Abstract
Normal pressure hydrocephalus (NPH) affects a substantial proportion of the elderly population. In Colombia, as many as 10,000 persons may be affected. Characteristic symptoms, including gait impairment and falling, uri- nary urgency and incontinence, and cognitive impairment and dementia, raise the question of NPH, but are not diagnostic because many disorders of the elderly include the same symptoms. In addition to demonstration of enlarged ventricles on brain CT or MRI, specific tests for NPH are necessary. Centers of excellence often use specialized methods such as cerebrospinal fluid (CSF) outflow resistance testing, or external lumbar CSF drainage to make the diagnosis; however, physicians in most clinical settings can identify patients with NPH and recom- mend treatment by assessing the clinical response to CSF removal via lumbar puncture. The treatment of NPH with a shunt results in substantial improvement of all symptoms, including dementia. Thus, NPH is a disorder that should be considered for many elderly patients with the appropriate history, symptoms, neurologic findings, and brain CT or MRI findings.
References
HAKIM S, ADAMS RD. The special clinical problem of symptomatic hydrocephalus with normal cerebro- spinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J of Neurol Sci 1965; 2: 307–327.
DUINKERKE A, WILLIAMS MA, RIGAMONTI D, HILLIS AE. Cognitive recovery in idiopathic normal pressure hydrocephalus after shunt. Cogn Behav Neurol 2004; 17: 179–184.
THOMAS G, MCGIRT MJ, WOODWORTH GF, ET AL. Baseline neuropsychological profile and cognitive response to cerebrospinal fluid. Dement Geriatr Cogn Disord 2005; 20: 163–168.
PALM WM, SACZYNSKI JS, VAN DER GROND J, ET AL. Ventricular dilation: Association with gait and cognition. Ann Neurol 2009; 66: 485–493.
BREAN A, EIDE PK. Prevalence of probable idio- pathic normal pressure hydrocephalus in a Norwegian population. Acta Neurol Scand 2008; 118: 48–53.
RELKIN N, MARMAROU A, KLINGE P, BERG SNEIDER M, BLACK PM. Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 2005; 57: S4–16.
COWAN JA, MCGIRT MJ, WOODWORTH G, RIGAMONTI D, WILLIAMS MA. The syndrome of hydrocephalus in young and middle-aged adults (SHYMA). Neurol Res 2005; 27: 540–547.
OI S, SHIMODA M, SHIBATA M, ET AL. Pathophysiology of longstanding overt ventriculomegaly in adults. J Neurosurg 2000; 92: 933–940.
FUKUHARA T, LUCIANO MC. Clinical features of late-onset idiopathic aqueductal stenosis. Surg Neurol 2001; 55:132–137..
PUJARI S, KHARKAR S, METELLUS P, SHUCK J,WILLIAMS MA, & RIGAMONTI D. Normal pressure hydrocephalus. Long-term outcome after shunt sur- gery. J Neurol Neurosurg Psychiatry 2008; 79: 1282–1286.
EKLUND A, SMIELEWSKI P, CHAMBERS I, ET AL. Assessment of cerebrospinal fluid outflow resis- tance. Med Bio Eng Comput 2007; 45: 719–735.
MALM J, KRISTENSEN B, KARLSSON T, ET AL. The predictive value of cerebrospinal fluid dynamic tests in patients with idiopathic adult hydrocephalus syndrome. Arch Neurol 1995; 52: 783–789.
MALM J, EKLUND A. Idiopathic normal pressure hydrocephalus. Pract Neurol 2006; 6: 14–27.
TULLBERG M, HULTIN L, EKHOLM S, ET AL. White matter changes in normal pressure hydro- cephalus and Binswanger disease: Specificity, predic- tive value and correlations to axonal degeneration and demyelination. Acta Neurol Scand 2002; 105: 417–426.
GRAFF-RADFORD NR. Normal pressure hydro- cephalus. Neurol Clin 2007; 25: 809–832.
WILSON RK, WILLIAMS MA. Evidence that congenital hydrocephalus is a precursor to idiopathic normal pressure hydrocephalus (INPH) in only a subset of patients. J Neurol Neurosurg Psychiatry 2007; 78: 508–511.
MCGIRT MJ, COON AL, THOMAS G, WOOD- WORTH G, WILLIAMS MA, RIGAMONTI D. Diagnosis, treatment and analysis of long-term outcomes in idiopathic normal pressure hydrocephalus. Neuro- surgery 2005; 57: 699–705.
IDDON JL, PICKARD JD, CROSS JJL, GRIFFITHS PD, CZOSNYKA M, SAHAKIAN BJ. Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer's dis- ease: a pilot study. J Neurol Neurosurg Psychiatry 1999; 67: 723–32.
SAKAKIBARA R, KANDA T, SEKIDO T, ET AL. Mechanism of bladder dysfunction in idiopathic normal pressure hydrocephalus. Neurourol Urodynam 2008; 27: 507–510.
SCAHILL RI, FROST C, JENKINS R, WHIT WELL JL, ROSSOR MN, FOX NC. A longitudinal study of brain volume changes in normal aging using serial registered magnetic resonance imaging. Arch Neurol 2003; 60: 989–994.
LENFELDT N, LARSSON A, NYBERG L, ET AL. Idiopathic normal pressure hydrocephalus. Increased supplementary motor activity accounts for improve- ment after CSF drainage. Brain 2008; 131: 2904–2912.
CHAUDRY P, KHARKAR S, HEIDLER-GARY J,
ET AL. Characteristics and reversibility of dementia in normal pressure hydrocephalus. Behav Neurol 2007; 18: 149–158.
MARMAROU A, BERGSNEIDER M, KLINGE P, RELKIN N, BLACK PM. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosur- gery 2005; 57: S17–S28.
MARMAROU A, YOUNG HF, AYGOK GA, SAWAUCHI S, TSUJI O, YAMAMOTO T, DUNBAR J. Diagnosis and management of idiopathic normal- pressure hydrocephalus. A prospective study in 151 patients. Neurosurgery 2005; 102:987–997.
KENNEDY CR, AYERS S, CAMPBELL MJ, ELBOURNE D, HOPE P, JOHNSON A. Random-
ized, controlled trial of acetazolamide and furosemide in posthemorrhagic ventricular dilation in infancy. Follow-up at 1 year. Pediatrics 2001; 108: 597–607.
BERGSNEIDER M, BLACK PML, KLINGE P, MARMAROU A, RELKIN N. Surgical management of idiopathic normal-pressure hydrocephalus. Neuro- surgery 2005; 57: S2–S39.
KLINGE P, MARMAROU A, BERGSNEIDER M, RELKIN N, BLACK PM. Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients. Neurosurgery 2005; 57: S40–S52.
RAVDIN LD, KATZEN HL, JACKSON AE, TSAKANIKAS D, ASSURAS S, RELKIN NR. Features of gait most responsive to tap test in normal pressure hydrocephalus. Clin Neurol Neurosurg 2008; 110: 455–61.
HELLSTRÖM P, EDSBAGGE M, BLOMSTER- WALL E, ET AL. Neuropsychological effects of shunt treatment in idiopathic normal pressure hydro- cephalus. Neurosurgery 2008; 63: 527–35.
RAFTOPOULOS C, DELEVAL J, CHASKIS C, ET AL. Cognitive recovery in idiopathic normal pres- sure hydrocephalus. A prospective study. Neurosurgery 1994; 35: 397–404.
SOLANA E, POCA MA, SAHUQUILLO J, BENE- JAM B, JUNQUÉ C, DRONAVALLI M. Cognitive and motor improvement after retesting in normal-pres- sure hydrocephalus. A real change or merely a learn- ing effect? J Neurosurg 2010; 112: 399–409.
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