• Srinivas Chivukula, Zachary J Tempel, Nathan T Zwagerman, W Christopher Newman, Samuel S Shin, Ching-Jen Chen, Paul A Gardner, Eric M McDade, and Andrew F Ducruet.
• Department of Neurological Surgery, University of California Los Angeles, Los Angeles, California, USA. Electronic address: schivukula@mednet.ucla.edu.
• World Neurosurg. 2015 Dec 1; 84 (6): 1871-6.

BackgroundDiagnosing normal pressure hydrocephalus (NPH) remains challenging. Most clinical tests currently used to evaluate suspected NPH patients for shunt surgery are invasive, require inpatient admission, and are not without complications. An objective, noninvasive, and low-cost alternative would be ideal.MethodsA retrospective review was performed of prospectively collected dynamic gait index (DGI) scores, obtained at baseline and on every day of a 3- to 5-day lumbar cerebrospinal fluid (CSF) drainage trial on patients with suspected NPH at our institution.ResultsBetween 2003 and 2014, 170 patients were suspected to have primary NPH (166, 97.6%) or secondary NPH (4, 2.4%). Using responsiveness to lumbar CSF drainage and subsequent shunting as the reference standard, we found that a baseline DGI ≥ 7 was found to have significant ability in selecting patients for permanent CSF diverting shunt surgery: sensitivity of 84.2% (95% confidence interval [95% CI]: 75.6%-90.2%), specificity of 80.6% (95% CI 70.0%-88.0%), and diagnostic odds ratio of 22.1 (95% CI 9.9-49.3).ConclusionsA baseline DGI ≥ 7 appears to provide an objective, low-cost, noninvasive measure to select patients with suspected NPH for a positive response to CSF diversion with high sensitivity, specificity and diagnostic odds ratio.Copyright © 2015 Elsevier Inc. All rights reserved.

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