Among the various disorders that manifest with gait disturbance, cognitive impairment, and urinary incontinence in the elderly population, idiopathic normal pressure hydrocephalus (iNPH) is becoming of great importance. The first edition of these guidelines for management of iNPH was published in 2004, and the second edition in 2012, to provide a series of timely, evidence-based recommendations related to iNPH. Since the last edition, clinical awareness of iNPH has risen dramatically, and clinical and basic research efforts on iNPH have increased significantly. This third edition of the guidelines was made to share these ideas with the international community and to promote international research on iNPH. The revision of the guidelines was undertaken by a multidisciplinary expert working group of the Japanese Society of Normal Pressure Hydrocephalus in conjunction with the Japanese Ministry of Health, Labour and Welfare research project. This revision proposes a new classification for NPH. The category of iNPH is clearly distinguished from NPH with congenital/developmental and acquired etiologies. Additionally, the essential role of disproportionately enlarged subarachnoid-space hydrocephalus (DESH) in the imaging diagnosis and decision for further management of iNPH is discussed in this edition. We created an algorithm for diagnosis and decision for shunt management. Diagnosis by biomarkers that distinguish prognosis has been also initiated. Therefore, diagnosis and treatment of iNPH have entered a new phase. We hope that this third edition of the guidelines will help patients, their families, and healthcare professionals involved in treating iNPH.

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Purpose To assess the state and dynamics of the intracranial system in idiopathic normal‐pressure hydrocephalus (I‐NPH), we determined intracranial compliance using magnetic resonance imaging (MRI). Materials and Methods The intracranial compliance index (ICCI), which was defined as the ratio of the peak‐to‐peak intracranial volume change (ICVCp‐p) to the peak‐to‐peak cerebrospinal fluid (CSF) pressure gradient (PGp‐p) during the cardiac cycle, was obtained from the net transcranial blood and CSF flow measured with phase‐contrast (PC) cine MRI. ICCI was determined in patients with I‐NPH (N = 7), brain atrophy, or asymptomatic ventricular dilation (VD) (N = 6), and in healthy volunteers (control group; N = 11). The changes in ICCI indices were also analyzed after a CSF tap test (N = 2). Results The ICCI in the I‐NPH group was significantly lower than in the control and VD groups, whereas no difference was found between the control and VD groups. The ICVCp‐p was also lower than in the control and VD groups. However, no significant difference was found in the PGp‐p between groups. The ICCI increased after the tap test. Conclusion Intracranial compliance analysis with MRI makes it possible to noninvasively obtain more detailed information of intracranial biomechanics in the I‐NPH and to assist in the diagnosis of I‐NPH. J. Magn. Reson. Imaging 2007. © 2007 Wiley‐Liss, Inc.

We concluded that a considerable number of cases appeared to need craniotomy and resection of intrahematomal membrane for complete recovery in CSDH, and that T2*-weighted MR imaging could be used as a basis for selecting the operative procedure for CSDH.