Hydrocéphalie chronique de l'adulte : clinique, imagerie et prise en charge

Adult chronic hydrocephalus is characterized by a clinical triad of gait disorders, neuro-cognitive decline and urinary incontinence. The signs appear insidiously in a patient over 40 years old. The radiological diagnosis requires brain MRI with ventricular enlargement, disproportionately enlarged subarachnoid space and an increase in the flow of the aqueductal CSF; in case of obstructive hydrocephalus, this flow is near zero and the floor of the third ventricle is lowered. Additional tests (LP depletion of at least 40 mL of CSF or a perfusion test) are used to confirm the surgical indication to a ventriculo-peritoneal shunt (if communicating hydrocephalus) or a ventriculostomy (in case of obstructive hydrocephalus). Clinical improvement occurs in 80% of patients if the surgical indication is identified, making this disease one of the few treatable causes of dementia.