Normal pressure hydrocephalus

How often does the diagnosis hold water?

Bryan Klassen, J. Eric Ahlskog

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

Objective: To determine our community's incidence of clinically suspected normal pressure hydrocephalus (NPH), the rate of shunting for NPH, and short- and long-term outcomes of shunting. Methods: A retrospective query of the Mayo Clinic medical records linkage system was conducted to identify residents of Olmsted County, Minnesota, undergoing an invasive diagnostic procedure for evaluation of suspected NPH from 1995 through 2003. Among patients with shunts, earlyand long-term outcomes were determined via a review of available medical records. Results: Forty-one patients underwent an invasive diagnostic procedure for evaluation of suspected NPH; 13 ultimately received shunts, representing an incidence of 1.19/100,000/year. The incidence of sustained definite improvements at 3 years after shunting was only 0.36/ 100,000/year. Definite gait improvement was documented in 75% at 3-6 months after shunt placement, although it dropped to 50% at 1 year and to 33% at 3 years. Only 1 of 8 patients with cognitive impairment and 1 of 6 patients with urinary incontinence had definite improvement in these symptoms at 3 years. No patient with moderate to severe postural instability experienced sustained definite improvement in any symptom. Complications occurred in 33% of patients including one perioperative death. Additional or alternative neurologic diagnoses later surfaced in 5 of 12 patients. Conclusions: In this community, NPH is relatively rare with an incidence approximating that of progressive supranuclear palsy in this population. Whereas early gait improvement was common, only one-third of patients enjoyed continued improvement by 3 years; cognition or urinary incontinence was even less responsive long term. Baseline postural instability predicted poor outcome. Clinicians should balance potential benefits of shunting against the known risks.

Original languageEnglish (US)
Pages (from-to)1119-1125
Number of pages7
JournalNeurology
Volume77
Issue number12
DOIs
StatePublished - Sep 20 2011

Fingerprint

Normal Pressure Hydrocephalus
Water
Incidence
Urinary Incontinence
Gait
Medical Record Linkage
Progressive Supranuclear Palsy
Delayed Diagnosis
Cognition
Nervous System
Medical Records

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Normal pressure hydrocephalus : How often does the diagnosis hold water? / Klassen, Bryan; Ahlskog, J. Eric.

In: Neurology, Vol. 77, No. 12, 20.09.2011, p. 1119-1125.

Research output: Contribution to journalArticle

Klassen, Bryan ; Ahlskog, J. Eric. / Normal pressure hydrocephalus : How often does the diagnosis hold water?. In: Neurology. 2011 ; Vol. 77, No. 12. pp. 1119-1125.
@article{8b3d66f1a98043b9ba990daab3982885,
title = "Normal pressure hydrocephalus: How often does the diagnosis hold water?",
abstract = "Objective: To determine our community's incidence of clinically suspected normal pressure hydrocephalus (NPH), the rate of shunting for NPH, and short- and long-term outcomes of shunting. Methods: A retrospective query of the Mayo Clinic medical records linkage system was conducted to identify residents of Olmsted County, Minnesota, undergoing an invasive diagnostic procedure for evaluation of suspected NPH from 1995 through 2003. Among patients with shunts, earlyand long-term outcomes were determined via a review of available medical records. Results: Forty-one patients underwent an invasive diagnostic procedure for evaluation of suspected NPH; 13 ultimately received shunts, representing an incidence of 1.19/100,000/year. The incidence of sustained definite improvements at 3 years after shunting was only 0.36/ 100,000/year. Definite gait improvement was documented in 75{\%} at 3-6 months after shunt placement, although it dropped to 50{\%} at 1 year and to 33{\%} at 3 years. Only 1 of 8 patients with cognitive impairment and 1 of 6 patients with urinary incontinence had definite improvement in these symptoms at 3 years. No patient with moderate to severe postural instability experienced sustained definite improvement in any symptom. Complications occurred in 33{\%} of patients including one perioperative death. Additional or alternative neurologic diagnoses later surfaced in 5 of 12 patients. Conclusions: In this community, NPH is relatively rare with an incidence approximating that of progressive supranuclear palsy in this population. Whereas early gait improvement was common, only one-third of patients enjoyed continued improvement by 3 years; cognition or urinary incontinence was even less responsive long term. Baseline postural instability predicted poor outcome. Clinicians should balance potential benefits of shunting against the known risks.",
author = "Bryan Klassen and Ahlskog, {J. Eric}",
year = "2011",
month = "9",
day = "20",
doi = "10.1212/WNL.0b013e31822f02f5",
language = "English (US)",
volume = "77",
pages = "1119--1125",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "12",

}

TY - JOUR

T1 - Normal pressure hydrocephalus

T2 - How often does the diagnosis hold water?

AU - Klassen, Bryan

AU - Ahlskog, J. Eric

PY - 2011/9/20

Y1 - 2011/9/20

N2 - Objective: To determine our community's incidence of clinically suspected normal pressure hydrocephalus (NPH), the rate of shunting for NPH, and short- and long-term outcomes of shunting. Methods: A retrospective query of the Mayo Clinic medical records linkage system was conducted to identify residents of Olmsted County, Minnesota, undergoing an invasive diagnostic procedure for evaluation of suspected NPH from 1995 through 2003. Among patients with shunts, earlyand long-term outcomes were determined via a review of available medical records. Results: Forty-one patients underwent an invasive diagnostic procedure for evaluation of suspected NPH; 13 ultimately received shunts, representing an incidence of 1.19/100,000/year. The incidence of sustained definite improvements at 3 years after shunting was only 0.36/ 100,000/year. Definite gait improvement was documented in 75% at 3-6 months after shunt placement, although it dropped to 50% at 1 year and to 33% at 3 years. Only 1 of 8 patients with cognitive impairment and 1 of 6 patients with urinary incontinence had definite improvement in these symptoms at 3 years. No patient with moderate to severe postural instability experienced sustained definite improvement in any symptom. Complications occurred in 33% of patients including one perioperative death. Additional or alternative neurologic diagnoses later surfaced in 5 of 12 patients. Conclusions: In this community, NPH is relatively rare with an incidence approximating that of progressive supranuclear palsy in this population. Whereas early gait improvement was common, only one-third of patients enjoyed continued improvement by 3 years; cognition or urinary incontinence was even less responsive long term. Baseline postural instability predicted poor outcome. Clinicians should balance potential benefits of shunting against the known risks.

AB - Objective: To determine our community's incidence of clinically suspected normal pressure hydrocephalus (NPH), the rate of shunting for NPH, and short- and long-term outcomes of shunting. Methods: A retrospective query of the Mayo Clinic medical records linkage system was conducted to identify residents of Olmsted County, Minnesota, undergoing an invasive diagnostic procedure for evaluation of suspected NPH from 1995 through 2003. Among patients with shunts, earlyand long-term outcomes were determined via a review of available medical records. Results: Forty-one patients underwent an invasive diagnostic procedure for evaluation of suspected NPH; 13 ultimately received shunts, representing an incidence of 1.19/100,000/year. The incidence of sustained definite improvements at 3 years after shunting was only 0.36/ 100,000/year. Definite gait improvement was documented in 75% at 3-6 months after shunt placement, although it dropped to 50% at 1 year and to 33% at 3 years. Only 1 of 8 patients with cognitive impairment and 1 of 6 patients with urinary incontinence had definite improvement in these symptoms at 3 years. No patient with moderate to severe postural instability experienced sustained definite improvement in any symptom. Complications occurred in 33% of patients including one perioperative death. Additional or alternative neurologic diagnoses later surfaced in 5 of 12 patients. Conclusions: In this community, NPH is relatively rare with an incidence approximating that of progressive supranuclear palsy in this population. Whereas early gait improvement was common, only one-third of patients enjoyed continued improvement by 3 years; cognition or urinary incontinence was even less responsive long term. Baseline postural instability predicted poor outcome. Clinicians should balance potential benefits of shunting against the known risks.

UR - http://www.scopus.com/inward/record.url?scp=80555143069&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80555143069&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e31822f02f5

DO - 10.1212/WNL.0b013e31822f02f5

M3 - Article

VL - 77

SP - 1119

EP - 1125

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 12

ER -