Savolainen S, Hurskainen H, Paljärvi L, Alafuzoff I, Vapalahti M
Department of Neurosurgery, University Hospital, Kuopio, Finland.
Acta Neurochir (Wien). 2002 Jun;144(6):515-23; discussion 523. doi: 10.1007/s00701-002-0936-3.
Between 1993-1995, 51 patients under 75 years of age with clinical symptoms and CT-based diagnosis of normal pressure hydrocephalus were investigated prospectively in order to clarify the value of neuropsychological tests, clinical symptoms and signs and infusion test in the differential diagnosis and prediction of outcome in normal pressure hydrocephalus.
Patients had a thorough neurological examination, and neuropsychological evaluation. A 24-hour intraventricular ICP-measurement, infusion test, neurophysiological investigations and MRI study were performed, and a cortical biopsy was obtained. The ICP measurement defined the need for a shunt. All 51 patients were re-examined three and twelve months later. The final follow-up was accomplished five years postoperatively.
25 of the patients needed a shunt operation. One year after a shunt placement 72% of these patients had a good recovery concerning activities of daily living, 58% benefited in their urinary incontinence and 57% walked better. During the 5 years of follow-up 8 patients with shunt and 9 without shunt had died. Positive effect of shunting remained. Only one neuropsychological test, recognition of words test, distinguishes the patients with the need for a shunt. Simple mini mental examination test was not different in those who improved. In the postoperative follow-up patients with shunt showed no change in neuropsychological tests even if they were subjectively better. The infusion test was of no value in diagnosing NPH. The 16 patients with Alzheimer's disease did worse after one year than those without pathological changes, but the mortality was not increased.
Specific neuropsychological tests are of little value in diagnosing NPH. Mini-Mental status examination was neither of value in diagnosing NPH nor in prediction of the outcome. In this study the infusion test did not improve diagnostic accuracy of NPH, but shunt placement relieves urinary incontinence and walking disability in patients with increased ICP. The patients with positive Alzheimer diagnosis on biopsy did not improve.
在1993年至1995年期间，对51例75岁以下有临床症状且经CT诊断为正常压力脑积水的患者进行了前瞻性研究，以明确神经心理学测试、临床症状和体征以及灌注试验在正常压力脑积水的鉴别诊断和预后预测中的价值。
对患者进行全面的神经系统检查和神经心理学评估。进行24小时脑室内颅内压测量、灌注试验、神经生理学检查和MRI研究，并获取皮质活检样本。颅内压测量确定是否需要分流。所有51例患者在3个月和12个月后进行复查。最终随访在术后5年完成。
25例患者需要进行分流手术。分流术后一年，这些患者中有72%在日常生活活动方面恢复良好，58%的尿失禁症状得到改善，57%的行走能力有所提高。在5年的随访期间，8例分流患者和9例未分流患者死亡。分流的积极效果仍然存在。只有一种神经心理学测试，即单词识别测试，能够区分需要分流的患者。简易精神状态检查在病情改善的患者中并无差异。在术后随访中，分流患者的神经心理学测试结果没有变化，即使他们主观感觉有所好转。灌注试验在诊断正常压力脑积水方面没有价值。16例阿尔茨海默病患者在一年后的病情比无病理改变的患者更差，但死亡率并未增加。
特定的神经心理学测试在诊断正常压力脑积水方面价值不大。简易精神状态检查在诊断正常压力脑积水和预测预后方面均无价值。在本研究中，灌注试验并未提高正常压力脑积水的诊断准确性，但分流手术可缓解颅内压升高患者的尿失禁和行走障碍。活检诊断为阿尔茨海默病阳性的患者病情并未改善。
