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Related Experiment Video

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Modeling Posthemorrhagic Hydrocephalus of Prematurity in Rats
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Neuroimaging in normal pressure hydrocephalus.

Benito Pereira Damasceno1

  • 1MD, PhD, Department of Neurology, Medical School, University of Campinas (UNICAMP), Campinas SP, Brazil.

Dementia & Neuropsychologia
|December 8, 2017
PubMed
Summary

Normal pressure hydrocephalus (NPH) diagnosis relies on clinical signs and imaging. The CSF tap-test is crucial for predicting shunt surgery success in NPH patients.

Keywords:
cerebrospinal fluid tap testmagnetic resonanceneuroimagingnormal pressure hydrocephalusshunt surgery

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Area of Science:

  • Neurology
  • Neurosurgery
  • Radiology

Background:

  • Normal pressure hydrocephalus (NPH) presents with gait disturbance, cognitive decline, and incontinence, often with atypical or incomplete symptoms.
  • Accurate diagnosis and prediction of surgical outcomes are challenging due to overlapping conditions and the need for supplementary tests.

Purpose of the Study:

  • To review diagnostic criteria and prognostic indicators for Normal pressure hydrocephalus (NPH).
  • To evaluate the role of the cerebrospinal fluid (CSF) tap-test and neuroimaging in NPH management.

Main Methods:

  • Review of clinical presentation, CSF tap-test protocols, and CT/MRI findings in NPH diagnosis.
  • Analysis of international guidelines for NPH diagnosis and shunt-responsive patient selection.

Main Results:

  • The CSF tap-test, particularly continuous lumbar drainage, shows high sensitivity and positive predictive value for predicting shunt response.
  • Specific CT/MRI findings, including disproportionate ventricular enlargement (Evans index >0.3), periventricular hyperintensities, and corpus callosum changes, are key diagnostic indicators.
  • Other advanced imaging techniques are suitable for diagnosis but lack proven superiority in predicting shunt responsiveness.

Conclusions:

  • The CSF tap-test remains the gold standard for predicting shunt responsiveness in NPH.
  • Standardized CT and MRI criteria are essential for diagnosing NPH and selecting patients for surgery.