Liouta Evangelia, Gatzonis Stylianos, Kalamatianos Theodosis, Kalyvas Aristotelis, Koutsarnakis Christos, Liakos Faidon, Anagnostopoulos Christos, Komaitis Spyridon, Giakoumettis Dimitris, Stranjalis George
Department of Neurosurgery, University of Athens, Evangelismos Hospital, EKNE Ploutarchou 3 str. Kolonaki, TK. 10675, Athens, Greece.
Hellenic Centre for Neurosurgical Research "Prof. Petros Kokkalis", Athens, Greece.
Acta Neurochir (Wien). 2017 Dec;159(12):2301-2307. doi: 10.1007/s00701-017-3301-2. Epub 2017 Aug 21.
Idiopathic normal pressure hydrocephalus (INPH) diagnosis is challenging as it can be mimicked by other neurological conditions, such as neurodegenerative dementia and motor syndromes. Additionally, outcomes after lumbar puncture (LP) tap test and shunt treatment may vary due to the lack of a common protocol in INPH assessment. The present study aimed to assess whether a post-LP test amelioration of frontal cognitive dysfunctions, characterizing this syndrome, can differentiate INPH from similar neurological conditions and whether this improvement can predict INPH post-shunt outcomes.
Seventy-one consecutive patients referred for INPH suspicion and LP testing, were enrolled. According to the consensus guidelines criteria, 29 patients were diagnosed as INPH and 42 were assigned an alternative diagnosis (INPH-like group) after reviewing clinical, neuropsychological and imaging data, and before LP results. A comprehensive neuropsychological assessment for frontal executive, upper extremity fine motor functions, aphasias, apraxias, agnosias and gait evaluation were administered at baseline. Executive, fine motor functions and gait were re-examined post-LP test in all patients and post-shunt placement in INPH patients.
Of the INPH patients, 86.2% showed cognitive amelioration in the post-LP test; in addition, all but one (97%) presented with neurocognitive and gait improvement post-shunt. Verbal phonological fluency and finger tapping task post-LP improvement predicted positive clinical outcome post-shunt. None of the INPH-like group presented with neurocognitive improvement post-LP.
Post-LP amelioration of verbal fluency and finger tapping deficits can differentiate INPH from similar disorders and predict positive post-shunt clinical outcome in INPH. This becomes of great importance when gait assessment is difficult to perform in clinical practice.
特发性正常压力脑积水（INPH）的诊断具有挑战性，因为它可能被其他神经系统疾病所模仿，如神经退行性痴呆和运动综合征。此外，由于INPH评估缺乏通用方案，腰椎穿刺（LP）试验和分流治疗后的结果可能会有所不同。本研究旨在评估LP试验后额叶认知功能障碍的改善（这是该综合征的特征）是否可以将INPH与类似的神经系统疾病区分开来，以及这种改善是否可以预测INPH分流后的结果。
纳入71例因怀疑INPH而接受LP检测的连续患者。根据共识指南标准，在回顾临床、神经心理学和影像学数据后，且在LP结果出来之前，29例患者被诊断为INPH，42例被指定为其他诊断（INPH样组）。在基线时进行了全面的神经心理学评估，包括额叶执行功能、上肢精细运动功能、失语症、失用症、失认症和步态评估。所有患者在LP试验后以及INPH患者在分流术后重新检查执行功能、精细运动功能和步态。
在INPH患者中，86.2%在LP试验后显示认知改善；此外，除1例（97%）外，所有患者在分流术后均出现神经认知和步态改善。LP试验后言语语音流畅性和手指敲击任务的改善预测了分流术后的良好临床结果。INPH样组中没有患者在LP试验后出现神经认知改善。
LP试验后言语流畅性和手指敲击缺陷的改善可以将INPH与类似疾病区分开来，并预测INPH分流术后的良好临床结果。当临床实践中难以进行步态评估时，这一点变得尤为重要。
