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Normal-Pressure Hydrocephalus - Patient Evaluation and Decision-Making.

Deepti Vibha1, Manjari Tripathi1

  • 1Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.

Neurology India
|February 1, 2022
PubMed
Summary

Idiopathic normal-pressure hydrocephalus (iNPH) is a treatable cause of gait and cognitive issues. This review guides diagnosis and management, distinguishing iNPH from secondary causes for better patient outcomes.

Keywords:
Cerebrospinal fluiddiagnosislumbar puncturenormal-pressure hydrocephalus

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Area of Science:

  • Neurology
  • Neurosurgery

Background:

  • Normal-pressure hydrocephalus (NPH) is characterized by gait disturbance, urinary incontinence, and cognitive decline.
  • Differentiating idiopathic NPH (iNPH) from secondary causes (sNPH) and other conditions is clinically challenging.

Purpose of the Study:

  • To provide a practical approach for evaluating patients with suspected iNPH.
  • To guide decision-making in the diagnosis and management of iNPH.

Main Methods:

  • This narrative review outlines diagnostic strategies for suspected iNPH.
  • Key investigations include clinical assessment, MRI brain, and cerebrospinal fluid (CSF) analysis.

Main Results:

  • Cardinal clinical features and diagnostic aids are detailed.
  • A decision algorithm is provided to manage ambiguous findings from MRI and CSF tests.
  • CSF tap assessment is crucial for diagnosis.

Conclusions:

  • iNPH is a treatable neurological disorder.
  • Patients showing improvement after CSF drainage warrant therapeutic intervention.
  • Co-existing neurodegenerative conditions should be considered.