Predictive value of the cerebrospinal fluid tap‐test

ABSTRACT Twenty‐seven patients with normal pressure hydrocephalus were operated upon by a ventriculo‐peritoneal shunt. Selection for shunt surgery was based on typical symptoms (gait disturbancy, mental deterioration and urgency incontinence) and characteristic changes at cranial computed tomography and/or radionuclide cisternography. Prior to operation a cerebrospinal fluid tap‐test (CSF‐TT) was performed with measurements of psychometric functions and gait pattern before and after a lumbar puncture of 50 cc CSF. Nineteen patients improved and 5 were unchanged after shunt operation. Three patients could not be evaluated. Improvement in the psychometric functions and gait pattern after lumbar puncture correlated to improvement after the shunt operation (r = 0.64, p < 0.01: r = 0.96, p < 0.001, respectively). Improvement in 2 or more of the 4 tests used (3 psychometric and 1 gait test) at CSF‐TT implied in all cases successful result of the shunt operation. It was concluded that CSF‐TT could predict which NPH patient will improve by a shunt operation, and albeit to envisage the degree of improvement.

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