Clinical outcomes of normal pressure hydrocephalus in 116 patients: objective versus subjective assessment

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  • 1 School of Medicine, The University of Texas Southwestern Medical Center;
  • 2 Department of Neurological Surgery, The University of Texas Southwestern Medical Center;
  • 3 Department of Neurology & Neurotherapeutics, Zale Lipshy Hospital, The University of Texas Southwestern Medical Center; and
  • 4 Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
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OBJECTIVE

Objective assessment tests are commonly used to predict the response to ventriculoperitoneal (VP) shunting in patients with normal pressure hydrocephalus (NPH). Whether subjective reports of improvement after a lumbar drain (LD) trial can predict response to VP shunting remains controversial. The goal in this study was to compare clinical characteristics, complication rates, and shunt outcomes of objective and subjective LD responders who underwent VP shunt placement.

METHODS

This was a retrospective review of patients with NPH who underwent VP shunt placement after clinical improvement with the LD trial. Patients who responded after the LD trial were subclassified into objective LD responders and subjective LD responders. Clinical characteristics, complication rates, and shunt outcomes between the 2 groups were compared with chi-square test of independence and t-test.

RESULTS

A total of 116 patients received a VP shunt; 75 were objective LD responders and 41 were subjective LD responders. There was no statistically significant difference in patient characteristics between the 2 groups, except for a shorter length of stay after LD trial seen with subjective responders. The complication rates after LD trial and VP shunting were not significantly different between the 2 groups. Similarly, there was no significant difference in shunt response between objective and subjective LD responders. The mean duration of follow-up was 1.73 years.

CONCLUSIONS

Reports of subjective improvement after LD trial in patients with NPH can be a reliable predictor of shunt response. The currently used objective assessment scales may not be sensitive enough to detect subtle changes in symptomatology after LD trial.

ABBREVIATIONS BBS = Berg Balance Scale; LD = lumbar drain; MMSE = Mini-Mental State Examination; NPH = normal pressure hydrocephalus; TUG = Timed Up and Go; VP = ventriculoperitoneal.

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Contributor Notes

Correspondence Jonathan A. White: UT Southwestern Medical Center, Dallas, TX. jonathan.white@utsouthwestern.edu.

INCLUDE WHEN CITING Published online April 12, 2019; DOI: 10.3171/2019.1.JNS181598.

Disclosures Dr. Olson is the editor-in-chief of the Journal of Neuroscience Nursing (American Association of Neuroscience Nurses). Also, he received clinical or research support for the study described (includes equipment or material) from Neuroptics, Inc. Dr. Welch is a consultant for Medtronic, Inc.

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