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Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date

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Intracranial Pressure and Brain Monitoring XII

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 95))

Summary

The aim of this project was to develop evidenced based guidelines for the diagnosis and management of idiopathic normal pressure hydrocephalus (iNPH). An advisory panel consisting of the authors assisted by international experts met on several occasions and formulated preliminary guidelines for iNPH managemen. The authors developed evidentiary tables based on available literature from 1966 to the present. Additional meetings to refine the evidentiary tables and incorporate expert opinion when necessary resulted in the development the iNPH guidelines. Evidence based guidelines identifying the value of clinical examination, brain imaging, Tap Test, CSF drainage, ICP monitoring and Surgical Management in diagnosing and treating the iNPH patient were developed. These are the first international evidence based guidelines focused on iNPH. Class I data were scant and guidelines relied mostly on class II and III evidence. It became clear that more prospective randomized studies are needed to resolve some of the controversial issues such as iNPH classification and sensitivity of diagnostic tests for identifying shunt responsive iNPH.

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References

  1. Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH (1965) Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure. A treatable syndrome. N Engl J Med 273: 117–126

    Article  PubMed  CAS  Google Scholar 

  2. Hakim S, Adams RD (1965) The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci 2(4): 307–327

    Article  PubMed  CAS  Google Scholar 

  3. Black PM (1980) Idiopathic normal-pressure hydrocephalus. Results of shunting in 62 patients. J Neurosurg 52(3): 371–377

    PubMed  CAS  Google Scholar 

  4. Black PM (1982) Normal-pressure hydrocephalus: current understanding of diagnostic tests and shunting. Postgrad Med 71(2): 57–61, 65–67

    PubMed  CAS  Google Scholar 

  5. Malm J, Kristensen V, Fagerlund M, Koskinen LO, Ekstedt J (1995) Cerebrospinal fluid shunt dynamics in patients with idiopathic adult hydrocephalus syndrome. J Neurol Neurosurg Psychiatry 58(6): 715–723

    Article  PubMed  CAS  Google Scholar 

  6. Walchenbach R, Geiger E, Thomeer RT, Vanneste JA (2002) The value of temporary external lumbar CSF drainage in predicting the outcome of shunting on normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 72(4): 503–506

    PubMed  CAS  Google Scholar 

  7. Williams MA, Razumovsky AY, Hanley DF (1998) Comparison of Pcsf monitoring and controlled CSF drainage diagnose normal pressure hydrocephalus. Acta Neurochir [Suppl] 71: 328–330

    CAS  Google Scholar 

  8. Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J (1995) The predictive value of cerebrospinal fluid dynamic tests in patients with th idiopathic adult hydrocephalus syndrome. Arch Neuro 52(8): 783–789

    CAS  Google Scholar 

  9. Krauss JK, Droste DW, Vach W, Regel JP, Orszagh M, Borremans JJ, Tietz A, Seeger W (1996) Cerebrospinal fluid shunting in idiopathic normal-pressure hydrocephalus of the elderly: effect of periventricular and deep white matter lesions. Neurosurgery 39(2): 292–299; discussion 299–300

    Article  PubMed  CAS  Google Scholar 

  10. Black PM, Ojemann RG, Tzouras A (1985) CSF shunts for dementia, incontinence, and gait disturbance. Clin Neurosurg 32: 632–651

    PubMed  CAS  Google Scholar 

  11. Stein SC, Langfitt TW (1974) Normal-pressure hydrocephalus. Predicting the results of cerebrospinal fluid shunting. J Neurosurg 41(4): 463–470

    Article  PubMed  CAS  Google Scholar 

  12. Boon AJ, Tans JT, Delwel EJ, Egeler-Peerdeman SM, Hanlo PW, Wurzer HA, Avezaat CJ, de Jong DA, Gooskens RH, Hermans J (1997) Dutch normal-pressure hydrocephalusstudy: prediction of outcome after shunting by resistance to outflow of cerebrospinal fluid. J Neurosurg 87(5): 687–693

    Article  PubMed  CAS  Google Scholar 

  13. Takeuchi T, Kasahara E, Iwasaki M, Mima T, Mori K (2000) Indications for shunting in patients with idiopathic normal pressure hydrocephalus presenting with dementia and brain atrophy (atypical idiopathic normal pressure hydrocephalus). Neurol Med Chir Tokyo 40(1): 38–46; discussion 46–47

    Article  PubMed  CAS  Google Scholar 

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Correspondence to A. Marmarou .

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© 2005 Springer-Verlag

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Marmarou, A., Black, P., Bergsneider, M., Klinge, P., Relkin, N., International NPH Consultant Group. (2005). Guidelines for management of idiopathic normal pressure hydrocephalus: progress to date. In: Poon, W.S., et al. Intracranial Pressure and Brain Monitoring XII. Acta Neurochirurgica Supplementum, vol 95. Springer, Vienna. https://doi.org/10.1007/3-211-32318-X_48

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  • DOI: https://doi.org/10.1007/3-211-32318-X_48

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-24336-7

  • Online ISBN: 978-3-211-32318-2

  • eBook Packages: MedicineMedicine (R0)

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