CC Sept 2017 Normal Pressure Hydocephalus (NPH)

echoecho's version from 2017-10-22 16:59


Question Answer
Gait and balance disorders in the elderly are common and usually caused by an underlying _____ condition, not simply a part of aging?medical
Early _______ of gait disorders is important in preventing falls and preserving independence?diagnosis
List NPH symptoms?1) gait abnormalities 2) falls 3) urinary incontinence 4) cognitive decline
*** Define INPH (idiopathic NPH)?a potentially reversible cause of dementia, which is most commonly treated with CSF shunting
In absence of other contraindications, should advanced age be considered an exclusionary factor for shunt placement?no
While all symptoms may improve or resolve with surgery, _____ ______ is most commonly the first to respond, followed by ____ ______, which is the most likely to respond and finally, ______ ______?1) urinary incontinence 2) gait disturbance 3) cognitive dysfunction
Symptoms improve in ___ to ___% of patients after shunting, independent of the postoperative change in ventricular size, which may not show substantial decrease?30-90%
List the factors associated with positive surgical outcomes?1) early diagnosis 2) gait disturbance as the chief complaint 3) symptom improvement following lumbar puncture
However, there is disagreement in the literature regarding prognostic factors, give an example?some authors suggest that gait impairment benefits most from shunting, while others find gait impairment to be associated with worse outcomes
INPH (idiopathic NPH) is often described by the classic triad, list these?1) subcortical and fontal dementia 2) urinary incontinence 3) gait disorder (pt has difficulty initiating steps and ambulates with a "magnetic" and unsteady gait
However, the full triad is not universally present, the most common complaint is _____ _______, followed by ______ ______ and finally, ______ ______?1) gait impairment 2) cognitive dysfunction 3) urinary incontinence
Are headaches a common feature of NPH and if present what needs to be done?1) no 2) a search for an unrelated cause may be indicated
Whille there are no unanimously accepted diagnostic criteris, guidelines exist to stratify patients into what 3 categories?1) probable NPH 2) possible NPH 3) unlikely NPH
List a probable NPH patient type?1) > 40 y.o. 2) gradual worsening of gait 3) urinary dysfunction 4) cognitive decline 5) over > 3 months 6) normal CSF pressure (70-245 mmHg) 7) neuroimaging findings (most notably ventriculomegaly out of proportion to cerebral atrophy)
How is ventriculomegaly defined?the Evans ratio is calculated by dividing maximal width of the lateral ventricles by the inner table of the parietal bones bilaterally. A result > 0.3 represents ventriculomegaly, but NOT necessarily NPH
List a possible INPH patient type?1) < 40 y.o. 2) nonprogressive symptoms or symptoms < 3 months 3) abnormal or unavailable CSF opening pressure 4) several cerebral atrophy that can explain the ventricular enlargment
List a possible patient type that would make NPH unlikely?1) presence of pappilledema 2) absence of ventriculomegaly 3) a condition that better explains the clinical picture
*** SUMMARY = Gait and balance disorders are very common in elderly, are often multifactorial and require ________ evaluation?comprehensive
*** SUMMARY = NPH is a rare cause of balance disorders and is accompanied by _____ _____ and _____ _____?1) cognitive deficits 2) urinary incontinence
*** SUMMARY = Treatment is with _______, the best results in ______ ______ (quickest to respond), and _______ ________ (most likely to respond). Does advanced dementia improve?1) shunting 2) urinary incontinence 3) gait disturbance 4) no