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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(03): 648-656
DOI: 10.4103/ajns.AJNS_14_19
Review Article

Current updates on idiopathic normal pressure hydrocephalus

Boon Liew
Department of Neurosurgery, Hospital Sungai Buloh, Selangor
,
Kiyoshi Takagi
1   Normal Pressure Hydrocephalus Center, Tokyo Neurological Center Hospital, Tokyo
,
Yoko Kato
2   Department of Neurosurgery, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya
,
Shyam Duvuru
3   Department of Neurosurgery, Velammal Hospitals, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu
,
Sengottuvel Thanapal
4   Department of Neurosurgery, Government Mohan Kumaramangalam Medical College, Salem, Tamil Nadu
,
Balamurugan Mangaleswaran
5   Department of Neurosurgery, Apollo Speciality Hospital, Chennai, Tamil Nadu
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Idiopathic normal pressure hydrocephalus (iNPH) is one of the neurodegenerative diseases which can be treated surgically with favorable outcome. The gait disturbance, cognitive, and urinary symptoms are known as the clinical triad of iNPH. In this review, we have addressed the comorbidities, differential diagnoses, clinical presentations, and pathology of iNPH. We have also summarized the imaging studies and clinical procedures used for the diagnosis of iNPH. The treatment modality, outcomes, and prognosis were also discussed.

Key-words:

Diagnostic methods - idiopathic normal pressure hydrocephalus - neuro-degenerative disease - surgical management

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Allali G, Laidet M, Armand S, Momjian S, Marques B, Saj A, et al. A combined cognitive and gait quantification to identify normal pressure hydrocephalus from its mimics: The Geneva's protocol. Clin Neurol Neurosurg 2017;160:5-11.
  • 2 Kuriyama N, Miyajima M, Nakajima M, Kurosawa M, Fukushima W, Watanabe Y, et al. Nationwide hospital-based survey of idiopathic normal pressure hydrocephalus in Japan: Epidemiological and clinical characteristics. Brain Behav 2017;7:e00635.
  • 3 Pyykkö OT, Nerg O, Niskasaari HM, Niskasaari T, Koivisto AM, Hiltunen M, et al. Incidence, comorbidities, and mortality in idiopathic normal pressure hydrocephalus. World Neurosurg 2018;112:e624-31.
  • 4 Israelsson H, Carlberg B, Wikkelsö C, Laurell K, Kahlon B, Leijon G, et al. Vascular risk factors in INPH: A prospective case-control study (the INPH-CRasH study). Neurology 2017;88:577-85.
  • 5 Andrén K, Wikkelsö C, Sundström N, Agerskov S, Israelsson H, Laurell K, et al. Long-term effects of complications and vascular comorbidity in idiopathic normal pressure hydrocephalus: A quality registry study. J Neurol 2018;265:178-86.
  • 6 Giliberto C, Mostile G, Lo Fermo S, Reggio E, Sciacca G, Nicoletti A, et al. Vascular parkinsonism or idiopathic NPH? New insights from CSF pressure analysis. Neurol Sci 2017;38:2209-12.
  • 7 Allali G, Garibotto V, Assal F. Parkinsonism differentiates idiopathic normal pressure hydrocephalus from its mimics. J Alzheimers Dis 2016;54:123-7.
  • 8 Santangelo R, Cecchetti G, Bernasconi MP, Cardamone R, Barbieri A, Pinto P, et al. Cerebrospinal fluid amyloid-β 42, total tau and phosphorylated tau are low in patients with normal pressure hydrocephalus: Analogies and differences with Alzheimer's disease. J Alzheimers Dis 2017;60:183-200.
  • 9 Nikaido Y, Kajimoto Y, Tucker A, Kuroda K, Ohno H, Akisue T, et al. Intermittent gait disturbance in idiopathic normal pressure hydrocephalus. Acta Neurol Scand 2018;137:238-44.
  • 10 Ma TS, Sharma N, Grady MS. A simplified pressure adjustment clinical pathway for programmable valves in NPH patients. Clin Neurol Neurosurg 2017;159:83-6.
  • 11 Molde K, Söderström L, Laurell K. Parkinsonian symptoms in normal pressure hydrocephalus: A population-based study. J Neurol 2017;264:2141-8.
  • 12 Allali G, Laidet M, Armand S, Saj A, Krack P, Assal F, et al. Apathy and higher level of gait control in normal pressure hydrocephalus. Int J Psychophysiol 2017;119:127-31.
  • 13 Jo KW, Kim Y, Park GY, Park IS, Jang Y, Gyun SD, et al. Oropharyngeal dysphagia in secondary normal pressure hydrocephalus due to corticobulbar tract compression: Cases series and review of literature. Acta Neurochir (Wien) 2017;159:1005-11.
  • 14 Haan J, Jansen EN, Oostrom J, Roos RA. Falling spells in normal pressure hydrocephalus: A favourable prognostic sign? Eur Neurol 1987;27:216-20.
  • 15 Onder H, Akkurt I. Dramatic improvement of impulsive aggressive behaviour following shunt surgery in a patient with idiopathic normal pressure hydrocephalus. Neurol Sci 2017;38:1889-91.
  • 16 Huovinen J, Helisalmi S, Paananen J, Laiterä T, Kojoukhova M, Sutela A, et al. Alzheimer's disease-related polymorphisms in shunt-responsive idiopathic normal pressure hydrocephalus. J Alzheimers Dis 2017;60:1077-85.
  • 17 Brix MK, Westman E, Simmons A, Ringstad GA, Eide PK, Wagner-Larsen K, et al. The Evans' index revisited: New cut-off levels for use in radiological assessment of ventricular enlargement in the elderly. Eur J Radiol 2017;95:28-32.
  • 18 Grahnke K, Jusue-Torres I, Szujewski C, Joyce C, Schneck M, Prabhu VC, et al. The quest for predicting sustained shunt response in normal-pressure hydrocephalus: An analysis of the callosal angle's utility. World Neurosurg 2018;115:e717-22.
  • 19 Perry A, Graffeo CS, Fattahi N, ElSheikh MM, Cray N, Arani A, et al. Clinical correlation of abnormal findings on magnetic resonance elastography in idiopathic normal pressure hydrocephalus. World Neurosurg 2017;99:695-700.e1.
  • 20 Ringstad G, Vatnehol SA, Eide PK. Glymphatic MRI in idiopathic normal pressure hydrocephalus. Brain 2017;140:2691-705.
  • 21 Takizawa K, Matsumae M, Hayashi N, Hirayama A, Yatsushiro S, Kuroda K, et al. Hyperdynamic CSF motion profiles found in idiopathic normal pressure hydrocephalus and Alzheimer's disease assessed by fluid mechanics derived from magnetic resonance images. Fluids Barriers CNS 2017;14:29.
  • 22 Benedetto N, Gambacciani C, Aquila F, Di Carlo DT, Morganti R, Perrini P, et al. A new quantitative method to assess disproportionately enlarged subarachnoid space (DESH) in patients with possible idiopathic normal pressure hydrocephalus: The SILVER index. Clin Neurol Neurosurg 2017;158:27-32.
  • 23 Yin LK, Zheng JJ, Zhao L, Hao XZ, Zhang XX, Tian JQ, et al. Reversed aqueductal cerebrospinal fluid net flow in idiopathic normal pressure hydrocephalus. Acta Neurol Scand 2017;136:434-9.
  • 24 Goujon A, Mejdoubi M, Purcell Y, Banydeen R, Colombani S, Arrigo A, et al. Can MRI water apparent diffusion coefficient (ADC) value discriminate between idiopathic normal pressure hydrocephalus, Alzheimer's disease and subcortical vascular dementia? J Neuroradiol 2018;45:15-22.
  • 25 Virhammar J, Laurell K, Ahlgren A, Larsson EM. Arterial spin-labeling perfusion MR imaging demonstrates regional CBF decrease in idiopathic normal pressure hydrocephalus. AJNR Am J Neuroradiol 2017;38:2081-8.
  • 26 Ziegelitz D, Arvidsson J, Hellström P, Tullberg M, Wikkelsø C, Starck G, et al. Pre-and postoperative cerebral blood flow changes in patients with idiopathic normal pressure hydrocephalus measured by computed tomography (CT)-perfusion. J Cereb Blood Flow Metab 2016;36:1755-66.
  • 27 Czerwosz L, Szczepek E, Nowiński K, Sokołowska B, Jurkiewicz J, Czernicki Z, et al. Discriminant analysis of intracranial volumetric variables in patients with normal pressure hydrocephalus and brain atrophy. Adv Exp Med Biol 2018;1039:83-94.
  • 28 Yamada S, Ishikawa M, Yamamoto K. Comparison of CSF distribution between idiopathic normal pressure hydrocephalus and Alzheimer disease. AJNR Am J Neuroradiol 2016;37:1249-55.
  • 29 Yamada S, Ishikawa M, Iwamuro Y, Yamamoto K. Choroidal fissure acts as an overflow device in cerebrospinal fluid drainage: Morphological comparison between idiopathic and secondary normal-pressure hydrocephalus. Sci Rep 2016;6:39070.
  • 30 Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: Second edition. Neurol Med Chir (Tokyo) 2012;52:775-809.
  • 31 Ko PW, Lee HW, Kang K. Frontal assessment battery and cerebrospinal fluid tap test in idiopathic normal-pressure hydrocephalus. Eur Neurol 2017;77:327-32.
  • 32 Liouta E, Gatzonis S, Kalamatianos T, Kalyvas A, Koutsarnakis C, Liakos F, et al. Finger tapping and verbal fluency post-tap test improvement in INPH: Its value in differential diagnosis and shunt-treatment outcomes prognosis. Acta Neurochir (Wien) 2017;159:2301-7.
  • 33 Wolfsegger T, Topakian R. Cognitive impairment predicts worse short-term response to spinal tap test in normal pressure hydrocephalus. J Neurol Sci 2017;379:222-5.
  • 34 Marques B, Laidet M, Armand S, Assal F, Allali G. CSF tapping also improves mental imagery of gait in normal pressure hydrocephalus. J Neural Transm (Vienna) 2017;124:1401-5.
  • 35 Bäcklund T, Frankel J, Israelsson H, Malm J, Sundström N. Trunk sway in idiopathic normal pressure hydrocephalus-quantitative assessment in clinical practice. Gait Posture 2017;54:62-70.
  • 36 Ertl M, Aigner R, Krost M, Karnasová Z, Müller K, Naumann M, et al. Measuring changes in the optic nerve sheath diameter in patients with idiopathic normal-pressure hydrocephalus: A useful diagnostic supplement to spinal tap tests. Eur J Neurol 2017;24:461-7.
  • 37 Spiegelberg A, Krause M, Meixensberger J, Seifert B, Kurtcuoglu V. Significant association of slow vasogenic ICP waves with normal pressure hydrocephalus diagnosis. Acta Neurochir Suppl 2018;126:243-6.
  • 38 Jurjević I, Miyajima M, Ogino I, Akiba C, Nakajima M, Kondo A, et al. Decreased expression of hsa-miR-4274 in cerebrospinal fluid of normal pressure hydrocephalus mimics with Parkinsonian syndromes. J Alzheimers Dis 2017;56:317-25.
  • 39 Nagata Y, Bundo M, Sugiura S, Kamita M, Ono M, Hattori K, et al. PTPRQ as a potential biomarker for idiopathic normal pressure hydrocephalus. Mol Med Rep 2017;16:3034-40.
  • 40 Murakami Y, Matsumoto Y, Hoshi K, Ito H, Fuwa TJ, Yamaguchi Y, et al. Rapid increase of 'brain-type' transferrin in cerebrospinal fluid after shunt surgery for idiopathic normal pressure hydrocephalus: A prognosis marker for cognitive recovery. J Biochem 2018;164:205-13.
  • 41 Nabbanja E, Czosnyka M, Keong NC, Garnett M, Pickard JD, Lalou DA, et al. Is there a link between ICP-derived infusion test parameters and outcome after shunting in normal pressure hydrocephalus? Acta Neurochir Suppl 2018;126:229-32.
  • 42 Meier U, Bartels P. The importance of the intrathecal infusion test in the diagnosis of normal pressure hydrocephalus. J Clin Neurosci 2002;9:260-7.
  • 43 Thakur SK, Serulle Y, Miskin NP, Rusinek H, Golomb J, George AE, et al. Lumbar puncture test in normal pressure hydrocephalus: Does the volume of CSF removed affect the response to tap? AJNR Am J Neuroradiol 2017;38:1456-60.
  • 44 Mirzayan MJ, Luetjens G, Borremans JJ, Regel JP, Krauss JK. Extended long-term (>5 years) outcome of cerebrospinal fluid shunting in idiopathic normal pressure hydrocephalus. Neurosurgery 2010;67:295-301.
  • 45 Miyajima M, Kazui H, Mori E, Ishikawa M; On behalf of the SINPHONI-2 Investigators. One-year outcome in patients with idiopathic normal-pressure hydrocephalus: Comparison of lumboperitoneal shunt to ventriculoperitoneal shunt. J Neurosurg 2016;125:1483-92.
  • 46 Hung AL, Vivas-Buitrago T, Adam A, Lu J, Robison J, Elder BD, et al. Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 2017;157:1-6.
  • 47 Chan AK, McGovern RA, Zacharia BE, Mikell CB, Bruce SS, Sheehy JP, et al. Inferior short-term safety profile of endoscopic third ventriculostomy compared with ventriculoperitoneal shunt placement for idiopathic normal-pressure hydrocephalus: A population-based study. Neurosurgery 2013;73:951-60.
  • 48 Grigorean VT, Sandu AM, Popescu M, Florian IS, Lupascu CD, Ursulescu CL, et al. Our initial experience with ventriculo-epiplooic shunt in treatment of hydrocephalus in two centers. Neurol Neurochir Pol 2017;51:290-8.
  • 49 Tudor KI, Tudor M, McCleery J, Car J. Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH). Cochrane Database Syst Rev 2015;(7):CD010033.
  • 50 Bayar MA, Tekiner A, Celik H, Yilmaz A, Menekse G, Yildirim T, et al. Efficacy of lumboperitoneal shunting in patients with normal pressure hydrocephalus. Turk Neurosurg 2018;28:62-6.
  • 51 Schenker P, Stieglitz LH, Sick B, Stienen MN, Regli L, Sarnthein J, et al. Patients with a normal pressure hydrocephalus shunt have fewer complications than do patients with other shunts. World Neurosurg 2018;110:e249-e257.
  • 52 Thompson SD, Shand Smith JD, Khan AA, Luoma AM, Toma AK, Watkins LD, et al. Shunting of the over 80s in normal pressure hydrocephalus. Acta Neurochir (Wien) 2017;159:987-94.