Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-2mbcq Total loading time: 0 Render date: 2025-04-30T07:31:48.767Z Has data issue: false hasContentIssue false

34 - Therapy of idiopathic normal pressure hydrocephalus

Published online by Cambridge University Press:  23 December 2009

By
Dennis A. Nowak
Edited by
Dennis A. Nowak  and
Joachim Hermsdörfer
Dennis A. Nowak
Affiliation:
Klinik Kipfenberg, Kipfenberg, Germany
Joachim Hermsdörfer
Affiliation:
Technical University of Munich
Get access

Summary

Summary

The clinical spectrum of idiopathic normal pressure hydrocephalus (INPH) comprises gait impairment, cognitive decline and urinary incontinence, all associated with ventricular enlargement and normal cerebrospinal fluid (CSF) pressure on random spinal taps. There is significant variation in the clinical presentation and progression of the disorder and correct diagnosis frequently represents a challenge to the clinical neurologist. Several reports have suggested that the motor disability to be found in INPH may also involve the upper limbs and recent reports provide direct kinetic evidence for this suggestion. Grip-force analysis may also allow an objective evaluation of the beneficial effects of therapeutic strategies in this entity. This chapter reviews the pertinent literature upon the kinetic assessment of upper limb motor disability in the diagnosis and therapy of INPH.

The symptom complex of INPH

Idiopathic normal pressure hydrocephalus (INPH), first described by Hakim & Adams (1965) and Adams et al. (1965), is characterized by the clinical triad of gait disorder, dementia and urinary incontinence, all in the presence of ventriculomegaly and normal cerebrospinal fluid (CSF) pressure on random lumbar puncture. The cause of INPH is not known. When the clinical syndrome occurs as a result of other diseases, such as hemorrhage, traumatic brain injury, cerebral infarction or meningitis, it is referred to as secondary normal pressure hydrocephalus (Gallia et al., 2006). The incidence of INPH has been reported to be about two cases per 100,000 individuals (Vanneste et al., 1992; Krauss & Halve, 2004).

Type
Chapter
Information
Sensorimotor Control of Grasping
Physiology and Pathophysiology
 , pp. 482 - 490
Publisher: Cambridge University Press
Print publication year: 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Adams, R. D., Fisher, C. & Hakim, S. (1965). Symptomatic occult hydrocephalus with “normal” cerebrospinal fluid pressure. N Engl J Med, 273, 117–126.CrossRefGoogle ScholarPubMed
Benice, T. S., Lou, J. S., Eaton, R. & Nutt, J. (2007). Hand coordination as a quantitative measure of motor abnormality and therapeutic response in Parkinson's disease. Clin Neurophysiol, 118, 1776–1784.CrossRefGoogle ScholarPubMed
Blomsterwall, E., Bilting, M., Stephensen, H. & Wikkelso, C. (1995). Gait abnormality is not the only motor disturbance in normal pressure hydrocephalus. Scand J Rehabil Med, 27, 205–209.Google Scholar
Duinkerke, A., Williams, M. A., Rigamonti, D. & Hillis, A. E. (2004). Cognitive recovery in idiopathic normal pressure hydrocephalus after shunt. Cogn Behav Neurol, 17, 179–184.CrossRefGoogle ScholarPubMed
Ekstedt, J. & Friden, H. (1984). CSF hydrodynamics for the study of the adult hydrocephalus syndrome. In Shapiro, K., Mamarou, A. & Portnoy, H. (Eds.), Hydrocephalus (pp. 363–384). New York, NY: Raven Press.Google Scholar
Fellows, S. J., Schwarz, M. & Noth, J. (1998). Precision grip in Parkinson's disease. Brain, 121, 1771–1784.CrossRefGoogle ScholarPubMed
Fisher, C. M. (1982). Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology, 32, 1358–1363.CrossRefGoogle ScholarPubMed
Flanagan, J. R., Johansson, R. S. (2002). Hand movements. In Ramachandran, V. S. (Ed.), Encyclopedia of the Human Brain, Vol. 2 (pp. 399–414). San Diego, CA: Academic Press.CrossRefGoogle Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). Mini-Mental State. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 12, 189–198.CrossRefGoogle Scholar
Fukuhara, T., Luciano, M. G., Liu, J. Z. & Yue, G. H. (2001). Functional magnetic resonance imaging before and after ventriculoperitoneal shunting for hydrocephalus – case report. Neurol Med Chir (Tokyo), 41, 626–630.CrossRefGoogle ScholarPubMed
Gallia, G. L., Rigamonti, D. & Williams, M. A. (2006). The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol, 2, 375–381.CrossRefGoogle ScholarPubMed
Graff-Radford, N. R. & Godersky, J. C. (1987). Idiopathic normal pressure hydrocephalus and systemic hypertension. Neurology, 37, 868–871.CrossRefGoogle ScholarPubMed
Greitz, T. V., Grepe, A. O., Kalmer, M. S. & Lopez, J. (1969). Pre- and postoperative evaluation of cerebral blood flow in low pressure hydrocephalus. J Neurosurg, 31, 644–651.CrossRefGoogle ScholarPubMed
Hakim, S. & Adams, R. D. (1965). The special clinical problem of symptomatic hydrocephalus with normal CSF pressure. J Neurol Sci, 2, 307–327.CrossRefGoogle Scholar
Hakim, S., Vengas, J. G. & Burton, J. D. (1970). The physics of the cranial cavity, hydrocephalus and normal pressure hydrocephalus: mechanical interpretation and mathematical model. Surg Neurol, 5, 187.Google Scholar
Hebb, A. O. & Cusimano, M. D. (2001). Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery, 49, 1166–1184.Google ScholarPubMed
Hoehn, M. M. & Yahr, M. D. (1967). Parkinsonism. Onset, progression and mortality. Neurology, 17, 427–442.CrossRefGoogle ScholarPubMed
Hughes, A. J., Daniel, S. E., Kilford, L. & Lees, A. J. (1992). Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg Psychiatry, 55, 181–184.CrossRefGoogle ScholarPubMed
Ingvarsson, P. E., Gordon, A. M. & Forssberg, H. (1997). Coordination of manipulative forces in Parkinson's disease. Exp Neurol, 145, 489–501.CrossRefGoogle ScholarPubMed
Krauss, J. K. & Halve, B. (2004). Normal pressure hydrocephalus: survey on contemporary diagnostic algorithms and therapeutic decision-making in clinical practice. Acta Neurochir, 146, 379–388.CrossRefGoogle ScholarPubMed
Krauss, J. K., Regel, J. P., Vach, W.et al. (1996). Vascular risk factors and arteriosclerotic disease in idiopathic normal pressure hydrocephalus of the elderly. Stroke, 27, 24–29.CrossRefGoogle ScholarPubMed
Krauss, J. K., Regel, J. P., Droste, D. W.et al. (1997). Movement disorders in adult hydrocephalus. Mov Disord, 12, 53–60.CrossRefGoogle ScholarPubMed
Marmarou, A., Young, H. F., Aygok, G. A.et al. (2005). Diagnosis and management of idiopathic normal-pressure hydrocephalus: a prospective study in 151 patients. J Neurosurg, 102, 987–997.CrossRefGoogle ScholarPubMed
Matousek, M., Wikkelso, C., Blomsterwall, E., Johnels, B. & Steg, G. (1995). Motor performance in normal pressure hydrocephalus assessed with an optoelectronic measurement technique. Acta Neurol Scand, 91, 500–505.CrossRefGoogle ScholarPubMed
McGirt, M. J., Woodworth, G., Coon, A. L.et al. (2005). Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus. Neurosurgery, 57, 699–705.CrossRefGoogle ScholarPubMed
Nowak, D. A. & Hermsdörfer, J. (2005). Grip force behavior in neurological disorders: toward an objective evaluation of manual performance deficits. Mov Disord, 20, 11–25.CrossRefGoogle ScholarPubMed
Nowak, D. A. & Topka, H. (2006). Broadening a classic clinical triad: the hypokinetic motor disorder of normal pressure hydrocephalus also affects the hand. Exp Neurol, 198, 81–87.CrossRefGoogle ScholarPubMed
Nowak, D. A., Gumprecht, H. & Topka, H. (2006). CSF drainage ameliorates the motor deficit in normal pressure hydrocephalus. Evidence from the analysis of grasping movements. J Neurol, 253, 640–647.CrossRefGoogle ScholarPubMed
Sand, T., Bovim, G., Grimse, R.et al. (1994). Idiopathic normal pressure hydrocephalus: the CSF tap-test may predict the clinical response to shunting. Acta Neurol Scand, 89, 311–316.CrossRefGoogle ScholarPubMed
Soelberg Sorensen, P., Jansen, E. C. & Gjerris, F. (1986). Motor disturbances in normal-pressure hydrocephalus. Special reference to stance and gait. Arch Neurol, 43, 34–38.CrossRefGoogle ScholarPubMed
Stein, S. C. & Langfitt, T. W. (1974). Normal-pressure hydrocephalus: predicting the results of cerebrospinal fluid shunting. J Neurosurg, 41, 463–470.CrossRefGoogle ScholarPubMed
Stolze, H., Kuhtz-Buschbeck, J. P., Drücke, H.et al. (2001). Comparative analysis of gait disorder of normal pressure hydrocephalus and Parkinson's disease. J Neurol Neurosurg Psychiatry, 70, 289–297.CrossRefGoogle ScholarPubMed
Sudarsky, L. (1997). Clinical Approach to Gait Disorders of Aging: An Overview. Philadelphia, PA: Lippincott-Raven.Google Scholar
Vanneste, J., Augustijn, P., Dirven, C., Tan, W. F. & Goedhart, Z. D. (1992). Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review. Neurology, 42, 54–59.CrossRefGoogle ScholarPubMed
Vanneste, J., Augustijn, P. & Tan, W. F. (1993). Shunting normal pressure hydrocephalus: the predictive value of combined clinical and CT data. J Neurol Neurosurg Psychiatry, 56, 251–256.CrossRefGoogle ScholarPubMed
Wilson, R. K. & Williams, M. A. (2006). Normal pressure hydrocephalus. Clin Geriatr Med, 22, 935–951.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×