Diagnosing Idiopathic Normal-pressure Hydrocephalus

Relkin, Norman; Marmarou, Anthony; Klinge, Petra M.; Bergsneider, Marvin; Black, Peter McL.

doi:10.1227/01.neu.0000168185.29659.c5

Cited by 797 publications

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References 41 publications

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“…21 The patients included in Oslo also had to present with abnormal ICP dynamics, defined as mean ICP wave amplitude above 4 mm Hg and > 5 mm Hg for at least 10% of the recording time.…”

Section: Patientsmentioning

confidence: 99%

“…21 The patients included in Oslo also had to present with abnormal ICP dynamics, defined as mean ICP wave amplitude above 4 mm Hg and > 5 mm Hg for at least 10% of the recording time. 7 The patients included in Gothenburg were assessed by means of the iNPH scale, 19 which comprises 4 domains (gait, neuropsychology, balance, and continence) and yields a total score (iNPH scale score) ranging between 0 and 100, where 100 represents normal performance among healthy individuals in an iNPH typical age range of 70-74 years.…”

Section: Patientsmentioning

confidence: 99%

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A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

Sæhle

Farahmand

Eide

et al. 2014

JNS

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I dIopathIc normal pressure hydrocephalus (iNPH) is a treatable condition, first described by Hakim in 1965. 10 It is characterized clinically by gait disturbance, cognitive impairment, and urinary incontinence and radiologically by ventriculomegaly. The condition is typically diagnosed in the elderly and most often treated by insertion of a ventriculoperitoneal (VP) shunt with either a fixed or an adjustable pressure valve. Adjustable valves were designed to lower the complication rate and optimize the effect of shunting. 26 After shunt surgery in iNPH patients, improvement rates between 61% and 90% have been reported, 6,[11][12][13][14]16,18,23 with recent studies revealing a rate above 80%. 13,24 The complication rates are high, up to 50%, 3,8,22 although a rate of 20% is evident in recent studies. 8,26 The major complications are mechanical obstruction, infection, and subdural hematoma (SDH); the frequency of SDH is between 2% and 16%. 7,13,23 A Dutch NPH study recommended the use of a low A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or "fixed" pressure valve settings Object. This study was undertaken to investigate whether a gradual reduction of the valve setting (opening pressure) decreases the complication rate in patients with idiopathic normal-pressure hydrocephalus (iNPH) treated with a ventriculoperitoneal (VP) shunt.Methods. In this prospective double-blinded, randomized, controlled, dual-center study, a VP shunt with an adjustable valve was implanted in 68 patients with iNPH, randomized into two groups. In one group (the 20-4 group) the valve setting was initially set to 20 cm H 2 O and gradually reduced to 4 cm H 2 O over the course of the 6-month study period. In the other group (the 12 group), the valve was kept at a medium pressure setting of 12 cm H 2 O during the whole study period. The time to and type of complications (hematoma, infection, and mechanical problems) as well as overdrainage symptoms were recorded. Symptoms, signs, and outcome were assessed by means of the iNPH scale and the NPH grading scale.Results. Six patients in the 20-4 group (22%) and 7 patients in the 12 group (23%) experienced a shunt complication; 9 had subdural hematomas, 3 mechanical obstructions, and 1 infection (no significant difference between groups). The frequency of overdrainage symptoms was significantly higher for a valve setting ≤ 12 cm H 2 O compared with a setting > 12 cm H 2 O. The 20-4 group had a higher improvement rate (88%) than the 12 group (62%) (p = 0.032). There was no significant relationship between complications and body mass index, the use of an antisiphon device, or the use of anticoagulants.Conclusions. Gradual lowering of the valve setting to a mean of 7 cm H 2 O led to the same rate of shunt complications and overdrainage symptoms as a fixed valve setting at a mean of 13 cm H 2 O but was associated with a significantly better outcome. (http://thejns.org/doi/abs/10.3171/2014.7.JNS14283) Key Wo...

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“…21 The patients included in Oslo also had to present with abnormal ICP dynamics, defined as mean ICP wave amplitude above 4 mm Hg and > 5 mm Hg for at least 10% of the recording time.…”

Section: Patientsmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

Sæhle

Farahmand

Eide

et al. 2014

JNS

View full text Add to dashboard Cite

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“…4) Ventricular dilation is a critically important neuroradiographical finding: an Evans index, the ratio of the maximum width of the frontal horns to the maximum width of the inner table of the skull, of greater than 0.3 is accepted as an essential diagnostic criterion for INPH. 31,32) In addition, recent MR imaging studies have indicated that tightness of the high parietal convexity is commonly observed in INPH patients. 5,18,35) Such anatomical changes in the cerebrospinal fluid (CSF) space have been widely accepted as neuroradiographical evidence justifying the diagnosis of INPH.…”

Section: Introductionmentioning

confidence: 99%

Diffusion Tensor Imaging of Idiopathic Normal Pressure Hydrocephalus: A Voxel-Based Fractional Anisotropy Study

Koyama

Marumoto

Domen

et al. 2012

Neurol. Med. Chir.(Tokyo)

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Diffusion tensor imaging (DTI) using a 3.0 tesla magnetic resonance scanner was used to investigate white matter changes caused by idiopathic normal pressure hydrocephalus (INPH) in 10 patients diagnosed by clinical symptoms (gait disturbance, dementia, and/or urinary incontinence) and Evans index À0.3, and compared with findings for 10 age-matched controls (AE60 years). Then, using a computer-automated method, fractional anisotropy (FA) brain maps were generated and finally transformed into the standard space. Voxel-based FA values within two regions of interests (ROIs), the forceps minor and corticospinal tracts, were then separately evaluated. Within each ROI, statistical comparisons of results from the INPH and control groups were performed. In addition, for INPH patients, grading scores for clinical symptoms and FA values were correlated. The forceps minor mean FA value was much smaller for the INPH group (0.504) than for the control group (0.631). The corticospinal tract mean FA value was slightly smaller for the INPH group (0.588) than for the control group (0.632). Additional analyses indicated that lower FA values within the forceps minor tended to be associated with clinical symptoms such as urinary incontinence and gait disturbance. Our findings indicate FA values decreased in the forceps minor of INPH patients. We also found that lower values were associated with severer clinical symptoms, implying that DTI techniques may be developed for more accurate diagnosis.

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“…3, 28,34,35,55 Because sNPH is so heterogeneous with regard to pathology, diagnosis, treatment, and outcome, it is not clear if the term "secondary normal pressure hydrocephalus" should be used to encompass such a wide array of entities and whether unifying guidelines should be made for the diagnosis and management of sNPH. The aim of this review study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences among the separate etiologies.…”

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confidence: 99%

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

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

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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.

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Diagnosing Idiopathic Normal-pressure Hydrocephalus

Cited by 797 publications

References 41 publications

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

A randomized controlled dual-center trial on shunt complications in idiopathic normal-pressure hydrocephalus treated with gradually reduced or “fixed” pressure valve settings

Diffusion Tensor Imaging of Idiopathic Normal Pressure Hydrocephalus: A Voxel-Based Fractional Anisotropy Study

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

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