PDF herunterladen
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(05): 324-331
DOI: 10.1590/0004-282X20180037
Article

Gait in normal pressure hydrocephalus: characteristics and effects of the CSF tap test

Marcha na hidrocefalia de pressão normal: características e efeitos do tap-test
Ricardo Krause Martinez de Souza
1   Instituto de Neurologia de Curitiba, Divisão de Demências e Outros Distúrbios Cognitivos e Comportamentais, Curitiba PR, Brasil
,
Samanta Fabrício Blattes da Rocha
2   Instituto de Neurologia de Curitiba, Serviço de Neuropsicologia, Curitiba PR, Brasil
,
Rodrigo Tomazini Martins
3   Box Hill Hospital (Eastern Health), Neurosciences Department, Melbourne VIC, Australia
4   Instituto de Neurologia de Curitiba, Departamento de Neurologia, Curitiba PR, Brasil
,
Pedro André Kowacs
4   Instituto de Neurologia de Curitiba, Departamento de Neurologia, Curitiba PR, Brasil
,
Ricardo Ramina
5   Instituto de Neurologia de Curitiba, Departamento de Neurocirurgia, Curitiba PR, Brasil
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

ABSTRACT

Normal pressure hydrocephalus (NPH), described by Hakim and Adams in 1965, is characterized by gait apraxia, urinary incontinence, and dementia. It is associated with normal cerebrospinal fluid (CSF) pressure and ventricular dilation that cannot be attributed to cerebral atrophy.

Objectives: To evaluate gait characteristics in patients with idiopathic NPH and investigate the effect of the CSF tap test (CSF-TT) on gait.

Methods: Twenty-five patients diagnosed with probable idiopathic NPH were submitted to the CSF-TT. The procedure aimed to achieve changes in gait parameters.

Results: Fifteen gait parameters were assessed before and after the CSF-TT. Five showed a statistically significant improvement (p < 0.05): walking speed (p < 0.001), cadence (p < 0.001), step length (p < 0.001), en bloc turning (p = 0.001), and step height (p = 0.004).

Conclusion: This study demonstrated that gait speed was the most responsive parameter to the CSF-TT, followed by cadence, step length, en bloc turning, and step height.

RESUMO

A hidrocefalia de pressão normal (HPN), descrita por Hakim-Adams em 1965, caracteriza-se por apraxia de marcha, incontinência urinária e demência e está associada com pressão normal do líquido cefalorraquidiano e dilatação ventricular não atribuída a atrofia cerebral.

Objetivos: Avaliar as características da marcha em pacientes com HPN idiopática e o efeito do “tap-test” (TT) na marcha.

Métodos: Vinte e cinco pacientes com o diagnóstico HPN idiopática provável, foram avaliados com o TT. O procedimento tem como objetivo causar mudanças nas características da marcha.

Resultados: Quinze parâmetros da marcha foram avaliados com o TT. Cinco mostraram melhora estatisticamente significativa (p < 0,05): velocidade da marcha (p < 0,001), cadência (p < 0,001), comprimento do passo (p < 0,001), giro em “bloco” (p = 0,001) e altura do passo (p = 0,004).

Conclusão: Este estudo demonstrou que a velocidade da marcha foi o parâmetro que mais respondeu ao efeito do TT, seguido da cadência, comprimento do passo, giro em “bloco” e altura do passo.

Keywords:

gait - normal pressure hydrocephalus

Palavras-chave:

marcha - hidrocefalia de pressão normal


Publikationsverlauf

Eingereicht: 22. November 2017

Angenommen: 14. Februar 2018

Artikel online veröffentlicht:
25. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with “normal” cerebrospinal-fluid pressure: a treatable syndrome. N Engl J Med. 1965 Jul;273(3):117-26. https://doi.org/10.1056/NEJM196507152730301
  • 2 Wikkelsø C, Andersson H, Blomstrand C, Lindqvist G. The clinical effect of lumbar puncture in normal pressure hydrocephalus. J Neurol Neurosurg Psychiatry. 1982 Jan;45(1):64-9. https://doi.org/10.1136/jnnp.45.1.64
  • 3 Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokyo). 2012;52(11):775-809. https://doi.org/10.2176/nmc.52.775
  • 4 Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM. Diagnosing idiopathic normal-pressure hydrocephalus [discussion ii-v.]. Neurosurgery. 2005 Sep;57(3 Suppl):S4-16. https://doi.org/10.1227/01.NEU.0000168185.29659.C5
  • 5 Ravdin LD, Katzen HL, Jackson AE, Tsakanikas D, Assuras S, Relkin NR. Features of gait most responsive to tap test in normal pressure hydrocephalus. Clin Neurol Neurosurg. 2008 May;110(5):455-61. https://doi.org/10.1016/j.clineuro.2008.02.003
  • 6 Stolze H, Kuhtz-Buschbeck JP, Drucke H, Johnk K, Diercks C, Palmie S et al. Gait analysis in idiopathic normal pressure hydrocephalus-which parameters respond to the CSF tap test? Clin Neurophysiol. 2000 Sep;111(9):1678-86. https://doi.org/10.1016/S1388-2457(00)00362-X
  • 7 Malm J, Kristensen B, Karlsson T, Fagerlund M, Elfverson J, Ekstedt J. The predictive value of cerebrospinal fluid dynamic tests in patients with th idiopathic adult hydrocephalus syndrome. Arch Neurol. 1995 Aug;52(8):783-9. https://doi.org/10.1001/archneur.1995.00540320059013
  • 8 Damasceno BP, Carelli EF, Honorato DC, Facure JJ. The predictive value of cerebrospinal fluid tap-test in normal pressure hydrocephalus. Arq Neuropsiquiatr. 1997 Jun;55(2):179-85. https://doi.org/10.1590/S0004-282X1997000200003
  • 9 Fisher CM. Hydrocephalus as a cause of disturbances of gait in the elderly. Neurology. 1982 Dec;32(12):1358-63. https://doi.org/10.1212/WNL.32.12.1358
  • 10 Tisell M, Tullberg M, Hellström P, Edsbagge M, Högfeldt M, Wikkelsö C. Shunt surgery in patients with hydrocephalus and white matter changes. J Neurosurg. 2011 May;114(5):1432-8. https://doi.org/10.3171/2010.11.JNS10967
  • 11 Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. [Suggestions for utilization of the mini-mental state examination in Brazil]. Arq Neuropsiquiatr. 2003 Sep;61(3B):777-81. https://doi.org/10.1590/S0004-282X2003000500014
  • 12 American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV. 4th ed. Washington, DC: American Psychiatric Press; 1994.
  • 13 Barkhof F, Fox NC, Bastos-Leite AJ, Scheltens P. Neuroimaging in dementia. Berlin: Springer-Verlag; 2001.
  • 14 Bugalho P, Guimarães J. Gait disturbance in normal pressure hydrocephalus: a clinical study. Parkinsonism Relat Disord. 2007 Oct;13(7):434-7. https://doi.org/10.1016/j.parkreldis.2006.08.007
  • 15 Castro CL, Santos JA, Leifeld PS, Bizzo LV, Silva LC, Almeida TF et al. Estudo da marcha em idosos: resultados preliminares. Acta Fisiatrica. 2000;7(3):103-7.
  • 16 Jankovic J, Nutt JG, Sudarsky L. Classification, diagnosis, and etiology of gait disorders. Adv Neurol. 2001;87:119-33.
  • 17 Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int. 2012 Jan;109(1-2):15-25. https://doi.org/10.3238/arztebl.2012.0015
  • 18 Mashimo AM, Caromano FA. A marcha em idosos saudáveis. Arq Cienc Saúde. 2002;6(2):117-21. https://doi.org/10.25110/arqsaude.v6i2.2002.1166
  • 19 Stolze H, Kuhtz-Buschbeck JP, Drücke H, Jöhnk K, Illert M, Deuschl G. Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson's disease. J Neurol Neurosurg Psychiatry. 2001 Mar;70(3):289-97. https://doi.org/10.1136/jnnp.70.3.289
  • 20 Thompson PD. Frontal lobe ataxia. Handb Clin Neurol. 2012;103:619-22. https://doi.org/10.1016/B978-0-444-51892-7.00044-9
  • 21 Oberg T, Karsznia A, Oberg K. Basic gait parameters: reference data for normal subjects, 10-79 years of age. J Rehabil Res Dev. 1993;30(2):210-23.
  • 22 Ishii M, Kawamata T, Akiguchi I, Yagi H, Watanabe Y, Watanabe T et al. Parkinsonian symptomatology may correlate with CT findings before and after shunting in idiopathic normal pressure hydrocephalus. Parkinson's disease. 2010;2010:201089. https://doi.org/10.4061/2010/201089
  • 23 Kang K, Jeon JS, Kim T, Choi D, Ko PW, Hwang SK et al. Asymmetric and upper body parkinsonism in patients with idiopathic normal-pressure hydrocephalus. J Clin Neurol. 2016 Oct;12(4):452-9. https://doi.org/10.3988/jcn.2016.12.4.452
  • 24 Gallia GL, Rigamonti D, Williams MA. The diagnosis and treatment of idiopathic normal pressure hydrocephalus. Nat Clin Pract Neurol. 2006 Jul;2(7):375-81. https://doi.org/10.1038/ncpneuro0237
  • 25 Bugalho P, Alves L, Miguel R. Gait dysfunction in Parkinson's disease and normal pressure hydrocephalus: a comparative study. J Neural Transm (Vienna). 2013;120(8):1201-7. https://doi.org/10.1007/s00702-013-0975-3
  • 26 Pastor MA, Day BL, Marsden CD. Vestibular induced postural responses in Parkinson's disease. Brain. 1993 Oct;116(Pt 5):1177-90. https://doi.org/10.1093/brain/116.5.1177
  • 27 Mocco J, Tomey MI, Komotar RJ, Mack WJ, Frucht SJ, Goodman RR et al. Ventriculoperitoneal shunting of idiopathic normal pressure hydrocephalus increases midbrain size: a potential mechanism for gait improvement. Neurosurgery. 2006 Oct;59(4):847-51. https://doi.org/10.1227/01.NEU.0000232655.78335.D5
  • 28 Yamada S, Ishikawa M, Miyajima M, Atsuchi M, Kimura T, Kazui H et al. Disease duration: the key to accurate CSF tap test in iNPH. Acta Neurol Scand. 2017 Feb;135(2):189-96. https://doi.org/10.1111/ane.12580