Artikel
Normal pressure hydrocephalus – are there predictive values for the response rate for shunting?
Normaldruckhydrozephalus – gibt es Prediktoren für den Therapieerfolg mit einer Liquorableitung
Suche in Medline nach
Autoren
Veröffentlicht: | 4. Mai 2005 |
---|
Gliederung
Text
Objective
Normal pressure hydrocephalus (NPH) is one of the few dementias which can be treated with success. A variety of methods have been proposed to confirm the diagnosis of NPH and to determine which patients are likely to respond to shunting of cerebrospinal fluid (CSF). The aim of the present study was to compare the withdrawal of CSF by lumbar puncture, continuous intracranial pressure (ICP) monitoring and neuropsychological improvement following withdrawal of 30 ml CSF in patients with suspected NPH.
Methods
From March 2003 until now, 30 consecutive patients with radiographic and clinical signs suggesting the presence of NPH were included in the ongoing study. In 27 Patient a CSF withdrawal via lumbar puncture (LP) was performed. A continuous invasive ICP monitoring was done in 18 patients for at least forty-eight hours. The ICP signal was digitized by means of an analog-to-digital converter (50 Hz sampling rate) and stored on a personal computer for off-line evaluation. In addition, a neuropsychological test battery including assessment of orientation, memory, alertness and executive function was performed two days prior to and two days following the withdrawal of 30 ml of CSF.
Results
5 out of 18 patients showed an elevated opening pressure and persistently elevated ICP above 150 mm H2O or recurrent pressure waves above 200 mm H2O. A neuropsychological improvement was observed in 3 of these 5 patients following CSF withdrawal. 8 out of 27 showed a general clinical improvement after LP and 5 of them a neuropsychological improvement as well. A shunt procedure was performed in 4 patients with elevated ICP and 7 patient improved after LP including the 5 patients with improved neuropsychological status. One of each group refused shunting.
Conclusions
Our preliminary results suggest that neuropsychological assessment prior to and after CSF withdrawal constitutes a valuable diagnostic approach in addition to continuous ICP monitoring or CSF withdrawal with lumbar puncture in patients with suspected NPH.