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Journal of Neurology

, Volume 247, Issue 1, pp 5–14 | Cite as

Diagnosis and management of normal-pressure hydrocephalus

  • J. A. L. Vanneste
Invited review

Abstract

The syndrome of normal-pressure hydrocephalus (NPH) remains a diagnostic and therapeutic challenge, especially as many patients do not display the classical clinical and neuroimaging patterns of NPH, thus questioning the usefulness of a shunt. Gait impairment remains the cardinal symptom, while mental deterioration may be subtle and even unrecognized. NPH is rarely the cause of severe dementia, and substantial improvement in NPH-related mental deterioration is limited to 30–40% of shunted patients. Many ancillary investigations have been described that can increase the probability of selecting the appropriate candidates for a shunt. The reliability and reproducibility of these tests are limited. Unfortunately, the best predictive tests are technically complex and are used only in a few specialized centers. The best management is still to adhere to strict clinical and magnetic resonance imaging criteria and to rely on a positive – but not negative – CSF tap test and the occurrence of B-waves during at least 50% of the continuous intracranial pressure recording time, when this procedure is available.

Key words Normal-pressure ¶hydrocephalus Subcortical ¶dementia Predictive testing Gait disorder Diagnosis 

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Copyright information

© Steinkopff Verlag 2000

Authors and Affiliations

  • J. A. L. Vanneste
    • 1
  1. 1.Department of Neurology, Sint Lucas Andreas Ziekenhuis, Postbus 9243, 1006 AE Amsterdam, The Netherlands Fax: +31-20-6837198NL

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