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Acta Neurochirurgica

, Volume 148, Issue 11, pp 1151–1156 | Cite as

Intracranial pulse pressure amplitude levels determined during preoperative assessment of subjects with possible idiopathic normal pressure hydrocephalus

  • P. K. Eide
  • A. Brean
Clinical Article

Summary

Background. It was previously reported that the intracranial pulse pressure amplitudes were elevated in idiopathic normal pressure hydrocephalus (iNPH) patients responding to shunt surgery. In this study, pulse pressure amplitudes were determined in all patients referred for tentative iNPH, and patients were selected for shunt surgery based on the determination of their threshold levels of intracranial pulse pressure amplitudes.

Patients and methods. All patients referred to our department for tentative iNPH during a 12 months time period were included. Using intracranial pressure (ICP) monitoring the intracranial pulse pressure amplitudes were determined as the mean wave amplitude in consecutive 6-seconds time windows. Intracranial pulse pressure amplitudes were defined as being elevated when the mean wave amplitudes were either ≥4 mmHg in ≥70%, ≥5 mmHg in ≥40% or ≥6 mmHg in ≥10% of the ICP recording time. Shunt treatment was offered to those with elevated mean wave amplitudes. Clinical state was assessed by using a NPH Grading Scale and the Stein-Langfitt scale before ICP monitoring, and then repeated after 12 months.

Results. Among the 40 iNPH patients included during the 12 months period, the mean wave amplitudes were elevated in 24 patients (60%), while not being elevated in 16 (40%). Neither pre-operative clinical state, radiological ventricular size nor co-morbidity differed between patient groups with elevated or non-elevated mean wave amplitudes. In the shunted patients who had pre-operatively elevated mean wave amplitudes, 91% had very significant clinical change after 12 months (median change in NPH score +4). In those with non-elevated amplitudes and no shunt, clinical state was somewhat worse after 12 months (median change in NPH score −1).

Conclusions. In this one-year material, mean wave amplitudes were elevated in 60% of iNPH patients. In those with elevated mean wave amplitudes who were treated with shunt, 91% had a significant clinical response.

Keywords: Idiopathic normal pressure hydrocephalus; extra-cranial shunts; outcome; intracranial pressure; single pressure wave parameters. 

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References

  1. Barcena, A, Mestre, C, Canizal, JM, Rivero, B, Lobato, RD 1997Idiopathic normal pressure hydrocephalus: analysis of factors related to cerebrospinal fluid dynamics determining functional prognosisActa Neurochir (Wien)139933941CrossRefGoogle Scholar
  2. Bech-Azeddine, R, Gjerris, F, Waldemar, G, Czosnyka, M, Juhler, M 2005Intraventricular or lumbar infusion test in adult communicating hydrocephalus? Practical consequences and clinical outcome of shunt operationActa Neurochir (Wien)14710271036CrossRefGoogle Scholar
  3. Boon, AJW, Tans, JTJ, Delwel, EJ, Egeler-Peerdeman, SM, Hanlo, PW, Wurzer, HAL, Avezaat, CJJ, deJong, DA, Gooskens, RHJM, Hermans, J 1997Dutch normal-pressure hydrocephalus study: Prediction of outcome after shunting by resistance to outflow of cerebrospinal fluidJ Neurosurg87687693PubMedCrossRefGoogle Scholar
  4. Boon, AJW, Tans, JTJ, Delwel, EJ, Egeler-Peerdeman, SM, Hanlo, PW, Wurzer, HAL, Hermans, J 1999Dutch normal-pressure hydrocephalus study: the role of cerebrovascular diseaseJ Neurosurg90221226PubMedGoogle Scholar
  5. Czosnyka, M, Pickard, JD 2004Monitoring and interpretation of intracranial pressureJ Neurol Neurosurg Psychiatry75813821PubMedCrossRefGoogle Scholar
  6. Delwel, EJ, deJong, DA, Avezaat, CJJ 2005The prognostic value of clinical characteristics and parameters of cerebrospinal fluid hydrodynamics in shunting for idiopathic normal pressure hydrocephalusActa Neurochir (Wien)14710371043CrossRefGoogle Scholar
  7. Eide, PK, Fremming, AD, Sorteberg, A 2003Lack of relationship between resistance to cerebrospinal fluid outflow and intracranial pressure in normal pressure hydrocephalusActa Neurol Scand108381388PubMedCrossRefGoogle Scholar
  8. Eide, PK 2003The relationship between intracranial pressure and size of cerebral ventricles assessed by computed tomographyActa Neurochir (Wien)145171179CrossRefGoogle Scholar
  9. Eide, PK 2006Intracranial pressure parameters in idiopathic normal pressure hydrocephalus patients treated with ventriculo-peritoneal shuntsActa Neurochr (Wien)1482129CrossRefGoogle Scholar
  10. Eide, PK 2006A new method for processing of continuous intracranial pressure signalsMed Eng Phys28579587PubMedCrossRefGoogle Scholar
  11. Foltz, EL, Aine, C 1981Diagnosis of hydrocephalus by CSF pulse-wave analysis: A clinical studySurg Neurol15283293PubMedCrossRefGoogle Scholar
  12. Foltz, EL, Blanks, JP, Yonemura, K 1990CSF pulsatility in hydrocephalus: respiratory effect on pulse wave slope as an indicator of intracranial complianceNeurol Res126774PubMedGoogle Scholar
  13. Hebb, AO, Cusimano, MD 2001Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcomeNeurosurgery4911661186PubMedCrossRefGoogle Scholar
  14. Marmarou, A, Young, HF, Aygok, GA, Sawauchi, S, Tsuji, O, Yamamoto, T, Dunbar, J 2005Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patientsJ Neurosurg102987997PubMedGoogle Scholar
  15. McGirth, MJ, Woodworth, G, Coon, AL, Thomas, G, Williams, MA, Rigamonti, D 2005Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalusNeurosurgery57699705CrossRefGoogle Scholar
  16. Raftopoulos, C, Deleval, J, Chaskis, C, Leonard, A, Cantraine, F, Desmyttere, F, Clarysse, S, Brotchi, J 1994Cognitive recovery in idiopathic normal pressure hydrocephalus: a prospective studyNeurosurgery35397405PubMedGoogle Scholar
  17. Savolainen, S, Hurskainen, H, Paljärvi, L, Alafuzoff, I, Vapalathi, M 2002Five-year outcome of normal pressure hydrocephalus with or without a shunt: Predictive value of the clinical signs, neuropsychological evaluation and infusion testActa Neurochir (Wien)144515523CrossRefGoogle Scholar
  18. Sorteberg, A, Eide, PK, Fremming, A 2004A prospective study on the clinical effect of surgical treatment of normal pressure hydrocephalus: the value of hydrodynamic evaluationBr J Neurosurg18149157PubMedCrossRefGoogle Scholar
  19. Stein, SH, Langfitt, TW 1974Normal-pressure hydrocephalus. Predicting the results of cerebrospinal fluid shuntingJ Neurosurg41463470PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • P. K. Eide
    • 1
  • A. Brean
    • 2
  1. 1.Department of NeurosurgeryThe National HospitalRikshospitaletNorway
  2. 2.Department of NeurologyCounty Hospital of VestfoldTuensbergNorway

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