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Predictors of improvement after shunting for normal pressure hydrocephalus

Predictors of improvement after shunting for normal pressure hydrocephalus
Favorable indicators*
Early appearance of gait disorder
Gait disorder most prominent symptom
Shorter duration of symptoms (<6 months)
Identified etiology of NPH
Clinical response to CSF removal (tap test, lumbar drain)
Unfavorable indicators*
Early appearance of dementia
Moderate to severe dementia
Dementia present for more than two years
Gait disorder absent or appearing after dementia
Alcoholism
MRI findings:
  • Marked white matter disease
  • Diffuse sulcal enlargement
  • Medial temporal atrophy
NPH: normal pressure hydrocephalus; CSF: cerebrospinal fluid; MRI: magnetic resonance imaging.
* Any one factor is not decisive in selecting patients for surgery.
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