Idiopathic normal-pressure hydrocephalus

Results of shunting in 62 patients

Restricted access

✓ Of 62 patients given shunts for normal-pressure hydrocephalus of idiopathic type, 46.8% showed some improvement and 27.4% enjoyed virtually complete recovery. The best clinical predictor of good response was the complete triad of memory difficulty, gait disorder, and urine incontinence; 61.2% of patients with this combination of symptoms improved. Gait disturbance alone was also accompanied by improvement in two of three patients. An “obstructive” cisternographic radioisotope pattern was not significantly different from a “normal” pattern in predicting a response to shunting. Computerized tomography (CT) showing large ventricles and little atrophy predicted improvement in 11 out of 13 patients. There were five deaths within 3 months of shunting. The complication rate was 35.4%; subdural collections, shunt malfunction, and postoperative seizures constituted the most frequent complications.

These data suggest that continued investigation for better predictions of shunt response is important, but that in the meantime the clinical pattern and cranial CT pattern are the most satisfactory guides to improvement after shunting.

Article Information

Contributor Notes

Address reprint requests to: Peter McL. Black, M.D., Neurosurgical Service, Massachusetts General Hospital, Boston, Massachusetts 02114.
Headings
References
  • 1.

    Adams RDFisher CMHakim S et 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.

    Black PMSweet WH: Normal pressure hydrocephalus — idiopathic type selection of patients for shunting procedures in Wüllenweber RBrock MHamer J (eds): Lumbar Disc. Adult Hydrocephalus. Vol 4: Advances in Neurosurgery. Berlin/Heidelberg/New York: Springer-Verlag1977 pp 106110Black PM Sweet WH: Normal pressure hydrocephalus — idiopathic type selection of patients for shunting procedures in Wüllenweber R Brock M Hamer J (eds): Lumbar Disc. Adult Hydrocephalus. Vol 4: Advances in Neurosurgery. Berlin/Heidelberg/New York: Springer-Verlag 1977 pp 106–110

    • Search Google Scholar
    • Export Citation
  • 3.

    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
  • 4.

    Croxton FE: Elementary Statistics with Applications in Medicine and Biological Sciences. New York: Dover1953Croxton FE: Elementary Statistics with Applications in Medicine and Biological Sciences. New York: Dover 1953

    • Search Google Scholar
    • Export Citation
  • 5.

    Fisher CM: The clinical picture in occult hydrocephalus. Clin Neurosurg 24:2702841977Fisher CM: The clinical picture in occult hydrocephalus. Clin Neurosurg 24:270–284 1977

    • Search Google Scholar
    • Export Citation
  • 6.

    Greenberg JOShenkin HAAdam R: Idiopathic normal pressure hydrocephalus — a report of 73 patients. J Neurol Neurosurg Psychiatry 40:3363411977Greenberg JO Shenkin HA Adam R: Idiopathic normal pressure hydrocephalus — a report of 73 patients. J Neurol Neurosurg Psychiatry 40:336–341 1977

    • Search Google Scholar
    • Export Citation
  • 7.

    Gunasekera LRichardson AE: Computerized axial tomography in idiopathic hydrocephalus. Brain 100:7497541977Gunasekera L Richardson AE: Computerized axial tomography in idiopathic hydrocephalus. Brain 100:749–754 1977

    • Search Google Scholar
    • Export Citation
  • 8.

    Heinz ERDavis DOKarp HR: Abnormal isotope cisternography in symptomatic occult hydrocephalus. A correlative isotopic-neuroradiological study in 130 subjects. Radiology 95:1091201970Heinz ER Davis DO Karp HR: Abnormal isotope cisternography in symptomatic occult hydrocephalus. A correlative isotopic-neuroradiological study in 130 subjects. Radiology 95:109–120 1970

    • Search Google Scholar
    • Export Citation
  • 9.

    Illingworth RD: Subdural haematoma after the treatment of chronic hydrocephalus by ventriculocaval shunts. J Neurol Neurosurg Psychiatry 33:95991970Illingworth RD: Subdural haematoma after the treatment of chronic hydrocephalus by ventriculocaval shunts. J Neurol Neurosurg Psychiatry 33:95–99 1970

    • Search Google Scholar
    • Export Citation
  • 10.

    Jacobs LConti DKinkel W et al: “Normal-pressure” hydrocephalus. Relationship of clinical and radiographic findings to improvement following shunt surgery. JAMA 235:5105121976Jacobs L Conti D Kinkel W 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
  • 11.

    Jacobs LKinkel W: Computerized axial transverse tomography in normal pressure hydrocephalus. Neurology 26:5015071976Jacobs L Kinkel W: Computerized axial transverse tomography in normal pressure hydrocephalus. Neurology 26:501–507 1976

    • Search Google Scholar
    • Export Citation
  • 12.

    Laws ER JrMokri B: Occult hydrocephalus. Results of shunting correlated with diagnostic tests. Clin Neurosurg 24:3163331977Laws ER Jr Mokri B: Occult hydrocephalus. Results of shunting correlated with diagnostic tests. Clin Neurosurg 24:316–333 1977

    • Search Google Scholar
    • Export Citation
  • 13.

    McCullough DCFox JL: Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma. J Neurosurg 40:3723751974McCullough DC Fox JL: Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma. J Neurosurg 40:372–375 1974

    • Search Google Scholar
    • Export Citation
  • 14.

    McCullough DCHarbert JCDi Chiro G et al: Prognostic criteria for cerebrospinal fluid shunting from isotope cisternography in communicating hydrocephalus. Neurology 20:5945981970McCullough DC Harbert JC Di Chiro G et al: Prognostic criteria for cerebrospinal fluid shunting from isotope cisternography in communicating hydrocephalus. Neurology 20:594–598 1970

    • Search Google Scholar
    • Export Citation
  • 15.

    Ojemann RG: Normal pressure hydrocephalus. Clin Neurosurg 18:3373691971Ojemann RG: Normal pressure hydrocephalus. Clin Neurosurg 18:337–369 1971

    • Search Google Scholar
    • Export Citation
  • 16.

    Salmon JH: Adult hydrocephalus. Evaluation of shunt therapy in 80 patients. J Neurosurg 37:4234281972Salmon JH: Adult hydrocephalus. Evaluation of shunt therapy in 80 patients. J Neurosurg 37:423–428 1972

    • Search Google Scholar
    • Export Citation
  • 17.

    Shenkin HAGreenberg JBouzarth WF et al: Ventricular shunting for relief of senile symptoms. JAMA 225:148614891973Shenkin HA Greenberg J Bouzarth WF et al: Ventricular shunting for relief of senile symptoms. JAMA 225:1486–1489 1973

    • Search Google Scholar
    • Export Citation
  • 18.

    Stein SCLangfitt TW: Normal pressure hydrocephalus. Predicting the results of cerebrospinal fluid shunting. J Neurosurg 41:4634691974Stein SC Langfitt TW: Normal pressure hydrocephalus. Predicting the results of cerebrospinal fluid shunting. J Neurosurg 41:463–469 1974

    • Search Google Scholar
    • Export Citation
  • 19.

    Symon LHinzpeter T: The enigma of normal pressure hydrocephalus: tests to select patients for surgery and to predict shunt function. Clin Neurosurg 24:2853151977Symon L Hinzpeter T: The enigma of normal pressure hydrocephalus: tests to select patients for surgery and to predict shunt function. Clin Neurosurg 24:285–315 1977

    • Search Google Scholar
    • Export Citation
  • 20.

    Udvarhelyi GBWood JHJames AE Jr et al: Results and complications in 55 shunted patients with normal pressure hydrocephalus. Surg Neurol 3:2712751975Udvarhelyi GB Wood JH James AE Jr et al: Results and complications in 55 shunted patients with normal pressure hydrocephalus. Surg Neurol 3:271–275 1975

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 386 223 24
Full Text Views 359 57 3
PDF Downloads 152 40 3
EPUB Downloads 0 0 0
PubMed
Google Scholar