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In healthcare diagnostics, laboratory tests play a crucial role in identifying and diagnosing a wide range of medical conditions. However, interpreting test results is not always straightforward. An abnormal test result does not always confirm the presence of a disease, just as a normal result does not guarantee its absence. To assess the reliability of these diagnostic tools, healthcare practitioners rely on two key statistical indicators: sensitivity and specificity.
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Related Experiment Video

Updated: Feb 17, 2026

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
14:59

Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus

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Normal pressure hydrocephalus: Diagnostic and predictive evaluationon.

Benito Pereira Damasceno1

  • 1Unidade de Neuropsicologia e Neurolinguística, Departamento de Neurologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, SP, Brazil.

Dementia & Neuropsychologia
|December 8, 2017
PubMed
Summary

Normal pressure hydrocephalus (NPH) diagnosis is challenging with atypical presentations. The CSF tap test and repeated lumbar drainage best predict shunt surgery success in NPH patients.

Keywords:
cerebrospinal fluid tap testneuropsychological testsnormal pressure hydrocephalusshunt surgery

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Area of Science:

  • Neurosurgery
  • Neurology
  • Diagnostic Imaging

Background:

  • Normal pressure hydrocephalus (NPH) typically presents with gait disturbance, cognitive decline, and urinary incontinence.
  • Diagnostic challenges arise in 25-50% of cases due to atypical or incomplete NPH manifestations, or when mimicked by other conditions.

Purpose of the Study:

  • To review clinical presentation, neuroimaging, and prognostic tests for NPH.
  • To focus on selecting appropriate candidates for shunt surgery.

Main Methods:

  • Literature search of PubMed from 1966 to present.
  • Analysis of diagnostic methods including radionuclide cisternography, intracranial pressure monitoring (ICP), and cerebrospinal fluid (CSF) tap tests (CSF-TT).

Main Results:

  • Typical NPH cases are diagnosed easily and improve with shunting.
  • Atypical NPH or mimicked conditions require complementary tests to predict surgical outcomes.
  • The CSF tap test (CSF-TT) is the only test to simulate shunt effects, but low sensitivity necessitates repeated CSF-TT (RTT) or lumbar external drainage (LED).

Conclusions:

  • Positive RTT or LED, combined with B-waves during ICP monitoring, offers the most reliable prediction of shunt success in NPH.
  • Accurate patient selection for NPH shunt surgery is critical, especially in complex cases.