Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus

Larsson, Anders; Wikkelsø, Carsten; Bilting, M.; Stephensen, Hannes

doi:10.1111/j.1600-0404.1991.tb04998.x

Cited by 193 publications

(139 citation statements)

References 30 publications

Supporting

Mentioning

125

Contrasting

Unclassified

Order By: Relevance

“…35 The differentiation between iNPH and sNPH has been highlighted by several authors as well, at least with regard to outcome after shunting. 4,30,71 Most of the recent work has focused on iNPH, whereas most of what we know regarding sNPH stems from studies originating from the 1960s to the 1990s. Differences in outcomes of iNPH and sNPH have been observed, with substantial improvement after shunting occurring in approximately 30%-50% of patients with no identifiable cause and in about 50%-70% of patients with sNPH.…”

Section: Discussionmentioning

confidence: 99%

“…2, 30 In general, most patients develop NPH soon after the primary diseases. Onset of iNPH is usually gradual, with progressive worsening over time.…”

Section: Discussionmentioning

confidence: 99%

“…Larsson et al reported that patients with sNPH had a better prognosis than did those with iNPH (94% SAH, 79% posttraumatic, 77% idiopathic). 30 The duration of preoperative symptoms has been reported to be a significant factor in the prognosis of NPH. 16,30 Patients with sNPH present with a shorter duration of preoperative symptoms, because the presence of a known etiology can lead to an earlier investigation and detection of NPH symptoms.…”

Section: 5mentioning

confidence: 99%

See 2 more Smart Citations

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

View full text Add to dashboard Cite

OBJECTIVE There are several etiologies that can lead to the development of secondary normal pressure hydrocephalus (sNPH). The aim of this study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences between the separate etiologies. METHODS A comprehensive review of the literature was performed to identify studies conducted between 1965 and 2015 that included data regarding the etiology, treatment, diagnosis, and outcome in patients with sNPH. Sixty-four studies with a total of 1309 patients were included. The inclusion criteria of this study were articles that were written in English, included more than 2 patients with the diagnosis of sNPH, and contained data regarding the etiology, diagnosis, treatment, or outcome of NPH. The most common assessment of clinical improvement was based on the Stein and Langfitt grading scale or equivalent improvement on other alternative ordinal grading scales. RESULTS The main etiologies of sNPH were subarachnoid hemorrhage (SAH) in 46.5%, head trauma in 29%, intracranial malignancies in 6.2%, meningoencephalitis in 5%, and cerebrovascular disease in 4.5% of patients. In 71.9% of patients the sNPH was treated with ventriculoperitoneal shunt placement, and 24.4% had placement of a ventriculoatrial shunt. Clinical improvement after shunt placement was reported in 74.4% and excellent clinical improvement in 58% of patients with sNPH. The mean follow-up period after shunt placement was 13 months. Improvement was seen in 84.2% of patients with SAH, 83% of patients with head trauma, 86.4% of patients with brain tumors, 75% of patients with meningoencephalitis, and 64.7% of patients with NPH secondary to stroke. CONCLUSIONS Secondary NPH encompasses a diverse group of clinical manifestations associated with a subset of patients with acquired hydrocephalus. The most common etiologies of sNPH include SAH and traumatic brain injury. Secondary NPH does indeed exist, and should be differentiated from idiopathic NPH based on outcome and on clinical, pathophysiological, and epidemiological characteristics, but should not be considered as a separate entity.

show abstract

Section: Discussionmentioning

confidence: 99%

“…2, 30 In general, most patients develop NPH soon after the primary diseases. Onset of iNPH is usually gradual, with progressive worsening over time.…”

Section: Discussionmentioning

confidence: 99%

Section: 5mentioning

confidence: 99%

See 1 more Smart Citation

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

View full text Add to dashboard Cite

show abstract

“…When the valve pressure is too low, there is excessive drainage, creating negative pressure inside the skull, sometimes causing rupture of veins in the subdural space, creating nontraumatic subdural hematomas or hygromas [12][13][14][15] .…”

mentioning

confidence: 99%

Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients

Oliveira

Saad

Reis

et al. 2013

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Idiopathic normal pressure hydrocephalus (iNPH) is a condition characterized by gait disturbance, dementia and/or urinary incontinence without causative disorders, as well as dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure and no secondary cause [1][2][3] . It is a differential diagnosis for most of the dementia syndromes and occurs mainly in elderly populations 4 .The known incidence is approximately 6 per 100,000 and it has a prevalence of 22 per 100,000 for suspected iNPH.There are associations with hypertension, cerebrovascular and Alzheimer diseases [1][2][3] .The clinical evolution of iNPH is not clear 5 . Without surgery, most iNPH patients present early clinical deterioration. A small number of patients might improve without shunting; however, the extent of improvement is not clear 3 .Ventricular CSF shunting is the main treatment in the management of iNPH and its results in reducing the caregiver's burden when caring for iNPH patients are well-established 6 . ABSTRACTIdiopathic normal pressure hydrocephalus (iNPH) is characterized by gait disturbance, dementia and /or urinary incontinence, dilation of the ventricular system and normal opening cerebrospinal fluid pressure. Shunt surgery is the standard treatment of iNHP. Diversions with programmable valves are recommended, once drainage pressure can be changed. However, well-defined protocols still lack guiding the steps to attain proper pressure for each patient. Methods: In our study, we reported the experience of shunting 24 patients with iNPH using Strata ® (Medtronic) valve, following a protocol based on a positive Tap Test. Results: We observed clinical improvement in 20 patients and stability/ worsening in 4 patients. Complications occurred in five patients, including one death. The results display improvement, and complications occurred at a lower rate than reported in other studies. Conclusions: The Strata ® valve used in the proposed protocol represents an efficient and safe tool in the treatment of iNPH.Key words: hydrocephalus, normal pressure, cerebrospinal fluid shunts, treatment. RESUMOA hidrocefalia de pressão normal idiopática (iNPH) é caracterizada por alterações na marcha, demência e/ou incontinência urinária, além de dilatação dos ventrículos com pressão normal de abertura no líquido cefalorraquidiano. A cirurgia de derivação é o principal tratamento da iNHP. São recomendadas válvulas programáveis, pois a pressão de drenagem pode ser alterada. Embora as válvulas programáveis sejam utilizadas, não há protocolos para atingir a pressão adequada de cada paciente. Métodos: Neste estudo, relatamos nossa experiência com 24 pacientes com iNPH que usaram a válvula Strata ® (Medtronic), seguindo protocolo baseado em um Tap test positivo. Resultados: Observamos melhora em 20 pacientes e estabilidade ou piora em 4. Ocorreram complicações em cinco pacientes, tendo um deles falecido. Houve importante melhora clínica, e as complicações ocorreram em taxa mais baixa do que as relatad...

show abstract

“…Because adults in this age range have been included in cohorts of predominately elderly patients with NPH (18,21,22) the clinical presentation of young adults has not been differentiated until Cowan et al (9) described in 2005 a new subgroup of HC patients -hydrocephalus in young and middle-aged adults. They proposed the recognition of a single, clinically distinct syndrome of hydrocephalus in young and middle-aged adults (SHYMA), which is associated with ventriculomegaly and signs and symptoms that are age related and mostly similar, regardless of the aetiology of the hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%