Flow Chart of Takeuchi et al for Identifying a Patient with Atypical Idiopathic Normal Pressure Hydrocephalus Who Is Likely to Benefit from a CSF Shunt
Takeuchi et al developed a flow diagram to help determine if a patient with atypical idiopathic normal pressure hydrocephalus (AINPH) is likely to benefit from having a CSF shunt placed. The authors are from Higashimatsuyama Municipal Hospital and Kochi Medical School in Japan.
Atypical idiopathic normal pressure hydrocephalus is isiopathic normal prssure hydrocephalus accompanied by brain atrophy.
Placement of a shunt is considered effective if NPH grading scale based on gait, dementia and urinary incontinence improved (was lower) by 1 point or more after the shunt was placed.
Parameters:
(1) CSF outflow resistance in mm Hg per mL per minute (determined by a single bolus injection infusion test)
(2) pathological pressure wave seen with an epidural pressure transducer
(3) serum alpha-1-antichymotrypsin in mg/dL
(4) cerebral arteriovenous difference in oxygen content in mL%
Cerebral arteriovenous difference in oxygen content is calculated using data from blood samples collected from the femoral artery and inferior jugular vein.
Outflow Resistance
Pressure Wave
serum alpha-1 ACT
cerebral AV O2 difference
CSF Shunt
< 20
NA
NA
NA
ineffective
>= 20
present
NA
NA
effective
>= 20
absent
>= 55
NA
ineffective
>= 20
absent
< 55
5 to 8.5
effective
>= 20
absent
< 55
other
ineffective
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