The idiopathic normal-pressure hydrocephalus Radscale : a radiological scale for structured evaluation

• BACKGROUND AND PURPOSE: Despite the important role of imaging in diagnosing idiopathic normal pressure hydrocephalus (iNPH), a structured overall assessment of radiological signs is still lacking. The purpose of this study was to construct a radiological scale, composed of morphological signs of iNPH, and compare it with clinical symptoms.METHODS: In this prospective, population based study of iNPH, 168 individuals (93 females, 75 males), mean age 75 years (range 66-92 years), underwent a computed tomography (CT) of the brain and a neurological examination with assessment of clinical symptoms according to Hellström's iNPH scale. Two radiologists, blinded to clinical data, independently evaluated and measured eight radiological parameters i.e. Evans' index, callosal angle, size of temporal horns, narrow high convexity sulci, dilated Sylvian fissures, focally dilated sulci, periventricular hypodensities and bulging of the lateral ventricular roof.RESULTS: In a linear regression model, all parameters except ventricular roof bulging were significantly associated with clinical iNPH symptoms. The seven remaining parameters were summarized into a total iNPH Radscale score ranging from 0 to 12. There was a significant correlation (r = 0.55, P < 0.001) between the total score of the iNPH Radscale and clinical symptoms. The interrater agreement for the included radiological parameters was high (ICC = 0.74-0.97).CONCLUSION: The iNPH Radscale may become a valuable diagnostic screening tool, allowing a structured radiological assessment. A high iNPH Radscale score together with clinical symptoms, should raise suspicion of iNPH motivating further evaluation for shunt-surgery.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Neurologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Neurology (hsv//eng)

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Radiologi och bildbehandling (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Radiology, Nuclear Medicine and Medical Imaging (hsv//eng)

Nyckelord

Gait disorders

Hydrocephalus

Memory disorders

Tomography

computed

neurologic

normal pressure

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