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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2023; 42(03): e200-e209
DOI: 10.1055/s-0043-1774741
Original Article | Artigo Original

Ten Steps for NPH Management: Advancements in Diagnosis and Treatment of Adult Hydrocephalus

Dez etapas para o manejo da NPH: avanços no diagnóstico e tratamento da hidrocefalia em adultos
Alex Roman 
1   Department of Neurosurgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
,
Prince Takkar
2   Neurorehabilitation Institute, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
,
Tanmoy Maiti
1   Department of Neurosurgery, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
› Author Affiliations Funding Source This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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Abstract

Objectives The authors of the present study intend to describe a straightforward protocol for normal pressure hydrocephalus diagnosis and management, with the employment of a multidisciplinary team approach effort.

Methods Using a strict methodological approach for initial diagnosis, taking into consideration occupational therapy and physical therapy assessment, the authors have set out to elaborate a simple protocol for suspicion and, once diagnosed, treatment of normal pressure hydrocephalus. We have used the MoCA (Montreal Cognitive Assessment) and walking assessment that included speed, independence, and distance (SID), 10 m walk test, TUG (timed up and go) evaluation, 6-minute Walk Test, MiniBESTest, as the main factors for pre and post lumbar drainage assessment, after which, the alternatives were deliberated and followed, or not, by ventriculoperitoneal shunt insertion.

Results The authors have described a protocol, consisting of ten easy steps, which involves a multidisciplinary team, including occupational therapy and physical therapy professionals, as well as neurologists and neurosurgeons for improved and objective assessment prior to insertion of lumbar drain and, thereafter, detecting the population at most benefit for ventriculoperitoneal shunt insertion. We have described the Ten Step Approach for Normal Pressure Hydrocephalus management, including from initial clinical presentation and imaging, to pre and post lumbar drainage, for lastly deciding upon necessity for ventriculoperitoneal shunt insertion.

Conclusions A straightforward protocol for normal pressure hydrocephalus seems not only feasible, but simple to implement in most neurosurgical departments, with good accuracy of prediction of lumbar drainage assessment to shunting outcomes.

Keywords

normal pressure hydrocephalus - ventriculoperitoneal shunt - idiopathic normal pressure hydrocephalus - adult hydrocephalus

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Publication History

Received: 28 December 2022

Accepted: 07 March 2023

Article published online:
29 September 2023

© 2023. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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