Comparison of the Benefits of the Lumbar Infusion Test and Lumbar Drainage in the Treatment of Hydrocephalus

Czech version

Authors: M. Mohapl ¹; P. Vaněk ¹; O. Bradáč ¹; D. Hořínek ¹; K. Saur ¹; M. Mohaplová ²
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a IPVZ, ÚVN Praha ¹; Dětská psychiatrická klinika 2. LF UK a FN v Motole, Praha ²
Published in: Cesk Slov Neurol N 2010; 73/106(6): 685-688
Category: Original Paper

Overview

The authors present the results of a prospective study comparing the benefits of the lumbar infusion test and external lumbar drainage in the diagnosis of normal-pressure hydrocephalus. Over a period of 24 months, 60 patients (age 29–83, average 66.5) were examined. The main symptom was gait impairment (53 patients), while disturbances of memory were noted in 44 subjects and incontinence in 36 individuals. All three were present in 28 subjects. A lumbar infusion test was performed on all patients, with a resistance to outflow >12 mmHg/ml/min or more considered as the level of cerebrospinal fluid resorption impairment. A lumbar infusion test followed immediately after the lumbar infusion test procedure and the effect of cerebrospinal fluid derivation was evaluated after 120 hours. The lumbar infusion test was positive in 23 subjects and 19 individuals in this group showed significant improvement after external lumbar drainage, while no significant improvement was observed in 4 of them. In the group with negative lumbar infusion test, an improvement was noted in 12 of the 37 subjects. The lumbar infusion test is a simple and effective method of diagnostic evaluation in patients in whom a diagnosis of normal-pressure hydrocephalus is suspected. Due to lower sensitivity, the diagnostic algorithm should also include lumbar drainage test in the event of negative or borderline results.

Key words:
normal pressure hydrocephalus – lumbar infusion test – external lumbar drainage

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