70 yr old lady with progressive dementia.no DM HTN.is VP shuntg useful?

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Venrticular enlargement is disproportionate to atrophy. Do drainage LP and remove 30-40ml of CSF and look for improvement in gait (timed walking) and cogntion (MMSE score before and after). If there is improvement, can try shunt.

Does the patient have other symptoms of NPH... like gait disturbances n urinary incontinence??? If yes... Then do Drainage LP with pre and post LP MMSE and Gait scoring... If there is improvement... Preferably programmable shunt which is a bit costly... Or medium pressure VP shunt... The problem with medium pressure VP shunt is it may lead to secondary chronic subdural Haematoma... Which can be prevented with programmable shunt with pressure adjustments...

Cortical atrophy with associated ventricular enlargement. Normal 4th ventricle. Has he got symptoms of NPH clinically?If the pt has symptoms of NPH and then do therapeutic CSF study ,remove30 ml of CSF in three consecutive days and look for improvements and then take a decision for CSF drainage

Depends on symptoms There is ventricular dilatation with pvl Memory loss urofaecal incontinence and gait disturbance if present shunting is must

Fundus may not show papilloedema in cases of nph. Nph is a misnomer The ventricles are dilated.......but the recorded csf pressure is in normal range. But for that person this pressure is high........do not look for raised pressure you will not find any........just look for improvement after lp drainage. Also the recent memory loss does not improve if the condition has been long standing but the gait and incontinence will improve
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The image shows senile atrophic changes with ventriculomegally. Plz do fundoscopy to see features of raised ICP. Lumbar drain can be done to see improvement if fundus is normal. Shunt surgery is associated with max complications. Hence should be done where indicated

vp shunt is useful in cases of nph..for which she needs drainage lp proven improvement n overview of other criteria.

Duration of symptom is very important here,, if dementia is more than 2 yrs,, then it's unlikely to improve However a drainage LP csf is worth doing

Nph Will require shunting

She may not respond to shunting 1. NPH with dementia do poorly on shunting 2. There is significant atrophy in addition ... hydrocephalus ex vacuo 3. White matter hypodensities in higher cuts may be ischemic rather than transependymal seepage

kindly mention if patient having other symptoms ataxia, urinary incontinence . fundus examination should be done to look for raised ICT . if ICT is raised then VP shunt will be helpful

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