KMID : 1001920130540050437
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Journal of Korean Neurosurgical Society 2013 Volume.54 No. 5 p.437 ~ p.440
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Shunt-Responsive Idiopathic Normal Pressure Hydrocephalus Patient with Delayed Improvement after Tap Test
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Kang Kyung-Hun
Hwang Sung-Kyoo Lee Ho-Won
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Abstract
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The cerebrospinal fluid tap test (CSFTT) is recommended as a key step in the diagnosis of idiopathic normal pressure hydrocephalus (iNPH). While there is no generally accepted evaluation period for ascertaining a CSFTT responder, a substantial number of patients are evaluated only once within 24 hours of the test for improvement in gait. We report an iNPH patient with a favorable response to shunt surgery, who was first judged a non-responder by this standard, though subsequently was judged a responder in virtue of repetitively testing gait over 7 days. A 68-year-old man presented with progressive impairment of gait, balance, and memory. He was diagnosed as iNPH with an Evans¡¯ ratio of 0.35. At first hospitalization, change in gait was evaluated 24 hours after the CSFTT. He didn¡¯t show any significant improvement and was judged as a non-responder. However, at the second CSFTT, we repetitively tested his change in gait over seven days. Forty-eight hours after the tap, he showed significant improvement in his gait. He was then confirmed as a responder. After the operation, the gait difficulties were almost fully resolved. Further studies developing the standard procedure of the CSFTT should be considered.
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KEYWORD
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Cerebrospinal fluid shunts, Normal pressure hydrocephalus, Predictive value of tests
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