Normal‐pressure hydrocephalus

Wood, James H.; Bartlet, D.; James, A. Everette; Udvarhelyi, George B.

doi:10.1212/wnl.24.6.517

Cited by 83 publications

(32 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The time required for the development of NPH after SAH, trauma, meningitis, stroke, tumors, or intracranial surgery has not been established, but studies have suggested that symptoms may begin immediately after the inciting event, or there may be a delayed onset of a few months' duration. 80 As described in Wood et al, Hammes et al reported that obliteration of subarachnoid spaces secondary to fibrosis begins as early as the 10th day after SAH. Ojemann et al reported that 3 weeks may be sufficient for the development of NPH.…”

Section: Discussionmentioning

confidence: 86%

“…36 Wood et al reported on 46 cases of sNPH and found that symptoms began either immediately or as late as 4 months after the event, with the majority of patients experiencing onset of disease within 1 month. 80 Hirai et al reported that the mean preoperative period was significantly longer in iNPH (10 months vs 1 month). 21 Other studies have reported that NPH can still develop years after the initial event.…”

Section: Discussionmentioning

confidence: 99%

“…However, their study was one of the few to conclude that etiology did not have an important prognostic value. 80 Other studies have further suggested that patients with sNPH may have a more favorable shunt outcome than patients with iNPH, because patients with iNPH may have brain atrophy in addition to hydrocephalic features, whereas sNPH patients only have a CSF circulatory disorder. 64,67 Although our results support the separation of iNPH and sNPH based on outcome, iNPH and sNPH do not represent separate entities; rather, they represent a clinical syndrome associated with a subset of patients with acquired hydrocephalus-patients of different ages with different etiologies and vastly different pathophysiology.…”

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: 86%

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

“…Many studies have demonstrated that ventriculoperitoneal shunting is an effective treatment for INPH, and adjustable valves seem to produce better results than both differential pressure systems and constant flow valves (2,9,13,15,20,22,(28)(29)(30). Adjustable valves are more effective in the prevention and management of complications after shunting, primarily nontraumatic subdural collections (7,31 Anderson et al (1) observed better results at 100% positive response, but their patient population included only 11 patients, which likely undermines the statistical power of their study for the purpose of determining clinical response.…”

Section: Discussionmentioning

confidence: 99%

Decreases in Ventricular Volume Correlate with Decreases in Ventricular Pressure in Idiopathic Normal Pressure Hydrocephalus Patients Who Experienced Clinical Improvement after Implantation with Adjustable Valve Shunts

McConnell¹,

Zou²,

Chabrerie³

et al. 2004

Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE:This retrospective study examined whether changes in ventricular volume correspond with changes in adjustable valve pressure settings in a cohort of patients who received shunts to treat idiopathic normal pressure hydrocephalus. We also examined whether these pressure -volume curves and other patient variables would co-occur with a positive clinical response to shunting. METHODS:We selected 51 patients diagnosed with idiopathic normal pressure hydrocephalus who had undergone implantation of a Codman Hakim programmable valve (Medos S.A., Le Locle, Switzerland). Clinical data were gathered from the patients' records and clinical notes by an investigator blinded to patients' ventricular volumes. Ventricular volume was measured using 3D Slicer, an image analysis and interactive visualization software package developed and maintained at the Surgical Planning Laboratory at Brigham and Women's Hospital. RESULTS:Eighty-six percent of patients with gait disturbance at presentation showed improvement of this symptom, 70% experienced improvement in incontinence, and 69% experienced improvement in dementia. For the group showing 100% clinical improvement, the correlation coefficient of average changes in valve pressure over time (ΔP/ΔT) and average changes in ventricular volume over time (ΔV/ΔT) were high at 0.843 (P < 0.05). For the group experiencing no or only partial improvement, the correlation coefficient was 0.257 (P = 0.32), indicating no correlation between average ΔV/ΔT and average ΔP/ΔT for each patient. CONCLUSION:This was a carefully analyzed modeling study of idiopathic normal pressure hydrocephalus treatment made possible only by adjustable valve technology. With careful volumetric analysis, we found that changes in ventricular volume correlated with adjustments in valve pressure settings for those patients who improved clinically after shunting. This suggests that positive clinical responders retained parenchymal elasticity, emphasizing the importance of dynamic changes in this cohort. NIH Public Access Author ManuscriptNeurosurgery. Author manuscript; available in PMC 2006 January 25. (5,6,14,17,19,21,23,26). These previous studies had only twodimensional measures, namely the Evans ratio, with which to follow any changes in ventricular size after shunting; such linear measures have been shown to be inadequately sensitive to the minimal changes in ventricular size typically sought for the treatment of INPH. The dynamic relationship between valve pressure setting and ventricular volume in the setting of INPH also is poorly understood.Anderson et al.(1) recently used a three-dimensional analysis to measure ventricular volume changes after shunting for INPH. They observed a decrease in ventricular volume after shunting in 10 of 11 patients. In their study, a traditional two-dimensional analysis by an independent radiologist found decreases in ventricular size in only 2 of the 11 patients. Anderson et al., however, were unable to examine any relationship between decreasing ventricular volume...

show abstract

“…al. (17) Insisted that patients with clinical symptoms of hydrocephalus for less than 6 months had a better prognosis. Decompressive craniectomy that has been found to be associated with development of PTH by various mechanism like altering CSF flow dynamics, mechanical blockage around convexities, inflammation of arachnoid granulation by post surgical debris.…”

Section: Resultsmentioning

confidence: 99%

Posttraumatic hydrocephalus: Lessons learned from management and evaluation at a tertiary institute with review of literature

Kumar¹,

Kumar²,

Jaiswal³

et al. 2017

Romanian Neurosurgery

View full text Add to dashboard Cite

Abstract:Background: Post traumatic hydrocephalus (PTH) is a commonest treatable complication of severe traumatic brain injury that's leads to failure of improvement and worsening of the outcome. Incidence of posttraumatic hydrocephalus is 0.7%-29% reported in different literature. We have observed the development of PTH frequently seen in patients with severe head injury and after decompressive craniectomy (DC). Pathophysiology includes inflammatory changes and adhesion of arachnoid granulation, cerebral ischemia and alteration in cerebrospinal fluid (CSF) dynamics. We studied 35 cases of PTH diagnosed and treated at our institute from May 2008 to May 2017. Material and methods: This is hospital based retrospective and prospective study conducted in tertiary center on the basis of neuro-radiological examination of the patient. Clinical biodata and radiological profile of the patients was studied at initial presentation with trauma, and when the patient worsened with symptoms of raised intracranial pressure (ICP) in state of established PTH. These cases were treated by medium pressure ventriculoperitoneal shunt (V.P shunt) and outcome was evaluated. Results: Incidence of PTH in our study is (2.3%). Out of 35 cases 24 (68.57%) were male and 11(31.4%) were female. Road traffic accident (RTA) was the most common mode of injury (82.85%), acute subdural hematoma (SDH) was the most common finding on C.T scan in 15 cases (42.8 %). Decompressive craniectomy was performed in 77% at time of initial trauma. PTH had favourable outcome with V.P. shunting in 91.42%. Conclusion: Patients with traumatic brain injury present with many complications but PTH is most frequent sequeale that can present in form of various neurological symptoms after trauma and decompressive craniectomy. C.T. scan brain is the investigation of choice for diagnosis of PTH. Outcome was favourable after V.P. shunt in PTH.

show abstract

Normal‐pressure hydrocephalus

Cited by 83 publications

References 0 publications

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

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

Decreases in Ventricular Volume Correlate with Decreases in Ventricular Pressure in Idiopathic Normal Pressure Hydrocephalus Patients Who Experienced Clinical Improvement after Implantation with Adjustable Valve Shunts

Posttraumatic hydrocephalus: Lessons learned from management and evaluation at a tertiary institute with review of literature

Contact Info

Product

Resources

About