[Normal pressure hydrocephalus: A review and practical aspects]

Area of Science:

• Neurology
• Geriatrics
• Neurosurgery

Context:

• Idiopathic normal pressure hydrocephalus (iNPH) is a chronic neurological disorder impacting the elderly population.
• Diagnosis is complicated by overlapping symptoms with conditions like Alzheimer's disease and microangiopathy.
• Established diagnostic criteria include Adams and Hakim's triad, ventricular dilation on imaging, and normal cerebrospinal fluid pressure.

Purpose:

• To establish a comprehensive standard of care for diagnosing idiopathic normal pressure hydrocephalus.
• To synthesize evidence from 459 articles published over the last decade.
• To provide guidance for clinicians facing diagnostic challenges in iNPH.

Summary:

• Brain MRI is crucial for iNPH diagnosis, with specific features predicting positive tap test results and shunt responsiveness.
• The tap test remains the gold standard for diagnosis, though continuous cerebrospinal fluid drainage offers improved sensitivity.
• Cerebrospinal fluid Alzheimer's biomarker analysis may aid diagnosis in ambiguous cases, predicting tap test response.

Impact:

• A standardized approach to iNPH diagnosis can improve patient outcomes.
• Enhanced diagnostic accuracy leads to more timely and appropriate treatment interventions.
• This review provides a foundation for future research and clinical guidelines in iNPH management.