scholarly journals Normal pressure hydrocephalus

2021 ◽  
Vol 13 ◽  
pp. e017
Author(s):  
Maria Eduarda Turczyn De Lucca ◽  
Leonardo Cesar Ferreira Antunes ◽  
Carlos Arteaga Rodriguez ◽  
Otto Jesus Hernández Fustes
Keyword(s):  
Urinary Incontinence ◽  
Cognitive Impairment ◽  
Normal Pressure Hydrocephalus ◽  
Randomized Clinical Trials ◽  
Brain Mri ◽  
Normal Pressure ◽  
The Elderly ◽  
Advanced Stages ◽  
Clinical Tools ◽  
Rule Out

Normal pressure hydrocephalus – NPH is one of the potentially reversible causes of dementia. In this work, we provide the clinical tools for the management of NPH to the Primary Health Care – PHC physicians. The PubMed and Cochrane databases were reviewed, and 40 articles were chosen, which include randomized clinical trials, metanalysis and systematic reviews. The symptoms of the classic triad are nonspecific and found in the elderly with other diseases. Gait apraxia is the earliest symptom, followed by cognitive impairment and urinary incontinence. The concomitance of the three symptoms occurs in about 60% of the cases in the advanced stages. Apraxia of gait is presented with short steps, without sensorial, vestibulocerebellar or muscle strength changes, which allows it to be distinguished from other pathological marches. Cognitive impairment is subcortical – psychomotor slowliness, inattention, loss of working memory and executive function and preservation of episodic memory – unlike cortical dementias, such as Alzheimer's disease. Urinary incontinence must be distinguished from overflow by prostatism and stress incontinence in women. The PHC physician, when faced with the triad, should request a CT scan or brain MRI and, in the presence of one or two symptoms, rule out other diagnoses. Patients with NPH seek help from the physician in the PHC who must know how to identify and differentiate their symptoms. In the case of suspicion, the study of neuroimaging is mandatory and referral to neurosurgery or neurology is recommended.

scholarly journals Normal-Pressure Hydrocephalus: Is There a Genetic Predisposition?

2011 ◽  
Vol 38 (2) ◽  
pp. 274-281 ◽  
Author(s):  
M. D. Cusimano ◽  
D. Rewilak ◽  
D. T. Stuss ◽  
J. C. Barrera-Martinez ◽  
F. Salehi ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Urinary Incontinence ◽  
Cognitive Impairment ◽  
Environmental Factors ◽  
Natural History ◽  
Normal Pressure Hydrocephalus ◽  
Genetic Predisposition ◽  
Fluid Pressure ◽  
Cerebral Atrophy ◽  
Normal Pressure

Background:Normal-pressure hydrocephalus (NPH) is characterized by gait disturbance, cognitive impairment, with or without urinary incontinence, enlarged ventricles with or without cerebral atrophy and normal cerebrospinal fluid pressure.Methods:We report two sisters with NPH who lived together their entire lives and whose natural history might provide insights into genetic and environmental mechanisms underlying this disorder. Both patients were in their early seventies, single, had similar daily habits and hypertension. No other family members had NPH.Results:They both underwent shunt placement and showed improvement documented by history and neuropsychological assessment. Both showed a delayed deterioration due to vasculopathy. Both patients were homozygous for the apolipoprotein E (ApoE) e3 allele on chromosome 19. No environmental factors that might have influenced the development of NPH were identified.Conclusion:Our report of two sisters with NPH may indicate the presence of genetic predisposition and further studies involving genetics and environmental factors are necessary to elucidate their role in the pathogenesis of NPH.

scholarly journals Secondary Normal-Pressure Hydrocephalus in Rheumatoid Meningitis

2021 ◽  
pp. 434-440
Author(s):  
Micaela Owens ◽  
Na Tosha Gatson ◽  
Gino Mongelluzzo ◽  
Oded Goren ◽  
Eric Newman ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Normal Pressure Hydrocephalus ◽  
Immune Suppression ◽  
Normal Pressure ◽  
The Elderly ◽  
Common Cause ◽  
Gait Abnormality ◽  
Ventriculoperitoneal Shunting ◽  
Patient Reported ◽  
Rheumatoid Meningitis

Normal-pressure hydrocephalus (NPH) is a common cause of gait apraxia, cognitive impairment, and urinary incontinence in the elderly. It is usually a primary idiopathic disorder but can be secondary. We present a case of secondary NPH due to biopsy-confirmed rheumatoid meningitis initially refractory to intravenous (IV) immunotherapy. Our patient reported an excellent response right after shunting. Her gait remains normal one and a half years later. We searched PubMed for similar cases of rheumatoid meningitis with gait abnormality for additional clinicopathologic discussion. The patient’s movement disorder initially improved with steroid taper. However, she developed progressive symptoms, later on, refractory to IV solumedrol and rituximab. She underwent ventriculoperitoneal shunting (VPS) and reported an outstanding outcome. This is the first reported biopsy-confirmed case of rheumatoid meningitis causing NPH to undergo shunting for immediate improvement. Previous cases of rheumatoid meningitis-associated Parkinsonism have improved with steroid induction. Although our patient’s rheumatoid arthritis is now controlled, her case illustrates that NPH in autoinflammatory conditions may not recover with immune suppression alone. VPS is an option for a faster response in secondary NPH due to rheumatoid meningitis or other inflammatory disorders with progressive symptoms despite standard induction therapy.

scholarly journals Progression in Neuroimaging of Normal Pressure Hydrocephalus

2021 ◽  
Vol 12 ◽  
Author(s):  
Rui Yin ◽  
Junxian Wen ◽  
Junji Wei
Keyword(s):  
Future Development ◽  
Normal Pressure Hydrocephalus ◽  
Large Scale ◽  
Elderly Population ◽  
Normal Pressure ◽  
The Elderly ◽  
Rapid Identification ◽  
Clinical Syndrome ◽  
Surgical Interventions ◽  
Large Scale Screening

Normal-pressure hydrocephalus is a clinical syndrome that mainly targets the elderly population. It features dementia, impaired walking, and the malfunction of sphincters. The rapid identification and large-scale screening of patients with normal-pressure hydrocephalus (NPH) are of great significance as surgical interventions can greatly improve or even reverse the symptoms. This review aims to summarize the traditional parameters used to diagnose NPH and the emerging progression in neuroimaging of the disease, hoping to provide an up-to-date overall perspective and summarize the possible direction of its future development.

scholarly journals Normal-pressure hydrocephalus: A critical review

2019 ◽  
Vol 13 (2) ◽  
pp. 133-143 ◽  
Author(s):  
Louise Makarem Oliveira ◽  
Ricardo Nitrini ◽  
Gustavo C. Román
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Critical Review ◽  
Normal Pressure ◽  
The Elderly ◽  
Expert Assessment ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Urinary Infections ◽  
Obstructive Sleep ◽  
Surgical Treatments

ABSTRACT. Normal-pressure hydrocephalus (NPH) is a potentially reversible syndrome characterized by enlarged cerebral ventricles (ventriculomegaly), cognitive impairment, gait apraxia and urinary incontinence. A critical review of the concept, pathophysiology, diagnosis, and treatment of both idiopathic and secondary NPH was conducted. We searched Medline and PubMed databases from January 2012 to December 2018 using the keywords “normal-pressure hydrocephalus” / “idiopathic normal-pressure hydrocephalus” / “secondary normal-pressure hydrocephalus” / “NPH” / “ventriculoperitoneal shunt”. The initial search produced 341 hits. After careful selection, a total of 54 articles were chosen and additional relevant studies were included during the process of writing this article. NPH is an important cause of potentially reversible dementia, frequent falls and recurrent urinary infections in the elderly. The clinical and imaging features of NPH may be incomplete or nonspecific, posing a diagnostic challenge for medical doctors and often requiring expert assessment to minimize unsuccessful surgical treatments. Recent advances resulting from the use of non-invasive MRI methods for quantifying cerebral blood flow, in particular arterial spin-labeling (ASL), and the frequent association of NPH and obstructive sleep apnea (OSA), offer new avenues to understand and treat NPH.

scholarly journals Comorbid Normal Pressure Hydrocephalus with Parkinsonism: A Clinical Challenge and Call for Awareness

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
A. Cucca ◽  
M. C. Biagioni ◽  
K. Sharma ◽  
J. Golomb ◽  
R. M. Gilbert ◽  
...  
Keyword(s):  
Clinical Features ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Postural Instability ◽  
Concomitant Disease ◽  
Clinical Challenge ◽  
Neurologic Disorders ◽  
Insidious Onset ◽  
Gait Dysfunction

Idiopathic normal pressure hydrocephalus (iNPH) is the most common cause of hydrocephalus in adults. The diagnosis may be challenging, requiring collaborative efforts between different specialists. According to the International Society for Hydrocephalus and Cerebrospinal Fluid Disorders, iNPH should be considered in the differential of any unexplained gait failure with insidious onset. Recognizing iNPH can be even more difficult in the presence of comorbid neurologic disorders. Among these, idiopathic Parkinson’s disease (PD) is one of the major neurologic causes of gait dysfunction in the elderly. Both conditions have their peak prevalence between the 6th and the 7th decade. Importantly, postural instability and gait dysfunction are core clinical features in both iNPH and PD. Therefore, diagnosing iNPH where diagnostic criteria of PD have been met represents an additional clinical challenge. Here, we report a patient with parkinsonism initially consistent with PD who subsequently displayed rapidly progressive postural instability and gait dysfunction leading to the diagnosis of concomitant iNPH. In the following sections, we will review the clinical features of iNPH, as well as the overlapping and discriminating features when degenerative parkinsonism is in the differential diagnosis. Understanding and recognizing the potential for concomitant disease are critical when treating both conditions.

Flow Void of Cerebrospinal Fluid in Idiopathic Normal Pressure Hydrocephalus of the Elderly: Can It Predict Outcome after Shunting?

Neurosurgery ◽  
1997 ◽  
Vol 40 (1) ◽  
pp. 67-74 ◽  
Author(s):  
Joachim K. Krauss ◽  
Jens P. Regel ◽  
Werner Vach ◽  
Freimut D. J??ngling ◽  
Dirk W. Droste ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Flow Void

scholarly journals Idiopathic normal pressure hydrocephalus presenting with paroxysmal paraparesis as a cardinal symptom: A case presentation

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Andreas Eleftheriou ◽  
◽  
Christina Koumantzia ◽  
Keyword(s):  
Normal Pressure Hydrocephalus ◽  
Elderly Population ◽  
Progressive Disease ◽  
Clinical History ◽  
Normal Pressure ◽  
The Elderly ◽  
Idiopathic Normal Pressure Hydrocephalus ◽  
Case Presentation ◽  
Physical Findings ◽  
Cardinal Symptom

Idiopathic normal pressure hydrocephalus (iNPH) is a gradually progressive disease affecting the elderly population. The diagnosis of probable iNPH is based on clinical history, physical findings, brain imaging. INPH involves non-obstructive enlargement of the cerebral ventricles combined with one or more symptoms of cognitive decline, impaired gait and balance, and urinary urgency. Our case describes an unusual coexistence of radiological and clinical iNPH symptoms with paroxysmal paraparesis.

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