scholarly journals Overview of Idiopathic Normal Pressure Hydrocephalus: Diagnosis and Improvement

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Julia Chen Sun
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Neurologic Examination ◽  
Cerebral Ventricles ◽  
Csf Hydrodynamics ◽  
Patient Responses ◽  
Testing Patient ◽  
Comprehensive History

Idiopathic normal pressure hydrocephalus (iNPH) is an uncommon yet potentially reversible cause of dementia in the elderly. It is characterized by cognitive deterioration, urinary incontinence, ventriculomegaly (enlarged cerebral ventricles) and gait apraxia. The diagnosis and management of iNPH requires an organized approach, starting with a comprehensive history and neurologic examination, a review of neuroimaging, and an evaluation of diagnosis. It is important to treat comorbidities in patients prior to specific iNPH testing, which includes testing patient responses to temporary CSF removal and assessing CSF hydrodynamics. In carefully selected patients, all physiological and neurological symptoms improved with a ventriculoperitoneal (VP) shunt surgery, which allows for a gradual adjustment in pressure to prevent complications caused by over-drainage.

Flow Void of Cerebrospinal Fluid in Idiopathic Normal Pressure Hydrocephalus of the Elderly: Can It Predict Outcome after Shunting?

Neurosurgery ◽  
1997 ◽  
Vol 40 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Joachim K. Krauss ◽  
Jens P. Regel ◽  
Werner Vach ◽  
Freimut D. J??ngling ◽  
Dirk W. Droste ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Flow Void

scholarly journals Idiopathic normal pressure hydrocephalus presenting with paroxysmal paraparesis as a cardinal symptom: A case presentation

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Andreas Eleftheriou ◽  
◽  
Christina Koumantzia ◽  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Elderly Population ◽  
Progressive Disease ◽  
Clinical History ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Case Presentation ◽  
Physical Findings ◽  
Cardinal Symptom

Idiopathic normal pressure hydrocephalus (iNPH) is a gradually progressive disease affecting the elderly population. The diagnosis of probable iNPH is based on clinical history, physical findings, brain imaging. INPH involves non-obstructive enlargement of the cerebral ventricles combined with one or more symptoms of cognitive decline, impaired gait and balance, and urinary urgency. Our case describes an unusual coexistence of radiological and clinical iNPH symptoms with paroxysmal paraparesis.

Selection of patients with idiopathic normal-pressure hydrocephalus for shunt placement: a single-institution experience

2010 ◽  
Vol 113 (1) ◽  
pp. 64-73 ◽  
Author(s):  
Carmelo Anile ◽  
Pasquale De Bonis ◽  
Alessio Albanese ◽  
Alessandro Di Chirico ◽  
Annunziato Mangiola ◽  
...  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Csf Shunt ◽  
Group Iii ◽  
Shunt Placement ◽  
Group I ◽  
Csf Hydrodynamics ◽  
The Mean ◽  
Group Ii

Object The ability to predict outcome after shunt placement in patients with idiopathic normal-pressure hydrocephalus (NPH) represents a challenge. To date, no single diagnostic tool or combination of tools has proved capable of reliably predicting whether the condition of a patient with suspected NPH will improve after a shunting procedure. In this paper, the authors report their experience with 120 patients with the goal of identifying CSF hydrodynamics criteria capable of selecting patients with idiopathic NPH. Specifically, they focused on the comparison between CSF-outflow resistance (R-out) and intracranial elastance (IE). Methods Between January 1977 and December 2005, 120 patients in whom idiopathic NPH had been diagnosed (on the basis of clinical findings and imaging) underwent CSF hydrodynamics evaluation based on an intraventricular infusion test. Ninety-six patients underwent CSF shunt placement: 32 between 1977 and 1989 (Group I) on the basis of purely clinical and radiological criteria; 44 between 1990 and 2002 (Group II) on the basis of the same criteria as Group I and because they had an IE slope > 0.25; and 20 between 2003 and 2005 (Group III) on the basis of the same criteria as Group II but with an IE slope ≥ 0.30. Outcomes were evaluated by means of both Stein-Langfitt and Larsson scores. Patients' conditions were considered improved when there was a stable decrease (at 6- and 12-month follow-up) of at least 1 point in the Stein-Langfitt score and 2 points in the Larsson score. Results Group I: while no statistically significant difference in mean R-out value between improved and unimproved cases was observed, a clear-cut IE slope value of 0.25 differentiated very sharply between unimproved and improved cases. Group II: R-out values in the 2 unimproved cases were 20 and 47 mm Hg/ml/min, respectively. The mean IE slope in the improved cases was 0.56 (range 0.30–1.4), while the IE slopes in the 2 unimproved cases were 0.26 and 0.27. Group III: the mean IE slope was 0.51 (range 0.31–0.7). The conditions of all patients improved after shunting. A significant reduction of the Evans ratio was observed in 34 (40.5%) of the 84 improved cases and in none of the unimproved cases. Conclusions Our strategy based on the analysis of CSF pulse pressure parameters seems to have a great accuracy in predicting surgical outcome in clinical practice.

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

Flow Void of Cerebrospinal Fluid in Idiopathic Normal Pressure Hydrocephalus of the Elderly: Can It Predict Outcome after Shunting?

Neurosurgery ◽  
1997 ◽  
Vol 40 (1) ◽  
pp. 67-74
Author(s):  
Joachim K. Krauss ◽  
Jens P. Regel ◽  
Werner Vach ◽  
Freimut D. Jüngling ◽  
Dirk W. Droste ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Flow Void

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.

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