This suggests that cisternography does not improve the diagnostic accuracy of combined clinical and CT scan criteria in patients with presumed normal-pressure hydrocephalus. Proper patient selection for shunt surgery is important. Other complications included cerebral infarcts, hemorrhages, infection, and seizures. Consult with a neurologist for the initial evaluation, including the lumbar puncture. Obtain neurosurgical consultation if and when shunt surgery is considered.
Prognosis is poor.
In the recent Dutch Normal-Pressure Hydrocephalus Study by Boon et al, concomitant cerebrovascular disease was documented as an indicator of poor prognosis. Two potential pitfalls include selecting the wrong patient for surgery and failure to send a patient who is a good candidate to surgery. Given the high risks associated with shunt surgery and its long-term complications, erring on the conservative side is preferred. Obtain a definite response to presurgical testing. Thorough counseling of the patient and family members is appropriate.