Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus - #34

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An approach to diagnoses of geriatric patients who have suspected NPH.

Diagnosis of Normal pressure hydrocephalus

Appropriate clinical response when brain imaging tests raises the suspicion of NPH. Insert image here

Patients presenting with gait disturbance, cognitive decline, or urinary incontinence present a common clinical dilemma for clinicians (1). This constellation of symptoms, while suggestive of NPH, can commonly occur in other neurodegenerative conditions or nonspecifically in advanced age (1). While some of the cases of NPH are due to prior meningitis, encephalitis, subarachnoid hemorrhage, or trauma; many causes remain idiopathic (2). Some people think that memory loss, difficulty finding words, walking problems, or urination problems are normal parts of aging. In many cases, however, these are symptoms of treatable conditions. Any of these problems, or changes in mood or behavior, warrants a visit to your health care provider. Patients with NPH may have typical imaging features of this disease process. However, a clinician may order brain imaging for other symptoms and the interpreting radiologist may raise the suspicion for NPH. This can lead to confusion for the clinician and patient anxiety.

Review the role of imaging in the diagnosis of normal pressure hydrocephalus (NPH).

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  2. Scharre DW. Normal pressure hydrocephalus: measure twice, shunt once. Neurology 2011;77:1110-1111. http://www.ncbi.nlm.nih.gov/pubmed/21849649
  3. Clarfield AM. The reversible dementias: do they reverse? Ann Intern Med 1988;109:476-86. http://www.ncbi.nlm.nih.gov/pubmed/3046450
  4. Larson EB, Reifler BV, Featherstone HJ, et al. Dementia in elderly outpatients: a prospective study. Ann Intern Med 1984;100:417-23.http://www.ncbi.nlm.nih.gov/pubmed/6696360
  5. Brean A, Eide PK. Prevalence of probable idiopathic normal pressure hydrocephalus in a Norwegian population. Neurol Scand 2008;118:48-53.http://www.ncbi.nlm.nih.gov/pubmed/18205881
  6. Marmarou A, Young HF, Aygok GA. Estimated incidence of normal pressure hydrocephalus and shutn outcome in patients residing in assisted-living and extended care facilities. Neurosurg Focus 2007;22:E1. http://www.ncbi.nlm.nih.gov/pubmed/17613187
  7. Shprecher D, Schwalb J, Kurlan R. Normal pressure hydrocephalus: diagnosis and treatment. Curr Neurology and Neuroscience Rep 2008;8:371-376. http://www.ncbi.nlm.nih.gov/pubmed/?term=normal+pressure+hydrocephalus+diagnosis+and+treatment+shprecher
  8. Kim MJ, Seo SW, Lee KM, et al. differential diagnosis of idiopathic normal pressure hydrocephalus from other dementias using diffusion tensor imaging. Am J Neuroradiol 2011;32:1496-1503. http://www.ncbi.nlm.nih.gov/pubmed/21700790
  9. Yousem DM, Grossman RI. Neuroradiology: The Requisites. 2010. Mosby, Inc. Philadelphia, PA.
You voted '2'.
This GFF ___ my competence in geriatrics.

Matthew Koeberl MD, Joseph Budovec MD, Steven Denson MD

Medical College of Wisconsin, Milwaukee, Wisconsin