Normal pressure hydrocephalus: a qualitative study on outcome

Abstract

Objective: To describe the natural history and shunt outcome in patients with normal pressure hydrocephalus (NPH) and the variables that influence both. Method: Motor and cognitive parameters of 35 patients with NPH, as well as shunt surgery status, were registered at two time points (T0 and T1). Results: Thirteen patients underwent shunt surgery. Favorable outcome in gait function occurred in 5 of 35 patients and was related to younger age, absence of cardiovascular risk factors (CVRF) and white matter lesions (WML), and shunt surgery. Cognitive outcome was favorable in 9 of 35 patients and associated with shunt surgery (trend level). Of the patients subjected to surgery, favorable outcome in motor function was related to younger age at T0 and absence of CVRF and WML (trend level). Conclusion: Shunt surgery had a significant effect on gait and less on cognition. Favorable outcome in gait was also associated with younger age and absence of CVRF and WML.Keywords: normal pressure hydrocephalus, natural history, shunt surgery. REsumo:Objetivo: Descrever a história natural e o prognóstico após cirurgia de derivação ventricular em doentes com hidrocefalia de pressão normal (HPN), e as variáveis que potencialmente os influenciam. Método: Foram registados os parâmetros motores e cognitivos de 35 doentes com HPN, assim como o status relativo a cirurgia, em dois pontos no tempo (T0 e T1). Resultados: Treze doentes foram submetidos a cirurgia. Melhoria na marcha ocorreu em 5 doentes e relacionou-se com idade mais jovem, ausência de factores de risco cardio-vascular (FRCV), ausência de lesões da substância branca (LSB) e colocação de derivação ventricular. Verificou-se melhoria cognitiva em 9 doentes, associada (p=0,05) com colocação de derivação ventricular. Em doentes submetidos a cirurgia, o prognóstico favorável a nível motor relacionou-se com idade mais jovem em T0, ausência de FRCV e de LSB. Conclusão: A cirurgia para colocação de derivação ventricular teve um efeito significativo sobre a marcha e menor na cognição. O prognóstico favorável na marcha parece também associar-se a idade mais jovem, a ausência de FRV e de LSB.Palavras-chave: hidrocefalia de pressão normal, história natural, cirurgia de derivação ventriculo-peritoneal.Normal pressure hydrocephalus (NPH) was first des cri bed by Hakim and Adams as a syndrome that consisted of the triad of gait dysfunction, dementia, and urinary in continence, was associated with ventricular dilation, was potentially treatable by cerebrospinal fluid (CSF) surgical derivation (shunt surgery) 1

Ventriculoperitoneal Shunt Outcomes of Normal Pressure Hydrocephalus: A Case Series of 116 Patients

“…We found that gait (64.9%) was more likely to improve after shunting than cognition (20.7%) or incontinence (18%). Our findings are consistent with previous studies, which concluded that shunting is associated with greater improvement in gait [11-12]. These studies also found that cognitive dysfunction was the least likely symptom to improve after shunting [12].…”

Susceptibility Weighted Imaging (SWI) Recommended as a Regular Magnetic Resonance Diagnosis for Vascular Dementia to Identify Independent Idiopathic Normal Pressure Hydrocephalus Before Ventriculo-Peritoneal (V-P) Shunt Treatment: A Case Study

“…Our study perspective could be supported by one previous study showing that INPH patients with cerebrovascular disease (CVD), such as LA or stroke, had poorer short- and long-term treatment outcome than those patients without CVD (13). Moreover, both studies also showed normal pressure hydrocephalus (NPH) with LA could not obtain a favorable outcome after V-P shunt surgery and they considered LA as a negative factor in decisions regarding V-P shunt treatment (14, 15), although several studies found that patients with severe LA could also benefit from the shunt surgery (16, 17). In addition, Alzheimer's disease (AD) has been shown to frequently coexist with INPH, and patients presenting with AD are less likely to obtain a fully favorable long-term outcome of shunt surgery than in those persons without AD (18).…”

Normal Pressure Hydrocephalus: Clinical Approach and Practical Considerations

“…The improvement rates are as variable as 39-81% in 3-6 months to 63-84% in 1 year [13]. In addition, the recovery in the first months is lower due to short-term complications such as excessive drainage, subdural hematomas, insufficient drainage, and shunt dysfunction [22]. Cognitive improvement is known to have mixed results.…”