The benefit of delayed reassessment post high-volume CSF removal in the diagnosis of shunt-responsive idiopathic normal-pressure hydrocephalus

Publication date: Available online 13 December 2019Source: Journal of Clinical NeuroscienceAuthor(s): Chrisovalantis Tsimiklis, Annika Mascarenhas, Minh-Son To, Christine Fairley Bishop, Felicity Jenkinson, Gemma Hunt, Natalie Knight, Marguerite Harding, Santosh PoonnooseAbstractThe principle aim of the study was to demonstrate the value of performing delayed reassessment in the diagnosis of idiopathic normal-pressure hydrocephalus (iNPH) and selection of suitable candidates for ventriculoperitoneal shunting (VPS).Thirty-one consecutive patients underwent the NPH protocol at the Flinders Medical Centre between March 2017 and November 2018. The protocol involved mobility and cognitive testing with reassessment post high-volume cerebrospinal fluid (CSF) removal at 24 h and 48 h. The Assessment of Quality of Life 6D (AQoL-6D) questionnaire and International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI SF) were completed and repeated again at 6 weeks and 6 months post shunting. Results were analysed to determine the significance of delayed reassessment.Twenty patients (64.5%) underwent insertion of a VPS on the basis of objective improvements and specific criteria. Of these, 6 patients (30%) were shunted based on delayed reassessment at 48 h post CSF removal. Continued improvements were seen for all mobility and cognitive tests from baseline to 48 h post CSF removal. At 6 weeks and 6 months post shunting, there was an...
Source: Journal of Clinical Neuroscience - Category: Neuroscience Source Type: research

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We present one of the largest single-center studies, which was designed to prove efficacy of our low-pressure setting of gravitational valve at all three symptoms of iNPH and to find statistically significant cut-off time for best clinical improvement according to the duration of symptoms.MethodsSixty-one consecutive patients (mean age 74.9 ± 5.3) with iNPH were prospectively observed from the time of surgery with minimal 6 months follow-up. All patients underwent implantation of the same type of gravitational valve with the same setting—pro GAV with low opening pressure at 5 cm H2O —and were operated by...
Source: Acta Neurochirurgica - Category: Neurosurgery Source Type: research
We report a case of a patient with newly diagnosed, locally extensive and cystic, suprasellar papillary craniopharyngioma successfully treated with single-agent Dabrafenib. The patient was symptomatic with gait imbalance with falls, lethargic episodes, fatigue and incontinence. Diagnostic imaging demonstrated a cystic suprasellar tumor extending into the third ventricle causing obstructive hydrocephalus. The tumor was partially debulked, and bilateral shunts were placed. NGS sequencing demonstrated BRAF V600E mutation, and the patient was prescribed dual agent Dabrafenib and Trametinib. However, due to insurance denial for...
Source: Oncotarget - Category: Cancer & Oncology Tags: Oncotarget Source Type: research
In this study, the authors aimed to provide an overview of the current management and outcomes for infants with MMC managed at their institution. This then provides a center-specific historical cohort for comparison with future antenatal-treated MMC cases. METHODS: This is a retrospective, single-institution cohort study including all consecutive MMC cases between January 1, 2000, and June 1, 2018, at Erasmus MC. Outcome data included closure of the defect (location, timing, and surgical parameters), hydrocephalus management, Chiari malformation type II (CMTII) management, incidence of spinal cord tethering and outcom...
Source: Neurosurgical Focus - Category: Neurosurgery Authors: Tags: Neurosurg Focus Source Type: research
Authors: Takeuchi T, Yajima K Abstract A total of 482 operated idiopathic normal pressure hydrocephalus (iNPH) patients were divided into those aged
Source: Neurologia Medico-Chirurgica - Category: Neurosurgery Tags: Neurol Med Chir (Tokyo) Source Type: research
ConclusionETV seems to be a safe and efficient alternative to shunt for chronic hydrocephalus with obstruction; the clinical improvement is usual and ventricular size decreases slightly.
Source: Acta Neurochirurgica - Category: Neurosurgery Source Type: research
A 73-year-old woman was referred for an elective aortic valve replacement for severe aortic stenosis. She had preserved biventricular function, mild left ventricular hypertrophy, and no significant coronary artery disease. From her medical history, she had dyslipidemia treated with statins and idiopathic normal pressure hydrocephalus (iNPH) awaiting shunt placement (Figure 1, Figure 2). She was experiencing only mild iNPH-related symptoms, namely urinary incontinence, gait disturbances, and dementia, and she had been following up regularly with a neurologist.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: Letter to the Editor Source Type: research
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Source: Trials - Category: Research Source Type: clinical trials
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Source: Neurosurgical Focus - Category: Neurosurgery Authors: Tags: Neurosurg Focus Source Type: research
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Source: Journal of Integrative Neuroscience - Category: Neuroscience Authors: Tags: J Integr Neurosci Source Type: research
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Source: Gait and Posture - Category: Orthopaedics Authors: Tags: Full length article Source Type: research
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