Prediction of Effectiveness of Shunting Operation for Normal Pressure Hydrocephalus by Quantitative Assessment of Clinical Symptoms

To determine indication of shunting operation for a case of posttraumatic normal pressure hydrocephalus (NPH), quantitative assessment of clinical symptoms before and after continuous spinal drainage (CSD) was helpful.Through a retention catheter located in the lumbar subarachnoid space, 150ml of cerebrospinal fluid (CSF) was continuously drained daily for 5 days. We assessed clinical symptoms before and after CSD with a newly developed objective measure: NPH scale, which comprises tests of attention, short-term memory, orientation and balance. Of the so-called “triad of NPH”, we speculated that “dementia” is a clinical manifestation of mild disturbance of consciousness and “gait disturbance” of disequilibrium. With the increments of NPH scale score after CSD, a shunting operation was performed. Postoperative improvement was confirmed by increments in HDS-R and FIM.Abnormal CT cisternogram must be an indication of shunting operation, and the expected clinical improvement will be distinctive. In rehabilitation settings, however, only subtle improvements can be of great significance to restore the patient's ADL. Only a serial observation, before and after temporary reduction of CSF pressure, can inform us of possibility of such changes. So as for the case, the result of cisternography failed to indicate shunting operation.