eMedicine Specialties > Neurology > Movement and Neurodegenerative Diseases

Normal Pressure Hydrocephalus: Follow-up

Author: Arif I Dalvi, MD, Clinical Associate Professor of Neurology, University of Chicago Pritzker School of Medicine; Director, Movement Disorders Center, NorthShore University HealthSytems
Coauthor(s): Ashvini P Premkumar, MD, Clinical Instructor of Neurology, Associate Director, Movement Disorders Center, University of Chicago School of Medicine, Northshore University Health Systems
Contributor Information and Disclosures

Updated: Nov 17, 2009

Follow-up

Prognosis

The overall prognosis of NPH remains poor both due to a lack of improvement in some patients following surgery as well as a significant complication rate. In a study by Vanneste et al, one of the more comprehensive studies described above, marked improvement was noted in only 21% of patients following shunt surgery. Complication rate was approximately 28% with death or severe residual morbidity in 7% of patients, further emphasizing the importance of careful patient selection.22 Concomitant cerebrovascular disease is a recognized negative prognostic factor.23
 
In patients who develop recurrent symptoms after initial improvement, shunt malfunction should be suspected and an evaluation for mechanical failure should be pursued. In some of these cases, catheter migration may have occurred, which is a correctable cause of shunt malfunction. In one case series, shunt revision was required in more than half of treated patients over a 6-year period, with improvement in most of these patients.24

The incidence of shunt complications is estimated in 30-40% of patients.19 These include anesthetic complications, intracranial hemorrhage from placement of the ventricular catheter, infection, CSF hypotensive headaches, subdural hematomas, shunt occlusion, and catheter breakage. Rapid reduction in ventricular size following the shunt favors complications such as subdural hematoma, which may occur in 2-17% of patients.19 Dual-switch valves and programmable valves may reduce the incidence of this complication.25

Patient Education

For excellent patient education resources, visit eMedicine's Dementia Center. Also, see eMedicine's patient education article Normal Pressure Hydrocephalus.

Miscellaneous

Medicolegal Pitfalls

Initial misdiagnosis may occur and remains a potential pitfall. Two additional potential pitfalls include selecting the wrong patient for surgery and failure to send a good candidate to surgery. Given the high risks associated with shunt surgery and its long-term complications, erring on the conservative side is preferred. In this regard, obtaining a definite response to presurgical testing is helpful. Furthermore, thorough counseling of the patient and family members is appropriate. Take care to avoid unrealistic expectations.

 


More on Normal Pressure Hydrocephalus

Overview: Normal Pressure Hydrocephalus
Differential Diagnoses & Workup: Normal Pressure Hydrocephalus
Treatment & Medication: Normal Pressure Hydrocephalus
Follow-up: Normal Pressure Hydrocephalus
Multimedia: Normal Pressure Hydrocephalus
References
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References

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Further Reading

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Keywords

normal pressure hydrocephalus, NPH, occult hydrocephalus, extraventricular obstructive hydrocephalus, abnormal gait, urinary incontinence, dementia, intracranial pressure, ICP, CSF pressure, cerebrospinal fluid pressure, extraventricular obstructive hydrocephalus, gait apraxia, gait disorder, parkinsonism

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Contributor Information and Disclosures

Author

Arif I Dalvi, MD, Clinical Associate Professor of Neurology, University of Chicago Pritzker School of Medicine; Director, Movement Disorders Center, NorthShore University HealthSytems
Arif I Dalvi, MD is a member of the following medical societies: European Neurological Society and Movement Disorders Society
Disclosure: Novartis Honoraria Speaking and teaching

Coauthor(s)

Ashvini P Premkumar, MD, Clinical Instructor of Neurology, Associate Director, Movement Disorders Center, University of Chicago School of Medicine, Northshore University Health Systems
Ashvini P Premkumar, MD is a member of the following medical societies: American Academy of Neurology and Movement Disorders Society
Disclosure: Nothing to disclose.

Medical Editor

Joseph F Hulihan, MD, Vice President, Medical Affairs, Ortho-McNeil Janssen Scientific Affairs, LLC
Joseph F Hulihan, MD is a member of the following medical societies: American Academy of Neurology, American Clinical Neurophysiology Society, American Epilepsy Society, American Headache Society, and American Medical Association
Disclosure: Johnson & Johnson Salary Employment; Johnson & Johnson Stock Employment

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Nestor Galvez-Jimenez, MD, MSc, MHA, Chairman, Department of Neurology, Program Director, Movement Disorders, Department of Neurology, Division of Medicine, Cleveland Clinic Florida
Nestor Galvez-Jimenez, MD, MSc, MHA is a member of the following medical societies: American Academy of Neurology, American College of Physicians, and Movement Disorders Society
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

 
 
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