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NEUROLOGY 1989;39:1601
© 1989 American Academy of Neurology

Variables predicting surgical outcome in symptomatic hydrocephalus in the elderly

Neill R. Graff-Radford, MBBCh, MRCP, John C. Godersky, MD and Michael P. Jones, PhD

From the Department of Neurology, Division of Neurobehavior and Cognitive Neuroscience (Dr. Graff-Radford), Department of Surgery, Division of Neurosurgery (Dr. Godersky), and Department of Preventive Medicine, Division of Biostatistics (Dr. Jones), The University of Iowa College of Medicine, Iowa City, IA.

We prospectively studied 30 older patients who had shunt surgery for symptomatic hydrocephalus and measured outcome using serial videotaping of gait, neuropsychological testing, and the Katz index of activities of daily living. Twenty-three patients improved and 7 did not. Using univariate analysis and the Fisher exact test, we found that the following variables were significantly related to outcome: (1) time B-waves present on 24-hour CSF pressure record; (2) anterior/posterior ratio on slice 4 of regional cerebral blood flow study; (3) duration of dementia prior to surgery; and (4) gait abnormality preceding dementia. The following variables showed a trend towards significance: (1) time CSF pressure > 15 mm Hg; and (2) scoring either pass or fail on the Multilingual Visual Naming Test. We conclude that several variables are significantly associated with surgical outcome in symptomatic hydrocephalus in the elderly and can be used in deciding whether to recommend surgery.

Address correspondence and reprint requests to Dr. Graff-Radford, Department of Neurology, Mayo Clinic Jacksonville, 4500 San Pablo Drive, Jacksonville, FL 32224.

Received April 7, 1989. Accepted for publication in final form June 1, 1989.




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