The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus

Damasceno, Benito P.; Carelli, Edmur F.; Honorato, Donizeti C.; Facure, Jose J.

doi:10.1590/S0004-282X1997000200003

Abstracts

Eighteen patients (mean age of 66.5 years) with normal pressure hydrocephalus (NPH) underwent a ventriculo-peritoneal shunt surgery. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of gait pattern and psychometric functions (memory, visuo-motor speed and visuo-constructive skills) before and after the removal of 50 ml CSFby lumbar puncture (LP). Fifteen patients improved and 3 were unchanged after surgery. Short duration of disease, gait disturbance preceding mental deterioration, wide temporal horns and small sulci on CT-scan were associated with good outcome after shunting. There was a good correlation between the results of CSF-TT and shunt surgery (X² = 4,11 ,phi = 0.48, p < 0.05), with gait test showing highest correlation (r = 0.99, p = 0.01). In conclusion, this version of CSF-TT proved to be an effective test to predict improvement after shunting in patients with NPH.

normal pressure hydrocephalus; lumbar puncture; shunt surgery

Este estudo visa melhorar o valor diagnóstico e preditivo da punção liquórica ("tap test", TT) na hidrocefalia de pressão normal (HPN), particularmente nos casos em que os dados clinicos e de neuroimagem são inconclusivos e não permitem uma decisão cirúrgica segura. Dezoito pacientes (média de idade = 66.5 anos) com HPN foram submetidos a derivação ("shunt") ventriculo-peritoneal. O TT era realizado antes da cirurgia, consistindo na análise quantitativa da marcha e funções cognitivas (memória, rapidez perceptivo-motora e habilidade vísuo-construtiva) antes e depois da retirada de 50 ml de liquor via punção lombar. Quinze pacientes melhoraram e 3 permaneceram inalterados após a cirurgia. Curta duração da doença, distúrbio da marcha precedendo a deterioração mental, dilatação dos cornos temporais e apagamento (ou redução) dos sulcos corticais na tomografia computadorizada cerebral estavam associados a bons resultados pós-operatórios. Houve boa correlação entre os resultados do TT e os do "shunt" (X² = 4.11, phi = 0.48, p < 0.05), principalmente no teste da marcha (r = 0.99, p = 0.01). Esta versão do TT liquórico mostrou-se efetiva na prediçâo da melhora pós-operatória em pacientes com HPN.

hidrocefalia de pressão normal; punção lombar; cirurgia de "shunt"

The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus

Valor preditivo da punção liquórica ("tap test") na hidrocefalia de pressão normal

Benito P. Damasceno^I; Edmur F. Carelli^II; Donizeti C. HonoratoII; Jose J. Facure^II

^IUnidade de Neuropsicologia e Neurolinguistica. Departamento de Neurologia, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP)

^IIDisciplina de Neurocirurgia. Departamento de Neurologia, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP)

ABSTRACT

Eighteen patients (mean age of 66.5 years) with normal pressure hydrocephalus (NPH) underwent a ventriculo-peritoneal shunt surgery. Prior to operation a cerebrospinal fluid tap-test (CSF-TT) was performed with measurements of gait pattern and psychometric functions (memory, visuo-motor speed and visuo-constructive skills) before and after the removal of 50 ml CSFby lumbar puncture (LP). Fifteen patients improved and 3 were unchanged after surgery. Short duration of disease, gait disturbance preceding mental deterioration, wide temporal horns and small sulci on CT-scan were associated with good outcome after shunting. There was a good correlation between the results of CSF-TT and shunt surgery (X² = 4,11 ,phi = 0.48, p < 0.05), with gait test showing highest correlation (r = 0.99, p = 0.01). In conclusion, this version of CSF-TT proved to be an effective test to predict improvement after shunting in patients with NPH.

Key words: normal pressure hydrocephalus, lumbar puncture, shunt surgery.

RESUMO

Este estudo visa melhorar o valor diagnóstico e preditivo da punção liquórica ("tap test", TT) na hidrocefalia de pressão normal (HPN), particularmente nos casos em que os dados clinicos e de neuroimagem são inconclusivos e não permitem uma decisão cirúrgica segura. Dezoito pacientes (média de idade = 66.5 anos) com HPN foram submetidos a derivação ("shunt") ventriculo-peritoneal. O TT era realizado antes da cirurgia, consistindo na análise quantitativa da marcha e funções cognitivas (memória, rapidez perceptivo-motora e habilidade vísuo-construtiva) antes e depois da retirada de 50 ml de liquor via punção lombar. Quinze pacientes melhoraram e 3 permaneceram inalterados após a cirurgia. Curta duração da doença, distúrbio da marcha precedendo a deterioração mental, dilatação dos cornos temporais e apagamento (ou redução) dos sulcos corticais na tomografia computadorizada cerebral estavam associados a bons resultados pós-operatórios. Houve boa correlação entre os resultados do TT e os do "shunt" (X² = 4.11, phi = 0.48, p < 0.05), principalmente no teste da marcha (r = 0.99, p = 0.01). Esta versão do TT liquórico mostrou-se efetiva na prediçâo da melhora pós-operatória em pacientes com HPN.

Palavras-chave: hidrocefalia de pressão normal, punção lombar, cirurgia de "shunt".

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 5-dezembro-1997.

Dr. Benito P. Damasceno - Departamento de Neurologia FCM/UNICAMP - Caixa Postal 6111 - 13083-970 Campinas, SP - Brasil.

1. Adams RD. Fisher CM. Hakim S. Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with "normal" cerebrospinal fluid pressure: a treatable syndrome. N Engl J Med 1965;273:117-126.
2. Bergstrand G, Oxenstierna G, Flyckt L, Larsson SA, Sedvall G. Radionuclide cisternography and computed tomography in 30 healthy volunteers. Neuroradiology 1986;28:154-160.
3. Bertolucci PHF. Brucki SMD, Campacci SR, Juliano Y - O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.
4. Chen IH, Huang CI, Liu HC. Chen KK. Effectiveness of shunting in patients with normal pressure hydrocephalus predicted by temporary, controlled-resislance, continuous lumbar drainage: a pilot study. J Neurol Neurosurg Psychiatry 1994:57:1430-1432.
5. Christensen A-L. Luria's neuropsychological investigation. Ed 2. Copenhagen: Munksgaard, 1979.
6. Di Lauro L. Mearini M, Botalli A. The predictive value of 5 days' CSF diversion for shunting in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 1986:49:842-843.
7. Fisher CM. Communicating hydrocephalus. Lancet 1978; Jan 7:37.
8. Fisher CM. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology 1982;32:1358-1363.
9. Folstein MF. Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. .1 Psychiatr Res 1975; 12:189-198.
¹⁰
Gammabatteriet (Gamma-battery) Manual. Stockholm: Psykologiforlaget AB, 1976.
11. Graff-Radford NR. Godersky JC. Normal-pressure hydrocephalus: onset of gait abnormality before dementia predicts good surgical outcome. Arch Neurol 1986;43:940-942.
12. Graff-Radford NR, Rezai K, Godersky JC, Eslinger P, Damasio H, Kirchncr PT. Regional cerebral blood flow in normal pressure hydrocephalus. .1 Neurol Neurosurg Psychiatry 1987;50:1589-96.
13. Larsson A. Wikkelso C. Billing M, Stephensen H. Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 1991 ;84:475-482.
14. McKahnn G. Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
15. Reisberg B. Ferris SH. De Leon M.I. Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136-1139.
16. Ross ED. Sensory-specific and fractional disorders of recent memory in man: II. Unilateral loss of tactile recent memory. Arch Neurol 1980:37:267-272.
17. Strub RL. Black FW. The mental state examination in neurology. Philadelphia: F.A. Davis, 1977.
18. Vannesle .1. Three decades of normal pressure hydrocephalus: are we wiser now? (editorial) J Neurol Neurosurg Psychiatry 1994:57:1021-1025.
19. Vanneste .J. van Acker R. Normal pressure hydrocephalus: did publications alter management? J Neurol Neurosurg Psychiatry 1990:53:564-568.
20. Vanneste .1, Augustijn P. Davies GAG. Dirven C. Tan WF. Normal-pressure hydrocephalus: is cisternography still useful in selecting patients for a shunt? Arch Neurol 1992; 49:366-370.
21. Waldemar G, Schmidt JF. Delecluse F, Andersen AR, Gjerris F, Paulson OB. High resolution SPECT with [^99mTc]-d.l-HMPAO in normal pressure hydrocephalus before and after shunt operation. .J Neurol Neurosurg Psychiatry 1993; 56:655-664.
²²
WHO. Mental behavioral and developmental disorders. In International Statistical Classsification of Diseases. 10th Revision (ICD-10). Geneva: World Health Organization; 1992: chap 5. Categories F00-F99.
23. Wikkelso C, Andersson H, Blomstrand C, Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 1982; 45:64-69.
24. Wikkelso C. Andersson H. Blomstrand C, Lindqvist G & Svendsen P. Normal pressure hydrocephalus: predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand 1986;73:566-573.

Publication Dates

Publication in this collection
10 Nov 2010
Date of issue
June 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Adams RD. Fisher CM. Hakim S. Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with "normal" cerebrospinal fluid pressure: a treatable syndrome. N Engl J Med 1965;273:117-126.

[2] 2. Bergstrand G, Oxenstierna G, Flyckt L, Larsson SA, Sedvall G. Radionuclide cisternography and computed tomography in 30 healthy volunteers. Neuroradiology 1986;28:154-160.

[3] 3. Bertolucci PHF. Brucki SMD, Campacci SR, Juliano Y - O mini-exame do estado mental em uma população geral: impacto da escolaridade. Arq Neuropsiquiatr 1994;52:1-7.

[4] 4. Chen IH, Huang CI, Liu HC. Chen KK. Effectiveness of shunting in patients with normal pressure hydrocephalus predicted by temporary, controlled-resislance, continuous lumbar drainage: a pilot study. J Neurol Neurosurg Psychiatry 1994:57:1430-1432.

[5] 5. Christensen A-L. Luria's neuropsychological investigation. Ed 2. Copenhagen: Munksgaard, 1979.

[6] 6. Di Lauro L. Mearini M, Botalli A. The predictive value of 5 days' CSF diversion for shunting in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 1986:49:842-843.

[7] 7. Fisher CM. Communicating hydrocephalus. Lancet 1978; Jan 7:37.

[8] 8. Fisher CM. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology 1982;32:1358-1363.

[9] 9. Folstein MF. Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. .1 Psychiatr Res 1975; 12:189-198.

[10] ¹⁰
Gammabatteriet (Gamma-battery) Manual. Stockholm: Psykologiforlaget AB, 1976.

[11] 11. Graff-Radford NR. Godersky JC. Normal-pressure hydrocephalus: onset of gait abnormality before dementia predicts good surgical outcome. Arch Neurol 1986;43:940-942.

[12] 12. Graff-Radford NR, Rezai K, Godersky JC, Eslinger P, Damasio H, Kirchncr PT. Regional cerebral blood flow in normal pressure hydrocephalus. .1 Neurol Neurosurg Psychiatry 1987;50:1589-96.

[13] 13. Larsson A. Wikkelso C. Billing M, Stephensen H. Clinical parameters in 74 consecutive patients shunt operated for normal pressure hydrocephalus. Acta Neurol Scand 1991 ;84:475-482.

[14] 14. McKahnn G. Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.

[15] 15. Reisberg B. Ferris SH. De Leon M.I. Crook T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136-1139.

[16] 16. Ross ED. Sensory-specific and fractional disorders of recent memory in man: II. Unilateral loss of tactile recent memory. Arch Neurol 1980:37:267-272.

[17] 17. Strub RL. Black FW. The mental state examination in neurology. Philadelphia: F.A. Davis, 1977.

[18] 18. Vannesle .1. Three decades of normal pressure hydrocephalus: are we wiser now? (editorial) J Neurol Neurosurg Psychiatry 1994:57:1021-1025.

[19] 19. Vanneste .J. van Acker R. Normal pressure hydrocephalus: did publications alter management? J Neurol Neurosurg Psychiatry 1990:53:564-568.

[20] 20. Vanneste .1, Augustijn P. Davies GAG. Dirven C. Tan WF. Normal-pressure hydrocephalus: is cisternography still useful in selecting patients for a shunt? Arch Neurol 1992; 49:366-370.

[21] 21. Waldemar G, Schmidt JF. Delecluse F, Andersen AR, Gjerris F, Paulson OB. High resolution SPECT with [^99mTc]-d.l-HMPAO in normal pressure hydrocephalus before and after shunt operation. .J Neurol Neurosurg Psychiatry 1993; 56:655-664.

[22] ²²
WHO. Mental behavioral and developmental disorders. In International Statistical Classsification of Diseases. 10th Revision (ICD-10). Geneva: World Health Organization; 1992: chap 5. Categories F00-F99.

[23] 23. Wikkelso C, Andersson H, Blomstrand C, Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry 1982; 45:64-69.

[24] 24. Wikkelso C. Andersson H. Blomstrand C, Lindqvist G & Svendsen P. Normal pressure hydrocephalus: predictive value of the cerebrospinal fluid tap-test. Acta Neurol Scand 1986;73:566-573.