Occult Disorders of the Cerebrospinal Fluid Dynamics

Abstract

Workable criteria are proposed that allow early recognition of mild forms of occult hydrocephalus and correlated disorders. Two groups of patients are analyzed, i.e. a group of twelve mild but classical forms of low-pressure hydrocephalus and another group of 20 patients with atypical clinical forms of disorders of the CSF dynamics. Two control groups are presented for neuropsychological comparison purposes: a normal control group of 50 subjects and a small group of three commissurotomized subjects. Patients with an overt demential syndrome due to a normotensive hydrocephalus syndrome were excluded from the study. The authors found the grasp reflex of the foot and the tonic foot response to be present in all cases with the Hakim and Adams triad. In such cases the grasp reflex is usually accompanied by the forward groping of the foot and the grasp reflex of the hand. The most helpful and useful clinical findings for an early diagnosis are the presence of the grasp reflex of the foot and of the tonic foot response of the sole in such organic brain-damaged patients with (1) a normal routine neurological examination and (2) an apparently normal mental status and even with a rather normal IQ. These reflexes are usually the single objective clinical findings in all forms of mild and occult disorders of the CSF dynamics, i.e., low-pressure hydrocephalus syndromes, cerebral atrophies and mixed forms cases. The next step for the diagnosis consists in a conventional IQ evaluation and a battery of tests exploring more specifically the sensorimotor integration, i.e. bimanual vs. unimanual activity, the Kohs block design test and part of the Halstead-Reitan neuropsychological test battery. In such patients there is a striking dissociation between a normal or rather normal IQ on the one hand and the results of the neuropsychological evaluation with the Kohs and Reitan tests on the other. The clinical and neuropsychological testings are then followed by isotope cisternography, PEG and EMI-Scan which confirm the presence of the organic brain damage. The recognition of such conditions is of great practical importance because it allows an early diagnosis of the brain damages. Some preliminary data regarding the medical treatment - acetazolamide - are shortly reviewed.

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

“…Botez et al [7] found 10 patients with loss of consciousness and falls and attacks of gen eral limpness in 32 patients with pure NPH or NPH with cortical atrophy. They stressed the clinical importance of these attacks in the diagnosis and management of NPH pa tients [10] and wondered why these falls are so seldom described in the literature.…”

“…In spite of this and in spite of the use of advanced methods of investiga tion, the outcome of surgery is still unpre dictable [2], It is generally accepted that the clinical picture and not the result of radiological investigations is the most important crite rion for the diagnosis NPH [2], It is also accepted that the presence of the complete clinical 'triad', namely gait disorder, demen tia and urine incontinence, is the most reli able sign for predicting the outcome of sur gery [3]. The gait disturbance, however, may appear without or may precede the other symptoms [4], Many additional clinical characteristics have been mentioned: fluc tuating and progressive course [5], improve ment after lumbar puncture [5,6], tonic foot reflex or grasp reflex of the foot [7], parkin sonian signs [8] and behavioural distur bances [8,9].…”

“…Disturbances of consciousness have been mentioned, appearing either spontaneously or as a complication of pneumoencephalog raphy [8], A few authors have reported sud den falls with or without loss of conscious ness -so-called 'falling spells' [1,5,7,10]. These falling spells have been seldom de scribed in detail [10], and no mention has been made of a relationship with response to shunting.…”

Neuropsychological Improvement in Patients With Cervical Spondylotic Myelopathy After Posterior Decompression Surgery

“…9) The Kohs Block Design Test is recognized as a standard clinical tool for detection of visuospatial disorganization, which indicates malfunction of the parietal lobe. 6,26) We used this test in its complete form with 17 designs and calculated the intelligence quotient (IQ) according to the Manual for Kohs Block Design Test (catalogue No. 37000; Stoelting, Chicago, Ill., U.S.A.).…”

Relapsing Neuropathy, Cerebral Atrophy and Folate Deficiency

“…(3) There is only one reported case of latent polyneuropathy responsive to folic acid therapy [14], in which the authors found an abnormal jejunal biopsy as well as low serum, red cell and CSF folate concentrations without any evidence of anemia. (4) Since 1974 [8], we have been using a neuropsychological battery to detect occult hydro cephalus and cerebral atrophies; the neuropsychological assessment is fol lowed by radionuclide cistemograms with m In and computerized transaxial tomography (CTT) of the brain. We have started this comprehen sive method of examination in all metabolic and nutritional disorders in cluding vitamin B," [9] and folic acid deficiencies.…”