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Clinical Research
Available online 2 July 2021
Prognostic value of the pulse pressure amplitudes, time to reach the plateau and the slope obtained in the lumbar infusion test for the study of idiophatic normal pressure hydrocephalus
Validez pronóstica de las amplitudes de presión, tiempo en alcanzar la meseta y la pendiente obtenidas en el test de infusión para el estudio de la hidrocefalia idiopática de presión normal
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Álvaro Otero Rodríguez
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aoteror@saludcastillayleon.es

Corresponding author.
, Daniel Ángel Arandia Guzmán, Andoni García Martín, Luis Torres Carretero, Alejandra Garrido Ruiz, Pablo Sousa Casasnovas, Juan Carlos Roa Montes de Oca
Servicio de Neurocirugía, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
Received 02 October 2020. Accepted 20 February 2021
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Tables (3)
Table 1. Patient demographic data, overall and by group.
Table 2. Sensitivity, specificity and Youden index of the most discriminatory value for each variable.
Table 3. Positive predictive values for the study variables.
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Abstract
Background and objective

To study the prognostic value of the resistance to the cerebrospinal fluid outflow (Rout) obtained in the lumbar infusion test in idiopathic normal pressure hydrocephalus (iNPH), as well as the pulse pressure amplitudes in the different periods of the test and other new variables extracted by Neuropicture® software.

Material and methods

Patients with ‘probable iNPH’ who underwent a lumbar infusion test were retrospectively revised. The positive predictive values (PPV) of the cutoff point of the best prognostic accuracy of the Rout, the basal pulse pressure amplitude (AMPo), the pulse pressure amplitude during the first 10 min (AMP10min), the plateau pulse pressure amplitude (AMPmes), the Rout pulse pressure amplitude (AMPRout), the time to reach the plateau (T), and the slope until reaching the plateau were determined. Patients were categorized either as responders or non-responders.

Results

The study included 64 responders patients and 16 non-responders patients. The PPV of Rout > 15 mmHg/mL/min was 91.7%; AMPo > 2.34 mmHg: 91.3%; AMP10 min > 4.34 mmHg: 83.3%; AMPmes > 12.44 mmHg: 84.6%; AMPRout > 6.34 mmHg: 85%; T < 634 s: 86.7%; p > 0.040 mmHg/s: 96.3%.

Conclusions

Rout is a valid criterion to indicate a ventricular shunt. Pulse pressure amplitudes in the different periods of the lumbar infusion test, in addition to T and P, are other variables whose positivity is indicative of shunt response and should be considered in the diagnostic protocol of the iNPH.

Keywords:
Idiopathic normal pressure hydrocephalus
Lumbar infusion test
Resistance to cerebrospinal fluid outflow
Pulse pressure amplitude
Clinical outcome
Resumen
Antecedentes y objetivo

Estudiar la validez pronóstica de la resistencia a la salida de líquido cefalorraquídeo (Rout) obtenida en el test de infusión lumbar en el estudio de la hidrocefalia idiopática de presión normal (iNPH), al igual que de las amplitudes en los diferentes tramos del test y otras nuevas variables obtenidas con el software Neuropicture®.

Materiales y métodos

Revisamos retrospectivamente pacientes con “probable iNPH” a los que se les sometió a un test de infusión lumbar. Se determinó el valor predictivo positivo (VPP) del punto de corte con mayor precisión pronóstica de la Rout, la amplitud de pulso en reposo (AMPo), la amplitud en los primeros 10 minutos (AMP10min), la amplitud de meseta (AMPmes), la amplitud de Rout (AMPRout), el tiempo en alcanzar la meseta (T) y la pendiente de la curva hasta alcanzar la meseta (P). Se dividió a los pacientes en respondedores y no respondedores.

Resultados

El estudio incluyó 64 pacientes respondedores y 16, no respondedores. El VPP de Rout > 15 mmHg/mL/min fue 91,7%; de la AMPo > 2,34 mmHg, 91,3%; de la AMP10min > 4,34 mmHG, 83,3%; de AMPmes > 12,44 mmHg, 84,6%; de AMPRout > 6,34 mmHG, 85%; de T < 634 segundos, 86,7%; y de p > 0,040 mmHg/seg, 96,3%.

Conclusiones

La Rout sigue siendo un criterio válido para indicar un shunt ventricular. Las amplitudes en diferentes tramos del test, junto a la T y la P son otras variables cuya positividad es indicativa de respuesta valvular y deberían formar parte del protocolo diagnóstico.

Palabras clave:
Hidrocefalia idiopática de presión normal
Prueba de infusión lumbar
Resistencia a la salida del líquido cefalorraquídeo
Amplitud de la presión del pulso
Resultado clínico

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