Yang Felix, Hickman Thu-Trang, Tinl Megan, Iracheta Christine, Chen Grace, Flynn Patricia, Shuman Matthew E, Johnson Tatyana A, Rice Rebecca R, Rice Isaac M, Wiemann Robert, Johnson Mark D
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Adult Hydrocephalus Program, Department of Neurosurgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA; Department of Rehabilitation Services, Brigham and Women's Hospital, Boston, MA, USA.
J Clin Neurosci. 2016 Jun;28:31-7. doi: 10.1016/j.jocn.2015.11.013. Epub 2016 Jan 7.
Idiopathic normal pressure hydrocephalus (iNPH) is characterized by gait instability, urinary incontinence and cognitive dysfunction. These symptoms can be relieved by cerebrospinal fluid (CSF) drainage, but the time course and nature of the improvements are poorly characterized. Attempts to prospectively identify iNPH patients responsive to CSF drainage by evaluating presenting gait quality or via extended lumbar cerebrospinal fluid drainage (eLCD) trials are common, but the reliability of such approaches is unclear. Here we combine eLCD trials with computerized quantitative gait measurements to predict shunt responsiveness in patients undergoing evaluation for possible iNPH. In this prospective cohort study, 50 patients presenting with enlarged cerebral ventricles and gait, urinary, and/or cognitive difficulties were evaluated for iNPH using a computerized gait analysis system during a 3day trial of eLCD. Gait speed, stride length, cadence, and the Timed Up and Go test were quantified before and during eLCD. Qualitative assessments of incontinence and cognition were obtained throughout the eLCD trial. Patients who improved after eLCD underwent ventriculoperitoneal shunt placement, and symptoms were reassessed serially over the next 3 to 15months. There was no significant difference in presenting gait characteristics between patients who improved after drainage and those who did not. Gait improvement was not observed until 2 or more days of continuous drainage in most cases. Symptoms improved after eLCD in 60% of patients, and all patients who improved after eLCD also improved after shunt placement. The degree of improvement after eLCD correlated closely with that observed after shunt placement.
特发性正常压力脑积水（iNPH）的特征是步态不稳、尿失禁和认知功能障碍。这些症状可通过脑脊液（CSF）引流得到缓解，但改善的时间进程和性质尚不明确。通过评估初始步态质量或进行延长腰段脑脊液引流（eLCD）试验来前瞻性地识别对CSF引流有反应的iNPH患者的尝试很常见，但此类方法的可靠性尚不清楚。在此，我们将eLCD试验与计算机化定量步态测量相结合，以预测接受可能的iNPH评估的患者的分流反应性。在这项前瞻性队列研究中，对50名出现脑室扩大以及步态、排尿和/或认知困难的患者，在为期3天的eLCD试验期间使用计算机化步态分析系统对其进行iNPH评估。在eLCD之前和期间对步态速度、步长、步频以及计时起立行走测试进行量化。在整个eLCD试验期间对尿失禁和认知进行定性评估。eLCD后病情改善的患者接受脑室腹腔分流术，在接下来的3至15个月内对症状进行连续重新评估。引流后病情改善的患者与未改善的患者在初始步态特征方面无显著差异。在大多数情况下，直到连续引流2天或更长时间才观察到步态改善。60%的患者在eLCD后症状改善，所有在eLCD后病情改善的患者在分流术后也有所改善。eLCD后的改善程度与分流术后观察到的改善程度密切相关。
