The grading of normal pressure hydrocephalus

Area of Science:

• Neurosurgery
• Neurology

Background:

• Normal pressure hydrocephalus (NPH) diagnosis and management require reliable assessment tools.
• Existing grading scales may not be optimal for NPH patient evaluation.

Purpose of the Study:

• To evaluate the effectiveness of the Black-Grading-Scale and the Kiefer scale for assessing normal pressure hydrocephalus (NPH).
• To identify a reliable bedside examination for grading NPH.

Main Methods:

• A 15-year study involving 200 patients suspected of NPH.
• Intrathecal infusion tests were used for diagnosis confirmation in 107 patients (54%).
• The Black-Grading-Scale and Kiefer scale were used for pre- and post-operative assessment and 7-month follow-up.

Main Results:

• The Black-Grading-Scale could not differentiate between stable and worsening NPH symptoms.
• The Kiefer scale demonstrated reliability for grading and long-term follow-up of NPH.
• A novel NPH-Recovery-Rate, based on the Kiefer scale, was developed for interindividual comparison.

Conclusions:

• The Kiefer scale is recommended as the most reliable tool for NPH grading and follow-up.
• The Black-Grading-Scale is not appropriate for NPH assessment.
• The NPH-Recovery-Rate offers a standardized method for comparing NPH patient outcomes.