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Master Thesis

Hydrocéphalie chronique de l'adulte : mise en place d'un protocole systématique d'évaluation pour l'aide à la décision chirurgicale

Abstract : Introduction. Idiopathic Normal Pressure Hydrocephalus (INPH) combines urinary incontinence, gait apraxia and cognitive impairment with enlarged ventricles. Treatment consists of neurosurgical intervention using ventricular shunt. One major concern of this disease is the careful selection of patients who will benefit from the surgery. To help with this decision, a large-volume CSF tap test is recommanded. Nevertheless, there is no standardized protocol of evaluation for beneficial effects. Our institution at the University Hospital of Caen has proposed a standardized protocol of clinical assessment of these patients. The main purpose of this work was to examine the relevance of this protocol and try to determine which tests are the most relevant criteria to help guide surgical decision of patients. Methods. Patients admitted in Neurology or Geriatrics wards for a large volume CSF Tap Test in the case of suspected INPH was included prospectively. Gait and manual dexterity assessments, urinary questionnaires and a standardised neuropsychological test were done before and after the CSF Tap Test. Results. 21 patients were divided into two groups : "Shunted" and "Non shunted". The patients from the "Shunted" group had a walking speed slower than the other patients, and it was significantly better after the CSF Tap Test. Conclusion. Studying gait seems to be the most discriminative test to help guide surgical decision-making. This work was done mutually with the three specialities concerned by the INPH (neurologists, geriatricians and neurosurgeons). It is a preliminary study with inclusions still in progress and the purpose of improving our clinical practices.
Document type :
Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03595942
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Submitted on : Thursday, March 3, 2022 - 2:13:34 PM
Last modification on : Wednesday, April 13, 2022 - 3:44:52 AM

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  • HAL Id : dumas-03595942, version 1

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François Saunier. Hydrocéphalie chronique de l'adulte : mise en place d'un protocole systématique d'évaluation pour l'aide à la décision chirurgicale. Médecine humaine et pathologie. 2021. ⟨dumas-03595942⟩

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