Normal pressure hydrocephalus - Revision history

Rossdonaldson1 at 20:59, 7 December 2022

2022-12-07T20:59:19Z

← Revisión anterior		Revisión del 20:59 7 dic 2022
Línea 3:		Línea 3:
	*CSF buildup in the ventricles leading to increased intracranial pressure with edema of the periventricular white matter and corona radiata		*CSF buildup in the ventricles leading to increased intracranial pressure with edema of the periventricular white matter and corona radiata
	**Sacral motor nerve fibers that produce gait instability; incontinence ensues when compressed		**Sacral motor nerve fibers that produce gait instability; incontinence ensues when compressed

	~~[[File:Example.jpg\|thumbnail]]~~

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Evaluation */

2022-12-07T20:58:44Z

Evaluation

← Revisión anterior		Revisión del 20:58 7 dic 2022
Línea 29:		Línea 29:
	*Additional workup (in coordination with neurology/neurosurgery), consider:		*Additional workup (in coordination with neurology/neurosurgery), consider:
	**MRI (done as part of the general work-up, and should be done before LP)		**MRI (done as part of the general work-up, and should be done before LP)
	**[[LP]] (definitive diagnosis), with normal opening pressure and CSF studies ~~(rarely done in the ED)~~		**[[LP]] (definitive diagnosis), with normal opening pressure and CSF studies
	***Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>		***Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>

Rossdonaldson1: /* Evaluation */

2022-12-07T20:58:00Z

Evaluation

← Revisión anterior		Revisión del 20:58 7 dic 2022
Línea 23:		Línea 23:

	==Evaluation==		==Evaluation==
	[[File:CT of Evan's index.jpg\|thumb\|Evan's index is the ratio of maximum width of the frontal horns to the maximum width of the inner table of the cranium. An Evan's index more than 0.31 indicates hydrocephalus.<ref>hii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>]]
	*Initial ED workup		*Initial ED workup
	**CBC		**CBC
Línea 54:		Línea 53:
	\| Vascular encephalopathy, in this case suggested by unilateral occurrence		\| Vascular encephalopathy, in this case suggested by unilateral occurrence
	\|}		\|}
			[[File:CT of Evan's index.jpg\|thumb\|Evan's index is the ratio of maximum width of the frontal horns to the maximum width of the inner table of the cranium. An Evan's index more than 0.31 indicates hydrocephalus.<ref>hii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>]]

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2022-12-07T20:57:22Z

Evaluation

← Revisión anterior		Revisión del 20:57 7 dic 2022
Línea 30:		Línea 30:
	*Additional workup (in coordination with neurology/neurosurgery), consider:		*Additional workup (in coordination with neurology/neurosurgery), consider:
	**MRI (done as part of the general work-up, and should be done before LP)		**MRI (done as part of the general work-up, and should be done before LP)
	**~~Diagnosis:~~ [[LP]], with normal opening pressure ~~with normal~~ CSF studies (rarely done in the ED)		**[[LP]] (definitive diagnosis), with normal opening pressure and CSF studies (rarely done in the ED)
	***Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>		***Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>

Rossdonaldson1: /* Evaluation */

2022-12-07T20:56:37Z

Evaluation

← Revisión anterior		Revisión del 20:56 7 dic 2022
Línea 24:		Línea 24:
	==Evaluation==		==Evaluation==
	[[File:CT of Evan's index.jpg\|thumb\|Evan's index is the ratio of maximum width of the frontal horns to the maximum width of the inner table of the cranium. An Evan's index more than 0.31 indicates hydrocephalus.<ref>hii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>]]		[[File:CT of Evan's index.jpg\|thumb\|Evan's index is the ratio of maximum width of the frontal horns to the maximum width of the inner table of the cranium. An Evan's index more than 0.31 indicates hydrocephalus.<ref>hii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>]]
	*CBC		*Initial ED workup
	*Chem 7		**CBC
	*CT brain non-con: Ventriculomegaly without signs of obstruction at the level of the third or fourth ventricles		**Chem 7
			**[[CT brain]] non-con: Ventriculomegaly without signs of obstruction at the level of the third or fourth ventricles
	~~Workup beyond this point should be made~~ in coordination with neurology/neurosurgery.		*Additional workup (in coordination with neurology/neurosurgery), consider:
	~~Additional workup may include~~:		**MRI (done as part of the general work-up, and should be done before LP)
	*MRI (done as part of the general work-up, and should be done before LP)		**Diagnosis: [[LP]], with normal opening pressure with normal CSF studies (rarely done in the ED)
	*Diagnosis: [[LP]], with normal opening pressure with normal CSF studies (rarely done in the ED)		***Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>
	**Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>

	===Normal pressure hydrocephalus vs brain atrophy<ref> Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>===		===Normal pressure hydrocephalus vs brain atrophy<ref> Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>===

Rossdonaldson1: /* Normal pressure hydrocephalus vs brain atrophy */

2022-12-07T20:55:03Z

Normal pressure hydrocephalus vs brain atrophy

← Revisión anterior		Revisión del 20:55 7 dic 2022
Línea 34:		Línea 34:
	**Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>		**Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>

	===Normal pressure hydrocephalus vs brain atrophy===		===Normal pressure hydrocephalus vs brain atrophy<ref> Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>===
	{\|class="wikitable"		{\|class="wikitable"
	\|+Typical imaging findings in normal pressure hydrocephalus versus brain atrophy.<ref> Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>
	\|		\|
	! Normal pressure hydrocephalus !! Brain atrophy		! Normal pressure hydrocephalus !! Brain atrophy

Rossdonaldson1: /* Normal pressure hydrocephalus vs brain atrophy */

2022-12-07T20:53:58Z

Normal pressure hydrocephalus vs brain atrophy

← Revisión anterior		Revisión del 20:53 7 dic 2022
Línea 37:		Línea 37:
	{\|class="wikitable"		{\|class="wikitable"
	\|+Typical imaging findings in normal pressure hydrocephalus versus brain atrophy.<ref> Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>		\|+Typical imaging findings in normal pressure hydrocephalus versus brain atrophy.<ref> Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>
			\|
			! Normal pressure hydrocephalus !! Brain atrophy
			\|-
	\| \|		\| \|
	\|align="center"\|[[File:Normal pressure hydrocephalus versus atrophy, NPH.jpg\|335px]]		\|align="center"\|[[File:Normal pressure hydrocephalus versus atrophy, NPH.jpg\|335px]]
	\|align="center"\|[[File:Normal pressure hydrocephalus versus atrophy, CA.jpg\|333px]]		\|align="center"\|[[File:Normal pressure hydrocephalus versus atrophy, CA.jpg\|333px]]
	\|-
	\|
	~~! Normal pressure hydrocephalus !! Brain atrophy~~
	\|-		\|-
	\| Preferable projection \|\|colspan=2\| Coronal plane at the level of the posterior commissure of the brain.		\| Preferable projection \|\|colspan=2\| Coronal plane at the level of the posterior commissure of the brain.

Rossdonaldson1: /* Evaluation */

2022-12-07T20:51:57Z

Evaluation

@@ Línea 33: / Línea 33: @@
 *Diagnosis: [[LP]], with normal opening pressure with normal CSF studies (rarely done in the ED)
 **Symptom improvement supports diagnosis<ref name="medscape">Schneck MJ. Normal pressure hydrocephalus. [http://emedicine.medscape.com/article/1150924-overview Medscape. Retrieved 8/4/2016]</ref>
 ==Management==

Rossdonaldson1: /* Evaluation */

2022-12-07T20:47:16Z

Evaluation

← Revisión anterior		Revisión del 20:47 7 dic 2022
Línea 23:		Línea 23:

	==Evaluation==		==Evaluation==
			[[File:CT of Evan's index.jpg\|thumb\|Evan's index is the ratio of maximum width of the frontal horns to the maximum width of the inner table of the cranium. An Evan's index more than 0.31 indicates hydrocephalus.<ref>hii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T, Mashimo H (March 2010). "Parkinsonian Symptomatology May Correlate with CT Findings before and after Shunting in Idiopathic Normal Pressure Hydrocephalus". Parkinson's Disease. 2010: 1–7. doi:10.4061/2010/201089. PMC 2951141. PMID 20948890.</ref>]]
	*CBC		*CBC
	*Chem 7		*Chem 7

Urinetrouble: /* Evaluation */ removed non-existent link

2022-12-01T19:30:57Z

Evaluation: removed non-existent link

← Revisión anterior		Revisión del 19:30 1 dic 2022
Línea 25:		Línea 25:
	*CBC		*CBC
	*Chem 7		*Chem 7
	*[[CT brain non-con]]: Ventriculomegaly without signs of obstruction at the level of the third or fourth ventricles		*CT brain non-con: Ventriculomegaly without signs of obstruction at the level of the third or fourth ventricles

	Workup beyond this point should be made in coordination with neurology/neurosurgery.		Workup beyond this point should be made in coordination with neurology/neurosurgery.