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Normal-pressure hydrocephalus

Predicting the results of cerebrospinal fluid shunting

Sherman C. Stein and Thomas W. Langfitt

S ince its appearance in the American literature in 1965, 1 the syndrome of normal-pressure hydrocephalus (NPH) has been a subject of considerable interest to all doctors caring for patients with dementia. Many diagnostic studies, most notably pneumoencephalography, isotope cisternography, and the intrathecal saline infusion test, have been adapted to identify patients with communicating hydrocephalus secondary to impaired cerebrospinal fluid (CSF) absorption (obstructive hydrocephalus), in the expectation that these patients would benefit from ventricular

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Idiopathic normal-pressure hydrocephalus

Results of shunting in 62 patients

Peter McL. Black

I diopathic normal-pressure hydrocephalus (NPH) is a well recognized cause of dementia and gait disturbance in the elderly. 1 Occasionally, its successful treatment by cerebrospinal fluid (CSF) shunting will transform a hopelessly bedridden and demented patient into a normal human being. More often, such treatment will allow a severely disabled person to achieve significant self-help. Despite examples of improvement after treatment, there is still significant doubt as to which patients should be shunted and what the general results of shunting are. A number

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John Vassilouthis

T he term “normal-pressure hydrocephalus” (NPH) is used to describe a clinical syndrome mainly comprising gait disturbance, dementia, and urinary incontinence, and is associated with dilatation of the ventricular system of the brain and normal cerebrospinal fluid (CSF) pressure at lumbar puncture. 27 Since the initial reports from the Massachussets General Hospital, 1, 2, 46, 47 numerous series of patients apparently suffering from this syndrome have been described in the literature. 3–6, 8, 9, 11, 22, 24, 32–34, 36, 41, 53, 56, 58, 64 In these studies

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John S. Meyer, Yasuhisa Kitagawa, Norio Tanahashi, Hisao Tachibana, Prasab Kandula, David A. Cech, Guy L. Clifton and James E. Rose

VP none 5 post-SAH 2 mos hypertension VP none 6 idiopathic 6 yrs hypertension VP originally shunted 4 yrs before present study, replaced 3¼ yrs after shunting 7 congenital aqueductal stenosis 40 yrs none VP none 8 idiopathic 3 yrs hypertension not done 9 idiopathic + initial shunt infection 8 yrs none VP infected VP shunt 10 idiopathic 6 mos none LP tube displacement * NPH = normal-pressure hydrocephalus; VP = ventriculoperitoneal shunt; LP

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Andrei V. Chistyakov, Hava Hafner, Alon Sinai, Boris Kaplan and Menashe Zaaroor

I diopathic normal-pressure hydrocephalus is characterized by the classic Adams triad of cognitive dysfunction, urinary incontinence, and gait disturbance, the latter being the most prominent and predominant symptom in the majority of patients. Improvement in walking performance following a large-volume lumbar puncture (CSF tap test) is the key selection criterion for ventricular shunt surgery and for predicting responsiveness to the shunt therapy. Despite the clinical importance of this symptom, the pathophysiological mechanisms of NPH gait disturbance

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Cerebral hemodynamics in normal-pressure hydrocephalus

Evaluation by 133Xe inhalation method and dynamic CT study

Norihiko Tamaki, Tadaki Kusunoki, Toshimitsu Wakabayashi and Satoshi Matsumoto

S ince the original description of normal-pressure hydrocephalus (NPH) by Hakim and Adams, 6 a number of studies on the diagnostic and therapeutic problems have been published; however, the pathogenesis of this disorder remains unclear. We investigated the cerebral hemodynamics of NPH both by the xenon-133 ( 133 Xe) inhalation method and by dynamic computerized tomography (CT) studies, to determine the relationship between the results obtained by both methods, and to evaluate the effect of shunt operation on cerebral hemodynamics. Clinical Material and

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Neurosurgical Forum: Letters to the Editor To The Editor Marek Czosnyka , Ph.D. Hugh K. Richards , Ph.D. Zofia Czosnyka , Ph.D. John D Pickard , F.Med.Sci. University of Cambridge Cambridge, UK 1083 1084 Abstract Object. It is well known that in patients with communicating hydrocephalus or normal-pressure hydrocephalus (NPH), ventricular size decreases following implantation of shunts with differential pressure valves. The aim of this study was to determine

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E. Scott Conner, Lorraine Foley and Peter McL. Black

and changes in the visco-elastic properties of the brain parenchyma. 8 None of these parameters have been proved to be of predominant importance. One of the early theories of normal-pressure hydrocephalus was that of Fishman, 6 who held that it was not the absolute ventricular pressure, but rather the difference between ventricular pressure and the pressure over the cerebral convexity (the transmantle pressure), that was the physiological determinant responsible for ventricular dilatation. The existence of an elevated transmantle pressure in hydrocephalus has

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Mark G. Burnett, Seema S. Sonnad and Sherman C. Stein

rates in patients not fulfilling test criteria range from 22 to 68%. 7 , 58 , 60 , 91 Until further research produces screening tests with higher negative predictive values, dogmatic recommendations for negative test results are unjustified. Disclaimer None of the authors has a financial interest in the subject under discussion. References 1 Ahlberg J , Norlen L , Blomstrand C , Wikkelso C : Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture . J Neurol Neurosurg Psychiatry 51

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Agnita J. W. Boon, Joseph T. J. Tans, Ernst J. Delwel, Saskia M. Egeler-Peerdeman, Patrick W. Hanlo, Hans A. L. Wurzer and Jo Hermans

T he pathogenesis of normal-pressure hydrocephalus (NPH) is thought to consist of disturbed absorption of cerebrospinal fluid (CSF) caused by an increase in the resistance to outflow of CSF (Rcsf), resulting in an increase in CSF pressure and ventricular dilation. This mechanism is not disputed for symptomatic NPH but is largely unexplained for idiopathic NPH. According to the few neuropathological studies of idiopathic NPH, leptomeningeal fibrosis was often absent or it was unclear whether this fibrosis was severe enough to impair absorption of CSF. 1, 3, 11