, the mechanisms of its development, and nosological independence. Developing in old age, NTH is often concurrent with other neurodegenerative or cerebrovascular diseases, posing certain diagnostic difficulties. The paper describes a clinical case of a patient initially diagnosed with NTH, followed by amyloid angiopathy signs detected during magnetic resonance imaging after bypass surgery. It discusses the diagnostic features of NTH and amyloid angiopathy and the possible common mechanisms of these diseases.

scholarly journals Idiopathic normal pressure hydrocephalus

2019 ◽  
pp. 272-276
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Cristiana Moisescu
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Imaging Techniques ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
High Rate ◽  
Third Ventriculostomy ◽  
Therapeutic Success ◽  
Surgical Interventions

Idiopathic normal pressure hydrocephalus (INPH) is a neurodegenerative disease which affects the elderly, with a significant prevalence in the general population (0,2% - 5,9%), thus a common pathology encountered by neurologists and neurosurgeons, alike. Although the widespread availability of modern imaging techniques has facilitated the diagnosis of this disorder, the clinical manifestations can often be misleading. Also, an overlap with other degenerative or psychiatric diseases can make the differential diagnosis even more challenging. Cerebrospinal fluid (CSF) diversion procedures are the first line of treatment for INPH. Nowadays, there are several shunting options available, including: ventriculoperitoneal (the most commonly used), ventriculoatrial, ventriculopleural, ventriculosternal, lumboperitoneal, endoscopic third ventriculostomy. Choosing a procedure tailored to the individual patient is essential for therapeutic success. Although they are generally straightforward surgical interventions, they associate a high rate of failure, regardless of procedure used, which emphasizes the need for regular clinical and imagistic follow-up. Thus, INPH remains a disease where there is significant room for improvement, both in diagnosis and treatment.

Diagnostic Intracranial Pressure Monitoring and Surgical Management in Idiopathic Normal Pressure Hydrocephalus

Neurosurgery ◽  
2010 ◽  
Vol 66 (1) ◽  
pp. 80-91 ◽  
Author(s):  
Per Kristian Eide ◽  
Wilhelm Sorteberg
Keyword(s):  
Intracranial Pressure ◽  
Normal Pressure Hydrocephalus ◽  
Clinical Symptoms ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Diagnostic Workup ◽  
Icp Monitoring ◽  
Recording Time ◽  
Scale Scores ◽  
Increased Icp

Abstract OBJECTIVE To review our experience of managing idiopathic normal pressure hydrocephalus (iNPH) during the 6-year period from 2002 to 2007, when intracranial pressure (ICP) monitoring was part of the diagnostic workup. METHODS The review includes all iNPH patients undergoing diagnostic ICP monitoring during the years 2002 to 2007. Clinical grading was done prospectively using a normal pressure hydrocephalus (NPH) grading scale (scores from 3 to 15). The selection of patients for surgery was based on clinical symptoms, enlarged cerebral ventricles, and findings on ICP monitoring. The median follow-up time was 2 years (range, 0.3–6 years). Both static ICP and pulsatile ICP were analyzed. RESULTS A total of 214 patients underwent the diagnostic workup, of whom 131 went on to surgery. Although 1 patient died shortly after treatment, 103 of the 130 patients (79%) improved clinically. This improvement lasted throughout the observation period. The static ICP observed during ICP monitoring was a poor predictor of the response to surgery. In contrast, among 109 of 130 patients with increased ICP pulsatility (ie, ICP wave amplitude >4 mm Hg on average and >5 mm Hg in >10% of recording time), 101 (93%) were responders (ie, increase in the NPH score of >2). Correspondingly, only 2 of 21 (10%) without increased ICP pulsatility were responders. Superficial wound infection was the only complication of ICP monitoring and occurred in 4 (2%) patients. CONCLUSION Surgical results in iNPH were good with almost 80% of patients improving after treatment. The data indicate that improvement after surgery can be anticipated in 9 of 10 iNPH patients with abnormal ICP pulsatility, but in only 1 of 10 with normal ICP pulsatility. Diagnostic ICP monitoring had a low complication rate.

scholarly journals Revisiting secondary normal pressure hydrocephalus: does it exist? A review

2016 ◽  
Vol 41 (3) ◽  
pp. E6 ◽  
Author(s):  
Badih Daou ◽  
Petra Klinge ◽  
Stavropoula Tjoumakaris ◽  
Robert H. Rosenwasser ◽  
Pascal Jabbour
Keyword(s):  
Clinical Improvement ◽  
Head Trauma ◽  
Normal Pressure Hydrocephalus ◽  
Clinical Manifestations ◽  
Normal Pressure ◽  
Shunt Placement ◽  
Grading Scale ◽  
The Mean ◽  
Epidemiological Characteristics

OBJECTIVE There are several etiologies that can lead to the development of secondary normal pressure hydrocephalus (sNPH). The aim of this study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences between the separate etiologies. METHODS A comprehensive review of the literature was performed to identify studies conducted between 1965 and 2015 that included data regarding the etiology, treatment, diagnosis, and outcome in patients with sNPH. Sixty-four studies with a total of 1309 patients were included. The inclusion criteria of this study were articles that were written in English, included more than 2 patients with the diagnosis of sNPH, and contained data regarding the etiology, diagnosis, treatment, or outcome of NPH. The most common assessment of clinical improvement was based on the Stein and Langfitt grading scale or equivalent improvement on other alternative ordinal grading scales. RESULTS The main etiologies of sNPH were subarachnoid hemorrhage (SAH) in 46.5%, head trauma in 29%, intracranial malignancies in 6.2%, meningoencephalitis in 5%, and cerebrovascular disease in 4.5% of patients. In 71.9% of patients the sNPH was treated with ventriculoperitoneal shunt placement, and 24.4% had placement of a ventriculoatrial shunt. Clinical improvement after shunt placement was reported in 74.4% and excellent clinical improvement in 58% of patients with sNPH. The mean follow-up period after shunt placement was 13 months. Improvement was seen in 84.2% of patients with SAH, 83% of patients with head trauma, 86.4% of patients with brain tumors, 75% of patients with meningoencephalitis, and 64.7% of patients with NPH secondary to stroke. CONCLUSIONS Secondary NPH encompasses a diverse group of clinical manifestations associated with a subset of patients with acquired hydrocephalus. The most common etiologies of sNPH include SAH and traumatic brain injury. Secondary NPH does indeed exist, and should be differentiated from idiopathic NPH based on outcome and on clinical, pathophysiological, and epidemiological characteristics, but should not be considered as a separate entity.

Vitamin D Therapy for Normal Pressure Hydrocephalus: A Case Study

2012 ◽  
Author(s):  
William J. Burns ◽  
August E. Shapiro ◽  
Yvonne Demsky ◽  
Kayreen A. Burns
Keyword(s):  
Vitamin D ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure
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