Highlights
- •Initial gait parameters are insufficient to identify shunt-responsive iNPH patients.
- •Most iNPH patients require several days of CSF drainage before symptoms improve.
- •Inclusion of urinary and cognitive changes increases lumbar drain predictive value.
- •The level of improvement after lumbar drain trial correlates with that after shunting.
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait instability,
urinary incontinence and cognitive dysfunction. These symptoms can be relieved by
cerebrospinal fluid (CSF) drainage, but the time course and nature of the improvements
are poorly characterized. Attempts to prospectively identify iNPH patients responsive
to CSF drainage by evaluating presenting gait quality or via extended lumbar cerebrospinal
fluid drainage (eLCD) trials are common, but the reliability of such approaches is
unclear. Here we combine eLCD trials with computerized quantitative gait measurements
to predict shunt responsiveness in patients undergoing evaluation for possible iNPH.
In this prospective cohort study, 50 patients presenting with enlarged cerebral ventricles
and gait, urinary, and/or cognitive difficulties were evaluated for iNPH using a computerized
gait analysis system during a 3 day trial of eLCD. Gait speed, stride length, cadence, and the Timed Up and Go test
were quantified before and during eLCD. Qualitative assessments of incontinence and
cognition were obtained throughout the eLCD trial. Patients who improved after eLCD
underwent ventriculoperitoneal shunt placement, and symptoms were reassessed serially
over the next 3 to 15 months. There was no significant difference in presenting gait characteristics between
patients who improved after drainage and those who did not. Gait improvement was not
observed until 2 or more days of continuous drainage in most cases. Symptoms improved
after eLCD in 60% of patients, and all patients who improved after eLCD also improved
after shunt placement. The degree of improvement after eLCD correlated closely with
that observed after shunt placement.
Keywords
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References
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Article info
Publication history
Published online: January 07, 2016
Accepted:
November 29,
2015
Received:
July 30,
2015
Identification
Copyright
© 2015 Elsevier Ltd. All rights reserved.
