70 yr old lady with progressive dementia.no DM HTN.is VP shuntg useful?
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
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
Cases that would interest you
- Login to View the image
3m pt, increasing head size with multiple seizure.. dx n prognosis...
Dr. Manish Verma10 Likes29 Answers - Login to View the image
A 68 yr old female who was a k/c/o Syst HTN presented with sudden onset fall in washroom in the morning and Altered Sensorium and was brought to ED...At presentation, her pupils were mid dilated and sluggishly reacting and b/l plantar response was Extensor....Discuss the treatment approach to this pt
Dr. Hardik Ahuja8 Likes24 Answers - Login to View the image
30yrs old female admitted with C/o fever with chills and headache since two months and altered sensorium of one day duration with difficulty in breathing.clinically obtunded,cold clammy. significant findings are CNS - Drowsy,Pupils - B/l 5mm SRTL,GCS - E3V1M6,Kernigs and brudzinski signs positive,B/l Plantar flexor.Power - 3/5 in all four limbs.Vitals stable.CT,MRI brain and CSF report enclosed.
Dr. Prashant Vedwan5 Likes26 Answers - Login to View the image
3mnths old baby seen with complaints of vomitting with normal neurological examination,no abnormal movements.MRI brain enclosed.KINDLY OPINE???
Dr. Prashant Ved3 Likes16 Answers - Login to View the image
17 year male c/o headache off and on for 3 months, now severe headache and vomiting for 2 days partially relieved by drugs... Suggest further management
Dr. Pawan Gupta0 Like17 Answers
1 Like