Idiopathic normal pressure hydrocephalus

J.Sales-Llopis

Neurosurgery Department, General University Hospital Alicante, Spain

• Postoperative changes in ventricular cerebrospinal fluid biomarkers with correlation to clinical outcome in idiopathic normal pressure hydrocephalus
• Deformation of brain in normal pressure hydrocephalus is more readily associated with slow vasomotion rather than heartbeat related pulsations of intracranial pressure
• Instrument-supported gait analysis characterizes gait domain changes in patients with suspected normal pressure hydrocephalus
• Evaluating longitudinal changes of gait parameters following shunt placement in patients with idiopathic normal pressure hydrocephalus
• Idiopathic normal pressure hydrocephalus: A sulcal morphometry approach to brain phenotype and clinical response
• Subject-specific variability in cerebrospinal fluid flow characteristics through cerebral aqueducts in a healthy population: a magnetic resonance imaging and computational investigation
• Cerebrospinal fluid analysis and changes over time in patients with subarachnoid hemorrhage: a prospective observational study
• Corrigendum to 'Long-term outcomes after shunt surgery in older patients with idiopathic normal pressure hydrocephalus' [Clin. Neurol. Neurosurg., Vol. 249 (2025) 108783]

Idiopathic Normal Pressure Hydrocephalus Definition.

see Idiopathic normal pressure hydrocephalus history.

Idiopathic Normal Pressure Hydrocephalus Epidemiology.

Idiopathic Normal Pressure Hydrocephalus Classification.

Idiopathic Normal Pressure Hydrocephalus Natural History.

Idiopathic Normal Pressure Hydrocephalus Etiology.

see Idiopathic normal pressure hydrocephalus Pathogenesis.

see Idiopathic normal pressure hydrocephalus pathophysiology.

see Idiopathic normal pressure hydrocephalus clinical features.

see Idiopathic normal pressure hydrocephalus scales.

see Idiopathic normal pressure hydrocephalus diagnosis.

see Idiopathic normal pressure hydrocephalus differential diagnosis.

Idiopathic normal pressure hydrocephalus guidelines.

see Idiopathic normal pressure hydrocephalus treatment.

see Idiopathic normal pressure hydrocephalus outcome.

The Nationwide Readmissions Database was queried from 2018 to 2019 for iNPH patients aged ≥ 60 years who underwent VPS surgery. Risk Analysis Index and modified 5-item Frailty Index scores were calculated and RAI cross-tabulation was used to analyze trends in frailty scores by the following binary outcome measures: overall complications, nonhome discharge, extended length of stay > 75th percentile, and mortality. Area under the receiver operating characteristic curve analysis was performed to assess the discriminatory accuracy of RAI and mFI-5 for primary outcomes.

Results: A total of 9319 iNPH patients underwent VPS surgery, and there were 685 readmissions, 7.4%, 593 perioperative complications, 6.4%, and 94 deaths, 1.0%. Increasing RAI score was significantly associated with increasing rates of postoperative complications: RAI scores 11-15, 5.4%, n = 80; 16-20, 5.6%, n = 291; 21-25, 7.6%, n = 166; and ≥ 26, 11.6%, n = 56. The discriminatory accuracy of RAI was statistically superior, DeLong test, p < 0.05, to mFI-5 for the primary endpoints of mortality, NHD, and eLOS. All RAI C-statistics were > 0.60 for mortality within 30 days, C-statistic = 0.69, 95% CI 0.68-0.70.

Conclusions: In a nationwide database analysis, increasing frailty, as measured by RAI, was associated with NHD, 30-day mortality, unplanned readmission, eLOS, and postoperative complications. Although the RAI outperformed the mFI-5, it is essential to account for the potentially reversible clinical issues related to the underlying disease process, as these factors may inflate frailty scores, assign undue risk, and diminish their utility. This knowledge may enhance provider understanding of the impact of frailty on postoperative outcomes for patients with iNPH, while highlighting the potential constraints associated with frailty assessment tools. ¹⁾,

A study was conducted by visualizing a total of 1232 brain CT scans performed in the Emergency Departments of four hospitals of a network on patients who were admitted for different complaints yet screened as suspicious for iNPH. Subsequently, corresponding Emergency Department medical records were investigated to understand the medical history of each patient in search of elements attributable to an alteration of CSF dynamics. The cohort of positive CT scans, according to the radiological and clinical inclusion criteria, included 192 patients. Among the reasons to require acute medical care, “Fall” was the most common. The cumulative incidence of CT scans suggestive of iNPH among the patients undergoing CT scans was as high as 15.58%, and the period prevalence calculated for the total amount of patients accessing the Emergency Departments was 1.084%. The real incidence of iNPH in the population may be underestimated, and the social burden linked to the assistance of patients suffering from such untreated conditions could be significantly relieved ²⁾

see Idiopathic normal pressure hydrocephalus case series.

see Idiopathic normal pressure hydrocephalus case reports.

see Idiopathic normal pressure hydrocephalus experimental animal model.