The clinical effect of lumbar puncture in normal pressure hydrocephalus.

Abstract

SUMMARY Owing to all the difficulties involved in selecting patients with normal pressure hydrocephalus for shunt-operation, a cerebrospinal fluid-tap-test (CSF-TT) is introduced. Psychometric and motor capacities of the patients are measured before and after lumbar puncture and removal of 40-50 ml CSF. Patients fulfilling criteria for normal pressure hydrocephalus were compared to patients with dementia and atrophy shown by computed tomography. Normal pressure hydrocephaluspatients showed temporary improvement after lumbar puncture. The extent of the temporary improvement appeared to be well correlated with the improvement after shunt operation. Accordingly, the CSF-TT seems to be of value when selecting those patients who will probably benefit from a shunt operation.

Lumbar Puncture Test in Normal Pressure Hydrocephalus: Does the Volume of CSF Removed Affect the Response to Tap?

“…Although high-volume spinal tap has been established as an accurate method to diagnose NPH and to identify patients who will likely benefit from shunt surgery, to our knowledge, there is no consensus on the amount of CSF required to be removed. The first formal study of the LTT by Wikkelsø et al 30 in 1982 removed 40 -50 mL of CSF in LTT, but the authors noted that there was no prior evidence that this was the ideal range. Prior reports, including the original description by Hakim and Adams 1 , frequently removed much smaller volumes of CSF.…”

“…Contrary to the high-volume LTT used today, in the original description of NPH by Hakim and Adams, 1 they noted improvement the next day in patients after an LTT removing only 10 -15 mL of CSF. In 1982, Wikkelsø et al 30 proposed the drainage of 50 mL of CSF, but future studies did not corroborate that this was an optimum volume. We examined the relationship between the volume of CSF removed and change in gait patterns among patients with clinically diagnosed NPH.…”

Idiopathic Normal Pressure Hydrocephalus: Cerebral Perfusion Measured with pCASL before and Repeatedly after CSF Removal

“…5 The CSF tap test (CSF TT) with removal of 30 to 50 mL CSF through a lumbar puncture needle is often used. 6 Clinical improvement after the CSF removal is considered a positive response, with high positive predictive value for a good outcome after shunt surgery. 7 Previous studies have tried to estimate the change in CBF after a CSF TT using inhalation or injection of xenon-133, single photon emission computed tomography, and dynamic susceptibility contrast magnetic resonance imaging (MRI).…”

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

“…A transient improvement in NPH symptoms following removal of CSF by lumbar puncture (LP) was first reported by Adams et al 1 . However, Wikkelsø et al 2 refined the technique with quantitative methods to assess gait and cognition. The test has now gained widespread acceptance and is referred to as the CSF tap test (CSF-TT) 2 .…”

“…However, Wikkelsø et al 2 refined the technique with quantitative methods to assess gait and cognition. The test has now gained widespread acceptance and is referred to as the CSF tap test (CSF-TT) 2 . The TT is important for diagnosing NPH 3,4 as well as predicting clinical postoperative outcomes 3,4 .…”