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Diagnosis of NPH

Ahmed Mohamed Tawfik, Lamiaa Elsorogy, Rabab Abdelghaffar, Ayman Abdel Naby, Ibrahim Elmenshawi
OBJECTIVE: Manual segmentation of the aqueduct for CSF flow analysis may induce measurement variability. The aim of our study was to assess observer agreement of manual segmentation and to compare the repeatability and accuracy of different flow parameters in differentiating normal-pressure hydrocephalus (NPH) from brain atrophy. SUBJECTS AND METHODS: Thirty-two subjects were included and were divided into three groups: control, NPH, and brain atrophy. Subjects underwent phase-contrast MRI...
April 2017: AJR. American Journal of Roentgenology
S D Thompson, A Coutts, C L Craven, A K Toma, L W Thorne, L D Watkins
BACKGROUND: Intracranial pressure monitoring is commonly undertaken to assess and manage acute patients following head injury. However, ICP monitoring can also be a useful diagnostic tool in the management of CSF dynamics in elective patients. To date, there is little published research to suggest how long these elective patients require ICP monitoring in order to gain an accurate picture of a patient's ICP dynamics. At the author's institution, a minimum of 48-h data collection is currently undertaken in patients with a suspected ICP abnormality...
March 2017: Acta Neurochirurgica
Ivana Jurjević, Masakazu Miyajima, Ikuko Ogino, Chihiro Akiba, Madoka Nakajima, Akihide Kondo, Mika Kikkawa, Mitsuyasu Kanai, Nobutaka Hattori, Hajime Arai
BACKGROUND: Patients presenting with the classical idiopathic normal pressure hydrocephalus (iNPH) triad often show additional parkinsonian spectrum signs. Accurate differential diagnosis strongly influences the long-term outcome of cerebrospinal fluid (CSF) shunting. OBJECTIVE: The aim of this study was to find potential CSF microRNA (miRNA) biomarkers for NPH mimics with parkinsonian syndromes that can reliably distinguish them from iNPH patients. METHODS: Two cohorts of 81 patients (cohort 1, n = 55; cohort 2, n = 26) with possible iNPH who were treated in two centers between January 2011 and May 2014 were studied...
2017: Journal of Alzheimer's Disease: JAD
Uygur Er, Çetin Akyol, Murad Bavbek
Aim of this paper is to present and discuss a case of a delayed cerebellar parenchymal hemorrhage developing after L/P shunt placement with a NPH patient. A hypertensive patient admitted to our clinic with a diagnosis of NPH. The patient was placed a pressure adjustable L/P shunt without any surgical complication. He was discharged with an uneventful period. The patient was admitted to the emergency clinic of our hospital with a 1.5 × 1.5 cm diameter hematoma at the left cerebellar hemisphere on 2 days after his discharge...
October 2016: Asian Journal of Neurosurgery
Badih Daou, Petra Klinge, Stavropoula Tjoumakaris, Robert H Rosenwasser, Pascal Jabbour
OBJECTIVE There are several etiologies that can lead to the development of secondary normal pressure hydrocephalus (sNPH). The aim of this study was to evaluate the etiology, diagnosis, treatment, and outcome in patients with sNPH and to highlight important differences between the separate etiologies. METHODS A comprehensive review of the literature was performed to identify studies conducted between 1965 and 2015 that included data regarding the etiology, treatment, diagnosis, and outcome in patients with sNPH...
September 2016: Neurosurgical Focus
Ekawut Chankaew, Prajak Srirabheebhat, Sriwimon Manochiopinig, Theerapol Witthiwej, Itsara Benjamin
OBJECTIVE Normal pressure hydrocephalus (NPH) is clinically characterized by gait disturbance, cognitive impairment, and urinary incontinence, as well as enlargement of the ventricles. To the best of the authors' knowledge, there have been no previous publications regarding the correlation between bulbar dysfunction and NPH. The primary objective of this study was to compare preoperative and postoperative prevalence of bulbar dysfunction in patients with NPH. Secondary objectives included assessing the results of surgery for swallowing, speech, gait, cognition, and urination, and evaluating the correlation between bulbar dysfunction and triad symptoms...
September 2016: Neurosurgical Focus
Ignacio Jusué-Torres, Jennifer Lu, Jamie Robison, Jamie B Hoffberger, Alicia Hulbert, Abanti Sanyal, Jan Wemmer, Benjamin D Elder, Daniele Rigamonti
INTRODUCTION: Early treatment of normal pressure hydrocephalus (NPH) yields better postoperative outcomes. Our current tests often fail to detect significant changes at early stages. We developed a new scoring system (LP log score) to determine if this tool is more sensitive in detecting clinical differences than current tests. MATERIAL AND METHODS: Sixty-two consecutive new patients with suspected idiopathic NPH were studied. Secondary, previously treated and obstructive cases were not included...
2016: Curēus
Roser Garcia-Armengol, Sira Domenech, Carlos Botella-Campos, Francisco Javier Goncalves, Belén Menéndez, Pilar Teixidor, Lucia Muñoz-Narbona, Jordi Rimbau
BACKGROUND: To compare the prognostic value of pulse amplitude on intracranial pressure (ICP) monitoring and disproportionately enlarged subarachnoid space hydrocephalus (DESH) on magnetic resonance imaging (MRI) for predicting surgical benefit after shunt placement in idiopathic normal pressure hydrocephalus (iNPH). METHOD: Patients with suspected iNPH were prospectively recruited from a single centre. All patients received preoperative MRI and ICP monitoring. Patients were classified as shunt responders if they had an improvement of one point or more on the NPH score at 1 year post-surgery...
November 2016: Acta Neurochirurgica
Lotta M Ellingsen, Snehashis Roy, Aaron Carass, Ari M Blitz, Dzung L Pham, Jerry L Prince
Normal pressure hydrocephalus (NPH) affects older adults and is thought to be caused by obstruction of the normal flow of cerebrospinal fluid (CSF). NPH typically presents with cognitive impairment, gait dysfunction, and urinary incontinence, and may account for more than five percent of all cases of dementia. Unlike most other causes of dementia, NPH can potentially be treated and the neurological dysfunction reversed by shunt surgery or endoscopic third ventriculostomy (ETV), which drain excess CSF. However, a major diagnostic challenge remains to robustly identify shunt-responsive NPH patients from patients with enlarged ventricles due to other neurodegenerative diseases...
March 21, 2016: Proceedings of SPIE
Anne M Koivisto, Mitja I Kurki, Irina Alafuzoff, Anna Sutela, Jaana Rummukainen, Sakari Savolainen, Ritva Vanninen, Juha E Jääskeläinen, Hilkka Soininen, Ville Leinonen
BACKGROUND: Differential diagnosis of ventricular enlargement with normal pressure hydrocephalus (NPH) related symptoms is challenging. Patients with enlarged ventricles often manifest cognitive deterioration but their long-term outcome is not well known. OBJECTIVES: We aim to evaluate long-term cognitive outcome in patients with enlarged ventricles and clinically suspected NPH. METHODS: A neurologist and a neurosurgeon clinically evaluated 468 patients with enlarged ventricles and suspected NPH using radiological methods, intraventricular pressure monitoring, and frontal cortical brain biopsy...
March 22, 2016: Journal of Alzheimer's Disease: JAD
Ryszard Czepko, Krzysztof Cieslicki
BACKGROUND: Only a few reports have been published on the natural history of non-shunted patients suspected of having NPH. The aim of this study is to follow up a group of such cases. METHODS: It was possible to follow up 27 patients who had not been qualified for shunting after the primary diagnosis. An assessment of Hakim's triad was performed, together with an analysis of radiological parameters and the results of lumbar infusion tests (LITs), both on admission and at the later date (on average, after 5...
May 2016: Acta Neurochirurgica
E Groenewald, J Alexander Joska, S Rothemeyer
A 62-year-old man presented with a 2-month history of psychiatric symptoms. These were preceded by cognitive deterioration, urinary incontinence and an abnormal gait. A diagnosis of normal-pressure hydrocephalus (NPH) was made, and the patient improved after surgery.
January 11, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Kristina Elfving, Deler Shakely, Maria Andersson, Kimberly Baltzell, Abdullah S Ali, Marc Bachelard, Kerstin I Falk, Annika Ljung, Mwinyi I Msellem, Rahila S Omar, Philippe Parola, Weiping Xu, Max Petzold, Birger Trollfors, Anders Björkman, Magnus Lindh, Andreas Mårtensson
BACKGROUND: Despite the fact that a large proportion of children with fever in Africa present at primary health care facilities, few studies have been designed to specifically study the causes of uncomplicated childhood febrile illness at this level of care, especially in areas like Zanzibar that has recently undergone a dramatic change from high to low malaria transmission. METHODS: We prospectively studied the aetiology of febrile illness in 677 children aged 2-59 months with acute uncomplicated fever managed by IMCI (Integrated Management of Childhood Illness) guidelines in Zanzibar, using point-of-care tests, urine culture, blood-PCR, chest X-ray (CXR) of IMCI-pneumonia classified patients, and multiple quantitative (q)PCR investigations of nasopharyngeal (NPH) (all patients) and rectal (GE) swabs (diarrhoea patients)...
2016: PloS One
Daniel Hořínek, Irena Štěpán-Buksakowska, Nikoletta Szabó, Bradley J Erickson, Eszter Tóth, Vlastimil Šulc, Vladimir Beneš, Jiří Vrána, Jakub Hort, Christopher Nimsky, Milan Mohapl, Miloslav Roček, László Vécsei, Zsigmond Tamás Kincses
OBJECTIVES: Alzheimer's disease (AD) and normal pressure hydrocephalus (NPH) are both associated with cognitive decline and ventriculomegaly. While promising approach in differentiating between the two diseases, only a few diffusion tensor imaging (DTI) studies compared directly NPH and AD patients. The current study compares global whitematter (WM) alterations in AD and NPH addressing some of the methodological issues of previous studies. PATIENTS AND METHODS: Diffusion tensor images were obtained from 17 patients with NPH, 14 with AD, and 17 healthy controls...
January 2016: Clinical Neurology and Neurosurgery
S Yamada, M Ishikawa, K Yamamoto
BACKGROUND AND PURPOSE: Despite the remarkable progress of 3D graphics technology, the Evans index has been the most popular index for ventricular enlargement. We investigated a novel reliable index for the MR imaging features specified in idiopathic normal pressure hydrocephalus, rather than the Evans index. MATERIALS AND METHODS: The patients with suspected idiopathic normal pressure hydrocephalus on the basis of the ventriculomegaly and a triad of symptoms underwent the CSF tap test...
December 2015: AJNR. American Journal of Neuroradiology
I Jonathan Pomeraniec, Aaron E Bond, M Beatriz Lopes, John A Jane
OBJECTIVE: Normal pressure hydrocephalus (NPH) remains most often a clinical diagnosis and has been widely considered responsive to the placement of a cerebrospinal fluid (CSF) shunt. The high incidence of patients with Alzheimer's disease (AD) with NPH symptoms leads to poorer outcomes than would be expected in patients with NPH alone. This article reviews a series of patients operated on for presumed NPH in whom preoperative high-volume lumbar puncture (HVLP) and intraoperative cortical brain biopsies were performed...
February 2016: Journal of Neurosurgery
Laurent Sakka, Alexandre Chomicki, Jean Gabrillargues, Toufic Khalil, Jean Chazal, Paul Avan
OBJECTIVE: Ventriculoperitoneal shunting is the first-line treatment for normal pressure hydrocephalus. Noninvasive auditory tests based on recorded otoacoustic emissions were assessed, as currently used for universal neonatal hearing screenings, for the diagnosis of cerebrospinal fluid shunt malfunction. The test was designed based on previous works, which demonstrated that an intracranial pressure change induces a proportional, characteristic, otoacoustic-emission phase shift. METHODS: Forty-four patients with normal pressure hydrocephalus (23 idiopathic and 21 secondary cases) were included in this prospective observational study...
February 2016: Journal of Neurosurgery
Walter Grand, Jody Leonardo, Andrea J Chamczuk, Adam J Korus
BACKGROUND: Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center. OBJECTIVE: To determine the efficacy, safety, and outcome of ETV in a large adult hydrocephalus patient series at a single neurosurgical center...
January 2016: Neurosurgery
Ewa Szczepek, Leszek Tomasz Czerwosz, Krzysztof Nowiński, Zbigniew Czernicki, Jerzy Jurkiewicz
INTRODUCTION: Imaging studies make it possible not only to visualize the general structure of the brain but also to take precise measurements of brain tissue volume and the size of individual lobes and their structure. The aim of this study was to determine the ratio of cerebrospinal fluid (CSF) volume contained in the intracranial ventricular system to the brain tissue volume and the ratio of CSF volume in the subarachnoid space and basal cisterns to the brain tissue volume. MATERIAL AND METHODS: The evaluation of volumetric measurements of computed tomographic (CT) images was undertaken on 23 male and female patients (average age 56...
2015: Folia Neuropathologica
Maria Kojoukhova, Anne M Koivisto, Riika Korhonen, Anne M Remes, Ritva Vanninen, Hilkka Soininen, Juha E Jääskeläinen, Anna Sutela, Ville Leinonen
BACKGROUND: Various radiological markers have been proposed for diagnostics in idiopathic normal pressure hydrocephalus (iNPH). We examined the usefulness of radiological markers in the diagnostics and prediction of shunt response in iNPH. METHOD: In this retrospective cohort study, we evaluated brain CT or MRI scans of 390 patients with suspected iNPH. Based on a 24-h intraventricular pressure monitoring session, patients were classified into a non-NPH (n = 161) or probable iNPH (n = 229) group...
October 2015: Acta Neurochirurgica
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