Normal Pressure Hydrocephalus: A Guide to Diagnosis and Management
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Abstract
Normal pressure hydrocephalus is a syndrome characterized by gait impairment, dementia and/or associated with ventriculomegaly and normal cerebroespinal liquid pressure. It may be secondary to processes that cause inflammation of the arachnoid, but more than half of patients do not have a recognizable risk factor, in these cases it is called idiopathic normal pressure hydrocephalus (INPH). Epidemiology data are limited; it may be seen at any age but it occurs more commonly between the sixth and seventh decades of life. Criteria for diagnosis includes more than one symptom of the classic triade: traditional findings in neuroimages, cerebroespinal liquid pressure measurement and the TAP-test. Many meassurement options exist, but the unique definitive is the surgery; VP Shunt is effective because it collects a large portion of liquid and provides higher capacitance, reducing interstitial edema, improving tissue perfusion and thus preventing ischemia.
Keywords
hidrocefalia, tratamiento, idiopática, Hydrocephalus, treatment, idiopathic,
References
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2. Pereira B. Normal pressure hydrocephalus. Diagnostic and predictive evaluation. Dement. Neuropsychol. 2009;3(1980-5764):8-5.
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6. Vanneste JA. Diagnosis and management of normal-pressure hydrocephalus. J Neurol. 2000;247(1):5-14.
7. Bateman GA. Vascular compliance in normal pressure hydrocephalus. AJNR. Am J Neuroradiol. 2000;21(9):1574-85.
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9. Fisher CM. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology. 1982;32(12):1358-63.
10. Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure.a treatable syndrome. N Eng J Med. 1965;273:117-26.
11. Sudarsky L, Simon S. Gait disorder in late-life hydrocephalus. Arch Neurol. 1987;44(3):263-7.
12. Graff-Radford N. Normal pressure hydrocephalus [internet]. 2014. Disponible en: http://www.uptodate.com/contents/normalpressure-hydrocephalus.
13. Lenfeldt N, Larsson A, Nyberg L, et al. Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage. Brain. 2008;131(Pt 11):2904-12.
14. Ishikawa M, Hashimoto M, Kuwana N, et al. Guidelines for management of idiopathic normal pressure hydrocephalus. Neurol Med-Chir (Tokyo). 2008;48 Suppl:S1-23.
15. Jacobs L, Kinkel W. Computerized axial transverse tomography in normal pressure hydrocephalus. Neurology. 1976;26(6 pt 1): 501-7.
16. Gyldensted C. Measurements of the normal ventricular system and hemispheric sulci of 100 adults with computed tomography. Neuroradiology. 1977;14(4):183-92.
17. Jack CR Jr., Petersen RC, O’Brien PC, Tangalos EG. MR-based hippocampal volumetry in the diagnosis of Alzheimer’s disease. Neurology. 1992;42(1):183-8.
18. Bradley WG, Jr., Scalzo D, Queralt J et al. Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology. 1996;198(2):523-9.
19. Sherman JL, Citrin CM, Gangarosa RE, Bowen BJ. The MR appearance of CSF flow in patients with ventriculomegaly. AJR. Am J Roentgenol. 1987;148(1):193-9.
20. Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006;2(7):375-81.
21. Wikkelso C, Andersson H, Blomstrand C et al. Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand. 1986;73(6):566-73.
22. Marmarou A, Bergsneider M, Klinge P et al. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(3 Suppl):S17-28; discussion ii-v.
23. Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965;2(4):307-27.
24. Wikkelso C, Andersson H, Blomstrand C, Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 1982;45(1):64-9.
25. Black PM, Ojemann RG, Tzouras A. CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg. 1985;32:632-51.
26. Iddon JL, Pickard JD, Cross JJ et al. Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer’s disease: a pilot study. J Neurol Neurosurg Psychiatry. 1999;67(6):723-32.
27. Miyoshi N, Kazui H, Ogino A et al. Association between cognitive impairment and gait disturbance in patients with idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord. 2005;20(2-3):71-6.
28. Graff-Radford NR, Godersky JC, Jones MP. Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology. 1989;39(12):1601-4.
29. Bergsneider M, Black PM, Klinge P et al. Surgical management of idiopathic normalpressure hydrocephalus. Neurosurgery. 2005;57(3 Suppl):S29-39; discussion ii-v.
30. Mitchell P, Mathew B. Third ventriculostomy in normal pressure hydrocephalus. Br J Neurosurg. 1999;13(4):382-5.
2. Pereira B. Normal pressure hydrocephalus. Diagnostic and predictive evaluation. Dement. Neuropsychol. 2009;3(1980-5764):8-5.
3. Hakim S. Some observations on CSF pressure: Hydrocephalic syndrome in adults with “normal” CSF pressure. Bogotá: Neurosurgery Javeriana University School of Medicine; 1964.
4. Marmarou A, Bergsneider M, Relkin N et al. Development of guidelines for idiopathic normal-pressure hydrocephalus: introduction. Neurosurgery. 2005;57(3 Suppl):S1-3; discussion ii-v.
5. Marmarou A, Young HF, Aygok GA, et al. Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. J Neurosurg. 2005;102(6):987-97.
6. Vanneste JA. Diagnosis and management of normal-pressure hydrocephalus. J Neurol. 2000;247(1):5-14.
7. Bateman GA. Vascular compliance in normal pressure hydrocephalus. AJNR. Am J Neuroradiol. 2000;21(9):1574-85.
8. Bradley WG. Normal pressure hydrocephalus: new concepts on etiology and diagnosis. AJNR. Am J Neuroradiol. 2000;21(9):1586-90.
9. Fisher CM. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology. 1982;32(12):1358-63.
10. Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure.a treatable syndrome. N Eng J Med. 1965;273:117-26.
11. Sudarsky L, Simon S. Gait disorder in late-life hydrocephalus. Arch Neurol. 1987;44(3):263-7.
12. Graff-Radford N. Normal pressure hydrocephalus [internet]. 2014. Disponible en: http://www.uptodate.com/contents/normalpressure-hydrocephalus.
13. Lenfeldt N, Larsson A, Nyberg L, et al. Idiopathic normal pressure hydrocephalus: increased supplementary motor activity accounts for improvement after CSF drainage. Brain. 2008;131(Pt 11):2904-12.
14. Ishikawa M, Hashimoto M, Kuwana N, et al. Guidelines for management of idiopathic normal pressure hydrocephalus. Neurol Med-Chir (Tokyo). 2008;48 Suppl:S1-23.
15. Jacobs L, Kinkel W. Computerized axial transverse tomography in normal pressure hydrocephalus. Neurology. 1976;26(6 pt 1): 501-7.
16. Gyldensted C. Measurements of the normal ventricular system and hemispheric sulci of 100 adults with computed tomography. Neuroradiology. 1977;14(4):183-92.
17. Jack CR Jr., Petersen RC, O’Brien PC, Tangalos EG. MR-based hippocampal volumetry in the diagnosis of Alzheimer’s disease. Neurology. 1992;42(1):183-8.
18. Bradley WG, Jr., Scalzo D, Queralt J et al. Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology. 1996;198(2):523-9.
19. Sherman JL, Citrin CM, Gangarosa RE, Bowen BJ. The MR appearance of CSF flow in patients with ventriculomegaly. AJR. Am J Roentgenol. 1987;148(1):193-9.
20. Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006;2(7):375-81.
21. Wikkelso C, Andersson H, Blomstrand C et al. Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand. 1986;73(6):566-73.
22. Marmarou A, Bergsneider M, Klinge P et al. The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus. Neurosurgery. 2005;57(3 Suppl):S17-28; discussion ii-v.
23. Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure: Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965;2(4):307-27.
24. Wikkelso C, Andersson H, Blomstrand C, Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 1982;45(1):64-9.
25. Black PM, Ojemann RG, Tzouras A. CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg. 1985;32:632-51.
26. Iddon JL, Pickard JD, Cross JJ et al. Specific patterns of cognitive impairment in patients with idiopathic normal pressure hydrocephalus and Alzheimer’s disease: a pilot study. J Neurol Neurosurg Psychiatry. 1999;67(6):723-32.
27. Miyoshi N, Kazui H, Ogino A et al. Association between cognitive impairment and gait disturbance in patients with idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Disord. 2005;20(2-3):71-6.
28. Graff-Radford NR, Godersky JC, Jones MP. Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly. Neurology. 1989;39(12):1601-4.
29. Bergsneider M, Black PM, Klinge P et al. Surgical management of idiopathic normalpressure hydrocephalus. Neurosurgery. 2005;57(3 Suppl):S29-39; discussion ii-v.
30. Mitchell P, Mathew B. Third ventriculostomy in normal pressure hydrocephalus. Br J Neurosurg. 1999;13(4):382-5.
How to Cite
Acevedo González, J. C., & Borda-Borda, M. G. (2014). Normal Pressure Hydrocephalus: A Guide to Diagnosis and Management. Universitas Medica, 56(1), 81–90. Retrieved from https://revistas.javeriana.edu.co/index.php/vnimedica/article/view/16342
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Reviews