Overview of Idiopathic Normal Pressure Hydrocephalus: Diagnosis and Improvement

Journal: Journal of Clinical Medicine Research DOI: 10.32629/jcmr.v2i3.462

Julia Chen Sun

University of California, San Diego

Abstract

Idiopathic normal pressure hydrocephalus (iNPH) is an uncommon yet potentially reversible cause of dementia in the elderly. It is characterized by cognitive deterioration, urinary incontinence, ventriculomegaly (enlarged cerebral ventricles) and gait apraxia. The diagnosis and management of iNPH requires an organized approach, starting with a comprehensive history and neurologic examination, a review of neuroimaging, and an evaluation of diagnosis. It is important to treat comorbidities in patients prior to specific iNPH testing, which includes testing patient responses to temporary CSF removal and assessing CSF hydrodynamics. In carefully selected patients, all physiological and neurological symptoms improved with a ventriculoperitoneal (VP) shunt surgery, which allows for a gradual adjustment in pressure to prevent complications caused by over-drainage.

Keywords

normal pressure hydrocephalus, ventriculoperitoneal shunt surgery, lumbar drainage, dementia, gait disturbance, NPH

References

[1] Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with "normal" cerebrospinal-fluid pressure A treatable syndrome. N Engl J Med. 1965;273:117– 126.
[2] Hebb AO, Cusimano MD. Idiopathic normal pressure hydrocephalus a systematic review of diagnosis and outcome. Neurosurgery. 2001;49:1166– 1186.
[3] Marmarou A, Young HF, Aygok GA, et al. Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. J Neurosurg. 2005;102:987–997.
[4] Bradley WG. Normal pressure hydrocephalus new concepts on etiology and diagnosis. AJNR Am J Neuroradiol. 2000;21:1586– 1590.
[5] Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus: INPH Guidelines, part II. Neurosurgery. 2005;57:S4–S16
[6] Ambarki K, Israelsson H, Wåhlin A, Birgander R, Eklund A, Malm J. Brain ventricular size in healthy elderly: comparison between Evans index and volume measurement.
[7] Thomas G, McGirt MJ, Woodworth G, et al. Baseline neuropsychological profile and cognitive response to CSF shunting for idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord. 2005;20:163– 168
[8] Mori E, Ishikawa M, Kato T, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir. 2012;52:775–809
[9] Børgesen SE. Conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir. 1984;71:1–45.
[10] Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986;34:119– 126.
[11] Katzen H, Ravdin LD, Assuras S, et al. Post shunt cognitive and functional improvement in idiopathic normal pressure hydrocephalus. Neurosurgery. 2011;68:416–419
[12] Kharkar S, Shuck J, Kapoor S, Batra S, Williams MA, Rigamonti D. Radionuclide shunt patency study for evaluation of suspected ventriculo-peritoneal shunt malfunction in adults with normal pressure hydrocephalus.
[13] Klinge P, Marmarou A, Bergsneider M, Relkin N, Black PM. Outcome of shunting in idiopathic normal-pressure hydrocephalus and the value of outcome assessment in shunted patients. Neurosurgery. 2005;57(3Suppl):S40–S52.
[14] Bateman GA. The pathophysiology of idiopathic normal pressure hydrocephalus Cerebral ischemia or altered venous hemodynamics? AJNR. Am J Neuroradiol. 2008;29:198–203.

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