Follow-up Management of Idiopathic Normal Pressure Hydrocephalus

Ullrich Meier

Following surgery, patients with idiopathic normal pressure hydrocephalus (iNPH) constitute a very special clientele. The vast majority are limited in their mobility, orientation, self-perception, and outlook. To properly follow up with patients who have iNPH, the physician providing care must deal with these problems.

14.1 Organizing Follow-up Examinations

iNPH is a life-long disease. Shunt insertion can provide permanent relief from symptoms, but it cannot produce healing in terms of eliminating the chain of causes of the disease, which are currently unknown. Therefore, shunt surgery is the first step in management, not the first step in healing.

This management must be continued for the duration of the disease. After receiving a shunt, the patient should be included in a life-long, follow-up program. The follow-up program should be organized in such a way that there are appointments agreed to in advance, with the option of additional ones being available should changes in symptoms require them.

14.2 Follow-up Intervals

Most authors recommend that follow-up examinations should take place at 1 or 3, 6, and 12 months after shunt surgery. Our view is that three follow-up examinations should take place within the first year.^1,2

14.2.1 One/Three Months

The first examination should be arranged relatively soon after the shunt implantation, for example, after 1 or 3 months. The aim of this follow-up examination is to identify complications that may be linked to surgery, such as: