Patient: [Patient Name] MRN: [Medical Record Number] Date: [Date of Visit]
Chief Complaint:
This section will vary depending on the severity of iNPH. Common symptoms may include:
Gait impairment (most common): Difficulty walking, shuffling gait, feeling unsteady or like feet are stuck to the ground.
Cognitive decline (can be subtle): Memory problems, difficulty concentrating, apathy.
Urinary urgency or incontinence
History of Present Illness:
Age at onset of symptoms
Duration and progression of symptoms (gradual worsening is typical)
Impact of symptoms on daily activities (gait difficulties, cognitive decline)
History of falls (common complication)
Past Medical History:
Underlying medical conditions that may increase risk of iNPH (e.g., head trauma, meningitis, subarachnoid hemorrhage)
Prior surgeries or procedures (especially brain surgery)
History of cognitive decline or dementia (important to differentiate)
Family History:
Family history of dementia (uncommon)
Social History:
Functional status (independent living, use of assistive devices)
Mental stimulation activities
Physical Examination:
Vital signs (normal in most cases)
Neurological exam:
Gait assessment (looking for shuffling, imbalance)
Mini-Mental State Examination (MMSE) or other cognitive tests (may show subtle decline)
Urinary incontinence evaluation
Laboratory Tests:
Routine blood tests to rule out other medical conditions
Imaging Studies:
Magnetic resonance imaging (MRI) of the brain:
Essential for diagnosis, showing enlarged ventricles (fluid-filled cavities) and evidence of Hachinski ischemic score (vascular changes).
Head CT scan (if MRI contraindicated): May be used as an alternative, but less sensitive for iNPH diagnosis.
Nuclear medicine cisternography (isotope CSF flow study): May be helpful in some cases to assess CSF flow dynamics (performed by a specialist).
Diagnosis:
Idiopathic normal pressure hydrocephalus (based on clinical presentation, characteristic MRI findings, and exclusion of other causes)
Treatment Plan:
Lumbar puncture (spinal tap):
Removing cerebrospinal fluid (CSF) can provide temporary relief and is a diagnostic tool.
Repeated lumbar punctures (serial taps) may be used as a long-term management strategy.
Ventriculoperitoneal (VP) shunt surgery:
The most definitive treatment, implanting a shunt to drain excess CSF from the ventricles to the abdomen.
Considered after discussion of risks and benefits.
Prognosis:
Discuss the outlook based on the severity of iNPH, response to treatment, and overall health.
Early diagnosis and treatment can improve gait, cognitive function, and quality of life.
Regular follow-up is essential to monitor symptoms and shunt function (if implanted).
Patient Education:
Importance of recognizing early signs and symptoms
Importance of following treatment recommendations (repeated lumbar punctures or shunt surgery)
Importance of physical and occupational therapy to improve gait and balance
Importance of cognitive stimulation activities
Importance of fall prevention strategies
Next Follow-up:
Schedule for the next appointment depends on the severity of iNPH and treatment plan.
Regular follow-up is crucial to monitor symptoms, response to treatment, and assess for complications.