Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients

Abstract

Data in this report affirm that gait improvement immediately following ELD is the best prognostic indicator of a positive shunt outcome, with an accuracy of prediction greater than 90%. Furthermore, bolus resistance testing is useful as a prognostic tool, does not require hospitalization, can be performed in an outpatient setting, and has an overall accuracy of 72% in predicting successful ELD outcome. Equally important is the finding that improvement with shunt surgery is independent of age up to the ninth decade of life in patients who improved on ELD.

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus: Second Edition

“…The efficacy of shunt procedures maintained for the short term ranged from 3-6 months in 64-96% of patients, 2,5,15,21,22,24,32,35,36,48) and at 1 year in 41-95% 10,12,18,25,33,40,49,50,62,66) ; while the efficacy of shunt procedures maintained for the long term ranged from 3-5 years in 28-91% of patients. 2,9,21,32,36,38,46,49,50,52) The best improvement rate was for gait disturbance, between 58-90%.…”

“…However, in studies including a large number of patients with iNPH, the mean age of onset of iNPH is approximately 75 years, and patients aged in their 40s and 50s are very uncommon. 24,33) Oi et al first described cases of longstanding overt ventriculomegaly in adults (LOVA), showing severe ventriculomegaly that was associated with macrocephalus and aqueductal stenosis 25) (Fig. 2).…”

“…31,108,109,141) 3) CSF pulse pressure: Increased amplitude together with decreased latency of the ICP pulse wave are noted in most of shunt-effective cases. 9,10,22,33,35,110) A high proportion of high amplitude waves of À9 mmHg predicts postsurgical improvement (positive predictive value 96%) 110) (Recommendation grade C1).…”

Intracranial Pressure versus Phase-Contrast MR Imaging for Normal Pressure Hydrocephalus

“…Some sites go beyond the outpatient tap test and use external lumbar drainage, which is a 3-day in-patient procedure in which 10 mL of CSF is removed every hour via a lumbar catheter with gait reassessment at the end. 8 In Sweden, the saline infusion technique is often used to determine increased resistance to inflow. 9 In Japan, a midcoronal MR imaging scan is used to look for the disproportionately enlarged subarachnoid space hydrocephalus (DESH) pattern, which includes an Evans ratio of Ͼ0.3, enlarged Sylvian cisterns, and a tight superior convexity subarachnoid space.…”

Clinical Significance of Cerebrospinal Fluid Tap Test and Magnetic Resonance Imaging/Computed Tomography Findings of Tight High Convexity in Patients With Possible Idiopathic Normal Pressure Hydrocephalus

“…9,10) This suggests that the continuous CSF drainage test might be more useful for decreasing false negative cases than the tap test. We performed this procedure for one patient who had progressive short-stepped gait with ventriculomegaly and tight high-convexity (Fig.…”