Normal pressure hydrocephalus

Abstract

Objective: To determine our community's incidence of clinically suspected normal pressure hydrocephalus (NPH), the rate of shunting for NPH, and short-and long-term outcomes of shunting.Methods: A retrospective query of the Mayo Clinic medical records linkage system was conducted to identify residents of Olmsted County, Minnesota, undergoing an invasive diagnostic procedure for evaluation of suspected NPH from 1995 through 2003. Among patients with shunts, earlyand long-term outcomes were determined via a review of available medical records.

Cerebral bleed after shunt for normal pressure hydrocephalus with cerebral amyloid angiopathy

“…Community-based studies indicate an incidence of 1.19/100,000/year. 2 Although some patients have a significant and meaningful improvement after VP shunt insertion, 1,3 hospital-based estimates of treatmentresponsive NPH can be as low as 0.22/100,000/year. 4 Improvement following shunt is more likely with short symptom duration, lesser degrees of cognitive impairment (with a pattern of subcortical-frontal impairment more typical), a syndrome dominated by gait impairment without other features of Parkinson disease, and a clear improvement in gait following high-volume CSF tap or external lumbar drain.…”

“…2,7,8 In a recent report evaluating right frontal lobe biopsies during shunt insertion for NPH, CAA was identified in 6 of 18 biopsies. The patients with Alzheimer pathology had less favorable responses to shunting, 8 but cerebral hemorrhage was not reported in those patients with CAA.…”

“…Complications in shunt surgery occur in between 25% and 30% of patients, [2][3][4] and death or severe residual morbidity occurs in 7%-10%. 2,4 Yet some patients clearly do obtain sustained benefit from shunt insertion, 3 so identifying appropriate candidates remains crucial.…”

“…[1][2][3][4] Unfortunately, the procedure is associated with major risk, and improvements following shunting are not guaranteed and are often shortlived. Assessing the harm to benefit ratio can be problematic.…”

“…Assessing the harm to benefit ratio can be problematic. 2,4 It is imperative not only to identify those likely to respond to shunting but also to identify those with a higher risk of adverse events or those unlikely to respond. Here we report a case of right frontal lobe hemorrhage following VP shunt placement in a patient with preoperative MRI evidence of cerebral amyloid angiopathy (CAA).…”