title: Clinical significance of cerebrospinal fluid tap test and magnetic resonance imaging/computed tomography findings of tight high convexity in patients with possible idiopathic normal pressure hydrocephalus.
abstract: Idiopathic normal pressure hydrocephalus (iNPH) is a treatable syndrome with a classical triad of symptoms. The Japanese iNPH guidelines indicate that the cerebrospinal fluid (CSF) tap test and tight high-convexity on magnetic resonance (MR) imaging are important for the diagnosis. The relationships between the effectiveness of CSF shunt surgery in possible iNPH patients, the tap test result, and the MR imaging/computed tomography (CT) findings of tight high-convexity were evaluated in 88 possible iNPH patients (mean age 75 years) with one or more of the classical triad of symptoms, and mild to moderate ventricular dilation. All patients underwent the tap test in the outpatient clinic, and patients and caregivers assessed the clinical changes during one week. The tap test was positive in 47 patients and negative in 41 patients. Surgery was performed in 19 patients with positive tap test, and was effective in 17 patients. Although the findings were inconsistent in some patients, the result of the tap test was found to be highly correlated with the MR imaging/CT finding of tight high-convexity (p < 0.0001), confirming that both these diagnostic tests are promising predictors of shunt effectiveness.
authors.affiliation: Department of Neurosurgery, Tazuke-Kofukai Kitano Hospital, Osaka. rakuwadr1001@rakuwadr.com
authors.forename: Masatsune
authors.initials: M
authors.lastname: Ishikawa
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Oowaki
authors.forename: Atsuhito
authors.initials: A
authors.lastname: Matsumoto
authors.forename: Takayuki
authors.initials: T
authors.lastname: Suzuki
authors.forename: Motomasa
authors.initials: M
authors.lastname: Furuse
authors.forename: Namiko
authors.initials: N
authors.lastname: Nishida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D015170:Cerebrospinal Fluid Pressure / Q000502:physiology; D002557:Cerebrospinal Fluid Shunts / Q000295:instrumentation / Q000379:methods; D003952:Diagnostic Imaging / Q000379:methods*; D005260:Female; D020546:Fourth Ventricle / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000134:cerebrospinal fluid* / Q000175:diagnosis* / Q000601:surgery; D020547:Lateral Ventricles / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013129:Spinal Puncture / Q000379:methods*; D013346:Subarachnoid Space / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D020542:Third Ventricle / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome