Predicting the response to ventriculoperitoneal shunt in patients with Normal Pressure HydrocephalusReport as inadecuate






Author: Gopal Balamurali

Source: https://core.ac.uk/

Objective: ud The diagnosis and management of normal pressure hydrocephalus (NPH) remains controversial. The aim of this prospective study was to assess the usefulness of clinical and radiological criteria together with supplemental neuropsychological and gait tests, cerebrospinal fluid (CSF) hydrodynamic studies and external lumbar drainage (ELD) in identifying those who may respond to a shunt and to compare the outcomes with the non-shunted patients at one year. ud Method: ud Forty patients with a clinical diagnosis of NPH were prospectively studied according to a fixed management protocol. Resistance to CSF (Rcsf) was measured using a lumbar infusion study and an ELD was used to determine improvement in neuropsychological and gait tests following CSF drainage. Based on specific criteria those who showed improvement were shunted. Clinical and radiological outcomes were assessed at one year in all patients. ud Results: ...


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Predicting the response to ventriculoperitoneal shunt in patients with Normal Pressure Hydrocephalus By G.BALAMURALI MBBS, MRCS, FRCS (SN) 2010 A thesis submitted for the degree of DOCTOR OF MEDICINE In the faculty of science, University of Central Lancashire undertaken in collaboration with Lancashire Teaching Hospitals NHS trust.
Preston. 1 Declaration All work contained within this thesis has been performed by myself unless otherwise specified. On occasions Mr Imran Bhatti, registrar in neurosurgery, reviewed some patients at the Royal Preston hospital for any acute problems and shunt pressure adjustments.
Physiotherapists in the neurosurgery department performed the gait assessments and specific protocol was adhered. 2 Abstract Objective: The diagnosis and management of normal pressure hydrocephalus (NPH) remains controversial.
The aim of this prospective study was to assess the usefulness of clinical and radiological criteria together with supplemental neuropsychological and gait tests, cerebrospinal fluid (CSF) hydrodynamic studies and external lumbar drainage (ELD) in identifying those who may respond to a shunt and to compare the outcomes with the non-shunted patients at one year. Method: Forty patients with a clinical diagnosis of NPH were prospectively studied according to a fixed management protocol.
Resistance to CSF (Rcsf) was measured using a lumbar infusion study and an ELD was used to determine improvement in neuropsychological and gait tests following CSF drainage.
Based on specific criteria those who showed improvement were shunted.
Clinical and radiological outcomes were assessed at one year in all patients. Results: Twenty three (57.5%) patients were shunted.
Improvement was observed in 74% of shunted patients, while 17% did not improve and 9% deteriorated following surgery.
Age, etiology, presentation, duration of symptoms and presence of co-morbid factors were unrelated to outcome.
Improvement was found in 63% of shunted patients with RCSF of 12 mmHg-ml-min or higher.
The sensitivity was 64% with a positive predictive value of 68%.
Both Rcsf testing and ELD enhanced the positive predictive outcome of shunt operation.
Using the non-shunted 3 patients as controls, the mean difference between the two groups over time differed significantly in all the neuropsychological tests and some gait test. Conclusions: No single test was able to predict overall success with shunting but the results showed that a high percentage of improv....






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