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Shunt-responsive idiopathic normal pressure hydrocephalus patient with delayed improvement after tap test.
J Korean Neurosurg Soc 2013; 54(5):437-40JK

Abstract

The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.

Authors+Show Affiliations

Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea.Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Korea.Department of Neurology, School of Medicine, Kyungpook National University, Daegu, Korea. ; Brain Science & Engineering Institute, Kyungpook National University, Daegu, Korea.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

24379955

Citation

Kang, Kyunghun, et al. "Shunt-responsive Idiopathic Normal Pressure Hydrocephalus Patient With Delayed Improvement After Tap Test." Journal of Korean Neurosurgical Society, vol. 54, no. 5, 2013, pp. 437-40.
Kang K, Hwang SK, Lee HW. Shunt-responsive idiopathic normal pressure hydrocephalus patient with delayed improvement after tap test. J Korean Neurosurg Soc. 2013;54(5):437-40.
Kang, K., Hwang, S. K., & Lee, H. W. (2013). Shunt-responsive idiopathic normal pressure hydrocephalus patient with delayed improvement after tap test. Journal of Korean Neurosurgical Society, 54(5), pp. 437-40. doi:10.3340/jkns.2013.54.5.437.
Kang K, Hwang SK, Lee HW. Shunt-responsive Idiopathic Normal Pressure Hydrocephalus Patient With Delayed Improvement After Tap Test. J Korean Neurosurg Soc. 2013;54(5):437-40. PubMed PMID: 24379955.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Shunt-responsive idiopathic normal pressure hydrocephalus patient with delayed improvement after tap test. AU - Kang,Kyunghun, AU - Hwang,Sung Kyoo, AU - Lee,Ho-Won, Y1 - 2013/11/30/ PY - 2013/06/03/received PY - 2013/09/25/revised PY - 2013/11/11/accepted PY - 2014/1/1/entrez PY - 2014/1/1/pubmed PY - 2014/1/1/medline KW - Cerebrospinal fluid shunts KW - Normal pressure hydrocephalus KW - Predictive value of tests SP - 437 EP - 40 JF - Journal of Korean Neurosurgical Society JO - J Korean Neurosurg Soc VL - 54 IS - 5 N2 - The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans' ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn't show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered. SN - 2005-3711 UR - https://www.unboundmedicine.com/medline/citation/24379955/Shunt_responsive_idiopathic_normal_pressure_hydrocephalus_patient_with_delayed_improvement_after_tap_test_ L2 - http://jkns.or.kr/journal/view.php?doi=10.3340/jkns.2013.54.5.437 DB - PRIME DP - Unbound Medicine ER -