CSF Hydrodynamics Especially in the Adult Hydrocephalus Syndrome

Abstract

The adult communicating hydrocephalus syndrome has been subjected to intense scientific study all over the world since Hakim and Adams drew attention to its existence (6, 7, 1). The initial enthusiasm of excellent surgical treatment results has, however, been replaced with a more subdued optimism (2, 12). No doubt, there are patients who dramatically respond to a shunt operation, but it is also obvious that many patients, fulfilling the original diagnostic criteria, do not benefit from the operation. The terms “normal-pressure hydrocephalus” and “low-pressure hydrocephalus” have been extensively used to characterize this syndrome. Systematic studies of CSF pressure have been rare. Many clinical reports have entirely lacked information of the CSF pressure values. There are reports (13) on episodic CSF pressure increase in the patients with otherwise normal pressure, and this condition has been considered to be pathogenetic. The original concept of Hakim and Adams was that here has been, at one stage of the development of the syndrome, a period of increased CSF pressure causing a dilatation of the ventricles. When the pressure decreases again, the ventricles should remain dilated also at a lower pressure due to the law of surface tension.

Supported by the Medical Research Council (Grant No. 04X-4125)