Objective: To identify and evaluate critical points of delay in the diagnosis and treatment of normal pressure hydrocephalus (NPH) at a tertiary care center.

Background: Treatment of normal pressure hydrocephalus often goes underdiagnosed due to its overlap with other neurodegenerative conditions.  Delays in diagnosis can postpone evaluation and treatment, potentially reducing the effectiveness of therapeutic outcomes such as lumbar punctures (LP) and ventriculoperitoneal (VP) shunting. Unfortunately, the factors contributing to these delays have not been sufficiently explored. This study aims to identify key points of delay in the diagnostic and treatment process thereby informing strategies to optimize outcomes for NPH patients within our institution.

Method: This retrospective cohort study included 19 patients diagnosed with NPH at Thomas Jefferson University Hospital. Data was extracted from electronic health records to assess key time points in patient care including symptom onset, Neurologist consultation, MRI, LP, and eventual VP shunt placement. MRI reports were interpreted as negative, equivocal, or positive for NPH based on radiology readings. Time from MRI to lumbar puncture was evaluated based on MRI interpretation.

Results: The median time from symptom onset to neurologist consultation was 510.5 days, from consultation to LP was 77 days, and from LP to VP shunt placement was 45 days. During the diagnostic phase, MRI findings were classified as negative in 7 (36.8%), equivocal in 6 (31.6%), and positive in 6 (31.6%) cases. The median time from MRI to LP was significantly longer for patients with negative or equivocal MRI findings (237 days) compared to those with positive MRI results (28.5 days; p = 0.036), indicating a delay in the diagnostic pathway for patients with non-positive MRI results.

Conclusion: This study identifies substantial delays in the diagnostic and treatment process for NPH, particularly between MRI and LP, which were influenced by the interpretation of MRI findings. These results underscore the need for standardized radiological reporting and broader education among providers to provide a timelier diagnosis, facilitate earlier intervention, and reduce morbidity associated with delayed NPH management.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-and-treatment-delays-in-normal-pressure-hydrocephalus-a-retrospective-analysis-at-a-tertiary-care-center/