Predictive tests for shunting normal pressure hydrocephalus – pro

Idiopathic normal pressure hydrocephalus (iNPH) is a syndrome characterized by gait disturbance, dementia, and/or urinary incontinence without causative disorders, and ventricular enlargement due to disturbance of the cerebrospinal fluid (SF) circulation. Surgical CSF shunting remains the main treatment modality. Prior to embarking upon surgical therapy, knowing which patients may benefit from surgery. Several different tests can be performed to predict success from shunting. While large volume lumbar puncture was the earliest invasive diagnostic test in predicting response to shunt surgery, external lumbar drainage (ELD) is being used with increased frequency, followed by shunting. The review by Burnett, questions to to to of any predictive test.

Ishikawa M; Guideline Committe for Idiopathic Normal Pressure Hydrocephalus, Clinical guidelines for idiopathic normal pressure hydrocephalus.
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Tsakanikas D, Relkin N. Normal pressure hydrocephalus. Semin Neurol. Feb 2007;27(1):58-65.

Burnett MG, Sonnad SS, Stein SC. Screening tests for normal-pressure hydrocephalus: sensitivity, specificity, and cost. J Neurosurg. Dec 2006;105(6):823-9.

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