The grading of normal pressure hydrocephalus.

PATIENTS AND METHOD During a period of 15 years we investigated 200 patients suspected of normal pressure hydrocephalus (NPH) by means of an intrathecal infusion test. In 107 patients (54%) the diagnosis of a normal pressure hydrocephalus could be confirmed. For the evaluation of the course of disease we used the Black-Grading-Scale for shunt assessment [1] and the clinical grading for chronic hydrocephalus (Kiefer-scale) [4] pre- and postoperatively as well as in a follow-up examination seven months after surgical treatment. The aim of our study was to find out a quick and easy-to-handle bed-side examination for the grading of NPH. DISCUSSION The Black-Grading-Scale does not allow to distinguish between patients in an unchanged condition and those with a worsening of their symptoms. Therefore this scale is useful for patients with an obstructive hydrocephalus but not for those with a NPH. In our opinion the clinical grading of Kiefer [4] seems to be the most reliable scale for the grading and long term follow-up of a normal pressure hydrocephalus. CONCLUSION Our own created NPH-Recovery-Rate is based on the clinical grading for chronic hydrocephalus (Kiefer-scale) [4]. It allows the interindividual comparison between the courses of disease in patients with normal pressure hydrocephalus.