Tanaka Tatsuya, Fujiwara Ren, Sashida Ryohei, Hirokawa Yu, Wakamiya Tomihiro, Michiwaki Yuhei, Shimoji Kazuaki, Suehiro Eiichi, Onoda Keisuke, Yamane Fumitaka, Kawashima Masatou, Matsuno Akira
Department of Neurosurgery, International University of Health and Welfare, School of Medicine Narita Hospital, Narita, Japan.
Department of Neurosurgery, Narita Tomisato Tokushukai Hospital, Tomisato, Japan.
JMA J. 2023 Jul 14;6(3):354-357. doi: 10.31662/jmaj.2023-0005. Epub 2023 Jun 12.
Idiopathic normal pressure hydrocephalus (iNPH) with gait disturbance can be effectively treated with a cerebrospinal fluid shunt. Furthermore, balloon kyphoplasty (BKP) is a successful minimally invasive treatment for osteoporotic vertebral compression fractures (VCFs). This case report presents the surgical management of an elderly patient with iNPH who presented after a VCF due to a fall. A 77-year-old woman who had been experiencing progressive gait disturbance for five years reported experiencing back pain one month after a fall. Imaging revealed a recent L1 VCF that did not compromise the spinal canal. Furthermore, the Mini-Mental State Examination results and the timed up-and-go test were 20 points and 17.96 seconds, respectively. Magnetic resonance imaging revealed ventriculomegaly with an Evans' index of 0.35. Her symptoms improved temporarily after a tap test, and she was diagnosed with probable iNPH. BKP was performed for VCFs, followed by the lumboperitoneal (LP) shunt placement for iNPH one month later. Following the operation, her symptoms improved without complications. After one month of performing BKP, an LP shunt would be placed to prevent shunt complications, such as infection and catheter-related neurological symptoms. Screening for iNPH in the elderly who present after VCFs due to a fall may identify iNPH patients who may benefit more from surgical treatments.
伴有步态障碍的特发性正常压力脑积水（iNPH）可通过脑脊液分流术得到有效治疗。此外，球囊后凸成形术（BKP）是治疗骨质疏松性椎体压缩骨折（VCF）的一种成功的微创手术。本病例报告介绍了一名老年iNPH患者在因跌倒导致VCF后接受的手术治疗。一名77岁女性，五年来一直患有进行性步态障碍，跌倒后一个月出现背痛。影像学检查显示近期L1椎体发生VCF，但未累及椎管。此外，简易精神状态检查表结果和计时起立行走测试结果分别为20分和17.96秒。磁共振成像显示脑室扩大，埃文斯指数为0.35。试行腰穿后她的症状暂时改善，被诊断为可能患有iNPH。先对VCF进行了BKP治疗，一个月后再为iNPH进行腰大池-腹腔（LP）分流术。术后，她的症状改善且无并发症。在进行BKP一个月后，放置LP分流管以预防分流并发症，如感染和与导管相关的神经症状。对因跌倒导致VCF后就诊的老年人进行iNPH筛查，可能会发现更多能从手术治疗中获益的iNPH患者。
