Abstract Details

Title Lumbar Tap Trial for the Evaluation of Normal Pressure Hydrocephalus

Topic General Neurology

Presentation(s) P1 - Poster Session 1 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-002

Objective We present an analysis of the largest single-provider database of tap trials done for the evaluation of NPH.

Background Normal pressure hydrocephalus (NPH) is classified by neurodegenerative (nNPH), secondary (sNPH), or idiopathic (iNPH) etiologies with symptoms including gait changes, cognitive decline, and urinary incontinence. Cerebrospinal fluid (CSF) diversion via shunting is the mainstay of treatment, though response varies with etiology and presentation. Operative candidacy can be stratified using a lumbar tap trial (TT) to screen a patient’s response to CSF diversion.

Design/Methods

A large sample retrospective analysis from January 1st, 2020 to December 30th, 2024 included 248 patients who underwent a TT. The protocol included pre-procedural gait evaluation by a neuro-physical therapist (timed walk (TW) and timed up-and-go (TUG)), cognitive assessments, and subjective bladder impairment. Patients then underwent a fluoroscopic-guided lumbar puncture, removing 30-50 mL of CSF. TW and TUG were reassessed immediately post-procedure and 24-hr post-procedure. A positive TT was defined by a reduction in TUG > 3.5 seconds, and a TW reduction > 20% with subjective symptomatic improvements.

Results NPH etiologies included n=59 nNPH, n=44 sNPH, and n=116 iNPH. 29 patients had mixed sNPH/nNPH. 237 patients (95.6%) completed the TT; 3 procedures were aborted and 8 patients lacked follow-up data. 36 patients reported transient headaches or low back pain, resolving conservatively. 86/237 (36.3%) had improvement in TUG (average 4.2 second reduction) and 75/237 (31.6%) in TW (average 6.2 second reduction). Subjective improvement occurred in gait 116/237 (49.8%), bladder 43/206 (21.1%), and cognition 50/209 (24.3%), defined by “yes”/“no”. 166 patients (70.0%) had positive tap trials and 116 (69.9%) underwent shunting.

Conclusions Combined with ambulatory biomarkers, cognitive function, and urinary control, the lumbar tap trial is a successful screening method for shunting patients with NPH.

Authors/Disclosures
Abigail McKenna PRESENTER	Ms. McKenna has nothing to disclose.
Kirvani Buddhiraju	Ms. Buddhiraju has nothing to disclose.
Sanjiv Harikumar	Mr. Harikumar has nothing to disclose.
Ethan Richman	Mr. Richman has nothing to disclose.
Stephen Jaffee (Allegheny Health Network, Neuroscience Institute)	No disclosure on file
Huihui Li, PhD	Dr. Li has received research support from National Natural Science Foundation of China.
Jody Leonardo, MD	No disclosure on file

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