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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.55 no.2 São Paulo June 1997

http://dx.doi.org/10.1590/S0004-282X1997000200003 

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. DamascenoI; Edmur F. CarelliII; Donizeti C. HonoratoII; Jose J. FacureII

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".


 

 

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Full text available only in PDF format.

 

 

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Aceite: 5-dezembro-1997.

 

 

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

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