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INPH and Parkinson disease: differentiation by levodopa response

Nature Reviews Neurology volume 6, pages 52–56 (2010)Cite this article

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Abstract

Differentiating between Parkinson disease (PD) and idiopathic normal pressure hydrocephalus (INPH) can be challenging for the practicing clinician. Patients with undiagnosed PD but with incidental ventriculomegaly run the risk of being subjected to unnecessary shunt surgery. Taking a family history of PD and establishing the presence of motor symptoms (tremor, rigidity, bradykinesia) and nonmotor symptoms could help to differentiate between the two disorders. For patients with parkinsonian features, a dopamine challenge test to exclude the possibility of idiopathic PD might be beneficial. In this article, we highlight the difficulty of accurately differentiating INPH from PD as illustrated by three clinical cases of patients referred for shunt surgery.

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Figure 1: CT scan demonstrating enlargement of the ventricles in a patient successfully treated by shunt surgery (Case 1).
Figure 2: Brain scans demonstrating enlargement of the ventricles (Case 2).
Figure 3: Suggested algorithm to differentiate Parkinson disease from SRINPH.

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Acknowledgements

This work was supported by a grant from The National Parkinson Foundation Center of Excellence at the University of Florida.

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Authors and Affiliations

  1. Department of Neurology, University of Florida College of Medicine, Shands Hospital, Movement Disorders Center, McKnight Brain Institute, 100 S. Newell Drive, Gainesville, 32610, FL, USA

    Takashi Morishita & Michael S. Okun

  2. Department of Neurosurgery, University of Florida College of Medicine, Shands Hospital, Movement Disorders Center, McKnight Brain Institute, 100 S. Newell Drive, Gainesville, 32610, FL, USA

    Kelly D. Foote

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  1. Takashi Morishita
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Correspondence to Michael S. Okun.

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Morishita, T., Foote, K. & Okun, M. INPH and Parkinson disease: differentiation by levodopa response. Nat Rev Neurol 6, 52–56 (2010). https://doi.org/10.1038/nrneurol.2009.195

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