Normal-pressure Hydrocephalus: Saga or Swamp? FREE

A. M. Clarfield, MD, CCFP, FRCPC

JAMA. 1989;262(18):2592-2593. doi:10.1001/jama.1989.03430180134044

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References

ABSTRACT

ABSTRACT | REFERENCES

Normal-pressure hydrocephalus (NPH) was first identified by Adams et al¹ in 1965. They described three patients: two women aged 62 and 63 years and one man aged 65 years who presented with the triad of dementia of recent onset, gait disorder, and urinary incontinence. Cerebrospinal fluid shunting provided a spectacular cure in all three cases.

Since that time, many case series have been published (for example, references 2 through 5) and reviewed.^6,7 The syndrome is one of communicating hydrocephalus in which intracranial hypertension is either absent or goes unrecognized. Although it can occur secondary to head injury, subarachnoid hemorrhage, intracranial surgery, brain tumors, or meningitis, most patients give no such history and the syndrome is consequently termed "idiopathic."⁶

In this issue of The Journal, Friedland⁸ provides us with a case history that involves a successful shunt procedure for an elderly woman with NPH. What makes this

REFERENCES

ABSTRACT | REFERENCES

Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with 'normal' cerebrospinal fluid pressure: a treatable syndrome . N Engl J Med. 1965;;273:117-126.

Gustafson L, Hagberg B. Recovery in hydrocephalic dementia after shunt operation . J Neurol Neurosurg Psychiatry. 1978;;41:940-947.

Hughes CP, Siegal BA, Coxe WS, et al. Adult idiopathic communicating hydrocephalus with and without shunting . J Neurol Neurosurg Psychiatry. 1978;;41:961-971.

Peterson RC, Mokri B, Lows ER. Surgical treatment of idiopathic hydrocephalus in elderly patients . Neurology. 1985;;35:307-311.

Thomsen AM, Borgesen SE, Bruhn P, Gjerris F. Prognosis of dementia in normal-pressure hydrocephalus after a shunt operation . Ann Neurol. 1986;;20:304-310.

Anderson M. Normal-pressure hydrocephalus . Br Med J. 1986;;293:837-838.

Turner DA, McGeachie RE. Normal-pressure hydrocephalus and dementia: evaluation and treatment . Clin Geriatr Med. 1988;;4:815-830.

Friedland RP. 'Normal'-pressure hydrocephalus and the saga of the treatable dementias . JAMA. 1989;;262:2577-2581.

Cox J, Knox J, Brocklehurst G. Normal-pressure hydrocephalus . J Am Geriatr Soc. 1988;;36:650.

Clarfield AM. The reversible dementias: do they reverse? Ann Intern Med. 1988;;109:476-486.

Bradshaw JR, Thomson JLG, Campbell MJ. Computed tomography in the investigation of dementia . Br Med J. 1983;;286:277-280.

Larson EB, Reifler BV, Sumi SM, et al. Diagnostic tests in the evaluation of dementia: a prospective study of 200 elderly outpatients . Arch Intern Med. 1986;;146:1917-1922.

Larson EB. Normal-pressure hydrocephalus . J Am Geriatr Soc. 1988;;36:651.

Mulrow CD, Feussner JR, Williams BC, Vokaty KA. The value of clinical findings in the detection of NPH . J Gerontol. 1987;;42:277-279.

Benson DF. Neuroimaging and dementia . Neurol Clin. 1986;;4:341-353.

Wyper D, Pickard JD, Matheson M. Accuracy of ventricular volume estimation . J Neurol Neurosurg Psychiatry. 1979;;42:345-350.

Drayer BP. Imaging of the aging brain, part II: pathologic conditions . Radiology. 1988;;166:797-806.

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