Falling Spells in Normal Pressure Hydrocephalus: A Favourable Prognostic Sign?

Haan, Joost; Jansen, E. N. H.; Oostrom, Jan; Roos, Raymund A.C.

doi:10.1159/000116159

Cited by 14 publications

(6 citation statements)

References 18 publications

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“…Postural instability and falls are frequently observed. 13 Their stance is often but not universally broad-based. INPH patients tend to assume a forward-leaning posture, yet also show spontaneous and provoked retropulsion.…”

Section: Disturbance In Gait and Posture And Other Movement Symptomsmentioning

confidence: 99%

Normal Pressure Hydrocephalus

Tsakanikas

Relkin

2007

Semin Neurol

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Idiopathic normal pressure hydrocephalus (INPH) is a treatable neurological disorder in older adults involving disturbances of gait/balance, control of micturition, and/or cognition in combination with enlargement of the cerebral ventricles. Diagnosis can be challenging due to its varied presentation and overlap with other disorders common in the elderly. Evidence-based consensus guidelines for diagnosis and treatment of INPH have been created that can assist in clinical management. Diagnosis requires clinical documentation of one or more of the characteristic symptoms of INPH in combination with a brain imaging study demonstrating nonobstructive ventricular enlargement disproportionate to cerebral atrophy. Gait and balance disturbances are the most common presenting findings in INPH and may occur alone or together with cognitive and urinary symptoms. Adjunct tests, particularly those involving transient removal of cerebrospinal fluid via lumbar puncture or lumbar drain, can serve the dual purpose of adding to diagnostic certainty and assisting in prognostication about response to treatment. Prognostication is important because neurosurgical treatment by placement of a ventricular shunt, while effective, carries the risk of potentially significant morbidity. Outcome of shunting in INPH is most often successful when patients are accurately diagnosed, suitably evaluated for surgical candidacy, and managed carefully throughout the preoperative, surgical, and postoperative periods.

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Section: Disturbance In Gait and Posture And Other Movement Symptomsmentioning

confidence: 99%

Normal Pressure Hydrocephalus

Tsakanikas

Relkin

2007

Semin Neurol

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“…A slowly progressive symmetric gait disturbance is the most prominent clinical hallmark of NPH [ 20 , 21 ] and is accompanied by impaired postural stability and the tendency to fall backwards [ 22 ]. Falls are frequent [ 23 ] and generally result in most harmful injury [ 24 ]. In addition, a specific feature is a broad-based gait pattern with outward rotated feet and a diminished height of steps [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus

Abram

Bohne

Bublak

et al. 2016

Dement Geriatr Cogn Disord Extra

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Background/Aims: Postural instability in patients with normal pressure hydrocephalus (NPH) is a most crucial symptom leading to falls with secondary complications. The aim of the current study was to evaluate the therapeutic effect of spinal tap on postural stability in these patients. Methods: Seventeen patients with clinical symptoms of NPH were examined using gait scale, computerized dynamic posturography (CDP), and neuropsychological assessment. Examinations were done before and after spinal tap test. Results: The gait score showed a significant improvement 24 h after spinal tap test in all subtests and in the sum score (p < 0.003), while neuropsychological assessment did not reveal significant differences 72 h after spinal tap test. CDP showed significant improvements after spinal tap test in the Sensory Organization Tests 2 (p = 0.017), 4 (p = 0.001), and 5 (p = 0.009) and the composite score (p = 0.01). Patients showed best performance in somatosensory and worst performance in vestibular dominated tests. Vestibular dominated tests did not improve significantly after spinal tap test, while somatosensory and visual dominated tests did. Conclusion: Postural stability in NPH is predominantly affected by deficient vestibular functions, which did not improve after spinal tap test. Conditions which improved best were mainly independent from visual control and are based on proprioceptive functions.

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“…Gait disturbances are the most common symptoms of NPH, and are usually the first to be observed. Postural instability and falls are frequently characteristic of the disease [3]. Parkinsonism symptoms have also been reported in approximately 11% of NPH patients [4].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Evaluation of an N-Ethyl-N-Nitrosourea-Created Murine Model with Normal Pressure Hydrocephalus

et al. 2009

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BackgroundNormal-pressure hydrocephalus (NPH) is a neurodegenerative disorder that usually occurs late in adult life. Clinically, the cardinal features include gait disturbances, urinary incontinence, and cognitive decline.Methodology/Principal FindingsHerein we report the characterization of a novel mouse model of NPH (designated p23-ST1), created by N-ethyl-N-nitrosourea (ENU)-induced mutagenesis. The ventricular size in the brain was measured by 3-dimensional micro-magnetic resonance imaging (3D-MRI) and was found to be enlarged. Intracranial pressure was measured and was found to fall within a normal range. A histological assessment and tracer flow study revealed that the cerebral spinal fluid (CSF) pathway of p23-ST1 mice was normal without obstruction. Motor functions were assessed using a rotarod apparatus and a CatWalk gait automatic analyzer. Mutant mice showed poor rotarod performance and gait disturbances. Cognitive function was evaluated using auditory fear-conditioned responses with the mutant displaying both short- and long-term memory deficits. With an increase in urination frequency and volume, the mutant showed features of incontinence. Nissl substance staining and cell-type-specific markers were used to examine the brain pathology. These studies revealed concurrent glial activation and neuronal loss in the periventricular regions of mutant animals. In particular, chronically activated microglia were found in septal areas at a relatively young age, implying that microglial activation might contribute to the pathogenesis of NPH. These defects were transmitted in an autosomal dominant mode with reduced penetrance. Using a whole-genome scan employing 287 single-nucleotide polymorphic (SNP) markers and further refinement using six additional SNP markers and four microsatellite markers, the causative mutation was mapped to a 5.3-cM region on chromosome 4.Conclusions/SignificanceOur results collectively demonstrate that the p23-ST1 mouse is a novel mouse model of human NPH. Clinical observations suggest that dysfunctions and alterations in the brains of patients with NPH might occur much earlier than the appearance of clinical signs. p23-ST1 mice provide a unique opportunity to characterize molecular changes and the pathogenic mechanism of NPH.

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Falling Spells in Normal Pressure Hydrocephalus: A Favourable Prognostic Sign?

Cited by 14 publications

References 18 publications

Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus

The Effect of Spinal Tap Test on Different Sensory Modalities of Postural Stability in Idiopathic Normal Pressure Hydrocephalus

Longitudinal Evaluation of an N-Ethyl-N-Nitrosourea-Created Murine Model with Normal Pressure Hydrocephalus

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