Idiopathic normal pressure hydrocephalus with synucleinopathy: diagnosis and treatment

Pearls  -    Idiopathic normal
pressure hydrocephalus (iNPH) is characterized by the classic triad of
gait disturbance, urinary incontinence, and cognitive impairment in the
presence of ventriculomegaly without known risk factors for communicating
hydrocephalus. Shunt surgery is indicated for iNPH patients who respond to
the removal of CSF.  Oy-sters -    The
striatal dopaminergic deficit on dopamine transporter (DAT) scan is not
uncommon in patients with iNPH, which might be related to an unfavorable
long-term outcome of shunt surgery. For iNPH patients with clinical
features suggesting synucleinopathy such as REM sleep behavior disorder,
DAT scan could be considered to identify concurrent synucleinopathy before
shunt surgery.  -    Repeated removal
of CSF could be considered as an alternative treatment instead of shunt
surgery in iNPH patients who are ineligible for shunt surgery or have
sustained improvement after CSF removal.