Clinical and Radiological Evolution of Idiopathic Normal Pressure Hydrocephalus: A Critical Review

Area of Science:

• Neurology
• Neurosurgery
• Geriatrics

Background:

• The pathophysiology of idiopathic normal pressure hydrocephalus (iNPH) is not fully understood.
• Preclinical and early stages of iNPH development are largely unknown.
• Understanding iNPH evolution is critical for patient management.

Purpose of the Study:

• To investigate the clinical and radiological manifestation of iNPH.
• To understand the evolution of major clinical symptoms in non-shunted iNPH patients.
• To gain insights into the natural history of iNPH.

Main Methods:

• Critical literature review on the evolution of iNPH.
• Search for manuscripts detailing early clinical features and symptom progression.
• Categorization of literature based on clinical and radiological findings.

Main Results:

• Gait disturbance is the earliest clinical symptom of iNPH.
• Cognitive impairment varies, influenced by comorbidities; urinary dysfunction progresses from urgency to incontinence.
• Radiological features like ventricular enlargement are present preclinically, but their sequence and impact of white matter lesions are unclear.

Conclusions:

• iNPH evolution exhibits significant heterogeneity.
• Defining distinct clinical stages and identifying preclinical iNPH are essential.
• Treatment outcome assessment must account for disease stage at intervention.