Verny Marc, Berrut Gilles
Centre de gériatrie, Groupe hospitalier Pitié-Salpêtrière Charles Foix, Paris, France.
Geriatr Psychol Neuropsychiatr Vieil. 2012 Dec;10(4):415-25. doi: 10.1684/pnv.2012.0373.
The definition of normal pressure hydrocephalus (NPH), in adults, associates clinical signs (Adams and Hakim triad) involving gait disorders, urinary incontinence and dementia, associated with aspects on brain imaging that are consistent with this hypothesis and also normal or slightly increased intracranial pressure. The aim of this study was to clarify the techniques and methods facilitating the diagnosis of NPH. The literature review has been conducted from the Medline database without date limitation including the keywords "normal pressure hydrocephalus" and "diagnosis." They should appear in the article title. From the 43 initially sorted, only 13 have been selected using exclusion criteria. The proposed methods are very sparse and focused on the improvement after surgical shunt. This focus is independent from the diagnosis criteria proposed in 2005. This introduces an ambiguity in the interpretation of the results. In practice, the diagnosis of NPH is more difficult in the elderly population where differential diagnoses are frequent, particularly vascular lesions (notably microangiopathy) and Alzheimer's disease. The more invasive techniques as continuous spinal drainage (usually during 3 days) or some features of CSF dynamics (Rout, compliance) seem to be the best predictors of after shunt improvement. However, these techniques are difficult to use in routine in the elderly. The combination of Evans index and corpus callosum angle on MRI is very useful to improve the differential diagnosis with cerebral atrophy. Spinal tap test (lumbar puncture with the removal of 40 mL of CSF) can be repeated two or three times for consecutive days to improve the predictive value before shunting. Gait and balance often improve after shunt, more than cognition and bladder disorders. In the elderly population, the prognosis after 3 years is non conclusive despite initial improvement. Poor prognosis seems to be due to associated pathologies in particular neurodegenerative diseases. This should be considered in decision-making of CSF shunt.
成人正常压力脑积水（NPH）的定义将临床体征（亚当斯和哈基姆三联征）与步态障碍、尿失禁和痴呆联系起来，同时伴有与该假说相符的脑成像表现以及正常或略升高的颅内压。本研究的目的是阐明有助于NPH诊断的技术和方法。通过无日期限制的Medline数据库进行文献综述，关键词包括“正常压力脑积水”和“诊断”，且这些关键词应出现在文章标题中。从最初筛选出的43篇文章中，仅使用排除标准选取了13篇。所提出的方法非常稀少，且侧重于手术分流后的改善情况。这种侧重与2005年提出的诊断标准无关。这在结果的解释上引入了模糊性。在实际中，NPH在老年人群中的诊断更为困难，因为鉴别诊断频繁出现，尤其是血管病变（特别是微血管病）和阿尔茨海默病。更具侵入性的技术，如持续脊髓引流（通常持续3天）或脑脊液动力学的一些特征（流出量、顺应性）似乎是分流后改善情况的最佳预测指标。然而，这些技术在老年人中难以常规使用。MRI上的埃文斯指数和胼胝体角的组合对于改善与脑萎缩的鉴别诊断非常有用。脊髓穿刺试验（腰椎穿刺抽取40 mL脑脊液）可连续重复两到三次，以提高分流前的预测价值。分流后步态和平衡通常比认知和膀胱功能障碍改善得更多。在老年人群中，尽管最初有所改善，但3年后的预后尚无定论。预后不良似乎是由于相关的病理状况，特别是神经退行性疾病。在脑脊液分流的决策中应考虑到这一点。
