Hidrocefalia de pressão normal

proposta de manejo na Atenção Primária à Saúde

Autores

  • Maria Eduarda Turczyn De Lucca Universidade Positivo
  • Leonardo Cesar Ferreira Antunes Universidade Positivo
  • Carlos Arteaga Rodriguez Universidade Positivo
  • Otto Jesus Hernández Fustes

DOI:

https://doi.org/10.14295/jmphc.v13.1130

Palavras-chave:

Hidrocefalia de Pressão Normal, Gerenciamento Clínico, Diagnóstico, Atenção Primária à Saúde

Resumo

A hidrocefalia de pressão normal – HPN é uma das causas de demência potencialmente reversíveis. Nosso objetivo é fornecer as ferramentas clínicas para manejo da HPN pelo médico da Atenção Primária a Saúde – APS. Fez-se uma revisão nas bases de dados PubMed e Cochrane e foram escolhidos 40 artigos para a apresentação desta proposta, que incluem ensaios clínicos randomizados, metanálises e revisões sistemáticas. Os sintomas da tríade clássica são inespecíficos e encontrados em idosos com outras enfermidades. A apraxia da marcha é o sintoma mais precoce, seguido pelo comprometimento cognitivo e pela incontinência urinária. A concomitância dos três sintomas ocorre em cerca de 60% dos casos nas fases avançadas. A apraxia da marcha se apresenta com passos curtos, sem alterações da força muscular, sensitivas ou vestibulocerebelar, o que permite diferenciá-la de outras marchas patológicas. O comprometimento cognitivo é subcortical – lentidão psicomotora, desatenção, perda da memória de trabalho e da função executiva e preservação da memória episódica –, diferente das demências corticais, como a doença de Alzheimer. A incontinência urinária deve ser diferenciada do transbordamento pelo prostatismo e da incontinência de esforço na mulher. O médico da APS, diante a tríade deve solicitar exame de tomografia ou ressonância cerebral e, na presença de um ou dois sintomas, afastar outros diagnósticos. Os pacientes com HPN buscam na APS auxílio do médico que deve saber identificar e diferenciar sua sintomatologia. Diante da suspeita, o estudo de neuroimagem é mandatório e o encaminhamento à neurocirurgia ou neurologia é recomendado.

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Referências

Pereira R, Mazeti L, Lopes DCP, Pinto FCG F. Hidrocefalia de pressão normal: visão atual sobre a fisiopatologia, diagnóstico e tratamento. Rev Med. 2012;91(2):96-109. https://doi.org/10.11606/issn.1679-9836.v91i2p96-109. DOI: https://doi.org/10.11606/issn.1679-9836.v91i2p96-109

Mori E, Ishikawa M, Kato T, Kazui H, Miyake H, Miyajima M, et al. Guidelines for management of idiopathic normal pressure hydrocephalus: second edition. Neurol Med Chir (Tokio). 2012;52(11):775-809. https://doi.org/10.2176/nmc.52.775. DOI: https://doi.org/10.2176/nmc.52.775

Ghosh S, Lippa C. Diagnosis and prognosis in idiopathic normal pressure hydrocephalus. Am J Alzheimers Dis Other Demen. 2014;29(7):583-9. https://doi.org/10.1177/1533317514523485. DOI: https://doi.org/10.1177/1533317514523485

Picascia M, Zangaglia R, Bernini S, Minafra B, Sinforiani E, Pacchetti C. A review of cognitive impairment and differential diagnosis in idiopathic normal pressure hydrocephalus. Funct Neurol. 2015;30(4):217-28. https://doi.org/10.11138/fneur/2015.30.4.217. DOI: https://doi.org/10.11138/FNeur/2015.30.4.217

Eide PK, Sorteberg W. Outcome of surgery for idiopathic normal pressure hydrocephalus: role of preoperative static and pulsatile intracranial pressure. World Neurosurg. 2016;86:186-93.e1. https://doi.org/10.1016/j.wneu.2015.09.067. DOI: https://doi.org/10.1016/j.wneu.2015.09.067

Chankaew E, Srirabheebhat P, Manochiopinig S, Witthiwej T, Benjamin I. Bulbar dysfunction in normal pressure hydrocephalus: a prospective study. Neurosurg Focus. 2016;41(3):E15. https://doi.org/10.3171/2016.6.FOCUS16183. DOI: https://doi.org/10.3171/2016.6.FOCUS16183

Daou B, Klinge P, Tjoumakaris S, Tjoumakaris S, Rosenwasser RH, Jabbour P. Revisiting secondary normal pressure hydrocephalus: does it exist?: a review. Neurosurg Focus. 2016;41(3):E6. https://doi.org/10.3171/2016.6.FOCUS16189. DOI: https://doi.org/10.3171/2016.6.FOCUS16189

Williams M, Malm J. Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn). 2016;22(2):579-99. https://doi.org/10.1212/CON.0000000000000305. DOI: https://doi.org/10.1212/CON.0000000000000305

Smith CE. Recognizing normal pressure hydrocephalus in older adults. Nursing. 2017;47(9):26-31. https://doi.org/10.1097/01.NURSE.0000522000.75525.7e. DOI: https://doi.org/10.1097/01.NURSE.0000522000.75525.7e

Saper CB. Is there even such a thing as “Idiopathic normal pressure hydrocephalus”?. Ann Neurol. 2017;82(4):514-5. https://doi.org/10.1002/ana.25053. DOI: https://doi.org/10.1002/ana.25053

Paranathala MP, Sitsapesan H, Green AL, Cadoux-Hudson TAD, Pereira EAC. Idiopathic normal pressure hydrocephalus: an important differential diagnosis. Br J Hosp Med (Lond). 2013;74(10):564-570. https://doi.org/10.12968/hmed.2013.74.10.564. DOI: https://doi.org/10.12968/hmed.2013.74.10.564

Suchorska B, Kunz M, Schniepp R, Jahn K, Goetz C, Tonn JC, et al. Optimized surgical treatment for normal pressure hydrocephalus: comparison between gravitational and differential pressure valves. Acta Neurochir (Wien). 2015;157(4):703-9. https://doi.org/10.1007/s00701-015-2345-4. DOI: https://doi.org/10.1007/s00701-015-2345-4

Aragonès JM, Altimiras J, Alonso F, Roura P, Alfonso S, Bajo L. Hidrocefalia normotensiva idiopática: alta incidencia en mayores de 80 años. Rev Esp Geriatr Gerontol. 2018;53(2):85-8. https://doi.org/10.1016/j.regg.2017.06.007. DOI: https://doi.org/10.1016/j.regg.2017.06.007

Graff-Radford NR. Is normal pressure hydrocephalus becoming less idiopathic?. Neurology. 2016;86(7):588-9. https://doi.org/10.1212/WNL.0000000000002377. DOI: https://doi.org/10.1212/WNL.0000000000002377

Martín-Láez R, Caballero-Arzapalo H, López-Menéndez LÁ, Arango-Lasprilla JC, Vázquez-Barquero A. Epidemiology of idiopathic normal pressure hydrocephalus: a systematic review of the literature. World Neurosurg, 2015;84(6):2002-9. https://doi.org/10.1016/j.wneu.2015.07.005. DOI: https://doi.org/10.1016/j.wneu.2015.07.005

Anderson J, Rosell M, Kockum K, Söderström L, Laurell K. Challenges in diagnosing normal pressure hydrocephalus: evaluation of the diagnostic guidelines. eNeurologicalSci. 2017;7:27-31. https://doi.org/10.1016/j.ensci.2017.04.002. DOI: https://doi.org/10.1016/j.ensci.2017.04.002

Shaw R, Everingham E, Mahant N, Jacobson E, Owler B. Clinical outcomes in the surgical treatment of idiopathic normal pressure hydrocephalus. J Clin Neurosci. 2016;29:81-6. https://doi.org/10.1016/j.jocn.2015.10.044 DOI: https://doi.org/10.1016/j.jocn.2015.10.044

Tudor KI, Tudor M, McCleery J, Car J. Endoscopic third ventriculostomy (ETV) for idiopathic normal pressure hydrocephalus (iNPH). Cochrane Database Syst Rev. 2015;(7):CD010033. https://doi.org/10.1002/14651858.CD010033.pub2. DOI: https://doi.org/10.1002/14651858.CD010033.pub2

Silva A, Corrêa MJU, Bastos AM. Sistema ventricular: anatomia e patologia aplicadas ao diagnóstico por imagem. J Bras Neurocirurg. 2003;14(2):60-5. https://doi.org/10.22290/jbnc.v14i2.443.

Machado A, Haertel LM. Neuroanatomia funcional. 3 ed. São Paulo: Atheneu; 2014.

Wang Z, Zhang Y, Hu F, Ding J, Wang X. Pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus. CNS Neurosci Ther. 2020;26(12):1230-40. https://doi.org/10.1111/cns.13526. DOI: https://doi.org/10.1111/cns.13526

Engel DC, Adib SD, Schuhmann MU, Brendle C. Paradigm-shift: radiological changes in the asymptomatic iNPH-patient to be: an observational study. Fluids Barriers CNS. 2018;15(1):5. https://doi.org/10.1186/s12987-018-0090-9. DOI: https://doi.org/10.1186/s12987-018-0090-9

Hellström P, Klinge P, Tans J, Wikkelsø C. A new scale for assessment of severity and outcome in iNPH. Acta Neurol Scand. 2012;126(4):229-37. https://doi.org/10.1111/j.1600-0404.2012.01677.x DOI: https://doi.org/10.1111/j.1600-0404.2012.01677.x

Oliveira LM, Nitrini R, Román GC. Normal-pressure hydrocephalus: A critical review. Dement Neuropsychol. 2019;13(2):133-43. https://doi.org/10.1590/1980-57642018dn13-020001. DOI: https://doi.org/10.1590/1980-57642018dn13-020001

Schirinzi T, Sancesario GM, Di Lazzaro G, D’Elia A, Imbriani P, Scalise S, et al. Cerebrospinal fluid biomarkers profile of idiopathic normal pressure hydrocephalus. J Neural Transm (Vianna). 2018;125(4):673-9. https://doi.org/10.1007/s00702-018-1842-z. DOI: https://doi.org/10.1007/s00702-018-1842-z

Kiefer M, Unterberg A. The differential diagnosis and treatment of normal-pressure hydrocephalus. Dtsch Arztebl Int. 2012;109(1-2):15-26; quiz 26. https://doi.org/10.3238/arztebl.2012.0015. DOI: https://doi.org/10.3238/arztebl.2012.0015

Pyykkö OT, Nerg O, Niskasaari H-M, Niskasaari T, Koivisto AM, Hiltunen M, et al. Incidence, comorbidities, and mortality in idiopathic normal pressure hydrocephalus. World Neurosurg. 2018;112:e624-31. https://doi.org/10.1016/j.wneu.2018.01.107. DOI: https://doi.org/10.1016/j.wneu.2018.01.107

Nikaido Y, Kajimoto Y, Tucker A, Kuroda K, Ohno H, Akisue T, et al. Intermittent gait disturbance in idiopathic normal pressure hydrocephalus. Acta Neurol Scand. 2017;137(2):238-44. https://doi.org/10.1111/ane.12853. DOI: https://doi.org/10.1111/ane.12853

Peterson KA, Savulich G, Jackson D, Killikelly C, Pickard JD, Sahakian BJ. The effect of shunt surgery on neuropsychological performance in normal pressure hydrocephalus: a systematic review and meta-analysis. J Neurol. 2016;263(8):1669-77. https://doi.org/10.1007/s00415-016-8097-0. DOI: https://doi.org/10.1007/s00415-016-8097-0

Porto CC. Semiologia médica. 7a ed. Rio de Janeiro: Guanabara Koogan; 2013.

Shaji K, Sivakumar PT, Rao GP, Paul N. Clinical practice guidelines for management of dementia. Indian J Psychiatry. 2018;60(suppl 3):312-28. https://doi.org/10.4103/0019-5545.224472.

Kockum K, Lilja-Lund O, Larsson E-M, Rosell M, Söderström L, Virhammar J, et al. The idiopathic normal-pressure hydrocephalus radscale: a radiological scale for structured evaluation. Eur J Neurol. 2018;25(3):569-76. https://doi.org/10.1111/ene.13555. DOI: https://doi.org/10.1111/ene.13555

Mihalj M, Dolić K, Kolić K, Ledenko V. CSF tap test: obsolete or appropriate test for predicting shunt responsiveness?: a systemic review. J Neurol Sci. 2016;362:78-84. https://doi.org/10.1016/j.jns.2016.01.028. DOI: https://doi.org/10.1016/j.jns.2016.01.028

Oliveira MF, Saad F, Reis RC, Rotta JM, Pinto FCG. Programmable valve represents an efficient and safe tool in the treatment of idiopathic normal-pressure hydrocephalus patients. Arq Neuropsiquiatr. 2013;71(4):229-36. https://doi.org/10.1590/0004-282x20130007. DOI: https://doi.org/10.1590/0004-282X20130007

Liu A, Sankey EW, Jusué-Torres I, Patel MA, Elder BD, Goodwin CR, et al. Clinical outcomes after ventriculoatrial shunting for idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg, 2016;143:34-8. https://doi.org/10.1016/j.clineuro.2016.02.013. DOI: https://doi.org/10.1016/j.clineuro.2016.02.013

Keong NCH, Pena A, Price SJ, Czosnyka M, Czosnyka Z, Pickard JD. Imaging normal pressure hydrocephalus: theories, techniques, and challenges. Neurosurg Focus. 2016;41(3):E11. https://doi.org/10.3171/2016.7.FOCUS16194. DOI: https://doi.org/10.3171/2016.7.FOCUS16194

Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD. Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir. 2013;155(10):1977-80. https://doi.org/10.1007/s00701-013-1835-5. DOI: https://doi.org/10.1007/s00701-013-1835-5

Halperin J, Kurlan R, Schwalb J, Cusimano MD, Gronseth G, Gloss D. Practice guideline: idiopathic normal pressure hydrocephalus: response to shunting and predictors of response. Neurology. 2015;85(23):2063-71. https://doi.org/10.1212/WNL.0000000000002193. DOI: https://doi.org/10.1212/WNL.0000000000002193

Vakili S, Moran D, Hung A, Elder BD, Jeon L, Fialho H, et al. Timing of surgical treatment for idiopathic normal pressure hydrocephalus: association between treatment delay and reduced short-term benefit. Neurosurg Focus. 2016;41(3):E2. https://doi.org/10.3171/2016.6.FOCUS16146. DOI: https://doi.org/10.3171/2016.6.FOCUS16146

Pfanner T, Henri-Bhargava A, Borchert S. Cerebrospinal fluid biomarkers as predictors of shunt response in idiopathic normal pressure hydrocephalus: a systematic review. Can J Neurol Sci. 2017;45(1):3-10. https://doi.org/10.1017/cjn.2017.251. DOI: https://doi.org/10.1017/cjn.2017.251

Publicado

02-12-2021

Como Citar

1.
De Lucca MET, Antunes LCF, Rodriguez CA, Fustes OJH. Hidrocefalia de pressão normal: proposta de manejo na Atenção Primária à Saúde. J Manag Prim Health Care [Internet]. 2º de dezembro de 2021 [citado 4º de novembro de 2024];13:e017. Disponível em: https://jmphc.emnuvens.com.br/jmphc/article/view/1130

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