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Communicating chronic hydrocephalus: A review.

P Roblot1, O Mollier2, M Ollivier3

  • 1Neurosurgery department A, university hospital of Bordeaux, place Amélie-Raba-Léon, Bordeaux, France; Laboratory of anatomy, university of Bordeaux, Bordeaux, France.

La Revue De Medecine Interne
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PubMed
Summary

Communicating chronic hydrocephalus (CCH) involves cerebrospinal fluid (CSF) resorption defects. Early CSF shunt treatment can significantly improve motor function in patients over 60.

Keywords:
CSF tap testCommunicating chronic hydrocephalusHydrocéphalie chronique communicanteHydrocéphalie à pression normaleLumbar punctureNormal pressure hydrocephalusPonction lombaireTests hydrodynamiques

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Area of Science:

  • Neurology
  • Neurosurgery
  • Geriatrics

Background:

  • Communicating chronic hydrocephalus (CCH), previously normal pressure hydrocephalus, affects 0.1-0.5% of individuals over 60.
  • Pathophysiology is often linked to cerebrospinal fluid (CSF) resorption defects, with recent insights implicating the glymphatic system.
  • Frequent comorbidities like Alzheimer's disease and parkinsonism complicate diagnosis.

Purpose of the Study:

  • To elucidate the diagnostic challenges and treatment efficacy of CCH.
  • To highlight the role of the glymphatic system in CCH.
  • To emphasize the importance of early diagnosis and intervention.

Main Methods:

  • Clinical assessment based on the Hakim and Adams triad (gait, cognitive, and sphincter disorders).
  • Magnetic resonance imaging (MRI) to identify ventriculomegaly and CSF resorption signs.
  • Diagnostic confirmation via clinical response to CSF depletion and subsequent shunt placement.

Main Results:

  • Early diagnosis and treatment with CSF shunts lead to significant motor improvement (75-90%).
  • Effectiveness of shunt treatment confirms the diagnosis of CCH.
  • Timely intervention is crucial for optimal patient outcomes.

Conclusions:

  • CCH diagnosis relies on a combination of clinical presentation, MRI findings, and response to CSF management.
  • CSF shunting is the standard treatment, with effectiveness validating the diagnosis.
  • Prompt treatment is associated with better motor recovery in CCH patients.