Normal pressure hydrocephalus in the elderly.

Introduction.-Idiopathic normal pressure hydrocephalus is a disease that mo st frequently concerns subjects of an advanced age. It is not easy to estab lish a definitive diagnosis, and the practitioner frequently encounters dec ision-making problems regarding the following question: should a shunt be p erformed, or not? Opinions remain contradictory, even though the available scientific data is increasingly precise. The aim of this review is to analy ze the physiopathogenic, clinical, paraclinical and therapeutic data associ ated with this type of hydrocephalus. Current knowledge and key points.-If the clinical triad is determinant, no other investigation is in fact necessary to confirm the diagnosis, although it should always be questioned in the case of ventricular enlargement dete rmined by tomodensitometry. The decision to perform the only efficient proc edure, i.e., a ventricular shunt operation, depends upon a number of establ ished arguments in favor of that procedure. Clinical improvement, which is often spectacular, can then confirm the diagnosis. Future prospects and projects.-The efficacy of surgical treatment has been confirmed by clinical studies, and there is a reduced tendency as regards p ost-operative complications. However, each case should be considered indivi dually and with the cooperation of and coordination between the family, the physician and the neurosurgeon. (C) 1999 Editions scientifiques et medical es Elsevier SAS.