The sustained improvement after lumbar puncture in an idiopathic normal pressure hydrocephalus subject with synucleinopathy

Excerpt

There is a large amount of work focusing on the diagnostic challenges in idiopathic normal pressure hydrocephalus (iNPH) [1, 2]. At this point, the aid of the neuroimaging techniques to increase the diagnostic certainty as well as distinguish from mimics constitutes particularly interesting topics for research [3‐5]. The systematic use of some classical neuroimaging signs on conventional MRI is emphasized to provide reliable evidence [6]. Besides, in a crucial study by Quattrone et al., automated ventricular volumetry and Magnetic Resonance Hydrocephalic Index were introduced as useful parameters in differentiation between iNPH and progressive supranuclear palsy[7], one of the crucial mimics of iNPH [1]. Some other authors also investigated the dopamine transporter imaging (DAT-SPECT) results in iNPH subjects. It has been found that DAT-SPECT may provide substantial data in distinguishing the underlying neurodegenerative pathologies mimicking iNPH[8]; however, dopaminergic imaging alterations have been found also in iNPH subjects making the diagnostic process strictly more complicated [8‐10]. In this regard, I read with great interest the recent article by Han et al. in which they illustrate an idiopathic normal pressure hydrocephalus (iNPH) subject demonstrating striatal dopaminergic deficit on dopamine transporter (DAT) scan and they discuss the comorbid synucleinopathy in iNPH [11]. …