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February 2, 1976

Meanwhile, Back at the Bedside...

Author Affiliations

Abraham Lincoln School of Medicine Chicago

JAMA. 1976;235(5):534. doi:10.1001/jama.1976.03260310048025

Events of the past ten years have confirmed the existence of a syndrome in middle-aged and older patients, consisting of dementia, ataxia or similar gait disturbance, and urinary incontinence, accompanied by normal cerebrospinal fluid pressure. In some cases improvement is obtained when cerebrospinal fluid is removed by lumbar puncture or when it is drained more permanently by diversion into the atrium, or peritoneal or pleural space. However, many more cases are not helped by shunting, and the significant problem has been the proper selection of patients for operation.

A variety of ancillary tests have been used, the most significant of which has been pneumoencephalography. The typical patient with normal-pressure hydrocephalus (NPH) has enlarged ventricles without coexisting widened sulci. If the sulci are enlarged, the enlarged ventricles are usually considered to be a part of the syndrome producing the widened sulci—cerebral atrophy—and most neurosurgeons believe there is little improvement after shunting