Kang Kyunghun, Hwang Sung Kyoo, Lee Ho-Won
Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.
Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.
J Korean Neurosurg Soc. 2013 Nov;54(5):437-40. doi: 10.3340/jkns.2013.54.5.437. Epub 2013 Nov 30.
The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.
脑脊液穿刺试验（CSFTT）被推荐作为特发性正常压力脑积水（iNPH）诊断的关键步骤。虽然对于确定CSFTT反应者没有普遍接受的评估期，但相当数量的患者仅在试验后24小时内接受一次步态改善评估。我们报告了一例对分流手术有良好反应的iNPH患者，该患者最初按此标准被判定为无反应者，但随后通过在7天内重复测试步态被判定为有反应者。一名68岁男性出现进行性步态、平衡和记忆障碍。他被诊断为iNPH，Evans比率为0.35。首次住院时，在CSFTT后24小时评估步态变化。他没有表现出任何显著改善，被判定为无反应者。然而，在第二次CSFTT时，我们在七天内重复测试他的步态变化。穿刺后48小时，他的步态有显著改善。然后他被确认为有反应者。手术后，步态困难几乎完全解决。应考虑进一步开展研究以完善CSFTT的标准程序。
