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Headache and INPH

Derya Kaya, Pinar Soysal, Ahmet Turan Isık
It is somewhat unexpected to have headaches in patients with idiopathic normal pressure hydrocephalus (INPH) for which the treatment is drainage of cerebrospinal fluid (CSF) using shunt. Moreover, intracranial hypotension syndrome (IHS) can be a challenging diagnosis, as CSF leak may be difficult to confirm as imaging findings can be normal. This report describes a woman with INPH who developed symptoms of IHS after a spinal tap test. There might be cases with IHS, like our case, who do not completely fulfill the current diagnostic criteria in terms of not having any objective evidence of intracranial hypotension but who also could not be explained by other conditions and recovered totally after classical IHS treatment...
September 2015: American Journal of Alzheimer's Disease and Other Dementias
Teppei Matsubara, Eiichi Ishikawa, Koji Hirata, Masahide Matsuda, Hiroyoshi Akutsu, Tomohiko Masumoto, Alexander Zaboronok, Akira Matsumura
Cerebrospinal fluid (CSF) overdrainage after lumboperitoneal (LP) shunt placement for the patients with idiopathic normal pressure hydrocephalus (iNPH) is mainly caused by insufficient management of pressure settings of the shunt valve and/or siphon effect of shunt systems induced by the patient's postural changes. We here report a unique case of intracranial hypotension (IH) due to CSF leakage after LP shunt placement in which another mechanism leads to the CSF leakage. A 67-year-old man suffered from persistent headache worsening with postural change 2 months after LP shunt reconstruction for iNPH...
2014: Neurologia Medico-chirurgica
Ullrich Meier, Dirk Stengel, Cornelia Müller, Michael J Fritsch, Uwe Kehler, Niels Langer, Michael Kiefer, Regina Eymann, Martin U Schuhmann, Andreas Speil, Friedrich Weber, Victor Remenez, Veit Rohde, Hans-Christoph Ludwig, Johannes Lemcke
BACKGROUND: Little is known about variables associated with overdrainage complications and neurofunctional and health-related quality of life outcomes in idiopathic normal-pressure hydrocephalus (iNPH) patients after shunt surgery. OBJECTIVE: To identify candidate demographic and disease-specific predictors of overdrainage and patient-related outcomes, allowing for more personalized care of patients with iNPH. METHODS: This was a secondary analysis of the dataset of the SVASONA study, a multicenter randomized trial comparing gravitational and conventional gravitational valves for treating iNPH...
December 2013: Neurosurgery
Leonie Gölz, Johannes Lemcke, Ullrich Meier
BACKGROUND: Modern ventriculoperitoneal shunts (VPS) are programmable, which enables clinicians to adjust valve-pressure according to their patients' individual needs. The aim of this retrospective analysis is to evaluate indications for valve-pressure adjustments in idiopathic normal pressure hydrocephalus (iNPH). METHODS: Patients operated between 2004 and 2011 diagnosed with iNPH were included. Kiefer-Scale was used to classify each patient. Follow-up exams were conducted 3, 6, and 12 months after shunt implantation and yearly thereafter...
2013: Surgical Neurology International
Qurat Ul Ain Khan, Robert E Wharen, Sanjeet S Grewal, Colleen S Thomas, H Gordon Deen, Ronald Reimer, Jay A Van Gerpen, Julia E Crook, Neill R Graff-Radford
OBJECT: Management of idiopathic normal-pressure hydrocephalus (iNPH) is hard because the diagnosis is difficult and shunt surgery has high complication rates. An important complication is overdrainage, which often can be treated with adjustable-shunt valve manipulations but also may result in the need for subdural hematoma evacuation. The authors evaluated shunt surgery overdrainage complications in iNPH and their relationship to lumbar puncture opening pressure (LPOP). METHODS: The authors reviewed the charts of 164 consecutive patients with iNPH who underwent shunt surgery at their institution from 2005 to 2011...
December 2013: Journal of Neurosurgery
Johannes Lemcke, Ullrich Meier, Cornelia Müller, Michael J Fritsch, Uwe Kehler, Niels Langer, Michael Kiefer, Regina Eymann, Martin U Schuhmann, Andreas Speil, Friedrich Weber, Victor Remenez, Veit Rohde, Hans-Christoph Ludwig, Dirk Stengel
OBJECTIVES: To investigate whether gravitational valves reduce the risk of overdrainage complications compared with programmable valves in ventriculoperitoneal (VP) shunt surgery for idiopathic normal pressure hydrocephalus (iNPH). BACKGROUND: Patients with iNPH may benefit from VP shunting but are prone to overdrainage complications during posture changes. Gravitational valves with tantalum balls are considered to reduce the risk of overdrainage but their clinical effectiveness is unclear...
August 2013: Journal of Neurology, Neurosurgery, and Psychiatry
Hiroji Miyake, Yoshinaga Kajimoto, Hisayuki Murai, Sadahiro Nomura, Shigeki Ono, Yuji Okamoto, Yoshihiro Sumi
BACKGROUND: Management of overdrainage complications in shunted patients with idiopathic normal pressure hydrocephalus (INPH) remains a difficult task despite the use of programmable pressure valves. OBJECTIVE: To assess the usefulness of a quick reference table (QRT) algorithm for achieving a suitable initial programmable pressure valve setting in INPH patients who participated in the Study for INPH on Neurological Improvement (SINPHONI). METHODS: One hundred registered patients diagnosed with probable INPH were treated with ventriculoperitoneal shunts using Codman-Hakim programmable valves (CHPVs)...
September 2012: Neurosurgery
J Virhammar, K G Cesarini, K Laurell
BACKGROUND: The cerebrospinal fluid tap test (TT) is a diagnostic tool used to select patients with idiopathic normal pressure hydrocephalus (iNPH) for shunt surgery. The procedure and the evaluation of the TT vary between centres. We aimed to describe the evaluation time after the TT, to assess the variability between repeated measurements, the interrater agreement of the gait tests chosen and finally to investigate whether pain affects the gait performance post-TT. METHODS: Forty patients (21 men and 19 women) under evaluation for iNPH underwent a TT...
February 2012: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Masaaki Hashimoto, Masatsune Ishikawa, Etsuro Mori, Nobumasa Kuwana
BACKGROUND: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable neurological syndrome in the elderly. Although the magnetic resonance imaging (MRI) findings of tight high-convexity and medial subarachnoid spaces and the ventriculo-peritoneal (VP) shunt with programmable valve are reportedly useful for diagnosis and treatment, respectively, their clinical significance remains to be validated. We conducted a multicenter prospective study (Study of Idiopathic Normal Pressure Hydrocephalus on Neurological Improvement: SINPHONI) to evaluate the utility of the MRI-based diagnosis for determining the 1-year outcome after VP shunt with the Codman-Hakim programmable valve...
2010: Cerebrospinal Fluid Research
S Pujari, S Kharkar, P Metellus, J Shuck, M A Williams, D Rigamonti
BACKGROUND/OBJECTIVE: Little is known about the long-term clinical course and management of patients with normal pressure hydrocephalus (NPH) treated by cerebrospinal fluid (CSF) shunting. METHODS: We retrospectively reviewed records of 55 patients diagnosed with idiopathic NPH (INPH) and treated with CSF shunts, all of whom were followed for more than 3 years after the original shunt surgery. At each annual follow-up visit, the patient was assessed by Folstein Mini Mental State Examination, detailed clinical evaluation of gait and assessment of headache, cognition, gait or urination, as assessed by the patient and relatives...
November 2008: Journal of Neurology, Neurosurgery, and Psychiatry
Michito Adachi, Toru Kawanami, Fumi Ohshima, Takeo Kato
PURPOSE: On magnetic resonance imaging (MRI) sagittal sections, we sometimes encounter abnormal aspects of the superior profile of the midbrain and the cingulate sulcus in patients with dementia. In this preliminary study, we refer to these findings as the "upper midbrain profile sign" and the "cingulate sulcus sign." We prospectively evaluated the usefulness of these signs for the diagnosis of idiopathic normal-pressure hydrocephalus (iNPH), Alzheimer's disease (AD) and progressive supranuclear palsy (PSP)...
October 2006: Radiation Medicine
M Tisell, M Tullberg, P Hellström, E Blomsterwall, C Wikkelsø
OBJECTIVE: To comprehensively describe and compare prospectively (pre/postoperatively) the symptomatology in aqueductal stenosis (AS) vs idiopathic normal pressure hydrocephalus (INPH). METHODS: Twenty-seven patients with AS and 39 patients with INPH were consecutively included. Postural functions, gait, wakefulness, cognitive functions, urinary continence and headache were examined before and 3 months after treatment with shunt operation or endoscopic ventriculostomy...
May 2003: Acta Neurologica Scandinavica
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