Normal Pressure Hydrocephalus Overshadowed by Traumatic and Degenerative Spinal Diseases: A New Assessment Proposal

Abstract

AIM: To evaluate normal pressure hydrocephalus (NPH) patients who admitted to clinic with a walking disability, depressed mood, cognitive dysfunction, and compromised quality of life in order to create a system for minimizing misdiagnosis, and inaccurate treatment of NPH at the first instance. MATERIAL and METHODS: In this study, patients diagnosed with NPH and registered in our clinical database from 2015 to May 2019 were retrospectively screened, and a “Ste-P” formula was applied to devise a new diagnostic scoring system. Representative cases showed that some of the patients received inaccurate medical and surgical treatments before being diagnosed with NPH. RESULTS: The study found that some of the 29 patients confused dizziness with truncal ataxia or imbalance due to gait abnormality. As the time between the onset of complaints and diagnosis increased, the diagnostic score approached zero, and diagnosis became difficult. CONCLUSION: Every unnecessary operation carries serious risks that may threaten the life of the patient and decrease the quality of life. These surgeries and instrumentation used also mean additional financial burden to the patient. Similarly, the long-term use of Parkinson’s and dementia medications has a serious economic burden on health insurance systems and is detrimental to the patient’s health. Considering all these diagnoses and physiological conditions that can easily confuse one disease for another, we recommend a new diagnostic scoring system to reduce the possibility of misdiagnosis and treatment of patients with walking disorders.