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[Hydrocephalus. Abesia--dementia--incontinence. Drain or not?].
Zeitschrift Fur Gerontologie
|November 1, 1985
Summary
In elderly patients with gait disturbance and incontinence, communicating hydrocephalus may be treatable with cerebrospinal fluid shunting. Accurate diagnosis is crucial to differentiate from cerebral atrophy, avoiding potentially harmful shunt procedures.
Area of Science:
- Neurology
- Neurosurgery
- Geriatrics
Context:
- The combination of abasia (gait disorder) and incontinence in the elderly presents an ambiguous etiological picture.
- Internal communicating hydrocephalus can manifest with these symptoms, suggesting malabsorption hydrocephalus and the need for cerebrospinal fluid (CSF) drainage.
Purpose:
- To outline diagnostic criteria for identifying treatable hydrocephalus in elderly patients with gait and incontinence.
- To differentiate between malabsorption hydrocephalus amenable to shunting and hydrocephalus ex vacuo (due to cerebral atrophy).
Summary:
- Diagnostic evaluation involves lumbar puncture, CSF scan, and potentially continuous CSF pressure monitoring to confirm the need for a shunt.
- Shunt placement in appropriately selected patients with communicating hydrocephalus can lead to significant improvement in over half of cases, with one-third achieving excellent recovery.
- Shunt surgery is contraindicated in hydrocephalus ex vacuo, as it can exacerbate the patient's condition.
Impact:
- Highlights the importance of accurate diagnostic discrimination between different types of hydrocephalus in the elderly.
- Emphasizes the potential benefits of CSF shunting for specific hydrocephalic conditions presenting with gait and incontinence.
- Warns against the risks of unnecessary shunt procedures in cases of cerebral atrophy, improving patient outcomes and resource allocation.