[Idiopathic normal pressure hydrocephalus: diagnosis or dilemma?]

Idiopathic normal pressure hydrocephalus is a condition that predominantly affects older adults and is subject to considerable controversy because symptoms and radiological features are commonly found in the general elderly population. Additionally, the diagnosis can only be definitively made after assessing the treatment response (improvement following shunt placement). Reliable tests to predict the effect of shunting are lacking.Recently, the PENS trial provided the first level I evidence for the effectiveness of shunting in idiopathic normal pressure hydrocephalus after three months. Although the study has high internal validity, the generalizability and longevity of the results is limited. It remains a challenge to select the appropriate patients for shunt treatment.In the Netherlands, there is currently significant variation in the treatment of idiopathic normal pressure hydrocephalus across hospitals. Therefore, a national guideline to standardize the multidisciplinary approach to this condition and identify knowledge gaps, could improve diagnostics and care.