Lumbar Infusion Test and Transcranial Dopplerometry in the Diagnose and Treatment of NormalPressure Hydrocephalus – Prospectively Evaluated Group of Patients in 2000 to 2002

Overview

Background.
The normal pressure hydrocephalus syndrome (NPH) is characterized by the presence of a clinicaltriad comprising dementia, motor apraxia, and sphincter complaint, along with the presence of distinct dilatation ofthe ventricular systemin the absence ofmajor cortical atrophy. The diagnosis of NPH must be confirmed by includingdynamic liquor tests into the algorithm of examination. The lumbar infusion test (LIT) represents the „gold standard“of liquor dynamic tests.Methods and Results. The authors present 24 patients in a prospective managed study. Indication of shunt surgerywas based on the result of LIT.At the time of assessment of the diagnosis 28%of the patients were greatly dependenton the nursing care; after the shunt implantation only 7 % were still greatly dependent. Shunt implantation broughtabout increased percentage of patients who were evaluated as quite independent (rise from 14 % to 64 %). Controlgroup consists of 10 patients with negative LITre sults; there were no changes in evaluated parameters in this group.The coincidence of cerebrovascular diseases is probably the most common reason of nonresponsibility to shuntimplantation in LITpos itive patients.Conclusions. In the presented study authors tried to evaluate the possibility of transcranial dopplerometry (TCD)for evaluation of the role of cerebrovascular diseases in the clinical picture of the LITpos itive patients in order todiminish the unsatisfactory clinical results of shunt implantation. The presented study is the largest one in our country,which is focused on these problems.

Key words:
normotensive hydrocephalus, lumbar infusion test, shunt, transcranial dopplerometry.