Impact factor analysis of cerebrospinal fluid tap test response in patients of idiopathic normal pressure hydrocephalus

Abstract

Objective To facilitate diagnosis and predict the outcome of shunting surgery in idiopathic normal pressure hydrocephalus (iNPH) and to explore the influence of clinical and neuroimaging factors on cerebrospinal fluid (CSF) tap test response in Han Chinese patients with iNPH. Methods Forty-three patients with possible clinical diagnosis of iNPH at neurology clinic and neurology inpatient at Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from March 2013 to January 2017 were recruited and underwent CSF tap test. Patients were categorized into CSF tap test responders (24 patients) and non-responders (19 patients) justified by two iNPH professional neurologists. The clinical parameters in those 2 groups including gender, age onset, duration, walking ability, neuropsychological testing result, clinical scores were analyzed. The neuroimaging parameters including Evan's index, callosum corpus angle, sign of disproportion of enlarged subarachnoid space and white matter lesion (WML) Fazekas rating score were also analyzed. Results The univariate analysis showed that compared with CSF tap test negative group, the proportion of males in the positive group was significantly higher (male ∶female 20 ∶4 vs. 9 ∶10, P=0.03), the duration of walking disturbance was longer [M (QR): 30(17) months vs. 12(20) months, P=0.04], Z score of executive function was lower [M(QR): -10.3(25.0) vs. -4.8(11.3), P=0.04], Fasekas score of paraventricular white matter lesions was higher[M (QR): 2.5 (1.0) vs. 1.0 (1.0), P=0.03]. However, those factors had no statistical correlation with the CSF tap test response by multivariate logistic regression analysis(all P>0.05). Conclusions Longer disease duration, worse walking ability, worse executive function test performance and prominent white matter lesions might be the impact factors of CSF tap test. Further research of large sample size is needed in the future. Key words: Hydrocephalus, normal pressure; Factor analysis, statistical; Idiopathic; Cere-brospinal fluid tap test