Objective: Our study examines the radiographic accuracy when suggesting normal pressure hydrocephalus (NPH), correlation with imaging study indication, and frequency of lumbar puncture (LP) for diagnostic confirmation.

Background: NPH can present with largely nonspecific radiographic and clinical findings, often posing a diagnostic challenge [1]. Since NPH may be suspected whether patients can either present with clinical findings or based on imaging alone, we queried what work-up, if any, was performed if NPH was included in the radiology report of brain imaging. We sought to identify the underlying diagnosis that triggered imaging to be performed and how many patients were subsequently referred for NPH work-up.

Method: Our retrospective, IRB exempt, single-center study identified patients with imaging findings suggestive of NPH between July 1, 2020, and July 1, 2022. Additional data collected included imaging indication, opening pressure at LP, and clinical response to LP.

Results: Of the 563 patients included in our study, the most common imaging indications were altered mental status (25%) and stroke (18%). Patients with imaging findings and clinical suspicion of NPH were significantly more likely to undergo LP than those with only imaging findings (34% vs 4%, p < 0.0001). Symptoms most correlated with referral for LP were urinary incontinence (70%) and gait disturbance (36%). Of the patients who underwent LP, those with both imaging findings and clinical suspicion were more likely to have an opening pressure and clinical improvement consistent with NPH than those with imaging findings alone (78% vs 22%, p < 0.001).

Conclusion: Although NPH can be difficult to distinguish from other etiologies of hydrocephalus, the combination of radiologic findings and knowledge of the patient’s clinical symptoms can improve diagnostic accuracy and aid in identifying those who may benefit from intervention.

References: [1] Hakim S, Adams RD. The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure Observations on cerebrospinal fluid hydrodynamics. J Neurol Sci. 1965;2:307–327.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/diagnostic-accuracy-of-nph-by-radiographic-suspicion-and-effect-on-patient-outcomes/