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Idiopathic Normal Pressure Hydrocephalus: A Comprehensive Review
Àlex Rovira1,2,3, Paula Alcaide-Leon4, Maria A Poca3,5,6
1Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Barcelona, Spain.
Summary
Idiopathic normal pressure hydrocephalus (iNPH) is a reversible neurological condition often missed in the elderly. Early diagnosis using MRI and other tests is key for potential symptom reversal through shunt surgery.
Area of Science:
- Neurology
- Radiology
- Neurosurgery
Background:
- Idiopathic normal pressure hydrocephalus (iNPH) presents with gait, cognitive, and urinary issues, often misdiagnosed in older adults.
- Its pathophysiology involves cerebrospinal fluid (CSF) dynamics, ischemia, and glymphatic dysfunction, leading to neurotoxicity.
Purpose of the Study:
- To highlight the diagnostic challenges and imaging role in idiopathic normal pressure hydrocephalus.
- To emphasize the importance of early recognition for potentially reversible symptoms.
Main Methods:
- Utilizes neuroradiological studies, primarily MRI, to identify ventriculomegaly and characteristic features like reduced callosal angle and DESH pattern.
- Incorporates complementary non-imaging tests to predict shunt surgery response.
- Explores advanced MRI techniques like DTI-ALPS for glymphatic dysfunction assessment.
Main Results:
- MRI is crucial for diagnosing iNPH and excluding other conditions, though predictive value for treatment response is limited.
- Characteristic imaging findings support the diagnosis but require complementary tests for treatment selection.
- Emerging biomarkers like DTI-ALPS show promise in understanding disease mechanisms and patient selection.
Conclusions:
- Early and accurate diagnosis of iNPH is vital due to potential symptom reversibility with shunt surgery.
- Advanced imaging techniques are improving the understanding and management of iNPH.
- A combination of imaging and non-imaging tests is essential for optimal patient selection for CSF shunting.
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