INPH and Parkinson disease: differentiation by levodopa response.
Differentiating between Parkinson disease (PD) and idiopathic normal pressure hydrocephalus (INPH) can be challenging for the practicing clinician. Patients with undiagnosed PD but with incidental ventriculomegaly run the risk of being subjected to unnecessary shunt surgery. Taking a family history of PD and establishing the presence of motor symptoms (tremor, rigidity, bradykinesia) and nonmotor symptoms could help to differentiate between the two disorders. For patients with parkinsonian features, a dopamine challenge test to exclude the possibility of idiopathic PD might be beneficial. In this article, we highlight the difficulty of accurately differentiating INPH from PD as illustrated by three clinical cases of patients referred for shunt surgery.
Morishita
Takashi
T
Department of Neurology, University of Florida College of Medicine, Shands Hospital, Movement Disorders Center, McKnight Brain Institute, 100 S. Newell Drive, Gainesville, FL 32610, USA.
Foote
Kelly D
KD
Okun
Michael S
MS
D000465:Algorithms; D000978:Antiparkinson Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D017408:Guidelines as Topic; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D007980:Levodopa / Q000627:therapeutic use; D010300:Parkinson Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D014057:Tomography, X-Ray Computed / Q000379:methods
D000978:Antiparkinson Agents; D007980:Levodopa