SUMMARY Owing to all the difficulties involved in selecting patients with normal pressure hydrocephalus for shunt-operation, a cerebrospinal fluid-tap-test (CSF-TT) is introduced. Psychometric and motor capacities of the patients are measured before and after lumbar puncture and removal of 40-50 ml CSF. Patients fulfilling criteria for normal pressure hydrocephalus were compared to patients with dementia and atrophy shown by computed tomography. Normal pressure hydrocephaluspatients showed temporary improvement after lumbar puncture. The extent of the temporary improvement appeared to be well correlated with the improvement after shunt operation. Accordingly, the CSF-TT seems to be of value when selecting those patients who will probably benefit from a shunt operation.
Twenty-seven patients with normal pressure hydrocephalus were operated upon by a ventriculo-peritoneal shunt. Selection for shunt surgery was based on typical symptoms (gait disturbancy, mental deterioration and urgency incontinence) and characteristic changes at cranial computed tomography and/or radionuclide cisternography. Prior to operation a cerebrospinal fluid tap-test (CSF-TI') was performed with measurements of psychometric functions and gait pattern before and after a lumbar puncture of 50 cc CSF. Nineteen patients improved and 5 were unchanged after shunt operation. Three patients could not be evaluated. Improvement in the psychometric functions and gait pattern after lumbar puncture correlated to improvement after the shunt operation (r = 0.64, p < 0.01: r = 0.96, p < 0.001, respectively). Improvement in 2 or more of the 4 tests used (3 psychometric and 1 gait test) at CSF-TT implied in all cases successful result of the shunt operation. It was concluded that CSF-TT could predict which NPH patient will improve by a shunt operation, and albeit to envisage the degree of improvement.
A new diagnostic system for organic psychiatry is presented. We first define "organic psychiatry", and then give the theoretical basis for conceiving organicpsychiatric disorders in terms of hypothetical psychopathogenetic processes, HPP:s. Such hypothetical disorders are not strictly identical to the clusters of symptoms in which they typically manifest themselves, since the symptoms may be concealed or modified by intervening factors in non-typical circumstances andor in the simultaneous presence of several disorders. 'I'he six basic disorders in our system are Astheno-Emotional Disorder (AED), Somnolence-Sopor-Coma Disorder (SSCD), Hallucination-Coenestopathy-Ikpersonalisation Disorder (HCDD), Confusional Disorder (CII), Emotional-Motivational Blunting Disorder (EMD) and Korsakoffs Amnestic Disorder (KAD). We describe their usual etiologies, their typical symptoms and course, and some forms of interaction between them.
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