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At least 127 records · Page 7Linked to original sources

PubMed1990

Cauda equina neurinoma associated with normal pressure hydrocephalus--case report.

A 45-year-old male was hospitalized because of gait disturbance, urinary incontinence, and memory disturbance. A computed tomographic (CT) scan revealed dilatation of the cerebral ventricles, and a metrizamide CT scan showed reflux into all ventricles. Cerebrospinal fluid obtained at the time of metrizamide CT was highly xanthochromic. Myelograms demonstrated a tumor between the inferior portion of the fifth lumbar vertebra and that of the second sacral vertebra. After removal of a spinal tumor involving nerve fibers at the cauda equina, his symptoms disappeared and the spinal fluid protein normalized. Three months after surgery, a CT scan revealed reduction of cerebral ventricular size. There are 10 reported cases of spinal tumors resulting in normal pressure hydrocephalus. All these and present cases involved protein in the spinal fluid, which might have been the cause of the hydrocephalus.

Cauda Equina↗

PubMed1984

[A biological rhythm in a patient with normal pressure hydrocephalus--comparative studies in pre- and postoperative patients by a polygraphy].

The authors had studies the correlation between the appearance of the pressure waves and the level of the sleep in pre- and postoperative patients with normal pressure hydrocephalus (NPH). The changes from preoperative findings to postoperative ones were discussed in detail with the relation of the pathophysiological state in these patients. Seventeen patients were evaluated for the suspected diagnosis of the disease of NPH. Thirteen patients of them were treated with ventriculo-peritoneal shunts. Four representative cases among them were evaluated by pre- and postoperative polygraphic studies. A polygraphic overnight study includes a monitoring of an intracranial pressure (ICP), electroencephalography (EEG), electrooculography (EOG), respiratory movement and electromyography (EMG). Each data was recorded for the analysis on data recorder using a computer system. A pressure waves (largely B type) appeared accompanied with an apnea at a resting state (so-called sleep) of each patients. An arousal response in EEG was also observed in the raising period of the pressure waves. At the peak respiration was resumed with transient activities in EMG and continued to the disappearance of the pressure wave. Pressure waves were observed frequently and continually in hours in the resting state of these patients. As a result the level of sleep alternated frequently between an awake stage and a stage 1, including extremely rare appearance of stage 2. In short, the level of sleep was frequently interrupted by the appearance of the pressure waves and apneas. Such pathological states of patient's sleep were involved in the entity of the sleep apnea syndrome.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1999

[Normal pressure hydrocephalus in an elderly patient].

INTRODUCTION: Idiopathic normal pressure hydrocephalus is a disease that most frequently concerns subjects of an advanced age. It is not easy to establish a definitive diagnosis, and the practitioner frequently encounters decision-making problems regarding the following question: should a shunt be performed, or not? Opinions remain contradictory, even though the available scientific data is increasingly precise. The aim of this review is to analyze the physiopathogenic, clinical, paraclinical and therapeutic data associated with this type of hydrocephalus. CURRENT KNOWLEDGE AND KEY POINTS: If the clinical triad is determinant, no other investigation is in fact necessary to confirm the diagnosis, although it should always be questioned in the case of ventricular enlargement determined by tomodensitometry. The decision to perform the only efficient procedure, i.e., a ventricular shunt operation, depends upon a number of established arguments in favor of that procedure. Clinical improvement, which is often spectacular, can then confirm the diagnosis. FUTURE PROSPECTS AND PROJECTS: The efficacy of surgical treatment has been confirmed by clinical studies, and there is a reduced tendency as regards post-operative complications. However, each case should be considered individually and with the cooperation of and coordination between the family, the physician and the neurosurgeon.

Aged↗

PubMed1991

Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus.

Seventy four consecutive patients diagnosed as normal pressure hydrocephalus (NPH) and operated with a ventriculo-peritoneal shunt were followed prospectively for an average of 2.1 years. The mean age was 64 years. The effect of the operation was estimated by calculating 6 indices expression social functioning, neurological signs, gait ability, continence, psychometric performance and psychiatric condition. Ninety-six % had mental symptoms, 95% gait disturbances and 75% incontinence. Improvement was observed in 78% after shunt surgery, while 22% deteriorated. Psychiatric improvement was seen in 80% and 76% improved in gait ability. Improvement was highest in the group caused by subarachnoid hemorrhage (98%) while 73% with idiopathic NPH improved. Old age was not correlated to poorer response, while long-standing pre-operative symptoms yielded worse results. No single symptom or sign could predict a positive outcome of the operation. Eleven % of the patients could leave long-term care institutions and there was a 36% reduction of aid in daily living. Complications to shunt surgery were observed in 50% of the patients and shunt related mortality was 1%. Shunt malfunction was the most frequent complication (31%) followed by infection (19%). Epilepsy developed in 9% after surgery. All shunt complication except one appeared within the first year after surgery.

Activities of Daily Living↗

PubMed1977

Psychiatric and behavioral manifestations of normal pressure hydrocephalus. A case report and brief review.

Normal pressure hydrocephalus (NPH) may suggest its presence by behavioral symptoms. Initally, the symptoms often manifest themselves as depression with marked psychomotor retardation. Older patients without a prior psychiatric history who have soft, nonlocalizing neurological signs and fluctuating cognitive and memory deficits in association with prominent affective and/or psychotic symptomatology of recent onset, such as the case reported here, should raise the clinician's index of suspicion. In such cases, the Halstead-Reitan neuropsychological battery may be helpful in differentiating an underlying dementia from a primary psychological dysfunction. When the presence of a dementing process is suspected, etiological diagnosis should be vigorously pursued with a CAT scan and, as indicated on clinical grounds, confirmatory and further delimiting studies such as pneumoencephalography, ventriculography, RISA scanning, electroencephalography, constant-infusion manometric testing, and/or angiography. Treatment of NPH includes one of several forms of shunting procedures and appropriate neuroleptic therapy for behavioral symptoms. Althoug there is a substantial risk (40 to 50 percent)ioral symptoms. Although there is a substantial risk (40 to 50 per cent) of shunt-related complications, as many as 60 per cent of operated patients will show objective imprvement, making the diagnosis of and referral for appropriate surgical treatment of NPH an important challenge for the psychiatrist.

Delusions↗

PubMed2003

Normal pressure hydrocephalus found after anesthesia--a case report.

Normal pressure hydrocephalus (NPH) is characterized by insidious onset and gradual development of the triad of gait disturbance, dementia, and urinary incontinence. Nausea, vomiting, and signs of increased intracranial pressure do not occur. A 71-year-old male patient was scheduled for total knee replacement due to osteoarthritis of right knee joint. No neurological symptoms and signs except mild forgetfulness were detected during physical examination following admission. Due to operational mistakes, the anesthesiologist was informed that the surgery was cancelled just after completion of induction of general anesthesia. The patient was allowed to emerge from anesthesia. Unfortunately, his consciousness became drowsy the next morning. After a series of examinations, he was at last diagnosed as a case of NPH principally by the brain computed tomography scan. So he was scheduled again but this time for vetriculoperitoneal (V-P) shunt. The patient regained consciousness after V-P shunt. From this case, we learned that NPH may remain in concealment in the patients we contacted in our daily practice. A vigilant physician should keep in mind that the presentation of gait disturbance, dementia, and urinary incontinence in a patient may indicate the likelihood of NPH.

Aged↗

PubMed1998

Comparison of Pcsf monitoring and controlled CSF drainage diagnose normal pressure hydrocephalus.

We evaluated 86 patients for possible normal pressure hydrocephalus (NPH) by: 1) CSF pressure (Pcsf) monitoring and analysis for percent of time with A or B-waves, and 2) controlled CSF drainage for 3 days via a lumbar subarachnoid catheter. Clinical outcome after CSF drainage and shunt surgery was assessed as change of clinical exam, with grades of none, minor, moderate, or marked change. For outcome analysis in 47 patients after shunt surgery, NPH was defined as moderate or marked clinical improvement. We assessed the diagnostic discrimination of percent-of-time thresholds of A and B-waves for 38 patients. At 10%, sensitivity for NPH is 91%, specificity is 13%, positive predictive value (PPV) is 62%, and the false positive rate is 38%. At the 25% threshold, sensitivity is 78%, specificity is 40%, PPV is 67%, false positive rate is 33%, and the false negative rate is 22%. For CSF drainage (threshold of minor improvement or better), the sensitivity is 97%, specificity is 60%, PPV is 84%, negative predictive value (NPV) is 90%, and the false negative rate is 3%. We conclude: 1) clinical response to controlled CSF drainage accurately predicts the outcome after shunt surgery in patients suspected of having NPH, and 2) A or B-waves poorly predict which patients will respond to shunt surgery. Three days of CSF drainage seems to encompass critical thresholds of CSF volume removal or duration of Pcsf reduction necessary for neuronal function to begin returning and symptoms to begin resolving in patients with NPH.

Catheters, Indwelling↗

PubMed1981

Normal pressure hydrocephalus in the elderly: a treatable cause of dementia?

Although normal pressure hydrocephalus is one of the few remediable causes of dementia, the diagnosis is often not considered in the elderly. Three patients are described who presented to an acute geriatric unit within a six-month period during which normal pressure hydrocephalus was actively sought and treated. Although two made striking initial improvement, the long-term prognosis was poor: complications were frequent, and all three died within two years of operation. This pilot study indicates that normal pressure hydrocephalus may account for a proportion of cases of 'senile' dementia, but that formal controlled studies are required to establish the best means of diagnosis and treatment.

Aged↗

PubMed2005

Preoperative spinal hydrodynamics versus clinical change 1 year after shunt treatment in idiopathic normal pressure hydrocephalus patients.

Nineteen consecutive cases treated for idiopathic normal pressure hydrocephalus (iNPH) with ventriculo-peritoneal shunts were clinically followed prospectively. Change in clinical state one year after shunt surgery was assessed as change on a 15-3 score NPH Grade Scale. Preoperative spinal hydrodynamics were assessed using a constant-rate lumbar infusion test. The pressure recordings were stored as raw data files and analysed retrospectively with regard to the mean cerebrospinal fluid pressure (CSFP), as well as mean CSFP wave amplitudes. Changes in NPH score 1 year after shunt surgery correlated significantly with the levels of single CSFP wave amplitudes, but not with the lumbar resistance to CSF outflow (R(out)). Mean CSFP wave amplitude was thus, in this cohort, a better predictor of clinical change one year after shunt treatment than R(out).

Aged↗

PubMed1981

The preselection value of the Doppler LP test for shunt-therapy in patients with normal pressure hydrocephalus.

The results of this study confirm the hypothesis that the simple innocuous Doppler LP test may be useful in obtaining information about CSFP-CBF (cerebrospinal fluid pressure-cerebral blood flow) relationships. The value of this test in predicting the clinical outcome of CSF shunting in patients with normal pressure hydrocephalus (NPH) was studied. Fourteen patients with NPH were examined; eight patients showed a positive and six patients a negative Doppler LP test. Seven of the eight patients with a positive test improved following the shunting procedure, but none of the six patients improved after operation. This study suggests that the Doppler LP test is a useful preoperative selection test in patients with NPH. In addition this study supports the hypothesis that CBF autoregulation may be impaired with NPH.

Adolescent↗

PubMed1995

Differing scintigraphic patterns of lumboperitoneal shunt dysfunction in patients with normal pressure hydrocephalus and pseudotumor cerebri.

The scintigraphic patterns of dysfunctioning lumboperitoneal shunts (LPS) may vary with the underlying disease. The authors reviewed 22 LPS studies performed on 15 patients during the past 2 years and correlated the findings with the patency status of the shunt as determined by brain CT/MRI and surgical revision. Most of the patients also had cerebrospinal fluid (CSF) pressure monitoring. Fifteen studies were performed in patients with LPS for the treatment of normal pressure hydrocephalus (NPH) and 7 were performed in patients with LPS for pseudotumor cerebri (PTC). After intrathecal administration of 0.5-1 mCi of In-111 DTPA, sequential 1 minute images of the abdomen were obtained for 20 minutes. Static images of the abdomen were then obtained at 30 minutes and 1, 2, 4, and 24 hours with imaging of the head at 4 and 24 hours. All NPH patients with partial obstruction had tracer activity in the peritoneal cavity with little or no shunt tubing visualization. However, all had marked penetration of the tracer into the lateral ventricles. Pseudotumor cerebri patients with partial obstruction also showed tracer entry into the peritoneal cavity. Shunt tubing and tracer extravasation into the needle tract, at the site of lumbar puncture was seen only in patients of PTC, probably because of high intracranial pressure. Although the tracer flowed quickly into the basal cistern in all patients with PTC, it entered the lateral ventricles. Complete shunt obstruction was characterized by nonvisualization of activity in the peritoneal cavity and flow of the tracer into the basal cistern within 1 hour after injection.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1991

[Binswanger's disease with normal pressure hydrocephalus. Case report].

A 72-year-old hypertensive male was hospitalized with progressive gait disturbance (small step gait), urinary incontinence, and dementia. Computed tomography (CT) showed ventriculomegaly with periventricular lucency. T2-weighted magnetic resonance imaging revealed wide periventricular high-signal intensity and small infarctions in the basal ganglia. CT cisternography demonstrated ventricular stasis and convexity stasis of the contrast medium. Continuous intracranial pressure monitoring showed increased B wave percentage, low pressure volume index, and high outflow resistance. These findings indicated the coexistence of normal pressure hydrocephalus. After ventriculoperitoneal shunting, gait disturbance was greatly improved and urinary incontinence disappeared. The development of Binswanger's disease may be partially due to disturbed cerebrospinal fluid (CSF) dynamics. The possible pathophysiology of CSF dynamics in relation to Binswanger's disease is discussed. Detailed investigations of CSF dynamics are important in patients with Binswanger's disease, especially in the early stage.

Aged↗

PubMed1986

Non-tumoural aqueduct stenosis and normal pressure hydrocephalus in the elderly.

From 1981 to 1985 a prospective study on normal pressure hydrocephalus was performed. One of the aims of this study was to determine the site of CSF obstruction. Among 17 consecutive patients with a tentative diagnosis of normal pressure hydrocephalus, nine appeared to have non-communicating hydrocephalus most probably due to primary non-tumoural aqueduct stenosis. This unexpected finding provides evidence that non-tumoural aqueduct stenosis is a frequent cause of normal pressure hydrocephalus in older patients. Some clinical, aetiological and therapeutic aspects in this particular subgroup are discussed.

Aged↗

PubMed1988

Outcome of shunt operation on urinary incontinence in normal pressure hydrocephalus predicted by lumbar puncture.

Bladder function in four patients with normal pressure hydrocephalus, one with dementia of Alzheimer type and five patients with multi-infarct dementia was studied by history and urodynamic tests (cystometry and Bor's ice water test). The bladder hyperactivity could be temporarily improved by a lumbar puncture and removal of 50 ml CSF and later abolished by a shunt operation in patients with normal pressure hydrocephalus while no changes occurred in the other patients. Urodynamic testing in connection with a lumbar puncture may be a reliable way to predict the outcome of a shunt operation in cases of normal pressure hydrocephalus.

Aged↗

PubMed2005

Diagnosing idiopathic normal-pressure hydrocephalus.

OBJECTIVE: The precise incidence and prevalence of idiopathic normal-pressure hydrocephalus (INPH) is not known, and evidence-based clinical diagnostic criteria have not been developed previously. This report contains evidence-based guidelines for clinical diagnosis of INPH that are intended to facilitate future epidemiological studies of INPH, promote earlier and more accurate diagnosis, and ultimately improve treatment outcome. METHODS: The criteria for the diagnosis of INPH are based on evidence from the medical literature, supplemented as necessary by expert opinion. From 1966 to 2003, 653 publications on "normal-pressure hydrocephalus" were cited in MEDLINE, including 29 articles that met the more stringent criteria of including "idiopathic normal-pressure hydrocephalus" in their title. Additional studies were considered that explicitly identified INPH cases and/or specified the criteria for a diagnosis of INPH. Studies were graded according to the class of evidence and results summarized in evidentiary tables. For issues of clinical relevance that lacked substantive evidence from the medical literature, the opinions of consulting experts were considered and contributed to "Options." RESULTS: Evidence-based guidelines for the clinical diagnosis of INPH have been developed. A detailed understanding of the range of clinical manifestations of this disorder and adherence to practice guidelines should improve the timely and accurate recognition of this disorder. CONCLUSION: It is recommended that INPH be classified into probable, possible, and unlikely categories. We hope that these criteria will be widely applied in clinical practice and will promote greater consistency in patient selection in future clinical investigations involving INPH.

Behavioral Symptoms↗

PubMed2002

The importance of the intrathecal infusion test in the diagnosis of normal pressure hydrocephalus.

The intrathecal infusion test is a reliable method in diagnosing normal pressure hydrocephalus. Between May 1982 and January 2000 we investigated 300 patients suspected of having normal pressure hydrocephalus (NPH) by carrying out an intrathecal infusion test in a constant flow technique. The resistance to cerebrospinal fluid outflow (R(out)) in the intrathecal infusion test was the main criterion of grouping patients into those with normal pressure hydrocephalus or those with cerebral atrophy. A further differentiation into early stage and late stage was made by measuring the compliance (C(p)) - this being the secondary criterion. In 162 patients (54%) the diagnosis of NPH could be confirmed. Of these, 154 patients (95%) underwent a shunt operation. Graduation of NPH and cerebral atrophy following the results of the infusion test at an early stage and an advanced stage allow the conclusion of prognostic evaluations about the course of disease to be made. Patients with NPH in an early stage report in the follow up an improvement of their symptoms after a shunt operation in 65 percent of cases, and those with advanced stage NPH, in 50 percent of cases. The computer aided infusion test allows a reliable differentiation between patients with NPH and those with cerebral atrophy.

Atrophy↗

PubMed1981

Normal pressure hydrocephalus in the newborn.

The entity of normal pressure hydrocephalus (NPH) following intraventricular hemorrhage in the newborn has been characterized. Of 87 infants with intraventricular hemorrhage, 20 had early and rapidly progressive hydrocephalus with intracranial hypertension and/or death. In 47 cases there was no increase in ventricular size and in 20 cases there was progressive increase in ventricular size with normal intracranial pressure, ie, NPH. Of these infants with NPH, nine had spontaneous arrest with or without resolution of ventriculomegaly, beginning within 31 days of onset. In 11 cases, after a stable period of NPH lasting 12 to 84 days, there was progressive increase in ventricular size accompanied ultimately by raised intracranial pressure. A relationship between the degree of ventriculomegaly and severity of intraventricular hemorrhage was demonstrated. The data thus define a state of NPH after intraventricular hemorrhage and indicate that approximately half of such cases will not develop progressive hydrocephalus with increased intracranial pressure. If arrest or onset of resolution of ventriculomegaly is not apparent within approximately one month, continued progression and necessity for intervention are to be expected. Serial measurements of intracranial pressure and ventricular size in newborns with posthemorrhagic ventricular dilation allow the diagnosis of NPH and permit early recognition of rapidly progressive ventricular dilation with intracranial hypertension which may follow a stable period of NPH. Such early recognition of this potentially harmful state allows prompt ventricular drainage, thereby preventing brain compression.

Cerebral Hemorrhage↗

PubMed1992

Significance of periventricular hemodynamics in normal pressure hydrocephalus.

To delineate the pathophysiology of periventricular hemodynamics in normal pressure hydrocephalus, we performed quantitative and three-dimensional measurements of cerebral blood flow (CBF) by using xenon-enhanced computed tomographic scans. Measurements were made on 7 patients in whom normal pressure hydrocephalus after subarachnoid hemorrhage had been confirmed by clinical improvement after shunting. We compared mean CBF values in the white matter and cortex of the frontal, temporal, parietal, and occipital lobes and in the thalamus before and after shunting, with an evaluation of dementia and the extent of ventricular dilation and periventricular lucency on computed tomographic scans. CBF returned to within normal limits in the white matter of the frontal and temporoparieto-occipital lobes. CBF restoration closely correlated with clinical improvement and reduction in ventricular dilation and periventricular lucency. We speculate that ischemia occurs initially in the periventricular white matter as a result of diffused cerebrospinal fluid and then extends of the cortex and to the thalamus, causing a "misery perfusion" state with neuronal dysfunction. Incomplete improvement of dementia and CBF in the cortex and thalamus may be explained by preexisting arteriosclerosis in aged patients, coexisting brain damage caused by subarachnoid hemorrhage and subsequent surgical insult in aneurysm patients, and delayed recovery of cortical function that has been secondarily impaired by the periventricular lesions.

Aged↗