The European iNPH Multicentre Study on the predictive values of resistance to CSF outflow and the CSF Tap Test in patients with idiopathic normal pressure hydrocephalus.

OBJECTIVE: The objective was to determine the sensitivity, specificity, and positive and negative predictive values of the CSF Tap Test (CSF TT) and resistance to CSF outflow (Rout) for the outcome of shunting in a sample of patients with idiopathic normal pressure hydrocephalus (iNPH). METHODS: 115 patients were included in this European multicentre study. Diagnosis was based on clinical symptoms and signs, and MRI changes. All patients were treated with programmable ventriculoperitoneal shunts and re-examined 12 months after surgery. Outcomes were measures with a newly developed iNPH Scale and the modified Rankin Scale (mRS). Before surgery, a CSF TT and measurement of Rout was performed, with the results blinded to all caregivers. The 12 month outcome was correlated with Rout and the result of the CSF TT. RESULTS: Rout and the results of the CSF TT showed no correlation with outcome measured by either domain, or with total iNPH score or mRS score. Only an increase in the gait task (10 m of walking at free speed) of the CSF TT correlated significantly (r=0.22, p=0.02) with improvement in iNPH score. The positive predictive value of both tests was >90% and the negative predictive value <20%. Rout >12 had an overall accuracy of 65% and the CSF TT 53%. Combining both tests did not improve their predictive power. No correlation was found between Rout and the results of the CSF TT. CONCLUSIONS: Rout and the results of the CSF TT did not correlate with outcome after 12 months. Rout and CSF TT can be used for selecting patients for shunt surgery but not for excluding patients from treatment. TRIAL REGISTRATION: The study has been registered at clinicaltrials.gov, identifier NCT00874198.

Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy.

OBJECTIVES: To evaluate the occurrence of symptomatic and asymptomatic root compression caused by herniated discs and spondylotic foraminal stenosis by MRI in patients with recent onset cervical radiculopathy. PARTICIPANTS: 78 patients with symptoms and signs of cervical radiculopathy of less than one month's duration. METHODS: The authors determined the clinically suspected level of root compression in each patient. Two neuroradiologists independently evaluated MRIs, blinded for the clinical findings. For each patient, the level of root compression on MRI was compared with the clinically affected level. The authors also examined the cause of compression: herniated disc, spondylotic foraminal stenosis or both. RESULTS: In 73% of patients, the clinically affected root was compressed on MRI. In 45%, MRI showed root compression without clinical substrate together with, or to a lesser extent without, the coexistence of compression of the clinically affected root. MRIs were assessed as normal in 13-15% of cases, and in 9-10% only asymptomatic roots were compressed. Herniated discs without spondylosis were more often responsible for root compressions only at the clinically affected level and spondylotic foraminal stenosis for multiple root compression including compression of clinically unaffected roots. CONCLUSION: MRI findings in patients with cervical radiculopathy should be interpreted together with the clinical findings, as false-positive and false-negative MRIs occur rather frequently.

Cervical collar or physiotherapy versus wait and see policy for recent onset cervical radiculopathy: randomised trial.

OBJECTIVE: To evaluate the effectiveness of treatment with collar or physiotherapy compared with a wait and see policy in recent onset cervical radiculopathy. DESIGN: Randomised controlled trial. SETTING: Neurology outpatient clinics in three Dutch hospitals. PARTICIPANTS: 205 patients with symptoms and signs of cervical radiculopathy of less than one month's duration INTERVENTIONS: Treatment with a semi-hard collar and taking rest for three to six weeks; 12 twice weekly sessions of physiotherapy and home exercises for six weeks; or continuation of daily activities as much as possible without specific treatment (control group). MAIN OUTCOME MEASURES: Time course of changes in pain scores for arm and neck pain on a 100 mm visual analogue scale and in the neck disability index during the first six weeks. RESULTS: In the wait and see group, arm pain diminished by 3 mm/week on the visual analogue scale (beta=-3.1 mm, 95% confidence interval -4.0 to -2.2 mm) and by 19 mm in total over six weeks. Patients who were treated with cervical collar or physiotherapy achieved additional pain reduction (collar: beta=-1.9 mm, -3.3 to -0.5 mm; physiotherapy: beta=-1.9, -3.3 to -0.8), resulting in an extra pain reduction compared with the control group of 12 mm after six weeks. In the wait and see group, neck pain did not decrease significantly in the first six weeks (beta=-0.9 mm, -2.0 to 0.3). Treatment with the collar resulted in a weekly reduction on the visual analogue scale of 2.8 mm (-4.2 to -1.3), amounting to 17 mm in six weeks, whereas physiotherapy gave a weekly reduction of 2.4 mm (-3.9 to -0.8) resulting in a decrease of 14 mm after six weeks. Compared with a wait and see policy, the neck disability index showed a significant change with the use of the collar and rest (beta=-0.9 mm, -1.6 to -0.1) and a non-significant effect with physiotherapy and home exercises. CONCLUSION: A semi-hard cervical collar and rest for three to six weeks or physiotherapy accompanied by home exercises for six weeks reduced neck and arm pain substantially compared with a wait and see policy in the early phase of cervical radiculopathy. Trial registration Clinical trials NCT00129714.