Prognosis of dementia in normal‐pressure hydrocephalus after a shunt operation

Thomsen, A.; Børgesen, S. E.; Bruhn, Peter; Gjerris, F.

doi:10.1002/ana.410200306

Cited by 133 publications

(35 citation statements)

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“…7) Patients with NPH generally display dysfunction of the frontal lobe causing impaired attention, memory, and language understanding. 2,8,9) The right posterior superior temporal-parietal region processes information on global properties, whereas the corresponding left region processes information on local properties. Therefore, we speculate that…”

Section: Discussionmentioning

confidence: 99%

Neuropsychological Changes After Endoscopic Third Ventriculostomy for Long-Standing Overt Ventriculomegaly in Adults -Case Report-

Hamada

Hayashi

Kurimoto

et al. 2009

Neurol. Med. Chir.(Tokyo)

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A 39-year-old woman presented with long-standing overt ventriculomegaly in adults (LOVA) manifesting as gradually worsening headache. Past history included treatment for myeloschisis at birth. Intelligence quotient (IQ) was 115 and preoperative psychological assessment using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) showed normal scores in all domains. However, scores for constructional ability were slightly low. Computed tomography revealed severe ventriculomegaly involving the lateral and third ventricles, and magnetic resonance imaging showed aqueductal stenosis. Endoscopic third ventriculostomy was performed under a diagnosis of LOVA. Postoperatively, the headache resolved and the RBANS showed improvements in memory and constructional ability. Detailed evaluation of cognitive function provides a good indicator in the treatment of hydrocephalus with normal IQ.

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Section: Discussionmentioning

confidence: 99%

Neuropsychological Changes After Endoscopic Third Ventriculostomy for Long-Standing Overt Ventriculomegaly in Adults -Case Report-

Hamada

Hayashi

Kurimoto

et al. 2009

Neurol. Med. Chir.(Tokyo)

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“…They reported that patients with sNPH usually have a more abrupt onset of dementia, whereas patients with iNPH usually experience gradual deterioration. 65 Wood et al reported that symptom duration of less than 6 months is a good prognostic factor for improvement after shunting. However, their study was one of the few to conclude that etiology did not have an important prognostic value.…”

Section: 5mentioning

confidence: 99%

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Daou

Klinge

Tjoumakaris

et al. 2016

FOC

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OBJECTIVE There are several etiologies that can lead to the development of secondary normal pressure hydrocephalus (sNPH). The aim of this study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences between the separate etiologies. METHODS A comprehensive review of the literature was performed to identify studies conducted between 1965 and 2015 that included data regarding the etiology, treatment, diagnosis, and outcome in patients with sNPH. Sixty-four studies with a total of 1309 patients were included. The inclusion criteria of this study were articles that were written in English, included more than 2 patients with the diagnosis of sNPH, and contained data regarding the etiology, diagnosis, treatment, or outcome of NPH. The most common assessment of clinical improvement was based on the Stein and Langfitt grading scale or equivalent improvement on other alternative ordinal grading scales. RESULTS The main etiologies of sNPH were subarachnoid hemorrhage (SAH) in 46.5%, head trauma in 29%, intracranial malignancies in 6.2%, meningoencephalitis in 5%, and cerebrovascular disease in 4.5% of patients. In 71.9% of patients the sNPH was treated with ventriculoperitoneal shunt placement, and 24.4% had placement of a ventriculoatrial shunt. Clinical improvement after shunt placement was reported in 74.4% and excellent clinical improvement in 58% of patients with sNPH. The mean follow-up period after shunt placement was 13 months. Improvement was seen in 84.2% of patients with SAH, 83% of patients with head trauma, 86.4% of patients with brain tumors, 75% of patients with meningoencephalitis, and 64.7% of patients with NPH secondary to stroke. CONCLUSIONS Secondary NPH encompasses a diverse group of clinical manifestations associated with a subset of patients with acquired hydrocephalus. The most common etiologies of sNPH include SAH and traumatic brain injury. Secondary NPH does indeed exist, and should be differentiated from idiopathic NPH based on outcome and on clinical, pathophysiological, and epidemiological characteristics, but should not be considered as a separate entity.

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“…Author manuscript; available in PMC 2006 January 25. (5,6,14,17,19,21,23,26). These previous studies had only twodimensional measures, namely the Evans ratio, with which to follow any changes in ventricular size after shunting; such linear measures have been shown to be inadequately sensitive to the minimal changes in ventricular size typically sought for the treatment of INPH.…”

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confidence: 99%

Decreases in Ventricular Volume Correlate with Decreases in Ventricular Pressure in Idiopathic Normal Pressure Hydrocephalus Patients Who Experienced Clinical Improvement after Implantation with Adjustable Valve Shunts

McConnell¹,

Zou²,

Chabrerie³

et al. 2004

Neurosurgery

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OBJECTIVE:This retrospective study examined whether changes in ventricular volume correspond with changes in adjustable valve pressure settings in a cohort of patients who received shunts to treat idiopathic normal pressure hydrocephalus. We also examined whether these pressure -volume curves and other patient variables would co-occur with a positive clinical response to shunting. METHODS:We selected 51 patients diagnosed with idiopathic normal pressure hydrocephalus who had undergone implantation of a Codman Hakim programmable valve (Medos S.A., Le Locle, Switzerland). Clinical data were gathered from the patients' records and clinical notes by an investigator blinded to patients' ventricular volumes. Ventricular volume was measured using 3D Slicer, an image analysis and interactive visualization software package developed and maintained at the Surgical Planning Laboratory at Brigham and Women's Hospital. RESULTS:Eighty-six percent of patients with gait disturbance at presentation showed improvement of this symptom, 70% experienced improvement in incontinence, and 69% experienced improvement in dementia. For the group showing 100% clinical improvement, the correlation coefficient of average changes in valve pressure over time (ΔP/ΔT) and average changes in ventricular volume over time (ΔV/ΔT) were high at 0.843 (P < 0.05). For the group experiencing no or only partial improvement, the correlation coefficient was 0.257 (P = 0.32), indicating no correlation between average ΔV/ΔT and average ΔP/ΔT for each patient. CONCLUSION:This was a carefully analyzed modeling study of idiopathic normal pressure hydrocephalus treatment made possible only by adjustable valve technology. With careful volumetric analysis, we found that changes in ventricular volume correlated with adjustments in valve pressure settings for those patients who improved clinically after shunting. This suggests that positive clinical responders retained parenchymal elasticity, emphasizing the importance of dynamic changes in this cohort. NIH Public Access Author ManuscriptNeurosurgery. Author manuscript; available in PMC 2006 January 25. (5,6,14,17,19,21,23,26). These previous studies had only twodimensional measures, namely the Evans ratio, with which to follow any changes in ventricular size after shunting; such linear measures have been shown to be inadequately sensitive to the minimal changes in ventricular size typically sought for the treatment of INPH. The dynamic relationship between valve pressure setting and ventricular volume in the setting of INPH also is poorly understood.Anderson et al.(1) recently used a three-dimensional analysis to measure ventricular volume changes after shunting for INPH. They observed a decrease in ventricular volume after shunting in 10 of 11 patients. In their study, a traditional two-dimensional analysis by an independent radiologist found decreases in ventricular size in only 2 of the 11 patients. Anderson et al., however, were unable to examine any relationship between decreasing ventricular volume...

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Prognosis of dementia in normal‐pressure hydrocephalus after a shunt operation

Cited by 133 publications

References 13 publications

Neuropsychological Changes After Endoscopic Third Ventriculostomy for Long-Standing Overt Ventriculomegaly in Adults -Case Report-

Neuropsychological Changes After Endoscopic Third Ventriculostomy for Long-Standing Overt Ventriculomegaly in Adults -Case Report-

Revisiting secondary normal pressure hydrocephalus: does it exist? A review

Decreases in Ventricular Volume Correlate with Decreases in Ventricular Pressure in Idiopathic Normal Pressure Hydrocephalus Patients Who Experienced Clinical Improvement after Implantation with Adjustable Valve Shunts

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