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Repeated assessment of suspected normal pressure hydrocephalus in non-shunted cases. A prospective study based on the constant rate lumbar infusion test

  • Clinical Article - Brain Tumors
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Abstract

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 5.6 months). All parameters were analyzed with respect to periventricular lucency (PVL), atrophy, type of NPH, and the age of the patients.

Results

There were no deteriorations and six patients improved. Those who were over 50 and who had no PVL or secondary NPH tended to improve more frequently. Significant improvement of dementia was noted (p = 0.042) in all cases, and in the group of patients without PVL (p = 0.04). The size of the ventricles did not change significantly. The values of the resistance to outflow (R), elastance (E), and ICP remained stable.

Conclusions

Analysis of our series revealed that the patients suspected of having NPH who had not been qualified for shunting did not deteriorate, while some of them even improved significantly as far as the level of dementia was concerned. As the CT and LIT parameters remained stable, there were no indications for repeating these examinations, at least within the period of nearly 6 months, which followed the primary diagnosis.

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Acknowledgments

We gratefully acknowledge the support of Miroslawa Orlowiejska, a neuropsychologist, in the assessment of the impairment of cognitive functions in the series of patients discussed in the present paper.

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Authors and Affiliations

  1. Department of Neurosurgery, St. Raphael’s Hospital, 12 Bochenka str, 30-001, Krakow, Poland

    Ryszard Czepko

  2. Laboratory of Bioflows, Institute of Automatic Control and Robotics, Warsaw University of Technology, Warsaw, Poland

    Krzysztof Cieslicki

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Correspondence to Ryszard Czepko.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Statement of the human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Statement on the welfare of animals

This article does not contain any studies with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Comments

This is an interesting study on borderline NPH patients who did not qualify for shunting and were retested regarding clinical parameters and objective lumbar infusion test results. It could be shown that short-term prognosis is good without neurosurgical treatment. The object of this series is well chosen and methodology is adequate. Only a few questions should possibly be discussed in addition: Is it possible that initial CSF tapping can play a positive role in these borderline cases? Did the patients present with comorbidities that potentially may influence CSF resorption at any time (e.g., heart or vascular diseases)? If yes, had they appropriate treatment and remained stable accordingly? Is it useful to have another clinical follow-up after a longer interval compared to the 5.6 months?

Angela-Martina Messing-Junger

Bonn, Germany

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Czepko, R., Cieslicki, K. Repeated assessment of suspected normal pressure hydrocephalus in non-shunted cases. A prospective study based on the constant rate lumbar infusion test. Acta Neurochir 158, 855–863 (2016). https://doi.org/10.1007/s00701-016-2732-5

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  • DOI: https://doi.org/10.1007/s00701-016-2732-5

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