Artikel
The difficulty of evaluating the diagnostics for normal pressure hydrocephalus: Sensitivity and specificity of the diagnostics in 128 patients
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Autoren
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Johannes Lemcke
- Neurochirurgische Klinik, Unfallkrankenhaus Berlin, Berlin, Germany
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Manuela Wasser
- Neurochirurgische Klinik, Unfallkrankenhaus Berlin, Berlin, Germany
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Ullrich Meier
- Neurochirurgische Klinik, Unfallkrankenhaus Berlin, Berlin, Germany
| Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: There is no gold standard for the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). The aim of this study was to re-evaluate a very large patient group of iNPH patients, who have been diagnosed with a standardised diagnostic pathway, in order to determine specificity and sensitivity of the diagnostic tests for iNPH.
Method: Patients, who underwent the complete diagnostic pathway with clinical and radiological examination, spinal tap test, lumbar infusion test and in case of contradictory results, lumbar CSF drainage and had a 12 months follow-up after shunt surgery were re-evaluated in order to determine the predictive value of the diagnostic tests.
Results: 128 patients with a mean follow-up time of 13.4 months showed a highly significant clinical improvement according to the Kiefer Score (p<0.001). The positive predictive value of the spinal tap test was 88%. The predictive value of the lumbar infusion test was dependent on the threshold value of Rout. The overall responder rate was 86%.
Conclusions: Since there is no gold standard for the diagnostics of iNPH, the evaluation of sensitivity and specificity of the diagnostic test has limitations. Nevertheless, the diagnostic pathway presented in this study enabled the authors to achieve a responder rate of 86% among their patients. This is established in the daily routine.
