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Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome
Hebb AO, Cusimano MD.. Neurosurgery, 2001-11-01
Topic: Risk, prevention and care in population studies
Objective Patient selection for cerebrospinal fluid diversion is difficult, because idiopathic normal pressure hydrocephalus (INPH) mimics other neurodegenerative disorders and no findings reliably predict outcome. The literature was reviewed to identify diagnostic criteria that predict shunt response and to formulate prognostic expectations. Methods MEDLINE was searched, and 44 articles meeting predetermined criteria were included. Results Clinical series were frequently retrospective with small patient numbers and unstandardized outcome evaluation. Clinical findings suggestive of shunt responsiveness were the complete triad (gait disturbance, urinary incontinence, and dementia) with early gait disturbance. Degree of hydrocephalus was not correlated with clinical improvement. Reduction of the subcortical low-blood flow area was correlated with improvement in three small studies. Clinical response to prolonged cerebrospinal fluid drainage predicted shunt outcome in all cases in two small series. Overall, 59% (range, 24-100%) of patients improved after shunting, and 29% (range, 10-100%) of patients experienced prolonged improvement. Complications occurred in 38% (range, 5-100%) of patients, additional surgery was required in 22% (range, 0-47%) of patients, and there was a 6% (range, 0-35%) combined rate of permanent neurological deficit and death. Conclusion Shunting INPH is associated with an approximately 29% rate of significant improvement and a 6% significant complication rate. Enlargement of the subcortical low-flow area and clinical improvement secondary to prolonged lumbar drainage may provide additive predictive value above clinical and computed tomographic criteria. A multicenter clinical trial that focuses on the value of ancillary tests, defines the clinical course of a patient with a ventriculoperitoneal shunt, and evaluates the cost effectiveness of shunting INPH is needed to better describe outcome from shunting in INPH.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Hebb, A. O., & Cusimano, M. D. (2001). Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery. https://doi.org/10.1097/00006123-200111000-00028
Vancouver
Hebb AO, Cusimano MD. Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome. Neurosurgery. 2001. doi:10.1097/00006123-200111000-00028. PMID: 11846911.
BibTeX
@article{hebb2001-11846911,
author = {Hebb, A. O. and Cusimano, M. D.},
title = {{Idiopathic normal pressure hydrocephalus: a systematic review of diagnosis and outcome}},
journal = {Neurosurgery},
year = {2001},
doi = {10.1097/00006123-200111000-00028},
pmid = {11846911},
url = {https://doi.org/10.1097/00006123-200111000-00028}
}
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Key findings
- Results Clinical series were frequently retrospective with small patient numbers and unstandardized outcome evaluation.
- Overall, 59% (range, 24-100%) of patients improved after shunting, and 29% (range, 10-100%) of patients experienced prolonged improvement.
- Conclusion Shunting INPH is associated with an approximately 29% rate of significant improvement and a 6% significant complication rate.
Why it matters
This review of idiopathic normal pressure hydrocephalus found that shunting produced improvement in about 59% of patients and prolonged improvement in about 29%, with a 6% combined rate of permanent neurological deficit and death. It concerns a different condition that can mimic neurodegenerative disorders and does not address treating, curing, or preventing Alzheimer's disease.
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Study details
- Evidence strengthLow
How this study scored 55/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Neurosurgery) |
| Journal's citation record | 3 / 4 | Neurosurgery: journal h-index 300 (OpenAlex, 2026-10-29) |
| Study design | 12 / 12 | A systematic review of all the studies on the question (from PubMed type “Systematic Review”) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2001 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | 6 / 7 | Cited 463 times (OpenAlex, 2026-10-10) |
| Citations per year | 3 / 5 | 17.1 citations a year over 27 year(s) since 2001 |
| Impact for its field and year | 1 / 6 | Cited 0.5× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 1 / 6 | Cited by 2 other studies in this library |
| Still being cited | 2 / 4 | Cited 30 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Michael D. Cusimano: h-index 76 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Toronto: institution h-index 1,923 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 3 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 11846911) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 55 / 100 | — |
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