The necessity of gait evaluation on the 7th day after tap tests for the idiopathic normal pressure hydrocephalus patients

Abstract Background A tap test is established as an evaluation method to indicate shunt surgery for hydrocephalus, especially idiopathic normal pressure hydrocephalus (iNPH). The timing of gait assessment after the test is still controversial, while some studies reported the effectiveness of the gait evaluation up to 2nd day after tap tests. Our study explored whether the gait evaluation on the 7th day after a tap test is necessary. Methods We retrospectively evaluated 129 consecutive cases with possible iNPH who performed gait assessment on all 1st, 3rd, and 7th days after tap tests between May 2020 and February 2022. We reviewed the following items of the patients: age, sex, modified Rankin scale, iNPH grading scale, Mini-Mental State Evaluation (MMSE), and neurological imaging. The number of probable iNPH patients who improved their gait each day after the test was analyzed. We also assessed the number of definite iNPH patients and revealed the background characteristics of the patients who showed gait improvement on the 7th day after the tests. Results Of the 129 patients who met our inclusion criteria, 57 were judged as probable iNPH on the 1st day, 28 were new on the 3rd, and 23 were new on the 7th. The number of probable iNPH patients up to the 7th day after tests was significantly more extensive than that of those up to the 3rd (108 [83.7%] vs. 85 [65.9%]; 95% confidence interval [CI], p < 0.0001). The number of definite iNPH patients was also significantly more prominent when the evaluation after the tests was performed on all of the 1st, the 3rd, and the 7th days than just on the 1st (72 vs. 42; 95% CI, p = 0.00016) or both of the 1st and the 3rd (72 vs. 61; 95% CI, p = 0.00074). No statistically significant difference existed in the patients’ backgrounds except for the pre-tap test MMSE. Conclusion Gait evaluation on the 7th day after tap tests, in addition to the first few days, may reduce the number of iNPH patients who miss the opportunity of getting beneficial treatment

Ruptured posterior inferior cerebellar artery aneurysm associated with persistent primitive hypoglossal artery: A case report

Until now, 9 cases of an association of a posterior inferior cerebellar artery (PICA) aneurysm with the persistent primitive hypoglossal artery (PPHA) have been reported. We reported a case of a ruptured PICA aneurysm associated with the PPHA, which was successfully treated by intravascular embolization using inflation of an endovascular occlusion balloon in the proximal artery to stabilize the microcatheter tip. A 19-year-old woman presenting headache and mild consciousness disturbance was admitted to our hospital. Head computed tomography (CT) showed a subarachnoid hemorrhage in the interpeduncular cistern. Right common carotid angiography revealed an aneurysm with a maximum diameter of 3.7 mm at the proximal PICA, which was fed from the common carotid artery (CCA) through the internal carotid artery (ICA) and the PPHA and the vertebral artery. During coil embolization, a pulsatile fluctuation of the microcatheter tip caused by the minimum curvature of the proximal arterial route from the aorta to the PPHA made the continuation of the coil embolization difficult. Then, we inflated an occlusion balloon in the PPHA to stabilize the microcatheter tip, and the coil embolization was performed under the blank roadmap fluoroscopy. The aneurysm disappeared completely with the preservation of the PICA on the postoperative angiogram. A case of ruptured PICA aneurysm with proximal PPHA, which was successfully embolized with the assist of a proximal occlusion balloon inflation. When the pulsative movement of a microcatheter tip made coil embolization difficult, this technique could be useful