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1

De Lucca, Maria Eduarda Turczyn, Leonardo Cesar Ferreira Antunes, Carlos Arteaga Rodriguez, and Otto Jesus Hernández Fustes. "Normal pressure hydrocephalus." JMPHC | Journal of Management & Primary Health Care | ISSN 2179-6750 13 (December 2, 2021): e017. http://dx.doi.org/10.14295/jmphc.v13.1130.

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Normal pressure hydrocephalus – NPH is one of the potentially reversible causes of dementia. In this work, we provide the clinical tools for the management of NPH to the Primary Health Care – PHC physicians. The PubMed and Cochrane databases were reviewed, and 40 articles were chosen, which include randomized clinical trials, metanalysis and systematic reviews. The symptoms of the classic triad are nonspecific and found in the elderly with other diseases. Gait apraxia is the earliest symptom, followed by cognitive impairment and urinary incontinence. The concomitance of the three symptoms occurs in about 60% of the cases in the advanced stages. Apraxia of gait is presented with short steps, without sensorial, vestibulocerebellar or muscle strength changes, which allows it to be distinguished from other pathological marches. Cognitive impairment is subcortical – psychomotor slowliness, inattention, loss of working memory and executive function and preservation of episodic memory – unlike cortical dementias, such as Alzheimer's disease. Urinary incontinence must be distinguished from overflow by prostatism and stress incontinence in women. The PHC physician, when faced with the triad, should request a CT scan or brain MRI and, in the presence of one or two symptoms, rule out other diagnoses. Patients with NPH seek help from the physician in the PHC who must know how to identify and differentiate their symptoms. In the case of suspicion, the study of neuroimaging is mandatory and referral to neurosurgery or neurology is recommended.
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2

Liang, Kyle, and Puja Chebrolu. "Normal-pressure hydrocephalus." Journal of the American Academy of Physician Assistants 35, no. 2 (February 2022): 35–38. http://dx.doi.org/10.1097/01.jaa.0000800300.26131.ef.

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3

Micchia, Katia, Caterina Formica, Simona De Salvo, Nunzio Muscarà, Placido Bramanti, Fabrizia Caminiti, Silvia Marino, and Francesco Corallo. "Normal pressure hydrocephalus." Medicine 101, no. 9 (March 4, 2022): e28922. http://dx.doi.org/10.1097/md.0000000000028922.

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4

Conn, Harold O. "Normal pressure hydrocephalus." Clinical Medicine 7, no. 4 (August 1, 2007): 416.3–416. http://dx.doi.org/10.7861/clinmedicine.7-4-416b.

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5

Byrd, Christine. "Normal Pressure Hydrocephalus." Nurse Practitioner 31, no. 7 (July 2006): 28???35. http://dx.doi.org/10.1097/00006205-200607000-00006.

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&NA;. "Normal Pressure Hydrocephalus." Nurse Practitioner 31, no. 7 (July 2006): 36???37. http://dx.doi.org/10.1097/00006205-200607000-00007.

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7

Tsakanikas, Diamanto, and Norman Relkin. "Normal Pressure Hydrocephalus." Seminars in Neurology 27, no. 1 (February 2007): 058–65. http://dx.doi.org/10.1055/s-2006-956756.

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8

Billek-Sawhney, Barbara, and Nicholas A. Jackson. "Normal Pressure Hydrocephalus." Journal of Acute Care Physical Therapy 3, no. 2 (2012): 182–88. http://dx.doi.org/10.1097/01592394-201203020-00002.

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9

Billek-Sawhney, Barbara, and Nicholas A. Jackson. "Normal Pressure Hydrocephalus." Journal of Acute Care Physical Therapy 3, no. 2 (2013): 182–88. http://dx.doi.org/10.1097/01592394-201303020-00002.

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10

Graff-Radford, Neill R., and David T. Jones. "Normal Pressure Hydrocephalus." CONTINUUM: Lifelong Learning in Neurology 25, no. 1 (February 2019): 165–86. http://dx.doi.org/10.1212/con.0000000000000689.

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11

Cox, James, John Knox, and Gordon Brocklehurst. "Normal Pressure Hydrocephalus." Journal of the American Geriatrics Society 36, no. 7 (July 1988): 650. http://dx.doi.org/10.1111/j.1532-5415.1988.tb06166.x.

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12

Akai, Keiichiro, Shinya Uchigasaki, Uichiro Tanaka, and Akio Komatsu. "NORMAL PRESSURE HYDROCEPHALUS." Pathology International 37, no. 1 (December 12, 2008): 97–110. http://dx.doi.org/10.1111/j.1440-1827.1987.tb03137.x.

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13

Atasoy, Bahar, Ayse Aralasmak, Ezra Cetinkaya, Huseyin Toprak, Ali Toprak, Sevil Tokdemir, Gulsen Babacan, and Alpay Alkan. "Normal Pressure Hydrocephalus." Journal of Computer Assisted Tomography 44, no. 1 (2020): 59–64. http://dx.doi.org/10.1097/rct.0000000000000959.

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14

Hakim, Carlos A., Rodolfo Hakim, and Salómon Hakim. "Normal-Pressure Hydrocephalus." Neurosurgery Clinics of North America 12, no. 4 (October 2001): 761–73. http://dx.doi.org/10.1016/s1042-3680(18)30033-0.

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15

Graff-Radford, Neill R. "NORMAL PRESSURE HYDROCEPHALUS." Neurologist 5, no. 4 (July 1999): 195–204. http://dx.doi.org/10.1097/00127893-199907000-00003.

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16

Graff-Radford, Neill R. "NORMAL PRESSURE HYDROCEPHALUS." CONTINUUM: Lifelong Learning in Neurology 13 (April 2007): 144–64. http://dx.doi.org/10.1212/01.con.0000267239.92250.d8.

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17

Thynne, Kelly. "Normal Pressure Hydrocephalus." Journal of Neuroscience Nursing 39, no. 1 (February 2007): 27–32. http://dx.doi.org/10.1097/01376517-200702000-00006.

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18

Rosseau, Gail. "Normal Pressure Hydrocephalus." Disease-a-Month 57, no. 10 (October 2011): 615–24. http://dx.doi.org/10.1016/j.disamonth.2011.08.023.

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19

Graff-Radford, Neill R. "Normal Pressure Hydrocephalus." Neurologic Clinics 25, no. 3 (August 2007): 809–32. http://dx.doi.org/10.1016/j.ncl.2007.03.004.

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20

Kernich, Catherine A. "Normal Pressure Hydrocephalus." Neurologist 12, no. 1 (January 2006): 57–58. http://dx.doi.org/10.1097/01.nrl.0000195829.16991.ef.

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21

Holmlund, T. "Normal pressure hydrocephalus." Cleveland Clinic Journal of Medicine 73, no. 8 (August 1, 2006): 705. http://dx.doi.org/10.3949/ccjm.73.8.705.

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22

Siedlecki, Sandra L. "Normal Pressure Hydrocephalus." Journal of Gerontological Nursing 34, no. 2 (February 1, 2008): 27–33. http://dx.doi.org/10.3928/00989134-20080201-11.

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23

Anderson, M. "Normal pressure hydrocephalus." BMJ 293, no. 6551 (October 4, 1986): 837–38. http://dx.doi.org/10.1136/bmj.293.6551.837.

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24

Hadley, D. M., R. Grant, and B. Condon. "Normal pressure hydrocephalus." BMJ 293, no. 6555 (November 1, 1986): 1173–74. http://dx.doi.org/10.1136/bmj.293.6555.1173-c.

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25

Bejjani, Ghassan K., and Maxim D. Hammer. "Normal-Pressure Hydrocephalus." Contemporary Neurosurgery 27, no. 16 (August 2005): 1–5. http://dx.doi.org/10.1097/00029679-200508150-00001.

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26

Bejjani, Ghassan K., and Maxim D. Hammer. "Normal-Pressure Hydrocephalus." Contemporary Neurosurgery 27, no. 17 (August 2005): 1–5. http://dx.doi.org/10.1097/00029679-200508310-00001.

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27

Graff-Radford, Neill R. "Normal-Pressure Hydrocephalus." Archives of Neurology 43, no. 9 (September 1, 1986): 940. http://dx.doi.org/10.1001/archneur.1986.00520090068020.

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28

Vanneste, Jan. "Normal-Pressure Hydrocephalus." Archives of Neurology 49, no. 4 (April 1, 1992): 366. http://dx.doi.org/10.1001/archneur.1992.00530280046021.

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29

Wilson, Robin K., and Michael A. Williams. "Normal Pressure Hydrocephalus." Clinics in Geriatric Medicine 22, no. 4 (November 2006): 935–51. http://dx.doi.org/10.1016/j.cger.2006.06.010.

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30

Hinterbuchner, L. P. "Normal-Pressure Hydrocephalus." JAMA: The Journal of the American Medical Association 264, no. 3 (July 18, 1990): 336. http://dx.doi.org/10.1001/jama.1990.03450030052022.

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31

Shih, Wei-Jen. "Normal-Pressure Hydrocephalus." JAMA: The Journal of the American Medical Association 264, no. 3 (July 18, 1990): 336. http://dx.doi.org/10.1001/jama.1990.03450030052023.

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32

Gordon, Neil. "NORMAL PRESSURE HYDROCEPHALUS AND ARRESTED HYDROCEPHALUS." Developmental Medicine & Child Neurology 19, no. 4 (November 12, 2008): 540–43. http://dx.doi.org/10.1111/j.1469-8749.1977.tb07953.x.

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33

Passos-Neto, Carlos Eduardo Borges, Cesar Castello Branco Lopes, Mauricio Silva Teixeira, Adalberto Studart Neto, and Raphael Ribeiro Spera. "Normal pressure hydrocephalus: an update." Arquivos de Neuro-Psiquiatria 80, no. 5 suppl 1 (May 2022): 42–52. http://dx.doi.org/10.1590/0004-282x-anp-2022-s118.

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ABSTRACT Normal pressure hydrocephalus (NPH) has been a topic of debate since its introduction in publications. More frequent in the elderly population, it is characterized by gait disturbance, urinary urge incontinence and cognitive decline. Therefore, it is a clinical-radiological entity with relatively common findings for the age group, which together may have greater specificity. Therefore, its diagnosis must be careful for an adequate selection of patients for treatment with ventricular shunt, since the symptoms are potentially reversible. The tap test has a high positive predictive value as a predictor of therapeutic response, but a negative test does not exclude the possibility of treatment. Scientific efforts in recent years have been directed towards a better understanding of NPH and this narrative review aims to compile recent data from the literature in a didactic way for clinical practice.
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34

Marianetti, Massimo, Concetta Mina, Massimo Miscusi, Filippo Maria Polli, and Paolo Missori. "Idiopathic Normal-Pressure Hydrocephalus." Journal of Neurosurgery 105, no. 5 (November 2006): 800–801. http://dx.doi.org/10.3171/jns.2006.105.5.800a.

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35

Heros, Roberto. "Editorial: Normal pressure hydrocephalus." Journal of Neurosurgery 114, no. 5 (May 2011): 1426–27. http://dx.doi.org/10.3171/2010.10.jns101754.

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36

Zipfel, Gregory J. "Editorial: Normal pressure hydrocephalus." Journal of Neurosurgery 121, no. 4 (October 2014): 769–70. http://dx.doi.org/10.3171/2014.2.jns132478.

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37

Nassar, Basant R., and Carol F. Lippa. "Idiopathic Normal Pressure Hydrocephalus." Gerontology and Geriatric Medicine 2 (April 20, 2016): 233372141664370. http://dx.doi.org/10.1177/2333721416643702.

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38

Tarnaris, Andrew, and Michael A. Williams. "Idiopathic Normal Pressure Hydrocephalus." Neurosurgery Quarterly 21, no. 1 (February 2011): 72–81. http://dx.doi.org/10.1097/wnq.0b013e3182087278.

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39

Hu, Tina, and Yuna Lee. "Idiopathic normal-pressure hydrocephalus." Canadian Medical Association Journal 191, no. 1 (January 6, 2019): E15. http://dx.doi.org/10.1503/cmaj.180877.

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40

Morales-Valero, Saul F., Giorgio Palandri, and Giuseppe Lanzino. "Idiopathic Normal Pressure Hydrocephalus." Contemporary Neurosurgery 36, no. 13 (June 2014): 1–4. http://dx.doi.org/10.1097/01.cne.0000453618.76943.9b.

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41

Malm, J., and A. Eklund. "Idiopathic normal pressure hydrocephalus." Practical Neurology 6, no. 1 (February 1, 2006): 14–27. http://dx.doi.org/10.1136/jnnp.2006.088351.

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42

Friedland, Robert P. "Normal-Pressure Hydrocephalus-Reply." JAMA: The Journal of the American Medical Association 264, no. 3 (July 18, 1990): 336. http://dx.doi.org/10.1001/jama.1990.03450030052024.

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43

Clarfield, A. M. "Normal-Pressure Hydrocephalus-Reply." JAMA: The Journal of the American Medical Association 264, no. 3 (July 18, 1990): 336. http://dx.doi.org/10.1001/jama.1990.03450030052025.

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44

Starr, Brian W., Matthew C. Hagen, and Alberto J. Espay. "Hydrocephalic Parkinsonism: lessons from normal pressure hydrocephalus mimics." Journal of Clinical Movement Disorders 1, no. 1 (2014): 2. http://dx.doi.org/10.1186/2054-7072-1-2.

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45

Miyajima, Masakazu, Yasuomi Nonaka, Madoka Nakajima, and Hajime Arai. "Neurosurgical Management of Idiopathic Normal Pressure Hydrocephalus(Idiopathic Normal Pressure Hydrocephalus (iNPH))." Japanese Journal of Neurosurgery 16, no. 5 (2007): 397–402. http://dx.doi.org/10.7887/jcns.16.397.

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46

Capone, Patrick M., John A. Bertelson, and Bela Ajtai. "Neuroimaging of Normal Pressure Hydrocephalus and Hydrocephalus." Neurologic Clinics 38, no. 1 (February 2020): 171–83. http://dx.doi.org/10.1016/j.ncl.2019.09.003.

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47

Mori, Etsuro. "Idiopathic Normal Pressure Hydrocephalus : The Key to Diagnosis(Idiopathic Normal Pressure Hydrocephalus (iNPH))." Japanese Journal of Neurosurgery 16, no. 5 (2007): 387–91. http://dx.doi.org/10.7887/jcns.16.387.

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48

Saldarriaga-Cantillo, Alejandra, Viviana Yepes-Gaviria, and Juan Carlos Rivas. "Normal pressure hydrocephalus: Diagnostic delay." Biomédica 40, no. 4 (December 2, 2020): 656–63. http://dx.doi.org/10.7705/biomedica.5382.

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Introduction: Normotensive hydrocephalus is a differential diagnosis in the evaluation of the dementia syndrome. The diagnostic protocols would allow detecting this pathology that has more effective treatment than other dementias.Objective: To describe a population with clinical suspicion of normal pressure hydrocephalus evaluated in a Colombian psychiatric hospital and discuss the possible reasons for its diagnostic and therapeutic delay.Materials and methods: We conducted a retrospective study of medical records to identify patients with suspected normal pressure hydrocephalus during a 5-year period.Results: Thirty-five patients with suspected normal pressure hydrocephalus underwent diagnostic lumbar puncture and five of them were considered candidates for a peritonealvenous shunt, but none underwent this surgical procedure. After three to six months of the lumbar puncture, the gait pattern improved in 22.8% of the patients, cognition in 22.8%, and sphincter control in 11.4%. Improvement was not sustained in the long term (1 year) in any of them.Conclusion: This study suggests the poor implementation of the protocols for evaluating patients with cognitive deficits and delays in the diagnosis of normal pressure hydrocephalus. A small number of patients were identified as candidates for treatment.Normal pressure hydrocephalus is a potentially reversible clinical entity with the placement of a peritoneal ventricular shunt, but delays in diagnosis and treatment have deleterious consequences for patients and their families.
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49

Nazwar, Tommy Alfandy, Farhad Bal'afif, Donny Wisnu Wardhana, Yuyun Yueniwati, and Wisniardhy Pradana. "IMAGING OF NORMAL PRESSURE HYDROCEPHALUS." Journal Of Cardiovascular, Neurovascular & Stroke 4, no. 4 (January 3, 2023): 1–12. http://dx.doi.org/10.32896/cvns.v4n4.1-12.

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Normal pressure hydrocephalus (NPH) is hydrocephalus without an increase in intracranial pressure. The term Idiopathic Normal Pressure Hydrocephalus (INPH) has been used to describe individuals presenting with ventriculomegaly of unexplained etiology, accompanied by the classic triad of symptoms (gait disturbance, urinary incontinence, and dementia). CT-scan is more practical, cheaper, widely available, and can assess the anatomical condition of the brain and ventricles, but MRI is the best modality and superior to CT. It can assess the anatomic conditions better, changes in white matter, and the presence of flow-void sign. Radiological signs of INPH are the presence of ventriculomegaly with Evan's index > 0.3, z-EI > 0.42, the presence of DESH (Disproportionately Enlarged Subarachnoid Space Hydrocephalus), cingulate sign, callosal angle <90°
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50

Damasceno, Benito Pereira. "Neuroimaging in normal pressure hydrocephalus." Dementia & Neuropsychologia 9, no. 4 (December 2015): 350–55. http://dx.doi.org/10.1590/1980-57642015dn94000350.

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ABSTRACT Normal pressure hydrocephalus (NPH) is a syndrome characterized by the triad of gait disturbance, mental deterioration and urinary incontinence, associated with ventriculomegaly and normal cerebrospinal fluid (CSF) pressure. The clinical presentation (triad) may be atypical or incomplete, or mimicked by other diseases, hence the need for supplementary tests, particularly to predict postsurgical outcome, such as CSF tap-tests and computed tomography (CT) or magnetic resonance imaging (MRI). The CSF tap-test, especially the 3 to 5 days continuous external lumbar drainage of at least 150 ml/day, is the only procedure that simulates the effect of definitive shunt surgery, with high sensitivity (50-100%) and high positive predictive value (80-100%). According to international guidelines, the following are CT or MRI signs decisive for NPH diagnosis and selection of shunt-responsive patients: ventricular enlargement disproportionate to cerebral atrophy (Evans index >0.3), and associated ballooning of frontal horns; periventricular hyperintensities; corpus callosum thinning and elevation, with callosal angle between 40º and 90º; widening of temporal horns not fully explained by hippocampal atrophy; and aqueductal or fourth ventricular flow void; enlarged Sylvian fissures and basal cistern, and narrowing of sulci and subarachnoid spaces over the high convexity and midline surface of the brain. On the other hand, other imaging methods such as radionuclide cisternography, SPECT, PET, and also DTI or resting-state functional MRI, although suitable for NPH diagnosis, do not yet provide improved accuracy for identifying shunt-responsive cases.
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