Idiopathic normal pressure hydrocephalus concomitant with progressive supranuclear palsy

Area of Science:

• Neurology
• Neurosurgery
• Geriatrics

Background:

• Idiopathic normal pressure hydrocephalus (iNPH) often co-occurs with neurodegenerative movement disorders like progressive supranuclear palsy (PSP).
• Understanding the clinical and radiological features of this comorbidity (iNPHc + PSP) is crucial for diagnosis and management.

Purpose of the Study:

• To investigate the clinical and radiological characteristics of patients with coexisting iNPH and PSP.
• To evaluate the effectiveness of lumboperitoneal shunt (LPS) surgery in this patient cohort.

Main Methods:

• Retrospective analysis of 85 iNPH patients between 2009 and 2024.
• Adherence to established clinical criteria for iNPH and modified Movement Disorder Society (MDS)-PSP criteria.
• Clinical and radiological assessments including MRI and DaTscan.

Main Results:

• 18 out of 85 iNPH patients (21.2%) had comorbid PSP (iNPHc + PSP).
• PSP comorbidity was associated with impaired vertical eye movement, axial-dominant parkinsonism, and backward falls.
• Radiological findings included shortened mesencephalic tegmentum length and asymmetrical dopamine transporter activity.
• LPS surgery improved modified Rankin Scale and iNPH grading scale scores one year post-surgery.

Conclusions:

• Progressive supranuclear palsy (PSP) can coexist with idiopathic normal pressure hydrocephalus (iNPH).
• Clinical and radiological assessments are vital for identifying this comorbidity.
• Lumboperitoneal shunt surgery offers significant benefits for patients with iNPHc + PSP.