Normal pressure hydrocephalus in people with multiple sclerosis.
TL;DR
PwMS and INPH may have a surgically amenable gait disorder.
Abstract
Background
Aging people with multiple sclerosis (pwMS) may develop idiopathic normal pressure hydrocephalus (INPH).
Objectives
Describe clinical, investigational, and treatment courses in pwMS and INPH.
Methods
Retrospective Mayo Clinic database review of "MS" and "NPH" and "Gait disorder" 1996-2025. INCLUSION CRITERIA 1) pwMS; 2) INPH; 3) INPH gait impairment (gait apraxia and/or ataxia). EXCLUSION CRITERIA non-INPH gait impairment or absent neurologist examination. Demographics, clinical course, INPH triad features (gait disorder, cognitive dysfunction, bladder dysfunction) were recorded. INPH was defined as possible (≥2 INPH triad and ventriculomegaly), probable (possible INPH with Disproportionately Enlarged Sub-arachnoid space Hydrocephalus [DESH] or positive high-volume tap test [HVTT]) and definite (gait improvement following ventriculoperitoneal [VP] shunt). Cerebrospinal fluid studies, brain magnetic resonance imaging findings and gait outcome following HVTT and VP shunt were recorded.
Results
Thirty-six pwMS and INPH were included. Twenty-six (72%) female, 35 (97%) white ethnicity, age (median, interquartile range [IQR]) at MS onset 49.0 (32.5-59.0) years, and at INPH onset 67.5 (60.8-70.3) years. Nineteen (53%) had secondary progressive MS; 10 (28%), relapsing-remitting and 7 (19%), primary progressive MS. INPH was definite in 10 (28%), probable in 9 (25%) and possible in 17 (47%). All had INPH gait disorder, 30 (83%) bladder dysfunction, 24 (67%) cognitive dysfunction and 20 (56%) with full INPH triad. DESH was present in 23/36 (64%). HVTT performed in 24/36 (67%), with gait improvement in 14 (58%). Twelve (33%) underwent VP shunt, with gait improvement in 10 (83%).
Conclusion
PwMS and INPH may have a surgically amenable gait disorder.