Oike Ryo, Inoue Yasuaki, Matsuzawa Kazuhito, Sorimachi Takatoshi
Department of Neurosurgery, Nadogaya Hospital, Chiba, Japan.
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Clin Neurol Neurosurg. 2021 Apr 24;205:106635. doi: 10.1016/j.clineuro.2021.106635.
Many patients with idiopathic normal pressure hydrocephalus (iNPH) have reportedly fallen prior to diagnosis. However, there are no previous reports on the iNPH prevalence among the elderly with history of falls. This study investigated the effectiveness of screening for iNPH in elderly patients presenting after a fall.
We retrospectively assessed the Evans' index (EI) of 235 consecutive patients aged 60-89 who presented after falls between May and October 2020. We also assessed the presence of the iNPH triad (gait disturbance, cognitive impairment, and urinary incontinence). Patients with EI > 0.3 and with all 3 triad were defined as having possible iNPH; those with clinical improvement after a cerebrospinal fluid (CSF) tap test as having probable iNPH; and those with clinical improvement after a shunt surgery as having definite iNPH. We also examined the 235 patients' EI, and performed a case-control study of EI using sex- and age-matched control patients.
Among the included 235 cases presenting after falls, 44 (18.7%) were diagnosed with possible iNPH, 29 (12.3%) with probable iNPH, and 25 (10.6%) with definite iNPH. The mean EI of these 235 patients was significantly larger than that of controls (0.30 ± 0.04 vs 0.26 ± 0.02, p < 0.0001). The proportion of possible iNPH in the cases was 44 out of 235 (18.7%), significantly higher than that of the controls (0%, p < 0.0001).
Screening for iNPH in the elderly presenting after falls can possibly identify iNPH patients in the earlier stage who may benefit more from surgical treatments.
据报道，许多特发性正常压力脑积水（iNPH）患者在确诊前曾跌倒。然而，既往尚无关于有跌倒史老年人中iNPH患病率的报道。本研究调查了对跌倒后就诊的老年患者进行iNPH筛查的有效性。
我们回顾性评估了2020年5月至10月间跌倒后就诊的235例年龄在60 - 89岁的连续患者的埃文斯指数（EI）。我们还评估了iNPH三联征（步态障碍、认知障碍和尿失禁）的存在情况。EI>0.3且具备所有三联征的患者被定义为可能患有iNPH；脑脊液（CSF）穿刺试验后临床症状改善的患者被定义为可能患有iNPH；分流手术后临床症状改善的患者被定义为确诊iNPH。我们还检查了这235例患者的EI，并对EI进行了一项使用性别和年龄匹配的对照患者的病例对照研究。
在纳入的235例跌倒后就诊的病例中，44例（18.7%）被诊断为可能患有iNPH，29例（12.3%）为可能患有iNPH，25例（10.6%）为确诊iNPH。这235例患者的平均EI显著高于对照组（0.30±0.04 vs 0.26±0.02，p<0.0001）。病例组中可能患有iNPH的比例为235例中的44例（18.7%），显著高于对照组（0%，p<0.0001）。
对跌倒后就诊的老年人进行iNPH筛查可能有助于在早期识别iNPH患者，这些患者可能从手术治疗中获益更多。
