Idiopathic Normal Pressure Hydrocephalus Controversy of Diagnosis and Management

Emara Elhawary, Mohammed; Badawy Sharshera, Waleed; Mohamed Nabil, Ahmed; Mohamed, Mohamed Emad Al-deen; Mamdouh El-Toukhy, Baher

doi:10.21608/bmfj.2024.315102.2175

Idiopathic Normal Pressure Hydrocephalus Controversy of Diagnosis and Management

Articles in Press

Document Type : Original Article

Authors

¹ Assistant Professor of Neurosurgery Faculty of Medicine, Benha University, EGYPT

² Professor of Neurosurgery, Faculty of Medicine – Benha University, Egypt

³ Assistant professor in Neurosurgery Department, Faculty of Medicine, Benha University, Egypt

⁴ (MB, B.Ch) Resident of neurosurgery, Banha University Hospitals

⁵ Lecturer of Neurosurgery Faculty of Medicine, Banha University, Egypt

10.21608/bmfj.2024.315102.2175

Abstract

Background: Normal pressure hydrocephalus is a chronic steadily progressing disease, characterized by an expansion of the ventricles of the brain with normal (ICP). The aim of this study was to study the importance of completing the clinical triad in the diagnosis, clarify the rule of MRI Flowmetry in the decision of V-P shunt insertion in patients with NPH
Methods: This study has been done on 25 patients who were suspected to have (iNPH). Patients were divided into two groups; group A included 12 patients with stroke volume above 42 microliter/cycle in MR-CSF Fflowmetry and group B included 13 patients with stroke volume below 42 microliter/cycle. These patients have been subjected to clinical examination, radiological, and laboratory investigations.
Results: There is a highly statistical significance between these two items as following; Dementia: All cases improved after tapping (11 cases), improved after shunting and 12 cases out of 14 didn’t show improvement in the test and shunting with a highly significant P value, Gait disturbance: 11 cases improved after tapping in comparison to 10 cases improved after shunting and 13 cases out of 14 didn’t show improvement in the test and shunting with a significant P value.
Urinary incontinence: 11 cases improved after tapping in comparison to a 13 cases improved after shunting and 11 cases out of 14 didn’t show improvement in the test and shunting with a highly significant P value.
Conclusions: CSF Tapping and clinical FU after tapping is the most important test in the decision of shunting.

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