**19. Conclusion**

NPH common, treatable disorder can be reliably diagnosed with an organized approach by most neurosurgeons and neurologists. Evidence supports the use of shunt surgery to treat patients with NPH, and when patients are properly selected, the benefit-to-risk ratio is favorable. Neurologists have a role in the longitudinal care of patients with NPH who have undergone shunt surgery, particularly in considering the differential diagnosis of any symptoms that may worsen after shunt surgery. Regular follow up and high index of suspicion is paramount.

**63**

**Author details**

Ravish Rajiv Keni1

Nellore, Andhra Pradesh, India

Madhya Pradesh, India

, Harsh Deora2

and Amit Agrawal3

3 Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal,

© 2020 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Department of Neurology, Narayana Medical College and Hospital,

2 Department of Neurosurgery, NIMHANS, Bangalore, India

\*Address all correspondence to: dramitagrawal@gmail.com

provided the original work is properly cited.

\*

*Normal Pressure Hydrocephalus*

*DOI: http://dx.doi.org/10.5772/intechopen.92058*

*Normal Pressure Hydrocephalus DOI: http://dx.doi.org/10.5772/intechopen.92058*

*New Insight into Cerebrovascular Diseases - An Updated Comprehensive Review*

with 4% complications rate [24].

**18. Follow up after shunt surgery**

the venous system (for ventriculoatrial shunts) [25].

**19. Conclusion**

with favorable risk benefit ratio. Age alone is not an exclusionary criterion unless there are other surgical risk factors. Surgical options for the management of INPH include ventriculoperitoneal shunt and endoscopic third ventriculostomy. Literature favors low pressure programmable ventriculo peritoneal shunt as both over and under drainage can be managed in non-invasive manner. Endoscopic third ventriculostomy is indicated in patients with relative aqueduct stenosis and when there is triventricular hydrocephalus. Gangemi et al. reported 72% improvement

Patients who have had shunt surgery should have periodic follow-up visits. The follow-up of patients with a shunt is similar to the follow-up of patients with parkinsonism or other chronic neurologic disorders. The interval history should cover all three NPH symptoms of gait impairment, incontinence, and dementia. The neurologic examination should include cognitive screening (e.g., MMSE), gait evaluation, and a general neurologic examination. Imaging may be done to rule out over-drainage, such as subdural effusion or hematoma, particularly in the first 6–12 months after shunt surgery until it is determined that the patient's condition and the appearance of the scan are stable. In most instances, a CT scan without contrast suffices. The setting of adjustable shunts should be confirmed during the follow-up visit, provided the neurologist has the device appropriate for the patient's shunt. Depending on the degree of symptomatic recovery and presence or absence of lowpressure signs and symptoms, the shunt setting can be raised or lowered in increments [25]. If there is suspicion regarding patency of the shunt radionucleotide, shunt patency test can determine the flow of radionuclide in the peritoneal cavity or

NPH common, treatable disorder can be reliably diagnosed with an organized approach by most neurosurgeons and neurologists. Evidence supports the use of shunt surgery to treat patients with NPH, and when patients are properly selected, the benefit-to-risk ratio is favorable. Neurologists have a role in the longitudinal care of patients with NPH who have undergone shunt surgery, particularly in considering the differential diagnosis of any symptoms that may worsen after shunt

surgery. Regular follow up and high index of suspicion is paramount.

**62**
