scholarly journals Risk factors for developing subdural hematoma: a registry-based study in 1457 patients with shunted idiopathic normal pressure hydrocephalus

2020 ◽  
pp. 1-10 ◽  
Author(s):  
Johan Gasslander ◽  
Nina Sundström ◽  
Anders Eklund ◽  
Lars-Owe D. Koskinen ◽  
Jan Malm
Keyword(s):  
Risk Factors ◽  
Normal Pressure Hydrocephalus ◽  
Platelet Aggregation Inhibitors ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Routine Practice ◽  
Opening Pressure ◽  
Quality Registry ◽  
Antiplatelet Medication ◽  
Lower Opening

OBJECTIVESubdural hematomas and hygromas (SDHs) are common complications in idiopathic normal pressure hydrocephalus (iNPH) patients with shunts. In this registry-based study, patients with shunted iNPH were screened nationwide to identify perioperative variables that may increase the risk of SDH.METHODSThe Swedish Hydrocephalus Quality Registry was reviewed for iNPH patients who had undergone shunt surgery in Sweden in 2004–2014. Potential risk factors for SDH were recorded preoperatively and 3 months after surgery. Drug prescriptions were identified from a national pharmacy database. Patients who developed SDHs were compared with those without SDHs.RESULTSThe study population consisted of 1457 patients, 152 (10.4%) of whom developed an SDH. Men developed an SDH more often than women (OR 2.084, 95% CI 1.421–3.058, p < 0.001). Patients on platelet aggregation inhibitors developed an SDH more often than those who were not (OR 1.733, 95% CI 1.236–2.431, p = 0.001). At surgery, shunt opening pressures had been set 5.9 mm H2O lower in the SDH group than in the no-SDH group (109.6 ± 24.1 vs 115.5 ± 25.4 mm H2O, respectively, p = 0.009). Antisiphoning devices (ASDs) were used in 892 patients but did not prevent SDH. Mean opening pressures at surgery and the follow-up were lower with shunts with an ASD, without causing more SDHs. No other differences were seen between the groups.CONCLUSIONSiNPH patients in this study were diagnosed and operated on in routine practice; thus, the results represent everyday care. Male sex, antiplatelet medication, and a lower opening pressure at surgery were risk factors for SDH. Physical status and comorbidity were not. ASD did not prevent SDH, but a shunt with an ASD allowed a lower opening pressure without causing more SDHs.

scholarly journals Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: a quality registry study

2017 ◽  
Vol 265 (1) ◽  
pp. 178-186 ◽  
Author(s):  
Kerstin Andrén ◽  
Carsten Wikkelsö ◽  
Nina Sundström ◽  
Simon Agerskov ◽  
Hanna Israelsson ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Registry Study ◽  
Long Term Effects ◽  
Quality Registry ◽  
Vascular Comorbidity

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

2013 ◽  
Vol 119 (6) ◽  
pp. 1498-1502 ◽  
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.

scholarly journals P.007 Familial idiopathic normal pressure hydrocephalus in a Canadian family

2018 ◽  
Vol 45 (s2) ◽  
pp. S17-S17
Author(s):  
BC Shettar ◽  
S Mirsattari
Keyword(s):  
Cognitive Impairment ◽  
Normal Pressure Hydrocephalus ◽  
Large Volume ◽  
Fluid Pressure ◽  
Cerebral Atrophy ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Opening Pressure ◽  
Vp Shunt ◽  
Surgery Patient

Background: Idiopathic Normal-pressure hydrocephalus (iNPH) is characterized by cognitive impairment, gait disturbance, enlarged ventricles with/without cerebral atrophy, with/without urinary incontinence, and normal cerebrospinal fluid pressure. Familial iNPH is very rarely described in the literature. A Canadian family with more than one generation of iNPH has never been described. Methods: Patient 1: 50-year-old female presented with wide-based and magnetic gait, multiple falls with subsequent freezing. LP with large volume tap was performed. Patient had ventriculo peritoneal (VP) shunt surgery. Patient 2: 52 year male (brother): Presented with long-standing cognitive impairment and fatigue. Montreal Cognitive Assessment (MOCA) was performed. Whole exome sequencing(WES) of both siblings as well as an unaffected first cousin was done. The father and grandmother of both patients was diagnosed with iNPH. Results: Patient 1: Opening pressure on LP was 22 cm-H2O. She responded well to large volume tap. She had VP shunt resulting in improved gait. Patient 2: Opening pressure on LP was 16cm-H2O. CSF flow study was slow for age indicative of NPH. MoCA score was 25/30. WES of patients and unaffected first cousin is underway. Conclusions: We present an undescribed Canadian family with iNPH in more than one generation. WES is underway for better understanding of genetic predesposition and inheritance of familial iNPH

scholarly journals Waiting time for surgery influences the outcome in idiopathic normal pressure hydrocephalus — a population-based study

2021 ◽  
Author(s):  
Christine Chidiac ◽  
N. Sundström ◽  
M. Tullberg ◽  
L. Arvidsson ◽  
M. Olivecrona
Keyword(s):  
Clinical Outcome ◽  
Waiting Time ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Population Based ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Shunt Surgery ◽  
Timed Up And Go ◽  
Population Based Study ◽  
Quality Registry

Abstract Introduction Idiopathic normal pressure hydrocephalus (iNPH) is a disease that comes with a great impact on the patient’s life. The only treatment for iNPH, which is a progressive disease, is shunt surgery. It is previously indicated that early intervention might be of importance for the outcome. Aim To investigate if a longer waiting time for surgery, negatively influences the clinical outcome. Methods Eligible for this study were all iNPH patients (n = 3007) registered in the Swedish Hydrocephalus Quality Registry (SHQR) during 1st of January 2004–12th of June 2019. Waiting time, defined as time between the decision to accept a patient for surgery and shunt surgery, was divided into the intervals ≤ 3, 3.1–5.9 and ≥ 6 months. Clinical outcome was assessed 3 and 12 months after surgery using the modified iNPH scale, the Timed Up and Go (TUG) test and the mini mental state examination (MMSE). Results Three months after surgery, 57% of the patients with ≤ 3 months waiting time showed an improvement in modified iNPH scale (≥ 5 points) whereas 52% and 46% of patients with 3.1–5.9 and ≥ 6 months waiting time respectively improved (p = 0.0115). At 12 months of follow-up, the corresponding numbers were 61%, 52% and 51% respectively (p = 0.0536). Conclusions This population-based study showed that in patients with iNPH, shunt surgery should be performed within 3 months of decision to surgery, to attain the best outcome.

Vascular Risk Factors and Arteriosclerotic Disease in Idiopathic Normal-Pressure Hydrocephalus of the Elderly

Stroke ◽  
1996 ◽  
Vol 27 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Joachim K. Krauss ◽  
Jens P. Regel ◽  
Werner Vach ◽  
Dirk W. Droste ◽  
Jan J. Borremans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Vascular Risk Factors ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Vascular Risk
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