NORMAL PRESSURE HYDROCEPHALUS: LITERATURE REVIEW
Keywords:Normal pressure hydrocephalus, ventriculomegaly, dementia, gait disorders, urinary incontinence, ventriculoperitoneal shunt
Objectives. Normal pressure hydrocephalus is a potentially reversible disease, characterized by a pathological enlargement of the cerebral ventricles, with a normal opening pressure during the lumbar puncture. The characteristic triad of Normal pressure hydrocephalus is dementia, gait disorders, and urinary incontinence. Because this clinical syndrome is potentially reversible by the placement of a ventriculoperitoneal shunt, early recognition and diagnosis are important. Differential diagnosis should be made between forms of communicating hydrocephalus from obstructive or noncommunicating hydrocephalus, in which there is a structural blockage of cerebrospinal fluid circulation (e.g., Sylvius aqueduct stenosis). We aimed to formulate a standard of care for patients diagnosed with idiopathic normal pressure hydrocephalus and to develop a Clinical Protocol within the Institute of Neurology and Neurosurgery, Chișinău, Republic of Moldova.
Materials and methods. We conducted an extensive review of the literature, using the PubMed database with the keywords„normal pressure hydrocephalus”, „NPH”, “ventriculoperitoneal shunt”, regarding articles, guidelines, and protocols published in the last 5 years.
Results. The initial search resulted in 1084 articles, published from 2014 till present (July 2020), and, after resource selection, based on abstracts and bibliographic sources from relevant articles, a total of 39 articles and guidelines on epidemiology, pathophysiology, diagnosis and treatment of idiopathic normal pressure hydrocephalus were selected and reviewed. The information was analyzed and systematized.
Conclusion. Normal pressure hydrocephalus is a common issue in medical practice, which is often not diagnosed in time, but which has a medical solution, with a positive impact on patient's quality of life. The development of a guideline regarding normal pressure hydrocephalus with clear recommendations, based on current scientific evidence, is appropriate.
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