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Diagnosis of NPH

Andreas Spiegelberg, Matthias Krause, Juergen Meixensberger, Burkhardt Seifert, Vartan Kurtcuoglu
OBJECTIVE: We aimed to test whether there is an association of slow vasogenic wave (SVW) occurrence with positive response to external lumbar drainage (ELD) and ventriculoperitoneal shunting and to design a method for the recognition and quantification of SVWs in the intracranial pressure (ICP) signal. MATERIALS AND METHODS: We constructed SVW templates using normalized sine waves. We calculated the cross-correlation between the respective SVW template and the ICP signal...
2018: Acta Neurochirurgica. Supplement
Charlotte Selge, Florian Schoeberl, Andreas Zwergal, Georg Nuebling, Thomas Brandt, Marianne Dieterich, Roman Schniepp, Klaus Jahn
OBJECTIVE: To test whether quantitative gait analysis of gait under single- and dual-task conditions can be used for a differential diagnosis of progressive supranuclear palsy (PSP) and idiopathic normal-pressure hydrocephalus (iNPH). METHODS: In this cross-sectional study, temporal and spatial gait parameters were analyzed in 38 patients with PSP (Neurological Disorders and Stroke and Society for Progressive Supranuclear Palsy diagnostic criteria), 27 patients with iNPH (international iNPH guidelines), and 38 healthy controls...
February 21, 2018: Neurology
I Jonathan Pomeraniec, Davis G Taylor, Aaron E Bond, M Beatriz Lopes
BACKGROUND: Patients with normal pressure hydrocephalus (NPH) and Alzheimer's dementia (AD) can often present with similar symptoms. NPH remains a clinical diagnosis and there are reported shared underlying dynamics of cerebrospinal fluid (CSF) flow and histopathology with patients with biopsy-proven AD. METHODS: This is a review on the histopathology and cerebrospinal fluid dynamics of both NPH and AD. In a prior study at the University of Virginia, the authors reviewed patients over a 15 year period who were shunted for a preoperative diagnosis of NPH...
February 13, 2018: Journal of Neurosurgical Sciences
Carl P C Chen, Yin-Cheng Huang, Chen-Nen Chang, Jean-Lon Chen, Chih-Chin Hsu, Wan-Ying Lin
Normal pressure hydrocephalus (NPH) was the first type of dementia ever described that can be treated using ventriculoperitoneal shunting surgery. Three typical clinical symptoms of NPH include gait disturbance, progressive cognitive dysfunction, and urinary incontinence. Although there are articles that have discovered several cerebrospinal fluid (CSF) protein biomarkers associated with NPH; however, studies examining individual and total protein concentrations from the ventricular CSF before and after shunting surgery are lacking...
February 1, 2018: Experimental Gerontology
Okko T Pyykkö, Ossi Nerg, Hanna-Mari Niskasaari, Timo Niskasaari, Anne M Koivisto, Mikko Hiltunen, Jussi Pihlajamäki, Tuomas Rauramaa, Maria Kojoukhova, Irina Alafuzoff, Hilkka Soininen, Juha E Jääskeläinen, Ville Leinonen
OBJECT: To investigate incidence, comorbidities, mortality, and causes of death in idiopathic normal pressure hydrocephalus (iNPH). METHODS: A cohort of 536 patients with possible NPH from a defined population with a median follow-up time of 5.1 years (range 0.04-19.9) was included in the study. Patients were evaluated by brain imaging and intraventricular pressure monitoring with a brain biopsy immunostained against amyloid-β and hyperphosphorylated tau. Hospital records were reviewed for vascular diseases and type 2 diabetes mellitus (T2DM)...
January 25, 2018: World Neurosurgery
Hitesh Raheja, Ankur Sinha, Pavan Kumar Irukulla, Yizhak Kupfer
We report a case of acute cryptococcal meningitis (CM) masquerading as normal pressure hydrocephalus (NPH) in an immune-competent female. An 85-year-old human immunodeficiency virus-negative female presented to the emergency room for altered mental status and difficulty walking. She was increasingly lethargic, with urinary incontinence and gait instability. A previous computed tomography was reported to have ventricular dilatation out of proportion to the degree of cortical atrophy. Magnetic resonance scan of the brain revealed ventricular dilatation and subtle debris layering the occipital horns of the lateral ventricles...
October 2017: Journal of Global Infectious Diseases
Jennifer W Wu, Laurent Azoulay, Agnieszka Majdan, Jean-François Boivin, Michael Pollak, Samy Suissa
Purpose The association between long-acting insulin analogs and increased breast cancer risk is uncertain, particularly with the short follow-up in previous studies. We assessed this risk long term in women with type 2 diabetes. Methods A population-based cohort of women 40 years or older, all of whom were treated with long-acting (glargine, detemir) or neutral protamine Hagedorn (NPH) insulin between 2002 and 2012, was formed using the United Kingdom's Clinical Practice Research Datalink. Women were followed until February 2015 or breast cancer diagnosis...
November 10, 2017: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Alberto J Espay, Gustavo A Da Prat, Alok K Dwivedi, Federico Rodriguez-Porcel, Jennifer E Vaughan, Michela Rosso, Johnna L Devoto, Andrew P Duker, Mario Masellis, Charles D Smith, George T Mandybur, Aristide Merola, Anthony E Lang
Idiopathic normal pressure hydrocephalus (NPH) remains both oversuspected on clinical grounds and underconfirmed when based on immediate and sustained response to cerebrospinal fluid diversion. Poor long-term postshunt benefits and findings of neurodegenerative pathology in most patients with adequate follow-up suggest that hydrocephalic disorders appearing in late adulthood may often result from initially unapparent parenchymal abnormalities. We critically review the NPH literature, highlighting the near universal lack of blinding and controls, absence of specific clinical, imaging, or pathological features, and ongoing dependence for diagnostic confirmation on variable cutoffs of gait response to bedside fluid-drainage testing...
October 2017: Annals of Neurology
Claudia Giliberto, Giovanni Mostile, Salvatore Lo Fermo, Ester Reggio, Giorgia Sciacca, Alessandra Nicoletti, Mario Zappia
Differential diagnosis between vascular parkinsonism (VP) and idiopathic normal pressure hydrocephalus (iNPH) is particularly challenging due to similar clinical and neuroradiological features. The objective of this study is to differentiate VP with radiological evidence of ventricular enlargement (REVE) from iNPH on the basis of cerebrospinal fluid (CSF) hydrodynamics. CSF pressure components were investigated in patients with a clinical diagnosis of VP and REVE. Data of eight patients (seven men; age 76 ± 3...
December 2017: Neurological Sciences
Nicole C Keong, Alonso Pena, Stephen J Price, Marek Czosnyka, Zofia Czosnyka, Elise E DeVito, Charlotte R Housden, Barbara J Sahakian, John D Pickard
BACKGROUND: The pathogenesis of normal pressure hydrocephalus (NPH) remains unclear which limits both early diagnosis and prognostication. The responsiveness to intervention of differing, complex and concurrent injury patterns on imaging have not been well-characterized. We used diffusion tensor imaging (DTI) to explore the topography and reversibility of white matter injury in NPH pre- and early after shunting. METHODS: Twenty-five participants (sixteen NPH patients and nine healthy controls) underwent DTI, pre-operatively and at two weeks post-intervention in patients...
2017: PloS One
Aswin Chari, Debayan Dasgupta, Alexander Smedley, Claudia Craven, Edward Dyson, Samir Matloob, Simon Thompson, Lewis Thorne, Ahmed K Toma, Laurence Watkins
BACKGROUND: Elective intraparenchymal intracranial pressure (ICP) monitoring is useful for the diagnosis and treatment of hydrocephalus and cerebrospinal fluid (CSF) disorders. This retrospective study analyzes median ICP and pulse amplitude (PA) recordings in neurosurgically naïve patients undergoing elective ICP monitoring for suspected CSF disorders. METHODS: Retrospective review of prospectively collated database of neurosurgically naïve patients undergoing elective ICP monitoring for suspected hydrocephalus and CSF disorders...
October 2017: Acta Neurochirurgica
Aline Klitzke Paliosa, Cassiano Teixeira, Regis Goulart Rosa, Carine Raquel Blatt
Objective: To identify factors that can determine the choice of intermittent subcutaneous regular insulin dose in critically ill patients with hyperglycemia. Method: Cross-sectional study in a general adult ICU with 26 beds, data collected between September and October 2014. The variables analyzed were: sex, age, previous diagnosis of diabetes mellitus, use of corticosteroids, use of lactulose, sepsis, fasting, enteral nutrition, use of dextrose 5% in water, NPH insulin prescription and blood glucose level...
May 2017: Revista da Associação Médica Brasileira
Gabriel André Silva Mendes, Matheus Fernandes de Oliveira, Fernando Campos Gomes Pinto
INTRODUCTION: Normal-pressure hydrocephalus (NPH) is a disease characterized by gait disturbance, urinary incontinence, and dementia. Our objectives were to define an average value of the test for the population, check the specificity and test sensitivity as evaluation criteria and diagnostic testing, and correlate with other already used more frequently. METHODS: A study conducted at the Neurosurgery Division of the Hospital do Servidor Público Estadual de São Paulo in which a group of 30 patients with NPH was submitted to the Mini-Mental State Test Examination, Time Up and Go (TUG), test and Japanese scale for NPH before the Tap Test 3 hours and 72 hours after the Tap Test...
September 2017: World Neurosurgery
Nityanand Miskin, Hersh Patel, Ana M Franceschi, Benjamin Ades-Aron, Alexander Le, Brianna E Damadian, Christian Stanton, Yafell Serulle, James Golomb, Oded Gonen, Henry Rusinek, Ajax E George
Purpose To assess the diagnostic performance of the callosal angle (CA) and Evans index (EI) measures and to determine their role versus automated volumetric methods in clinical radiology. Materials and Methods Magnetic resonance (MR) examinations performed before surgery (within 1-5 months of the MR examination) in 36 shunt-responsive patients with normal-pressure hydrocephalus (NPH; mean age, 75 years; age range, 58-87 years; 26 men, 10 women) and MR examinations of age- and sex-matched patients with Alzheimer disease (n = 34) and healthy control volunteers (n = 36) were studied...
October 2017: Radiology
Vengalathur Ganesan Ramesh, Vidhya Narasimhan, Chandramouli Balasubramanian
CONTEXT: Communicating hydrocephalus often poses a challenge in diagnosis and management decisions. AIMS: The objective of this study is to measure the opening pressure (Po), pressure volume index (PVI), and cerebrospinal fluid outflow resistance (Rout), in patients with communicating hydrocephalus using bolus lumbar injection method and to evaluate its diagnostic and prognostic value. MATERIALS AND METHODS: The study was conducted in 50 patients with communicating hydrocephalus, including normal pressure hydrocephalus (NPH) (19), post-meningitic hydrocephalus (23) and post-traumatic hydrocephalus (8)...
April 2017: Asian Journal of Neurosurgery
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
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