Mongin M, Hommet C, Mondon K
Service de neurologie, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37000 Tours, France; Université François-Rabelais, BP 3223, 37032 Tours cedex 01, France.
Université François-Rabelais, BP 3223, 37032 Tours cedex 01, France; Service de médecine interne gériatrique, centre mémoire ressources recherche (CMRR) de la région Centre, hôpital Bretonneau, CHRU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France; Inserm U930, 37044 Tours cedex 9, France.
Rev Med Interne. 2015 Dec;36(12):825-33. doi: 10.1016/j.revmed.2015.08.001. Epub 2015 Oct 1.
Idiopathic normal pressure hydrocephalus is a chronic disorder affecting the elderly. It is defined by Adams and Hakim's triad in addition to ventricular dilation visible by brain imaging and normal cerebrospinal fluid pressure during lumbar puncture. The objective of this review was to propose a standard of care for idiopathic normal pressure hydrocephalus based on an extensive literature review conducted on 459 articles published over the last 10 years. Those articles were obtained by searching for the keywords "normal pressure hydrocephalus" in the PubMed database and selecting all the articles published in English or in French. The diagnosis of idiopathic normal pressure hydrocephalus is difficult because of commonly associated diseases, such as Alzheimer's disease and microangiopathy. Brain MRI is one of the key procedures to assist in the diagnosis of idiopathic normal pressure hydrocephalus. Indeed, the presence of certain MRI features is highly predictive of a positive tap test and shunt responsiveness. Nevertheless, tap test remains the standard of care for diagnosis. Continuous cerebrospinal fluid drainage test is an alternative because it improves the sensitivity of diagnosis (but is a more complicated test to perform). Alzheimer's biomarkers dosing in the cerebrospinal fluid seems interesting when diagnosis remains uncertain: the presence of Alzheimer's profile of the biological markers is predictive of a lower response to the tap test.
特发性正常压力脑积水是一种影响老年人的慢性疾病。除了通过脑成像可见的脑室扩张以及腰椎穿刺时脑脊液压力正常外，它还由亚当斯和哈基姆三联征定义。本综述的目的是基于对过去10年发表的459篇文章进行的广泛文献综述，提出特发性正常压力脑积水的护理标准。这些文章是通过在PubMed数据库中搜索关键词“正常压力脑积水”并选择所有以英文或法文发表的文章获得的。由于常伴有阿尔茨海默病和微血管病变等疾病，特发性正常压力脑积水的诊断很困难。脑磁共振成像（MRI）是辅助诊断特发性正常压力脑积水的关键检查之一。事实上，某些MRI特征的存在对腰穿试验阳性和分流反应性具有高度预测性。然而，腰穿试验仍然是诊断的护理标准。持续脑脊液引流试验是一种替代方法，因为它提高了诊断的敏感性（但操作起来更复杂）。当诊断仍不确定时，脑脊液中阿尔茨海默病生物标志物的检测似乎很有意义：生物标志物的阿尔茨海默病特征的存在预示着对腰穿试验的反应较低。
