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Hui Ming Khoo, Haruhiko Kishima, Naoki Tani, Satoru Oshino, Tomoyuki Maruo, Koichi Hosomi, Takufumi Yanagisawa, Hiroaki Kazui, Yoshiyuki Watanabe, Toshio Shimokawa, Toshihiko Aso, Atsushi Kawaguchi, Fumio Yamashita, Youichi Saitoh and Toshiki Yoshimine

, Wachi A , : Guidelines for management of idiopathic normal pressure hydrocephalus . Neurol Med Chir (Tokyo) 48 : Suppl S1 – S23 , 2008 15 Kay BP , DiFrancesco MW , Privitera MD , Gotman J , Holland SK , Szaflarski JP : Reduced default mode network connectivity in treatment-resistant idiopathic generalized epilepsy . Epilepsia 54 : 461 – 470 , 2013 16 Kubo Y , Kazui H , Yoshida T , Kito Y , Kimura N , Tokunaga H , : Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus

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Geir Ringstad, Kyrre Eeg Emblem and Per Kristian Eide

Neurochir Suppl 71 : 340 – 342 , 1998 19 Eide PK : Demonstration of uneven distribution of intracranial pulsatility in hydrocephalus patients . J Neurosurg 109 : 912 – 917 , 2008 20 Eide PK , Saehle T : Is ventriculomegaly in idiopathic normal pressure hydrocephalus associated with a transmantle gradient in pulsatile intracranial pressure? . Acta Neurochir (Wien) 152 : 989 – 995 , 2010 21 Eide PK , Sorteberg W : Association among intracranial compliance, intracranial pulse pressure amplitude and intracranial pressure in patients with

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Sharif Vakili, Dane Moran, Alice Hung, Benjamin D. Elder, Lee Jeon, Hugo Fialho, Eric W. Sankey, Ignacio Jusué-Torres, C. Rory Goodwin, Jennifer Lu, Jamie Robison and Daniele Rigamonti

F irst identified in 1965, 5 idiopathic normal pressure hydrocephalus (iNPH) is a syndrome of progressive neurological deterioration associated with ventricular enlargement but normal cerebrospinal fluid (CSF) pressure on lumbar puncture. 8 Classically, the disease has been associated with a syndromic triad of gait disturbance, urinary incontinence, and cognitive decline, with gait disturbance and one other feature generally required for diagnosis. 9 , 18 , 20 Generally, the diagnosis of iNPH is multifactorial and made through the assessment of clinical

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Jakob Petersen, Per Hellström, Carsten Wikkelsø and Åsa Lundgren-Nilsson

: Hellström, Wikkelsø, Lundgren-Nilsson. An abstract of this work was presented orally at Hydrocephalus 2013 Athens, the Fifth Meeting of the International Society of Hydrocephalus and CSF Disorders (ISHCSF), Athens, Greece, July 1, 2013. References 1 Bergsneider M , Black PM , Klinge P , Marmarou A , Relkin N : Surgical management of idiopathic normal-pressure hydrocephalus . Neurosurgery 57 : 3 Suppl S29 – S39 , ii – v , 2005 2 Blomsterwall E , Bilting M , Stephensen H , Wikkelsö C : Gait abnormality is not the only motor

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Dan Farahmand, Terje Sæhle, Per Kristian Eide, Magnus Tisell, Per Hellström and Carsten Wikkelsö

. Neurosurgery 34 : 1110 – 1113 , 1994 5 Boon AJ , Tans JT , Delwel EJ , Egeler-Peerdeman SM , Hanlo PW , Wurzer HA , : Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts . J Neurosurg 88 : 490 – 495 , 1998 6 Delwel EJ , de Jong DA , Dammers R , Kurt E , van den Brink W , Dirven CM : A randomised trial of high and low pressure level settings on an adjustable ventriculoperitoneal shunt valve for idiopathic normal pressure hydrocephalus: results of the Dutch evaluation programme

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Leonie Gölz, Finn-Hannes Ruppert, Ullrich Meier and Johannes Lemcke

P atients with idiopathic normal pressure hydrocephalus (iNPH) present with gait disorder, urinary incontinence, and cognitive decline. This complex, known as Hakim's triad, can include headaches and vertigo, but enlargement of the ventricles on cerebral imaging is mandatory for the diagnosis. 14 , 31 Over the years, the cognitive decline can evolve into true dementia. 24 Those affected by iNPH are mostly older than 60 years, 5 and in Norway there are approximately 5.5 new cases diagnosed per 100,000 persons per year. 3 Currently, the estimated number

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Johan Virhammar, Katarina Laurell, Kristina Giuliana Cesarini and Elna-Marie Larsson

-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging . Radiology 198 : 523 – 529 , 1996 7 Evans WA : An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy . Arch Neurol 47 : 931 – 937 , 1942 8 Folstein MF , Folstein SE , McHugh PR : “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res 12 : 189 – 198 , 1975 9 Hashimoto M , Ishikawa M , Mori E , Kuwana N : Diagnosis of idiopathic normal pressure hydrocephalus

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Cynthia V. Mahr, Markus Dengl, Ulf Nestler, Martin Reiss-Zimmermann, Gerrit Eichner, Matthias Preuß and Jürgen Meixensberger

during ELD have a high probability for nonresponse after neurosurgical CSF diversion. References 1 Andrén K , Wikkelsø C , Tisell M , Hellström P : Natural course of idiopathic normal pressure hydrocephalus . J Neurol Neurosurg Psychiatry 85 : 806 – 810 , 2014 2 Czosnyka M , Czosnyka Z , Keong N , Lavinio A , Smielewski P , Momjian S , : Pulse pressure waveform in hydrocephalus: what it is and what it isn't . Neurosurg Focus 22 : 4 E2 , 2007 3 Czosnyka M , Smielewski P , Timofeev I , Lavinio A , Guazzo E

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Masakazu Miyajima, Hiroaki Kazui, Etsuro Mori and Masatsune Ishikawa

iNPH. 5 A previous multicenter, prospective cohort study (i.e., Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement [SINPHONI]), in which 100 patients were enrolled between November 2004 and November 2006, showed that specific MRI features in patients with iNPH, i.e., tight high-convexity and medial subarachnoid spaces and ventriculomegaly, which is defined as disproportionately enlarged subarachnoid space hydrocephalus (DESH), were associated with high responsiveness to VP shunting. 8 However, to date, there have been no randomized

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Terje Sæhle, Dan Farahmand, Per Kristian Eide, Magnus Tisell and Carsten Wikkelsö

: Farahmand, Tisell, Wikkelsö. Administrative/technical/material support: all authors. Study supervision: Eide, Tisell, Wikkelsö. References 1 Bergsneider M , Black PM , Klinge P , Marmarou A , Relkin N : Surgical management of idiopathic normal-pressure hydrocephalus . Neurosurgery 57 : 3 Suppl S29 – S39 , 2005 2 Boon AJ , Tans JT , Delwel EJ , Egeler-Peerdeman SM , Hanlo PW , Wurzer HA , : Dutch Normal-Pressure Hydrocephalus Study: randomized comparison of low- and medium-pressure shunts . J Neurosurg 88 : 490 – 495 , 1998