The need for an institution-specific normal pressure hydrocephalus management protocol.

Area of Science:

• Neurology
• Neurosurgery
• Clinical Audit

Background:

• Management of normal pressure hydrocephalus (NPH) lacks standardization despite international guidelines.
• Clinical practice varies due to individual clinician preferences and evolving evidence.
• An audit was conducted to review current NPH management pathways.

Purpose of the Study:

• To review current clinical practice in NPH management.
• To identify variations in diagnostic and treatment pathways.
• To inform the development of an institution-specific NPH protocol.

Main Methods:

• Internal audit of NPH patient management at Princess Alexandra Hospital (Jan 2016 - Feb 2019).
• Inclusion of 41 patients diagnosed with NPH.
• Review of diagnostic tests (lumbar puncture, lumbar drain) and treatment (ventriculoperitoneal shunt).

Main Results:

• Lumbar puncture was the most common diagnostic test (63.4%).
• Only 60% of patients received ventriculoperitoneal shunt insertion.
• Inconsistent pre/post-intervention assessments for gait and cognition were noted, with MoCA showing better cognitive improvement than MMSE.

Conclusions:

• Multiple NPH treatment pathways exist, indicating a lack of standardization.
• Low rates of objective symptom assessment highlight a need for improvement.
• An institution-specific protocol is required to standardize NPH diagnostic workup, management, and allied health assessment.