Is the placement of shunts in patients with idiopathic normal pressure hydrocephalus worth the risk? Results of a study based on continuous monitoring of intracranial pressure

Restricted access

Object. Data from many studies have demonstrated that shunt insertion in patients with idiopathic normal-pressure hydrocephalus (NPH) is associated with high morbidity and a lack of significant improvement; however, the use of strict diagnostic and treatment protocols can improve the results of surgery in these patients. The primary aim in this prospective study was to analyze the results of shunt placement in 43 patients with idiopathic NPH. A secondary aim was to determine the relationship between several clinical and neuroimaging factors, and patient outcome after surgery.

Methods. Thirty men and 13 women with a mean age of 71.1 ± 6.9 years participated in this study. All patients underwent clinical, neuropsychological, and radiological assessment before and 6 months after surgery. In all patients continuous monitoring of intracranial pressure was performed using a fiberoptic extradural sensor. In 31 patients cerebrospinal fluid dynamics were also determined. Eighty-six percent of patients showed clinical improvement after shunt insertion, 11.6% showed no change, and 2.3% exhibited some worsening. Gait improved in 81.4% of the patients, sphincter control in 69.8%, and cognitive dysfunction in 39.5%. There was no treatment-related death. Early or late postsurgical complications occurred in six patients (14%), although all of these complications were minor or were satisfactorily resolved. The complete clinical triad, cortical sulci size, and periventricular lucencies were related to outcome, whereas patient age, symptom duration, ventricular dilation, and the degree of presurgical dementia were unrelated to outcome.

Conclusions. Given the correct diagnosis, shunt insertion can produce marked improvement in patients with idiopathic NPH syndrome, causing few deaths and few clinically relevant complications.

Article Information

Address reprint requests to: Maria A. Poca, M.D., Ph.D., Ferran Puig 70–72, 1–2, 08023 Barcelona, Spain. email: 26382app@comb.es.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Computerized tomography scans demonstrating measurements of ventricle size: A, maximal bifrontal distance; B, distance between the caudate nuclei at the level of the foramen of Monro; C, maximal width of the third ventricle; D, minimal width of both cella media; E, maximal inner diameter of the skull at the level of the measurement of the maximal bifrontal distance; F, maximal outer diameter of the skull at the level of the minimal width of both cella media. CM = cella media index; III-V = third ventricle index; VS = ventricular score.

  • View in gallery

    Tracings of high-amplitude (upper) and low-amplitude (lower) B-waves obtained in two patients from the study. The fragment of the ICP recording that shows high-amplitude B-waves corresponds to those in Case 5 in Table 4.

  • View in gallery

    Graph demonstrating the number of patients in each category of the Stein and Langfitt Scale in the pre- and postoperative periods.

  • View in gallery

    Box-and-whisker plot of Rout values (Katzman and Hussey constant-rate infusion test). The median Rout value was 14.5 mm Hg/ml/min (interquartile range 7.6 to 19.6 mm Hg/ml/min; minimal 1.8 mm Hg/ml/min; maximal 30.7 mm Hg/ml/min). The Rout value was normal (< 10 mm Hg/ml/min) in 11 (35.5%) of the 31 patients who had undergone CSF dynamics studies. In these 11 patients the total percentage of B-waves was between 5 and 55% (median 19%; interquartile range 11.3 to 44%).

References

  • 1.

    Adams RDFisher CMHakim Set al: Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. A treatable syndrome. N Engl J Med 273:1171261965Adams RD Fisher CM Hakim S et al: Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. A treatable syndrome. N Engl J Med 273:117–126 1965

    • Search Google Scholar
    • Export Citation
  • 2.

    Albeck MJSkak CNielsen PRet al: Age dependency of resistance to cerebrospinal fluid outflow. J Neurosurg 89:2752781998Albeck MJ Skak C Nielsen PR et al: Age dependency of resistance to cerebrospinal fluid outflow. J Neurosurg 89:275–278 1998

    • Search Google Scholar
    • Export Citation
  • 3.

    Anderson RCGrant JJde la Paz Ret al: Volumetric measurements in the detection of reduced ventricular volume in patients with normal-pressure hydrocephalus whose clinical condition improved after ventriculoperitoneal shunt placement. J Neurosurg 97:73792002Anderson RC Grant JJ de la Paz R et al: Volumetric measurements in the detection of reduced ventricular volume in patients with normal-pressure hydrocephalus whose clinical condition improved after ventriculoperitoneal shunt placement. J Neurosurg 97:73–79 2002

    • Search Google Scholar
    • Export Citation
  • 4.

    Bech RAWaldemar GGjerris Fet al: Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir 141:6336391999Bech RA Waldemar G Gjerris F et al: Shunting effects in patients with idiopathic normal pressure hydrocephalus; correlation with cerebral and leptomeningeal biopsy findings. Acta Neurochir 141:633–639 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Bech-Azeddine RWaldemar GKnudsen GMet al: Idiopathic normal-pressure hydrocephalus: evaluation and findings in a multidisciplinary memory clinic. Eur J Neurol 8:6016112001Bech-Azeddine R Waldemar G Knudsen GM et al: Idiopathic normal-pressure hydrocephalus: evaluation and findings in a multidisciplinary memory clinic. Eur J Neurol 8:601–611 2001

    • Search Google Scholar
    • Export Citation
  • 6.

    Belloni Gdi Rocco CFocacci Cet al: Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of surgical treatment. Acta Neurochir 33:1211976Belloni G di Rocco C Focacci C et al: Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of surgical treatment. Acta Neurochir 33:1–21 1976

    • Search Google Scholar
    • Export Citation
  • 7.

    Benzel EC: Comment, in Raftopoulos C, Deleval J, Chaskis C, et al: Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 35:4044051994Benzel EC: Comment in Raftopoulos C Deleval J Chaskis C et al: Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 35:404–405 1994

    • Search Google Scholar
    • Export Citation
  • 8.

    Benzel ECPelletier ALLevy PG: Communicating hydrocephalus in adults: prediction of outcome after ventricular shunting procedures. Neurosurgery 26:6556601990Benzel EC Pelletier AL Levy PG: Communicating hydrocephalus in adults: prediction of outcome after ventricular shunting procedures. Neurosurgery 26:655–660 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Black PM: Idiopathic normal-pressure hydrocephalus. Results of shunting in 62 patients. J Neurosurg 52:3713771980Black PM: Idiopathic normal-pressure hydrocephalus. Results of shunting in 62 patients. J Neurosurg 52:371–377 1980

    • Search Google Scholar
    • Export Citation
  • 10.

    Boon AJTans JTDelwel EJet al: Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87:6876931997Boon AJ Tans JT Delwel EJ et al: Dutch normal-pressure hydrocephalus study: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87:687–693 1997

    • Search Google Scholar
    • Export Citation
  • 11.

    Boon AJTans JTDelwel EJet al: Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg 90:2212261999Boon AJ Tans JT Delwel EJ et al: Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease. J Neurosurg 90:221–226 1999

    • Search Google Scholar
    • Export Citation
  • 12.

    Borgesen SE: Conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir 71:1451984Borgesen SE: Conductance to outflow of CSF in normal pressure hydrocephalus. Acta Neurochir 71:1–45 1984

    • Search Google Scholar
    • Export Citation
  • 13.

    Borgesen SEGjerris F: The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain 105:65861982Borgesen SE Gjerris F: The predictive value of conductance to outflow of CSF in normal pressure hydrocephalus. Brain 105:65–86 1982

    • Search Google Scholar
    • Export Citation
  • 14.

    Bradley WG: Normal pressure hydrocephalus and deep white matter ischemia: which is the chicken, and which is the egg? AJNR 22:163816402001Bradley WG: Normal pressure hydrocephalus and deep white matter ischemia: which is the chicken and which is the egg? AJNR 22:1638–1640 2001

    • Search Google Scholar
    • Export Citation
  • 15.

    Bradley WGQuencer RM: Hydrocephalus, atrophy and intracranial CSF flow in Stark DBradley WG (eds): Magnetic Resonance Imaging. St Louis: Mosby1992 pp 14831507Bradley WG Quencer RM: Hydrocephalus atrophy and intracranial CSF flow in Stark D Bradley WG (eds): Magnetic Resonance Imaging. St Louis: Mosby 1992 pp 1483–1507

    • Search Google Scholar
    • Export Citation
  • 16.

    Bradley WG JrKortman KEBurgoyne B: Flowing cerebrospinal fluid in normal and hydrocephalic states: appearance on MR images. Radiology 159:6116161986Bradley WG Jr Kortman KE Burgoyne B: Flowing cerebrospinal fluid in normal and hydrocephalic states: appearance on MR images. Radiology 159:611–616 1986

    • Search Google Scholar
    • Export Citation
  • 17.

    Bradley WG JrScalzo DQueralt Jet al: Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology 198:5235291996Bradley WG Jr Scalzo D Queralt J et al: Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology 198:523–529 1996

    • Search Google Scholar
    • Export Citation
  • 18.

    Bradley WG JrWhittemore ARKortman KEet al: Marked cerebrospinal fluid void: indicator of successful shunt in patients with suspected normal-pressure hydrocephalus. Radiology 178:4594661991Bradley WG Jr Whittemore AR Kortman KE et al: Marked cerebrospinal fluid void: indicator of successful shunt in patients with suspected normal-pressure hydrocephalus. Radiology 178:459–466 1991

    • Search Google Scholar
    • Export Citation
  • 19.

    Bradley WG JrWhittemore ARWatanabe ASet al: Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normalpressure hydrocephalus. AJNR 12:31391991Bradley WG Jr Whittemore AR Watanabe AS et al: Association of deep white matter infarction with chronic communicating hydrocephalus: implications regarding the possible origin of normalpressure hydrocephalus. AJNR 12:31–39 1991

    • Search Google Scholar
    • Export Citation
  • 20.

    Bret PChazal JJanny Pet al: L'hydrocephalie chronique de l'adulte. Neurochirurgie 36 (Suppl 1):11591990Bret P Chazal J Janny P et al: L'hydrocephalie chronique de l'adulte. Neurochirurgie 36 (Suppl 1): 1–159 1990

    • Search Google Scholar
    • Export Citation
  • 21.

    Caltagirone CGainotti GMasullo Cet al: Neurophysiological study of normal pressure hydrocephalus. Acta Psychiatr Scand 65:931001982Caltagirone C Gainotti G Masullo C et al: Neurophysiological study of normal pressure hydrocephalus. Acta Psychiatr Scand 65:93–100 1982

    • Search Google Scholar
    • Export Citation
  • 22.

    Cardoso ERDel Bigio MR: Age-related changes of cerebral ventricular size. Part II: Normalization of ventricular size following shunting. Acta Neurochir 97:1351381989Cardoso ER Del Bigio MR: Age-related changes of cerebral ventricular size. Part II: Normalization of ventricular size following shunting. Acta Neurochir 97:135–138 1989

    • Search Google Scholar
    • Export Citation
  • 23.

    Caruso RCervoni LVitale AMet al: Idiopathic normal-pressure hydrocephalus in adults: result of shunting correlated with clinical findings in 18 patients and review of the literature. Neurosurg Rev 20:1041071997Caruso R Cervoni L Vitale AM et al: Idiopathic normal-pressure hydrocephalus in adults: result of shunting correlated with clinical findings in 18 patients and review of the literature. Neurosurg Rev 20:104–107 1997

    • Search Google Scholar
    • Export Citation
  • 24.

    Casmiro MCacciatore FMD'Alessandro R: The pathogenesis of idiopathic normal pressure hydrocephalus: an open problem. Funct Neurol 4:4034101989Casmiro M Cacciatore FM D'Alessandro R: The pathogenesis of idiopathic normal pressure hydrocephalus: an open problem. Funct Neurol 4:403–410 1989

    • Search Google Scholar
    • Export Citation
  • 25.

    Chawla JCHulme ACooper R: Intracranial pressure in patients with dementia and communicating hydrocephalus. J Neurosurg 40:3763801974Chawla JC Hulme A Cooper R: Intracranial pressure in patients with dementia and communicating hydrocephalus. J Neurosurg 40:376–380 1974

    • Search Google Scholar
    • Export Citation
  • 26.

    Crockard HAHanlon KDuda EEet al: Hydrocephalus as a cause of dementia: evaluation by computerised tomography and intracranial pressure monitoring. J Neurol Neurosurg Psychiatry 40:7367401977Crockard HA Hanlon K Duda EE et al: Hydrocephalus as a cause of dementia: evaluation by computerised tomography and intracranial pressure monitoring. J Neurol Neurosurg Psychiatry 40:736–740 1977

    • Search Google Scholar
    • Export Citation
  • 27.

    Earnest MPFahn SKarp JHet al: Normal pressure hydrocephalus and hypertensive cerebrovascular disease. Arch Neurol 31:2622661974Earnest MP Fahn S Karp JH et al: Normal pressure hydrocephalus and hypertensive cerebrovascular disease. Arch Neurol 31:262–266 1974

    • Search Google Scholar
    • Export Citation
  • 28.

    Ekstedt J: CSF hydrodynamic studies in man. 2. Normal hydrodynamic variables related to CSF pressure and flow. J Neurol Neurosurg Psychiatry 41:3453531978Ekstedt J: CSF hydrodynamic studies in man. 2. Normal hydrodynamic variables related to CSF pressure and flow. J Neurol Neurosurg Psychiatry 41:345–353 1978

    • Search Google Scholar
    • Export Citation
  • 29.

    Enzmann DRPelc NJ: Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging. Radiology 178:4674741991Enzmann DR Pelc NJ: Normal flow patterns of intracranial and spinal cerebrospinal fluid defined with phase-contrast cine MR imaging. Radiology 178:467–474 1991

    • Search Google Scholar
    • Export Citation
  • 30.

    Evans WA Jr: An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry 42:9319371942Evans WA Jr: An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy. Arch Neurol Psychiatry 42:931–937 1942

    • Search Google Scholar
    • Export Citation
  • 31.

    Feinberg DAMark AS: Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging. Radiology 163:7937991987Feinberg DA Mark AS: Human brain motion and cerebrospinal fluid circulation demonstrated with MR velocity imaging. Radiology 163:793–799 1987

    • Search Google Scholar
    • Export Citation
  • 32.

    Fillenbaum GG: Screening the elderly. A brief instrumental activities of daily living measure. J Am Geriatr Soc 33:6987061985Fillenbaum GG: Screening the elderly. A brief instrumental activities of daily living measure. J Am Geriatr Soc 33:698–706 1985

    • Search Google Scholar
    • Export Citation
  • 33.

    Fisher CM: Communicating hydrocephalus. Lancet 1:371978(Letter)Fisher CM: Communicating hydrocephalus. Lancet 1:37 1978 (Letter)

  • 34.

    Fisher CM: Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology 32:135813631982Fisher CM: Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology 32:1358–1363 1982

    • Search Google Scholar
    • Export Citation
  • 35.

    Folstein MFFolstein SEMcHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 12:1891981975Folstein MF Folstein SE McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatry Res 12:189–198 1975

    • Search Google Scholar
    • Export Citation
  • 36.

    Friedland RP: ‘Normal’-pressure hydrocephalus and the saga of the treatable dementias. JAMA 262:257725811989Friedland RP: ‘Normal’-pressure hydrocephalus and the saga of the treatable dementias. JAMA 262:2577–2581 1989

    • Search Google Scholar
    • Export Citation
  • 37.

    Gideon PStahlberg FThomsen Cet al: Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI. Neuroradiology 36:2102151994Gideon P Stahlberg F Thomsen C et al: Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI. Neuroradiology 36:210–215 1994

    • Search Google Scholar
    • Export Citation
  • 38.

    Golomb Jde Leon MJGeorge AEet al: Hippocampal atrophy correlates with severe cognitive impairment in elderly patients with suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 57:5905931994Golomb J de Leon MJ George AE et al: Hippocampal atrophy correlates with severe cognitive impairment in elderly patients with suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 57:590–593 1994

    • Search Google Scholar
    • Export Citation
  • 39.

    Graff-Radford NRGodersky JC: Normal-pressure hydrocephalus. Onset of gait abnormality before dementia predicts good surgical outcome. Arch Neurol 43:9409421986Graff-Radford NR Godersky JC: Normal-pressure hydrocephalus. Onset of gait abnormality before dementia predicts good surgical outcome. Arch Neurol 43:940–942 1986

    • Search Google Scholar
    • Export Citation
  • 40.

    Graff-Radford NRGodersky JCJones MP: Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology 39:160116041989Graff-Radford NR Godersky JC Jones MP: Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology 39:1601–1604 1989

    • Search Google Scholar
    • Export Citation
  • 41.

    Graff-Radford NRTorner JAdams HP Jret al: Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. Arch Neurol 46:7447521989Graff-Radford NR Torner J Adams HP Jr et al: Factors associated with hydrocephalus after subarachnoid hemorrhage. A report of the Cooperative Aneurysm Study. Arch Neurol 46:744–752 1989

    • Search Google Scholar
    • Export Citation
  • 42.

    Hakim S: Algunas observaciones sobre ia presion del LC.R. sindrome hidroceffalico en al adulto con “presion normal” del LC.R. Bogota, Colombia: Universidad Javeriana1964Hakim S: Algunas observaciones sobre ia presion del LC.R. sindrome hidroceffalico en al adulto con “presion normal” del LC.R. Bogota Colombia: Universidad Javeriana 1964

    • Search Google Scholar
    • Export Citation
  • 43.

    Hakim SAdams RD: The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2:3073271965Hakim S Adams RD: The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2:307–327 1965

    • Search Google Scholar
    • Export Citation
  • 44.

    Hartmann AAlberti E: Differentiation of communicating hydrocephalus and presenile dementia by continuous recording of cerebrospinal fluid pressure. J Neurol Neurosurg Psychiatry 40:6306401977Hartmann A Alberti E: Differentiation of communicating hydrocephalus and presenile dementia by continuous recording of cerebrospinal fluid pressure. J Neurol Neurosurg Psychiatry 40:630–640 1977

    • Search Google Scholar
    • Export Citation
  • 45.

    Hartmann AAlberti ELange D: Effects of CSF-drainage on CBF and CBV in subarachnoid hemorrhage and communicating hydrocephalus. Acta Neurol Scand Suppl 64:3363371977Hartmann A Alberti E Lange D: Effects of CSF-drainage on CBF and CBV in subarachnoid hemorrhage and communicating hydrocephalus. Acta Neurol Scand Suppl 64:336–337 1977

    • Search Google Scholar
    • Export Citation
  • 46.

    Hebb AOCusimano MD: Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:116611862001Hebb AO Cusimano MD: Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery 49:1166–1186 2001

    • Search Google Scholar
    • Export Citation
  • 47.

    Holodny AIGeorge AEde Leon MJet al: Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus. J Neurosurg 89:7427471998Holodny AI George AE de Leon MJ et al: Focal dilation and paradoxical collapse of cortical fissures and sulci in patients with normal-pressure hydrocephalus. J Neurosurg 89:742–747 1998

    • Search Google Scholar
    • Export Citation
  • 48.

    Hughes CPBerg LDanziger WLet al: A new clinical scale for the staging of dementia. Br J Psychiatry 140:5665721982Hughes CP Berg L Danziger WL et al: A new clinical scale for the staging of dementia. Br J Psychiatry 140:566–572 1982

    • Search Google Scholar
    • Export Citation
  • 49.

    Hussey FSchanzer BKatzman R: A simple constant-infusion manometric test for measurement of CSF absorption. II. Clinical studies. Neurology 20:6656801970Hussey F Schanzer B Katzman R: A simple constant-infusion manometric test for measurement of CSF absorption. II. Clinical studies. Neurology 20:665–680 1970

    • Search Google Scholar
    • Export Citation
  • 50.

    Iddon JLPickard JDCross JJet al: Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer's disease: a pilot study. J Neurol Neurosurg Psychiatry 67:7237321999Iddon JL Pickard JD Cross JJ et al: Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer's disease: a pilot study. J Neurol Neurosurg Psychiatry 67:723–732 1999

    • Search Google Scholar
    • Export Citation
  • 51.

    Jacobs LConti DKinkel WRet al: “Normal-pressure” hydrocephalus. Relationship of clinical and radiographic findings to improvement following shunt surgery. JAMA 235:5105121976Jacobs L Conti D Kinkel WR et al: “Normal-pressure” hydrocephalus. Relationship of clinical and radiographic findings to improvement following shunt surgery. JAMA 235:510–512 1976

    • Search Google Scholar
    • Export Citation
  • 52.

    Jorm AFJacomb PA: The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms. Psychol Med 19:101510221989Jorm AF Jacomb PA: The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates reliability validity and some norms. Psychol Med 19:1015–1022 1989

    • Search Google Scholar
    • Export Citation
  • 53.

    Jorm AFScott RCullen JSet al: Performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia. Psychol Med 21:7857901991Jorm AF Scott R Cullen JS et al: Performance of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia. Psychol Med 21:785–790 1991

    • Search Google Scholar
    • Export Citation
  • 54.

    Kahlon BSundbarg GRehncrona S: Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 73:7217262002Kahlon B Sundbarg G Rehncrona S: Comparison between the lumbar infusion and CSF tap tests to predict outcome after shunt surgery in suspected normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 73:721–726 2002

    • Search Google Scholar
    • Export Citation
  • 55.

    Katzman RHussey F: A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 20:5345441970Katzman R Hussey F: A simple constant-infusion manometric test for measurement of CSF absorption. I. Rationale and method. Neurology 20:534–544 1970

    • Search Google Scholar
    • Export Citation
  • 56.

    Kaye JAGrady CLHaxby JVet al: Plasticity in the aging brain. Reversibility of anatomic, metabolic, and cognitive deficits in normal-pressure hydrocephalus following shunt surgery. Arch Neurol 47:133613411990Kaye JA Grady CL Haxby JV et al: Plasticity in the aging brain. Reversibility of anatomic metabolic and cognitive deficits in normal-pressure hydrocephalus following shunt surgery. Arch Neurol 47:1336–1341 1990

    • Search Google Scholar
    • Export Citation
  • 57.

    Kitagaki HMori EIshii Ket al: CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR 19:127712841998Kitagaki H Mori E Ishii K et al: CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. AJNR 19:1277–1284 1998

    • Search Google Scholar
    • Export Citation
  • 58.

    Koto ARosenberg GZingesser LHet al: Syndrome of normal pressure hydrocephalus: possible relation to hypertensive and arteriosclerotic vasculopathy. J Neurol Neurosurg Psychiatry 40:73791977Koto A Rosenberg G Zingesser LH et al: Syndrome of normal pressure hydrocephalus: possible relation to hypertensive and arteriosclerotic vasculopathy. J Neurol Neurosurg Psychiatry 40:73–79 1977

    • Search Google Scholar
    • Export Citation
  • 59.

    Krauss JKDroste DWBohus Met al: The relation of intracranial pressure B-waves to different sleep stages in patients with suspected normal pressure hydrocephalus. Acta Neurochir 136:1952031995Krauss JK Droste DW Bohus M et al: The relation of intracranial pressure B-waves to different sleep stages in patients with suspected normal pressure hydrocephalus. Acta Neurochir 136:195–203 1995

    • Search Google Scholar
    • Export Citation
  • 60.

    Krauss JKRegel JPVach Wet al: Vascular risk factors and arteriosclerotic disease in idiopathic normal-pressure hydrocephalus of the elderly. Stroke 27:24291996Krauss JK Regel JP Vach W et al: Vascular risk factors and arteriosclerotic disease in idiopathic normal-pressure hydrocephalus of the elderly. Stroke 27:24–29 1996

    • Search Google Scholar
    • Export Citation
  • 61.

    Kristensen BMalm JFagerland Met al: Regional cerebral blood flow, white matter abnormalities, and cerebrospinal fluid hydrodynamics in patients with idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 60:2822881996Kristensen B Malm J Fagerland M et al: Regional cerebral blood flow white matter abnormalities and cerebrospinal fluid hydrodynamics in patients with idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 60:282–288 1996

    • Search Google Scholar
    • Export Citation
  • 62.

    Lamas EEsparza JDiez Lobato R: Intracranial pressure in adult non-tumoral hydrocephalus. J Neurosurg Sci 19:2262331975Lamas E Esparza J Diez Lobato R: Intracranial pressure in adult non-tumoral hydrocephalus. J Neurosurg Sci 19:226–233 1975

    • Search Google Scholar
    • Export Citation
  • 63.

    Lamas ELobato RD: Intraventricular pressure and CSF dynamics in chronic adult hydrocephalus. Surg Neurol 12:2872951979Lamas E Lobato RD: Intraventricular pressure and CSF dynamics in chronic adult hydrocephalus. Surg Neurol 12:287–295 1979

    • Search Google Scholar
    • Export Citation
  • 64.

    Larsson AWikkelso CBilting Met al: Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 84:4754821991Larsson A Wikkelso C Bilting M et al: Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 84:475–482 1991

    • Search Google Scholar
    • Export Citation
  • 65.

    Linn MWLinn BS: The rapid disability rating scale-2. J Am Geriatr Soc 30:3783821982Linn MW Linn BS: The rapid disability rating scale-2. J Am Geriatr Soc 30:378–382 1982

    • Search Google Scholar
    • Export Citation
  • 66.

    Lobato RD: Utilidad del estudio de ladinámica del líquido cefalorraquídeo in el paciente hidrocefálico. Neurocirugía 1:3101990Lobato RD: Utilidad del estudio de ladinámica del líquido cefalorraquídeo in el paciente hidrocefálico. Neurocirugía 1:3–10 1990

    • Search Google Scholar
    • Export Citation
  • 67.

    Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand 36 (Suppl 149):11931960Lundberg N: Continuous recording and control of ventricular fluid pressure in neurosurgical practice. Acta Psychiatr Scand 36 (Suppl 149): 1–193 1960

    • Search Google Scholar
    • Export Citation
  • 68.

    Malm JKristensen BKarlsson Tet al: The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Arch Neurol 52:7837891995Malm J Kristensen B Karlsson T et al: The predictive value of cerebrospinal fluid dynamic tests in patients with the idiopathic adult hydrocephalus syndrome. Arch Neurol 52:783–789 1995

    • Search Google Scholar
    • Export Citation
  • 69.

    Meier UParis SGrawe Aet al: Is there a correlation between operative results and change in ventricular volume after shunt placement? A study of 60 cases of idiopathic normal-pressure hydrocephalus. Neuroradiology 45:3773802003Meier U Paris S Grawe A et al: Is there a correlation between operative results and change in ventricular volume after shunt placement? A study of 60 cases of idiopathic normal-pressure hydrocephalus. Neuroradiology 45:377–380 2003

    • Search Google Scholar
    • Export Citation
  • 70.

    Meyer JSKitagawa YTanahashi Net al: Evaluation of treatment of normal-pressure hydrocephalus. J Neurosurg 62:5135211985Meyer JS Kitagawa Y Tanahashi N et al: Evaluation of treatment of normal-pressure hydrocephalus. J Neurosurg 62:513–521 1985

    • Search Google Scholar
    • Export Citation
  • 71.

    Meyer JSKitagawa YTanahashi Net al: Pathogenesis of normal-pressure hydrocephalus—preliminary observations. Surg Neurol 23:1211331985Meyer JS Kitagawa Y Tanahashi N et al: Pathogenesis of normal-pressure hydrocephalus—preliminary observations. Surg Neurol 23:121–133 1985

    • Search Google Scholar
    • Export Citation
  • 72.

    Nitz WRBradley WG JrWatanabe ASet al: Flow dynamics of cerebrospinal fluid: assessment with phase-contrast velocity MR imaging performed with retrospective cardiac gating. Radiology 183:3954051992Nitz WR Bradley WG Jr Watanabe AS et al: Flow dynamics of cerebrospinal fluid: assessment with phase-contrast velocity MR imaging performed with retrospective cardiac gating. Radiology 183:395–405 1992

    • Search Google Scholar
    • Export Citation
  • 73.

    Petersen RCMokri BLaws ER Jr: Surgical treatment of idiopathic hydrocephalus in elderly patients. Neurology 35:3073111985Petersen RC Mokri B Laws ER Jr: Surgical treatment of idiopathic hydrocephalus in elderly patients. Neurology 35:307–311 1985

    • Search Google Scholar
    • Export Citation
  • 74.

    Pickard JD: Normal pressure hydrocephalus—to shunt or not to shunt? in Warlow CGarfield J (eds): Dilemmas in the Management of the Neurological Patient. Edinburgh: Churchill Livingstone1984 pp 207211Pickard JD: Normal pressure hydrocephalus—to shunt or not to shunt? in Warlow C Garfield J (eds): Dilemmas in the Management of the Neurological Patient. Edinburgh: Churchill Livingstone 1984 pp 207–211

    • Search Google Scholar
    • Export Citation
  • 75.

    Pickard JDTeasdale GMatheson M et al: Intraventricular pressure waves. The best predictive test for shunting in normal pressure hydrocephalus in Shulman KMarmarou AMiller JDet al (eds): Intracranial Pressure IV. Berlin: Springer-Verlag1980 pp 498500Pickard JD Teasdale G Matheson My et al: Intraventricular pressure waves. The best predictive test for shunting in normal pressure hydrocephalus in Shulman K Marmarou A Miller JD et al (eds): Intracranial Pressure IV. Berlin: Springer-Verlag 1980 pp 498–500

    • Search Google Scholar
    • Export Citation
  • 76.

    Pleasure SJFishman RA: Ventricular volume and transmural pressure gradient in normal pressure hydrocephalus. Arch Neurol 56:119912001999 (Editorial)Pleasure SJ Fishman RA: Ventricular volume and transmural pressure gradient in normal pressure hydrocephalus. Arch Neurol 56:1199–1200 1999 (Editorial)

    • Search Google Scholar
    • Export Citation
  • 77.

    Poca MASahuquillo JBusto Met al: Agreement between CSF flow dynamics in MRI and ICP monitoring in the diagnosis of normal pressure hydrocephalus. Sensitivity and specificity of CSF dynamics to predict outcome. Acta Neurochir Suppl 81:7102002Poca MA Sahuquillo J Busto M et al: Agreement between CSF flow dynamics in MRI and ICP monitoring in the diagnosis of normal pressure hydrocephalus. Sensitivity and specificity of CSF dynamics to predict outcome. Acta Neurochir Suppl 81:7–10 2002

    • Search Google Scholar
    • Export Citation
  • 78.

    Poca MASahuquillo JBusto Met al: Clinical management of patients with normal pressure hydrocephalus syndrome. Ann Psychiatry 6:2732921996Poca MA Sahuquillo J Busto M et al: Clinical management of patients with normal pressure hydrocephalus syndrome. Ann Psychiatry 6:273–292 1996

    • Search Google Scholar
    • Export Citation
  • 79.

    Poca MASahuquillo JMataro M: Actualizaciones en el diagnostico y tratamiento de la hidrocefalia “normotensiva (hidrocefalia cronica del adulto). Neurología 16:3533692001Poca MA Sahuquillo J Mataro M: Actualizaciones en el diagnostico y tratamiento de la hidrocefalia “normotensiva (hidrocefalia cronica del adulto). Neurología 16:353–369 2001

    • Search Google Scholar
    • Export Citation
  • 80.

    Poca Pastor MASahuquillo Barris JIbañez Dominguez Jet al: Aplicación de la monitorization continua de la presión intracraneal al diagnóstico de la hidrocefalia crónica del adulto. Introducción a la interpretación de registros gráficos in Vázquez-Barquero APoca Pastor MAMartín Láez R (eds): Hidrocefalèa Crónica del Adulto. Santander: Gráficas Calima2001 pp 69102Poca Pastor MA Sahuquillo Barris J Ibañez Dominguez J et al: Aplicación de la monitorization continua de la presión intracraneal al diagnóstico de la hidrocefalia crónica del adulto. Introducción a la interpretación de registros gráficos in Vázquez-Barquero A Poca Pastor MA Martín Láez R (eds): Hidrocefalèa Crónica del Adulto. Santander: Gráficas Calima 2001 pp 69–102

    • Search Google Scholar
    • Export Citation
  • 81.

    Poca Pastor MASahuquillo Barris JIbañez Dominguez Jet al: Estudio de la dinámica del líquido cefalorraquídeo en el diagnóstico de la hidrocefalia crónica del adulto in Vázquez APoca MAMartín (eds): Hidrocefalía Crónica del Adulto. Santander: Gráficas Calima2001 pp 103122Poca Pastor MA Sahuquillo Barris J Ibañez Dominguez J et al: Estudio de la dinámica del líquido cefalorraquídeo en el diagnóstico de la hidrocefalia crónica del adulto in Vázquez A Poca MA Martín (eds): Hidrocefalía Crónica del Adulto. Santander: Gráficas Calima 2001 pp 103–122

    • Search Google Scholar
    • Export Citation
  • 82.

    Raftopoulos CDeleval JChaskis Cet al: Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 35:3974041994Raftopoulos C Deleval J Chaskis C et al: Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective study. Neurosurgery 35:397–404 1994

    • Search Google Scholar
    • Export Citation
  • 83.

    Raftopoulos CMassager NBaleriaux Det al: Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery 38:51591996Raftopoulos C Massager N Baleriaux D et al: Prospective analysis by computed tomography and long-term outcome of 23 adult patients with chronic idiopathic hydrocephalus. Neurosurgery 38:51–59 1996

    • Search Google Scholar
    • Export Citation
  • 84.

    Reilly P: In normal pressure hydrocephalus, intracranial pressure monitoring is the only useful test. J Clin Neurosci 8:66672001Reilly P: In normal pressure hydrocephalus intracranial pressure monitoring is the only useful test. J Clin Neurosci 8:66–67 2001

    • Search Google Scholar
    • Export Citation
  • 85.

    Reitan RM: Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8:2712761958Reitan RM: Validity of the trail making test as an indicator of organic brain damage. Percept Mot Skills 8:271–276 1958

    • Search Google Scholar
    • Export Citation
  • 86.

    Rosenfeld JVSiraruj S: In normal pressure hydrocephalus, intracranial pressure monitoring is the only useful test. J Clin Neurosci 8:68692001Rosenfeld JV Siraruj S: In normal pressure hydrocephalus intracranial pressure monitoring is the only useful test. J Clin Neurosci 8:68–69 2001

    • Search Google Scholar
    • Export Citation
  • 87.

    Sahuquillo JRubio ECodina Aet al: Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called “normal pressure hydrocephalus” syndrome. Acta Neurochir 112:50611991Sahuquillo J Rubio E Codina A et al: Reappraisal of the intracranial pressure and cerebrospinal fluid dynamics in patients with the so-called “normal pressure hydrocephalus” syndrome. Acta Neurochir 112:50–61 1991

    • Search Google Scholar
    • Export Citation
  • 88.

    Sand TBovim GGrimse Ret al: Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting. Acta Neurol Scand 89:3113161994Sand T Bovim G Grimse R et al: Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting. Acta Neurol Scand 89:311–316 1994

    • Search Google Scholar
    • Export Citation
  • 89.

    Savolainen SPaljarvi LVapalahti M: Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir 141:8498531999Savolainen S Paljarvi L Vapalahti M: Prevalence of Alzheimer's disease in patients investigated for presumed normal pressure hydrocephalus: a clinical and neuropathological study. Acta Neurochir 141:849–853 1999

    • Search Google Scholar
    • Export Citation
  • 90.

    Stambrook MCardoso EHawryluk GAet al: Neuropsychological changes following the neurosurgical treatment of normal pressure hydrocephalus. Arch Clin Neuropsychol 3:3233301988Stambrook M Cardoso E Hawryluk GA et al: Neuropsychological changes following the neurosurgical treatment of normal pressure hydrocephalus. Arch Clin Neuropsychol 3:323–330 1988

    • Search Google Scholar
    • Export Citation
  • 91.

    Stein SC: Normal-pressure hydrocephalus: an update. Neurosurgery Q 11:26352001Stein SC: Normal-pressure hydrocephalus: an update. Neurosurgery Q 11:26–35 2001

    • Search Google Scholar
    • Export Citation
  • 92.

    Tans JTJ: Differentiation of normal pressure hydrocephalus and cerebral atrophy by computed tomography and spinal infusion test. J Neurol 222:1091181979Tans JTJ: Differentiation of normal pressure hydrocephalus and cerebral atrophy by computed tomography and spinal infusion test. J Neurol 222:109–118 1979

    • Search Google Scholar
    • Export Citation
  • 93.

    Thomsen AMBorgesen SEBruhn Pet al: Prognosis of dementia in normal-pressure hydrocephalus after a shunt operation. Ann Neurol 20:3043101986Thomsen AM Borgesen SE Bruhn P et al: Prognosis of dementia in normal-pressure hydrocephalus after a shunt operation. Ann Neurol 20:304–310 1986

    • Search Google Scholar
    • Export Citation
  • 94.

    Tromp CNStaal MJKalma LE: Effects of ventricular shunt treatment of normal pressure hydrocephalus on psychological functions. Z Kinderchir 44 (Suppl 1):41431989Tromp CN Staal MJ Kalma LE: Effects of ventricular shunt treatment of normal pressure hydrocephalus on psychological functions. Z Kinderchir 44 (Suppl 1): 41–43 1989

    • Search Google Scholar
    • Export Citation
  • 95.

    Tullberg MHultin LEkholm Set al: White matter changes in normal pressure hydrocephalus and Binswanger disease: specificity, predictive value and correlations to axonal degeneration and demyelination. Acta Neurol Scand 105:4174262002Tullberg M Hultin L Ekholm S et al: White matter changes in normal pressure hydrocephalus and Binswanger disease: specificity predictive value and correlations to axonal degeneration and demyelination. Acta Neurol Scand 105:417–426 2002

    • Search Google Scholar
    • Export Citation
  • 96.

    Vanneste JAugustijn PDirven Cet al: Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review. Neurology 42:54591992Vanneste J Augustijn P Dirven C et al: Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review. Neurology 42:54–59 1992

    • Search Google Scholar
    • Export Citation
  • 97.

    Vanneste JA: Diagnosis and management of normal-pressure hydrocephalus. J Neurol 247:5142000Vanneste JA: Diagnosis and management of normal-pressure hydrocephalus. J Neurol 247:5–14 2000

    • Search Google Scholar
    • Export Citation
  • 98.

    Vanneste JA: Three decades of normal pressure hydrocephalus: are we wiser now? J Neurol Neurosurg Psychiatry 57:102110251994Vanneste JA: Three decades of normal pressure hydrocephalus: are we wiser now? J Neurol Neurosurg Psychiatry 57:1021–1025 1994

    • Search Google Scholar
    • Export Citation
  • 99.

    Wechsler D: A standardized memory scale for clinical use. J Psychol 19:87951945Wechsler D: A standardized memory scale for clinical use. J Psychol 19:87–95 1945

    • Search Google Scholar
    • Export Citation
  • 100.

    Wikkelso CAndersson HBlomstrand Cet al: Computed tomography of the brain in the diagnosis of and prognosis in normal pressure hydrocephalus. Neuroradiology 31:1601651989Wikkelso C Andersson H Blomstrand C et al: Computed tomography of the brain in the diagnosis of and prognosis in normal pressure hydrocephalus. Neuroradiology 31:160–165 1989

    • Search Google Scholar
    • Export Citation
  • 101.

    Wikkelso CAndersson HBlomstrand Cet al: Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid taptest. Acta Neurol Scand 73:5665731986Wikkelso C Andersson H Blomstrand C et al: Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid taptest. Acta Neurol Scand 73:566–573 1986

    • Search Google Scholar
    • Export Citation
  • 102.

    Wood JHBartlet DJames AE Jret al: Normal-pressure hydrocephalus: diagnosis and patient selection for shunt surgery. Neurology 24:5175261974Wood JH Bartlet D James AE Jr et al: Normal-pressure hydrocephalus: diagnosis and patient selection for shunt surgery. Neurology 24:517–526 1974

    • Search Google Scholar
    • Export Citation
  • 103.

    Zimmerman RDFleming CALee BCet al: Periventricular hyperintensity as seen by magnetic resonance: prevalence and significance. AJR 146:4434501986Zimmerman RD Fleming CA Lee BC et al: Periventricular hyperintensity as seen by magnetic resonance: prevalence and significance. AJR 146:443–450 1986

    • Search Google Scholar
    • Export Citation

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 490 490 14
Full Text Views 165 121 2
PDF Downloads 125 106 1
EPUB Downloads 0 0 0

PubMed

Google Scholar