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    "datePublished": "2012-01-13", 
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    "description": "BackgroundThe cerebrospinal fluid (CSF) tap test (TT) has been regarded as an important test for the prediction of shunt effectiveness in patients with suspected idiopathic normal pressure hydrocephalus (iNPH). Although its specificity and sensitivity are reportedly high, there remains some disagreement over this point. Herein, the TT as a test for predicting shunt effectiveness was investigated in our multicenter prospective study named SINPHONI and strategies to increase its predictability were examined.MethodsOne hundred suspected iNPH patients with the following entry criteria were enrolled in the study: (1) 60 to 85 years old, (2) one or more of the NPH triad signs, (3) ventriculomegaly (Evans index > 0.3), (4) high convexity tightness in coronal-section MRI, and (5) no antecedent disorders. Changes in NPH triad symptoms were assessed using the iNPH grading scale and other measures before and after removal of 30 ml lumbar CSF. A positive response to TT was pre-defined by specific improvements on the grading and other scales. A ventriculoperitoneal shunt was performed with a programmable valve. The sensitivity and specificity of the TT was calculated with a contingency table. A decision tree analysis was performed to increase the predictability of the TT.ResultsAmong 100 patients, 80 were shunt responders. A statistically-significant variable between shunt responders and non-responders was CSF pressure. The changes in single variables in the iNPH grading scale after TT showed high specificity with low sensitivity. In contrast, change of the total score in the iNPH grading scale showed a relatively high sensitivity of 71.3% with specificity of 65%. A decision tree analysis revealed that using the iNPH grading scale total score and pre-shunt CSF pressure \u2265 15 cmH20, sensitivity increased to 82.5%, without a decrease in specificity.ConclusionsThe sensitivity and specificity of the TT for predicting shunt responsiveness were optimum when improvement on any iNPH grading scale was combined with CSF pressure \u2265 15 cmH20. To increase the sensitivity of the TT, further effort is necessary.Trial RegistrationThis study is registered with ClinicalTrials.gov, with the number NCT00221091.", 
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        "name": "Fluids and Barriers of the CNS", 
        "publisher": "Springer Nature", 
        "type": "Periodical"
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    "keywords": [
      "idiopathic normal pressure hydrocephalus", 
      "cerebrospinal fluid tap test", 
      "normal pressure hydrocephalus", 
      "shunt effectiveness", 
      "CSF pressure", 
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      "high convexity tightness", 
      "ResultsAmong 100 patients", 
      "Trial RegistrationThis study", 
      "multicenter prospective study", 
      "Scale total score", 
      "decision tree analysis", 
      "antecedent disorder", 
      "iNPH patients", 
      "ventriculoperitoneal shunt", 
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      "MethodsOne hundred", 
      "entry criteria", 
      "triad symptoms", 
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      "programmable valve", 
      "patients", 
      "hydrocephalus", 
      "responders", 
      "ConclusionsThe sensitivity", 
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      "scores", 
      "low sensitivity", 
      "high specificity", 
      "specificity", 
      "further efforts", 
      "significant variables", 
      "cmH20", 
      "ventriculomegaly", 
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    "name": "The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus", 
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