Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients

Citation: Skalický P, Vlasák A, Mládek A, Vrána J, Bajaček M, Whitley H, Beneš V, Bradáč O. Role of DESH, callosal angle and cingulate sulcus sign in prediction of gait responsiveness after shunting in iNPH patients. J Clin Neurosci. 2021 Jan;83:99-107. doi: 10.1016/j.jocn.2020.11.020. Epub 2020 Dec 14. PMID: 33334664.

Primary endpoint of our prospective consecutive cohort study was to evaluate disproportionately enlarged subarachnoid spaces hydrocephalus (DESH) score, callosal angle (CA), cingulate sulcus sign (CSS) and Evan’s index of suspected idiopathic normal pressure hydrocephalus (iNPH) patients against the reference standard of lumbar infusion test (LIT) and external lumbar drainage (ELD) in prediction of gait response after ventriculoperitoneal (VP) shunt implantation in patients with iNPH. Patients were assigned to NPH and non-NPH groups based on LIT and ELD results. Age-matched controls were added for group comparison. 32 NPH, 46 non-NPH and 15 control subjects were enrolled in the study. There were significant differences in mean preoperative DESH scores of NPH, non-NPH and control groups (6.3 ± 2.3 ([±SD]) (range 2–10) vs 4.5 ± 2.4 (range 0–10) vs 1.0 ± 1.2 (range 0–4)). Differences in mean CA and Evan’s index were not significant between NPH and non-NPH groups. CSS showed 62.5% sensitivity, 60.87% specificity, 52.63% PPV and 70% NPV for differentiation of NPH and non-NPH groups. A CA of 68 degrees had 48.49% sensitivity, 76.09% specificity, 59.26% PPV 67.31% NPV and DESH score of 4 had 93.75% sensitivity, 41.30% specificity, 52.63% PPV and 90.48% NPV for differentiation between NPH and non-NPH groups.