Background The Kuopio University Hospital (KUH) idiopathic normal pressure hydrocephalus (iNPH) cerebrospinal fluid (CSF) shunting protocol is described together with the initial outcomes of 175 patients with probable iNPH treated according to this protocol from a defined population. Our secondary aim was to display the variety of differential diagnoses referred to the KUH iNPH outpatient clinic from 2010 until 2017. Methods Patients were divided into four groups according to the prognostic tests: tap test (positive or negative) and infusion test (positive or negative). The short-term outcome was compared between groups. The 3-month outcome following shunt surgery was assessed by measuring gait speed improvement, using a 12-point iNPH grading scale (iNPHGS) and the 15D instrument. Results From 341 patients suspected of iNPH, 88 patients were excluded from further research mostly due to deviation from the protocol’s gait assessment guidelines. Hence 253 patients with suspected iNPH were included in the study, 177/253 (70%) of whom were treated with a CSF shunt. A favorable clinical outcome following surgery was observed in 79–93% of patients depending on the prognostic group. A moderate association (Cramer’s V = 0.32) was found between the gait speed improvement rate and the prognostic group (X2, p = 0.003). Patients with a positive tap test had the highest gait speed improvement rate (75%). In addition, an improvement in walking speed was observed in 4/11 patients who had both a negative tap test and a negative infusion test. Other outcome measures did not differ between the prognostic groups. Conditions other than iNPH were found in 25% of the patients referred to iNPH outpatient clinic, with the most prevalent being Alzheimer’s disease. Conclusions Our results emphasize the importance of a systematic diagnostic and prognostic workup especially in cases with an atypical presentation of iNPH. Additional diagnostic testing may be required, but should not delay adequate care. Active surgical treatment is recommended in patients with a high clinical probability of iNPH. Other neurological conditions contributed to most of the non iNPH diagnoses. Electronic supplementary material The online version of this article (10.1186/s12987-019-0142-9) contains supplementary material, which is available to authorized users.

中文翻译：

---

Kuopio 特发性正常压力脑积水方案：175 名患者的初步结果

背景 库奥皮奥大学医院 (KUH) 特发性正常压力脑积水 (iNPH) 脑脊液 (CSF) 分流方案与 175 名可能患有 iNPH 的患者的初始结果一起描述，根据该方案来自特定人群。我们的次要目的是显示从 2010 年到 2017 年转诊到 KUH iNPH 门诊的各种鉴别诊断。 方法 根据预后试验将患者分为四组：抽头试验（阳性或阴性）和输液试验（阳性或阴性） ）。比较组间的短期结果。使用 12 点 iNPH 分级量表 (iNPHGS) 和 15D 仪器，通过测量步态速度改善来评估分流手术后 3 个月的结果。结果 来自 341 名疑似 iNPH 的患者，88 名患者被排除在进一步研究之外，主要是由于偏离了协议的步态评估指南。因此，253 名疑似 iNPH 的患者被纳入研究，其中 177/253 (70%) 接受了脑脊液分流术。根据预后组，在 79-93% 的患者中观察到手术后良好的临床结果。步态速度改善率与预后组之间存在中等关联（Cramer V = 0.32）（X2，p = 0.003）。轻敲试验阳性的患者步态速度改善率最高（75%）。此外，在 4/11 的轻敲试验和输液试验均为阴性的患者中观察到步行速度有所改善。其他结局指标在预后组之间没有差异。在转诊到 iNPH 门诊的患者中，有 25% 的患者发现了 iNPH 以外的其他疾病，其中最普遍的是阿尔茨海默病。结论 我们的结果强调了系统诊断和预后检查的重要性，尤其是在 iNPH 非典型表现的病例中。可能需要额外的诊断测试，但不应延误适当的护理。建议对 iNPH 临床概率较高的患者进行积极的手术治疗。大多数非 iNPH 诊断是由其他神经系统疾病引起的。电子补充材料本文的在线版本（10.1186/s12987-019-0142-9）包含补充材料，可供授权用户使用。结论 我们的结果强调了系统诊断和预后检查的重要性，尤其是在 iNPH 非典型表现的病例中。可能需要额外的诊断测试，但不应延误适当的护理。建议对 iNPH 临床概率较高的患者进行积极的手术治疗。大多数非 iNPH 诊断是由其他神经系统疾病引起的。电子补充材料本文的在线版本（10.1186/s12987-019-0142-9）包含补充材料，可供授权用户使用。结论 我们的结果强调了系统诊断和预后检查的重要性，尤其是在 iNPH 非典型表现的病例中。可能需要额外的诊断测试，但不应延误适当的护理。建议对 iNPH 临床概率较高的患者进行积极的手术治疗。大多数非 iNPH 诊断是由其他神经系统疾病引起的。电子补充材料本文的在线版本（10.1186/s12987-019-0142-9）包含补充材料，可供授权用户使用。大多数非 iNPH 诊断是由其他神经系统疾病引起的。电子补充材料本文的在线版本（10.1186/s12987-019-0142-9）包含补充材料，可供授权用户使用。大多数非 iNPH 诊断是由其他神经系统疾病引起的。电子补充材料本文的在线版本（10.1186/s12987-019-0142-9）包含补充材料，可供授权用户使用。