DiagnosisandTreatmentofIdiopathicNormalPressure特发性正常压力的诊断和治疗.pptVIP

Diagnosis and Treatment of Idiopathic Normal Pressure Hydrocephalus Rohini Selvarajah 2007 Neuroscience presentation Introduction First described by Hakim and Adams in 1965, idiopathic normal pressure hydrocephalus (INPH) is an enlargement of cerebral ventricles without evidence of chronic increased intracranial pressure (ICP). INPH is associated with a triad of symptoms including gait disturbance, dementia, and urinary incontinence In 2000, the costs of treating INPH exceeded $1 billion. There were 27,870 patients with INPH treated that year, and more than 8,000 new cases diagnosed. INPH is clinically diagnosed in most patients during the sixth or seventh decade of life. Many older adults are incorrectly diagnosed with disorders such as Parkinsons disease and dementia when their symptoms are actually caused by INPH. The diagnosis of INPH is challenging and requires a combination of clinical signs and symptoms, radiographic findings, and diagnostic testing. The purpose of evaluation and testing of individuals with suspected INPH is to determine if surgical implantation of a ventriculoperitoneal (VP) shunt will be beneficial. VP shunting is now a common neurosurgical procedure, but it is one associated with risks and complications, which makes evaluation of shunt-responsiveness essential. Presentation A 65-year-old man, presented with a profile of progressively worsening symptoms, including gait and balance impairment, deterioration of memory and cognition, and recent urinary urgency and incontinence. A family member brought him to his physician for evaluation and treatment. Although his signs and symptoms could be attributed to the effects of aging, a careful and thorough evaluation was necessary to accurately diagnose his disorder. His evaluation included careful review of his medical history, as well as a thorough systems examination. Special attention was paid to any specific brain disease or brain trauma that could precipitate his presenting