Walking assessment after lumbar puncture in normal-pressure hydrocephalus: a delayed improvement over 3 days

OBJECTIVE The determination of gait improvement after lumbar puncture (LP) in idiopathic normal-pressure hydrocephalus (iNPH) is crucial, but the best time for such an assessment is unclear. The authors determined the time course of improvement in walking after LP for single-task and dual-task walking in iNPH. METHODS In patients with iNPH, sequential recordings of gait velocity were obtained prior to LP (time point [TP]0), 1–8 hours after LP (TP1), 24 hours after LP (TP2), 48 hours after LP (TP3), and 72 hours after LP (TP4). Gait analysis was performed using a pressure-sensitive carpet (GAITRite) under 4 conditions: walking at preferred velocity (STPS), walking at maximal velocity (STMS), walking while performing serial 7 subtractions (dual-task walking with serial 7 [DTS7]), and walking while performing verbal fluency tasks (dual-task walking with verbal fluency [DTVF]). RESULTS Twenty-four patients with a mean age of 76.1 ± 7.8 years were included in this study. Objective responder status moderately coincided with the self-estimation of the patients with subjective high false-positive results (83%). The extent of improvement was greater for single-task walking than for dual-task walking (p < 0.05). Significant increases in walking speed were found at TP2 for STPS (p = 0.042) and DTVF (p = 0.046) and at TP3 for STPS (p = 0.035), DTS7 (p = 0.042), and DTVF (p = 0.044). Enlargement of the ventricles (Evans Index) positively correlated with early improvement. Gait improvement at TP3 correlated with the shunt response in 18 patients. CONCLUSIONS Quantitative gait assessment in iNPH is important due to the poor self-evaluation of the patients. The maximal increase in gait velocity can be observed 24–48 hours after the LP. This time point is also best to predict the response to shunting. For dual-task paradigms, maximal improvement appears to occur later (48 to 72 hours). Assessment of gait should be performed at Day 2 or 3 after LP.

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Normal-pressure hydrocephalus: White matter lesions correlate negatively with gait improvement after lumbar puncture

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2007.07.012 ◽

2007 ◽

Vol 109 (9) ◽

pp. 774-778 ◽

Cited By ~ 19

Author(s):

Paulo Bugalho ◽

Luísa Alves

Keyword(s):

White Matter ◽

Lumbar Puncture ◽

Normal Pressure Hydrocephalus ◽

White Matter Lesions ◽

Normal Pressure

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Effects of a Dual-Task Paradigm and Gait Velocity on Dynamic Gait Stability during Stair Descent

Applied Sciences ◽

10.3390/app10061979 ◽

2020 ◽

Vol 10 (6) ◽

pp. 1979 ◽

Cited By ~ 1

Author(s):

Qipeng Song ◽

Wei Sun ◽

Cui Zhang ◽

Min Mao ◽

Li Li

Keyword(s):

Dual Task ◽

Center Of Pressure ◽

Force Plate ◽

Gait Velocity ◽

Task Condition ◽

Dual Task Condition ◽

Gait Stability ◽

Single Task ◽

Dual Task Paradigm ◽

Dynamic Gait

Falls during stair negotiation have become one of the leading causes of accidental death. The effects of a concurrent cognitive or manual dual-task paradigm on dynamic gait stability remain uncertain. How much dynamic gait stability is influenced by gait velocity is also not clear. A total of 16 healthy young females descended a staircase under three different walking conditions: descend stairs only (single task), descend stairs while performing subtraction (cognitive dual-task), and descend stairs while carrying a glass of water (manual dual-task). An eight-camera Vicon motion analysis system and a Kistler force plate embedded into the third step of the staircase were used synchronously to collect kinematic and kinetic data. Gait velocity decreased and dynamic gait stability increased with both cognitive and manual dual-task conditions. The center of mass–center of pressure inclination angle increased with gait velocity but decreased with the manual dual-task condition compared to the single-task condition. Changes in gait velocity caused by the dual-task paradigm can partially explain the effects of dual-task dynamic gait stability. The influence of gait velocity should be considered in the assessment of dual-task effects.

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Lumbar Puncture Test in Normal Pressure Hydrocephalus: Does the Volume of CSF Removed Affect the Response to Tap?

American Journal of Neuroradiology ◽

10.3174/ajnr.a5187 ◽

2017 ◽

Vol 38 (7) ◽

pp. 1456-1460 ◽

Cited By ~ 7

Author(s):

S.K. Thakur ◽

Y. Serulle ◽

N.P. Miskin ◽

H. Rusinek ◽

J. Golomb ◽

...

Keyword(s):

Lumbar Puncture ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure

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Lumbar Puncture Alleviates Chorea in a Patient with Huntington’s Disease and Normal Pressure Hydrocephalus

Behavioural Neurology ◽

10.1155/2009/606438 ◽

2009 ◽

Vol 21 (3-4) ◽

pp. 193-195 ◽

Cited By ~ 2

Author(s):

Peyman Shirani ◽

Alicia R. Salamone ◽

Elham Lahijani ◽

Michele K. York ◽

Paul E. Schulz

Keyword(s):

Lumbar Puncture ◽

Normal Pressure Hydrocephalus ◽

Test Scores ◽

African American Male ◽

Normal Pressure ◽

Rapid Progression ◽

Head Ct ◽

Atypical Symptoms ◽

Poor Cognitive Function ◽

Difficulty Walking

A 44-year-old African-American male was admitted to our hospital after a suicide attempt. He had depression, poor cognitive function, choreiform movements, difficulty pronouncing words, and difficulty walking. His symptoms had worsened markedly over several months. Chorea lead to genetic testing that confirmed a diagnosis of Huntington Disease (HD). A CT scan of the head showed wider ventricles than is typical of HD. The head CT and gait change suggested normal pressure hydrocephalus (NPH). Lumbar puncture (LP) led to improved neuropsychologic test scores and walking thereby supporting the diagnosis of NPH. Surprisingly, the LP also led to an 80% improvement of chorea. There are two other reports of an association between HD and NPH. NPH should be considered in HD patients with atypical symptoms, such as the inability to walk or rapid progression, as its treatment may lead to improved cognition, gait, and chorea.

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Overdrainage shunt complications in idiopathic normal-pressure hydrocephalus and lumbar puncture opening pressure

Journal of Neurosurgery ◽

10.3171/2013.7.jns13484 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1498-1502 ◽

Cited By ~ 20

Author(s):

Qurat ul Ain Khan ◽

Robert E. Wharen ◽

Sanjeet S. Grewal ◽

Colleen S. Thomas ◽

H. Gordon Deen ◽

...

Keyword(s):

Lumbar Puncture ◽

Normal Pressure Hydrocephalus ◽

Subdural Hematoma ◽

Normal Pressure ◽

Idiopathic Normal Pressure Hydrocephalus ◽

Complication Rates ◽

Shunt Surgery ◽

Opening Pressure ◽

Presenting Symptoms ◽

Subdural Hematomas

Object Management of idiopathic normal-pressure hydrocephalus (iNPH) is hard because the diagnosis is difficult and shunt surgery has high complication rates. An important complication is overdrainage, which often can be treated with adjustable–shunt valve manipulations but also may result in the need for subdural hematoma evacuation. The authors evaluated shunt surgery overdrainage complications in iNPH and their relationship to lumbar puncture opening pressure (LPOP). Methods The authors reviewed the charts of 164 consecutive patients with iNPH who underwent shunt surgery at their institution from 2005 to 2011. They noted age, sex, presenting symptoms, symptom duration, hypertension, body mass index (BMI), imaging findings of atrophy, white matter changes, entrapped sulci, LPOP, valve opening pressure (VOP) setting, number of valve adjustments, serious overdrainage (subdural hematoma requiring surgery), radiological overdrainage (subdural hematomas or hygroma seen on postoperative imaging), clinical overdrainage (sustained or postural headache), other complications, and improvements in gait, urine control, and memory. Results Eight patients (5%) developed subdural hematomas requiring surgery. All had an LPOP of greater than 160 mm H2O and an LPOP-VOP of greater than 40 mm H2O. Radiological overdrainage was more common in those with an LPOP of greater than 160 mm H2O than in those with an LPOP of less than 160 mm H2O (38% vs 21%, respectively; p = 0.024). The BMI was also significantly higher in those with an LPOP of greater than 160 mm H2O (median 30.2 vs 27.0, respectively; p = 0.005). Conclusions Serious overdrainage that caused subdural hematomas and also required surgery after shunting was related to LPOP and LPOP-VOP, which in turn were related to BMI. If this can be replicated, individuals with a high LPOP should have their VOP set close to the LPOP, or even higher. In doing this, perhaps overdrainage complications can be reduced.

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Analysis of Lumbar Puncture Test in 5 Patients with Good Prognosis of Shunt Operation for Normal Pressure Hydrocephalus

Journal of the Korean Neurological Association ◽

10.17340/jkna.2015.1.7 ◽

2015 ◽

Vol 33 (1) ◽

pp. 29-32

Author(s):

Yoonju Lee ◽

Jun Hong Lee ◽

Jeong Hee Cho ◽

Gyu Sik Kim ◽

Jong Hun Kim ◽

...

Keyword(s):

Lumbar Puncture ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Good Prognosis ◽

Shunt Operation

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DUAL-TASK BALANCE CONTROL IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00152 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0015

Author(s):

Tracy Zaslow ◽

Camille Burton ◽

Nicole M. Mueske ◽

Adriana Conrad-Forrest ◽

Bianca Edison ◽

...

Keyword(s):

Dual Task ◽

Verbal Fluency ◽

Walking Speed ◽

Balance Control ◽

Dynamic Balance ◽

Center Of Mass ◽

Quiet Standing ◽

Return To Play ◽

Treatment Protocols ◽

Single Task

Background: Previous research has identified deficient dual-task balance control at the time of return to play (RTP) and possible worsening after RTP in older adolescents/young adults with concussion. These findings have not been investigated in younger patients with concussion. Hypothesis/Purpose: We hypothesized that concussed adolescents would have slower walking speed and increased medial-lateral (ML) center of mass (COM) movement, which would normalize by the time of RTP but worsen after resuming activity. Methods: 13 adolescent concussion patients (7 male; age 10-17 years) were prospectively evaluated at their initial visit (IV) (mean 18, range 4-43 days post-concussion), at RTP clearance (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days post-RTP) along with 11 controls (3 male) seen for similarly timed visits. Standing balance was assessed using range and root mean squared (RMS) COM motion in the anterior-posterior (AP) and ML directions during standing on both legs with eyes open while performing quiet standing, dual-task audio Stroop, side-to-side head turns, and side-to-side thumb tracking tasks. Dynamic balance was assessed using walking speed and COM ML range and velocity during walking alone and with side-to-side head turns and verbal fluency (reciting words starting with “F”) dual tasks. Patients were compared against controls using t-tests, and changes over time were evaluated using linear mixed-effects regression. Results: During standing, patients had higher COM ML RMS than controls at IV during head turns and higher COM AP range during thumb tracking. COM ML motion decreased from IV to RTP (head turns range -6.5mm, p=0.058; head turns RMS -16.8mm, p=0.002; thumb range 9.2mm, p=0.012) and increased from RTP to 1 month follow-up (head turns RMS +10.0mm, p=0.040; Stroop RMS +8.4mm, p=0.086). Patients walked slower than controls at IV during all tasks, and COM ML range was higher in patients vs. controls during verbal fluency at IV and RTP. Walking speed increased from IV to RTP during verbal fluency (+7.8cm/s, p=0.044), from RTP to post-RTP in single task walking (+6.1cm/s, p=0.041), and at each successive visit during head turns (+6.0cm/s and +6.5cm/s, p<0.07). COM ML range also decreased in patients from IV to RTP with verbal fluency (-14.7mm, p=0.011) and from RTP to post-RTP in single task walking ( 4.0mm, p=0.061). Conclusion: Adolescent concussion patients had deficits in static and dynamic balance control at initial presentation. This tended to improve by RTP and only worsened post-RTP for dual-task ML control during standing, suggesting that current conservative treatment protocols are appropriate.

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P12.09 Clinical features and management of normal pressure hydrocephalus associated with non-obstructive vestibular schwannoma

Neuro-Oncology ◽

10.1093/neuonc/noab180.111 ◽

2021 ◽

Vol 23 (Supplement_2) ◽

pp. ii32-ii32

Author(s):

V Redaelli ◽

P Gaviani ◽

G Simonetti ◽

A G Botturi ◽

M Marchetti ◽

...

Keyword(s):

High Risk ◽

Lumbar Puncture ◽

Clinical Features ◽

Vestibular Schwannoma ◽

Normal Pressure Hydrocephalus ◽

Normal Pressure ◽

Maximum Diameter ◽

Tap Test ◽

Risk Of Falls ◽

Vs Removal

Abstract BACKGROUND Some (elderly) patients present a communicating (normal pressure) hydrocephalus (NPH) in association with or secondary to vestibular schwannoma (VS). We aim to investigate the usefulness ventriculo-peritoneal shunt (VPS) without tumor removal. MATERIALS AND METHODS 8 patients aged from 50 to 78 years received both diagnosis of VS (mean maximum diameter 21 mm, range 13–28 mm) and NPH. None presented the classical Hakim’s triad. They presented isolated ataxia with gait impairment and loss of equilibrium. It was hard to distinguish if these symptoms were due to NPH or to VIII cranial nerve compression. They underwent TAP test, through a lumbar puncture with a very slow whithdrawal of at least 30 ml of cerebrospinal fluid (CSF). RESULTS None of the 8 patients presented improvement after lumbar puncture. Despite this, we decided to proceed with VPS in 4 patients because of a high risk of falls.... All these 4 patients showed clinical improvement after VPS.. The VS were treated as follows: 4 surgery, 2 radiosurgery, 2 observation. CONCLUSIONS Although some authors indicate VS removal as the best option to improve also NPH symptoms, some patients present high risk of falls in the presence of a small VS. These clinical features are more likely to be relayed related to NPH instead of VS.. VPS carries lower postoperative risks compared to VS removal. For this reason, VPS has to be considered, even without a positive response to a TAP test, as a good alternative to improve quality of life in patient affected by NPH associated with VS.

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