To Shunt or Not to Shunt Patients with Idiopathic Normal Pressure Hydrocephalus? A Reappraisal of an Old Question

Sahuquillo, Juan; Poca, María A.

doi:10.3390/jcm9124120

Cited by 5 publications

(7 citation statements)

References 23 publications

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“…More studies in the future may help to reach a consensus of generally accepted clinical scales and neuroimaging criteria leading to a better screening and diagnosis of patients with iNPH [ 46 ]. This will probably help iNPH patients to be better treated.…”

Section: Discussionmentioning

confidence: 99%

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Pyrgelis

Paraskevas

Constantinides

et al. 2022

JCM

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The aim of the present study was the implementation of the composite imaging “Radscale” in patients with idiopathic normal pressure hydrocephalus (iNPH) and the evaluation of its score, as well as absolute stroke volume and peak flow velocity of cerebrospinal fluid (CSF) in aqueduct as indicators of a positive response following a tap test. Forty-five patients with iNPH were included. Clinical evaluation involved the 10 m timed walk test before and every 24 h for 3 consecutive days after evacuative lumbar puncture (LP). Neuropsychological evaluation comprised a mini mental state examination (MMSE), frontal assessment battery (FAB), 5-word test (5WT) and CLOX drawing test 1 and 2, which were carried out before and 48 h after LP. The tap test’s response was defined as a ≥20% improvement in gait and/or a ≥10% improvement in neuropsychological tests. All scores of neuropsychological and clinical variables, except for immediate 5WT and CLOX-1, differed significantly before and 48 h after LP. Improvement in time and steps of a 10 m timed walk test differed significantly between female and male patients. Out of 45 total patients, 19 were tap test responders and 26 non-responders. The total score of Radscale and CSF flow parameters did not differ between responders and non-responders. However, “Callosal angle” sub-score differed significantly between these two groups. A greater “callosal angle” sub-score, meaning more acute callosal angle, was associated with a positive tap test response, rendering it a useful measurement in the stratification of iNPH patients that will potentially respond to CSF shunting.

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Section: Discussionmentioning

confidence: 99%

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Pyrgelis

Paraskevas

Constantinides

et al. 2022

JCM

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“…Otras demencias que se deben de descartar es la demencia por cuerpos de Lewy, demencia vascular (6). Cuando se presentan datos de ataxia se debe descartar un evento cerebrovascular, masa compresiva, hemorragia subaracnoidea, entre otros (15). En cuanto a los síntomas de incontinencia urinaria, se debe descartar problemas de esfínter, infección urinaria, prostatitis (15).…”

Section: Diagnostico Diferencialunclassified

Diagnóstico de la hidrocefalia de presión normal

Alan

Alvarado

2021

Rev.méd.sinerg.

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La hidrocefalia normotensa es una patología infrecuente y reversible, de etiología desconocida ya que las teorías presentadas no explican la sintomatología en su totalidad. Se clasifica como idiopática cuando se presenta el cuadro clínico usual de pacientes mayores de 70 años junto con la triada de Hakim clásica y las secundarias a alguna patología cerebral que se puede presentar a cualquier edad. El diagnóstico se basa en la clínica, medida de la presión media del líquido cefalorraquídeo y ventriculomegalia en imágenes radiológicas. Presenta una correlación con la enfermedad de Alzheimer y que no son excluyentes entre sí. Entre los diagnósticos diferenciales se encuentran las demencias e incontinencias urinarias usuales en edades avanzadas. La colocación de la válvula ventrículo peritoneal sigue siendo el tratamiento de primera línea.

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“…This is substantiated by an estimate from the Hydrocephalus Association that 80% of patients with NPH remain unrecognized with most frequent misdiagnoses being Alzheimer’s Dementia (AD) or Parkinson’s Disease (PD) ( 8 ), which themselves significantly contribute to the global burden of neurological disorders ( 9 ). About half of the cases of NPH are estimated to be idiopathic, and the other half secondary to traumatic brain injury (TBI), tumor, meningitis, or infections ( 10 , 11 ). Adding complexity to its recognition may be the fact that in the secondary NPH group, while tumors or infection linked to the disease can be detected definitively, a TBI-related origin may not be accurately identified due to incomplete medical history.…”

Section: Introductionmentioning

confidence: 99%

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

Kadaba Sridhar,

Dysterheft Robb,

Gupta

et al. 2024

Front. Neurol.

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IntroductionNormal Pressure Hydrocephalus (NPH) is a prominent type of reversible dementia that may be treated with shunt surgery, and it is crucial to differentiate it from irreversible degeneration caused by its symptomatic mimics like Alzheimer’s Dementia (AD) and Parkinson’s Disease (PD). Similarly, it is important to distinguish between (normal pressure) hydrocephalus and irreversible atrophy/degeneration which are among the chronic effects of Traumatic Brain Injury (cTBI), as the former may be reversed through shunt placement. The purpose of this review is to elucidate the structural imaging markers which may be foundational to the development of accurate, noninvasive, and accessible solutions to this problem.MethodsBy searching the PubMed database for keywords related to NPH, AD, PD, and cTBI, we reviewed studies that examined the (1) distinct neuroanatomical markers of degeneration in NPH versus AD and PD, and atrophy versus hydrocephalus in cTBI and (2) computational methods for their (semi-) automatic assessment on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) scans.ResultsStructural markers of NPH and those that can distinguish it from AD have been well studied, but only a few studies have explored its structural distinction between PD. The structural implications of cTBI over time have been studied. But neuroanatomical markers that can predict shunt response in patients with either symptomatic idiopathic NPH or post-traumatic hydrocephalus have not been reliably established. MRI-based markers dominate this field of investigation as compared to CT, which is also reflected in the disproportionate number of MRI-based computational methods for their automatic assessment.ConclusionAlong with an up-to-date literature review on the structural neurodegeneration due to NPH versus AD/PD, and hydrocephalus versus atrophy in cTBI, this article sheds light on the potential of structural imaging markers as (differential) diagnostic aids for the timely recognition of patients with reversible (normal pressure) hydrocephalus, and opportunities to develop computational tools for their objective assessment.

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To Shunt or Not to Shunt Patients with Idiopathic Normal Pressure Hydrocephalus? A Reappraisal of an Old Question

Cited by 5 publications

References 23 publications

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response

Diagnóstico de la hidrocefalia de presión normal

Structural neuroimaging markers of normal pressure hydrocephalus versus Alzheimer’s dementia and Parkinson’s disease, and hydrocephalus versus atrophy in chronic TBI—a narrative review

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