Normal pressure hydrocephalus: evaluation of diagnostic and prognostic tests

This paper reviews the clinical findings in the Hakim-Adams syndrome and distinguishes it from the more general term of normal pressure hydrocephalus. The radiographic tests to diagnose these entities are discussed in their historical context. Computed tomography has recently replaced the pneumoencephalogram for evaluating ventricular size and configuration and computed tomographic metrizamide cisternography is beginning to replace the more traditional radionuclide studies of cerebrospinal fluid dynamics. A protocol is suggested for the future study of Hakim-Adams syndrome which emphasizes strict adherence to clinical criteria for the diagnosis. Studies of the microanatomic and physiologic condition of the underlying brain seem to be emerging as more reliable predictors of the success of shunt procedures than those of cerebrospinal fluid dynamics which have heretofore dominated treatment planning.