Repeated assessment of suspected normal pressure hydrocephalus in non-shunted cases. A prospective study based on the constant rate lumbar infusion test

Abstract

Background: Only a few reports have been published on the natural history of non-shunted patients suspected of having NPH. The aim of this study is to follow up a group of such cases.

Methods: It was possible to follow up 27 patients who had not been qualified for shunting after the primary diagnosis. An assessment of Hakim's triad was performed, together with an analysis of radiological parameters and the results of lumbar infusion tests (LITs), both on admission and at the later date (on average, after 5.6 months). All parameters were analyzed with respect to periventricular lucency (PVL), atrophy, type of NPH, and the age of the patients.

Results: There were no deteriorations and six patients improved. Those who were over 50 and who had no PVL or secondary NPH tended to improve more frequently. Significant improvement of dementia was noted (p = 0.042) in all cases, and in the group of patients without PVL (p = 0.04). The size of the ventricles did not change significantly. The values of the resistance to outflow (R), elastance (E), and ICP remained stable.

Conclusions: Analysis of our series revealed that the patients suspected of having NPH who had not been qualified for shunting did not deteriorate, while some of them even improved significantly as far as the level of dementia was concerned. As the CT and LIT parameters remained stable, there were no indications for repeating these examinations, at least within the period of nearly 6 months, which followed the primary diagnosis.

Keywords: Intracranial pressure–volume reserve; Lumbar infusion test; Non-shunted hydrocephalus; Normal pressure hydrocephalus; Repeated hydrodynamic test.