Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients

• Published in: Journal of clinical neuroscience Vol. 83; pp. 99 - 107
• Main Authors: Skalický, Petr, Vlasák, Aleš, Mládek, Arnošt, Vrána, Jiří, Bajaček, Michal, Whitley, Helen, Beneš, Vladimír, Bradáč, Ondřej
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.01.2021
• Subjects: Aged; Callosal angle; Cingulate sulcus sign; Cohort Studies; DESH; Disproportionately enlarged subarachnoid space hydrocephalus; Female; Gait Disorders, Neurologic - etiology; Gait Disorders, Neurologic - surgery; Humans; Hydrocephalus, Normal Pressure - diagnostic imaging; Hydrocephalus, Normal Pressure - pathology; Hydrocephalus, Normal Pressure - surgery; Idiopathic normal pressure hydrocephalus; iNPH; Magnetic Resonance Imaging - methods; Middle Aged; Neuroimaging - methods; Prospective Studies; Ventriculoperitoneal Shunt - methods; DESH; Disproportionately enlarged subarachnoid space hydrocephalus; Callosal angle; iNPH; Cingulate sulcus sign; Idiopathic normal pressure hydrocephalus
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2020.11.020

•The mean DESH score is higher in the group of patients who benefit from CSF diversion.•DESH should not be used to exclude patients from shunting.•DESH score does not correlate with gait improvement after ELD.•Cingulate sulcus sign and callosal angle seems to be poor for prediction of gait improvement after shunting.•Functional CSF testing should be used in the selection of shunt candidates. Primary endpoint of this single-centre, prospective consecutive cohort study was to evaluate DESH score, CA, CSS and Evans index of suspected iNPH patients against the reference standard of lumbar infusion test (LIT) and external lumbar drainage (ELD) in prediction of gait response after VP shunt implantation in patients with idiopathic normal pressure hydrocephalus (iNPH). Patients were assigned to NPH and non-NPH groups based on LIT and ELD results. Age-matched controls were added for group comparison. 32 NPH, 46 non-NPH and 15 control subjects were enrolled in the study. There were significant differences in mean preoperative DESH scores of NPH, non-NPH and control groups (6.3 ± 2.3 ([±SD]) (range 2–10) vs 4.5 ± 2.4 (range 0–10) vs 1.0 ± 1.2 (range 0–4)). Differences in mean CA and Evans index were not significant between NPH and non-NPH groups. CSS showed 62.5% sensitivity, 60.87% specificity, 52.63% PPV and 70% NPV for differentiation of NPH and non-NPH groups. A CA of 68 degrees had 48.49% sensitivity, 76.09% specificity, 59.26% PPV 67.31% NPV and DESH score of 4 had 93.75% sensitivity, 41.30% specificity, 52.63% PPV and 90.48% NPV for differentiation between NPH and non-NPH groups. The groups of probable iNPH patients with gait impairment diagnosed by high DESH score or positive functional testing did not overlap and DESH score did not correlate with gait improvement after ELD. DESH score should not be used as a simple diagnostic or prognostic marker of iNPH and we could not confirm the benefit of measurement of callosal angle and cingulate sulcus sign.