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Subjective body vertical: a promising diagnostic tool in idiopathic normal pressure hydrocephalus?

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Abstract

Postural instability is a frequent symptom of patients with idiopathic normal pressure hydrocephalus (iNPH), and might be due to the misperception of body verticality. The objective of this study was to assess the usefulness of the subjective body vertical (SBV) as a potential tool for diagnosing iNPH. Twenty patients with iNPH underwent tests of SBV in the pitch and roll planes before and after cerebrospinal fluid (CSF) drainage. Ten patients with other central gait disorders served as controls and also underwent tests for SBV. Before CSF drainage, patients with iNPH showed an impaired verticality perception in the pitch plane with a significant backward deviation of the SBV as compared to the control group (iNPH: mean ± SD −3.7 ± 3.6°; control group: −0.8 ± 2.2°; t value = −2.30, p t-test = 0.03). After CSF drainage, the SBV of the iNPH patients normalized for the pitch plane (−0.9 ± 1.9°). There was a correlation between the backward deviation of the SBV and the ventricular enlargement of the frontal horns (Evan’s index; r = −0.52; p Pearson = 0.02). An even stronger correlation was found with the enlargement of the third ventricle (Thalamus index; r = −0.64; p Pearson = 0.002). The new and clinically relevant finding of this study is that verticality perception of patients with iNPH is primarily impaired the pitch plane, and it improves after CSF drainage. This disturbance in pitch might be due to a bilateral central vestibular dysfunction of the thalamus. Determination of the SBV in pitch promises to increase diagnostic accuracy in the cases of suspected iNPH.

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Abbreviations

iNPH:

Idiopathic normal pressure hydrocephalus

SPV:

Subjective postural vertical

SBV:

Subjective body vertical

SVV:

Subjective visual vertical

CSF:

Cerebrospinal fluid

FGA:

Functional Gait Assessment

ABC:

Activities-specific balance confidence

FES-I:

Falls Efficacy Scale-International Version

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Acknowledgments

The authors wish to thank Judy Benson for copyediting the manuscript and Elisabeth Wlasich for doing the neuropsychological testing.

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Authors and Affiliations

  1. Department of Neurology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany

    C. Selge, F. Schoeberl, R. Schniepp, M. Dieterich & A. Zwergal

  2. German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany

    C. Selge, F. Schoeberl, J. Bergmann, A. Kreuzpointner, S. Bardins, A. Schepermann, R. Schniepp, T. Brandt, M. Dieterich, A. Zwergal & K. Jahn

  3. Schoen Klinik Bad Aibling, Bad Aibling, Germany

    J. Bergmann, E. Koenig, F. Mueller & K. Jahn

  4. SyNergy, Munich Cluster of Systems Neurology, Munich, Germany

    M. Dieterich

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  1. C. Selge
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Correspondence to C. Selge.

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Study funding

This work was supported by the German Federal Ministry of Education and Research (Grant No. BMBF 01EO0901).

Ethical standards

The study was performed in accordance with the 1964 Declaration of Helsinki and was approved by the local ethics committee. Written informed consent was obtained from all participants.

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The authors declare that they have no conflict of interest.

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Selge, C., Schoeberl, F., Bergmann, J. et al. Subjective body vertical: a promising diagnostic tool in idiopathic normal pressure hydrocephalus?. J Neurol 263, 1819–1827 (2016). https://doi.org/10.1007/s00415-016-8186-0

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  • DOI: https://doi.org/10.1007/s00415-016-8186-0

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