{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:18:13Z","timestamp":1793333893699,"version":"4.5.0"},"reference-count":46,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T00:00:00Z","timestamp":1653004800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The aim of the present study was the implementation of the composite imaging \u201cRadscale\u201d in patients with idiopathic normal pressure hydrocephalus (iNPH) and the evaluation of its score, as well as absolute stroke volume and peak flow velocity of cerebrospinal fluid (CSF) in aqueduct as indicators of a positive response following a tap test. Forty-five patients with iNPH were included. Clinical evaluation involved the 10 m timed walk test before and every 24 h for 3 consecutive days after evacuative lumbar puncture (LP). Neuropsychological evaluation comprised a mini mental state examination (MMSE), frontal assessment battery (FAB), 5-word test (5WT) and CLOX drawing test 1 and 2, which were carried out before and 48 h after LP. The tap test\u2019s response was defined as a \u226520% improvement in gait and\/or a \u226510% improvement in neuropsychological tests. All scores of neuropsychological and clinical variables, except for immediate 5WT and CLOX-1, differed significantly before and 48 h after LP. Improvement in time and steps of a 10 m timed walk test differed significantly between female and male patients. Out of 45 total patients, 19 were tap test responders and 26 non-responders. The total score of Radscale and CSF flow parameters did not differ between responders and non-responders. However, \u201cCallosal angle\u201d sub-score differed significantly between these two groups. A greater \u201ccallosal angle\u201d sub-score, meaning more acute callosal angle, was associated with a positive tap test response, rendering it a useful measurement in the stratification of iNPH patients that will potentially respond to CSF shunting.<\/jats:p>","DOI":"10.3390\/jcm11102898","type":"journal-article","created":{"date-parts":[[2022,5,20]],"date-time":"2022-05-20T13:56:12Z","timestamp":1653054972000},"page":"2898","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Callosal Angle Sub-Score of the Radscale in Patients with Idiopathic Normal Pressure Hydrocephalus Is Associated with Positive Tap Test Response"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2197-2434","authenticated-orcid":false,"given":"Efstratios-Stylianos","family":"Pyrgelis","sequence":"first","affiliation":[{"name":"1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"},{"name":"Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2481-3060","authenticated-orcid":false,"given":"George P.","family":"Paraskevas","sequence":"additional","affiliation":[{"name":"Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"},{"name":"2nd Department of Neurology, School of Medicine, \u201cAttikon\u201d University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7432-5009","authenticated-orcid":false,"given":"Vasilios C.","family":"Constantinides","sequence":"additional","affiliation":[{"name":"1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"},{"name":"Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9691-9465","authenticated-orcid":false,"given":"Fotini","family":"Boufidou","sequence":"additional","affiliation":[{"name":"Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0050-284X","authenticated-orcid":false,"given":"Georgios","family":"Velonakis","sequence":"additional","affiliation":[{"name":"Research Unit of Radiology, 2nd Department of Radiology, Medical School, \u201cAttikon\u201d University General Hospital, National and Kapodistrian University of Athens, Rimini 1, Chaidari, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonidas","family":"Stefanis","sequence":"additional","affiliation":[{"name":"1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth","family":"Kapaki","sequence":"additional","affiliation":[{"name":"1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"},{"name":"Neurochemistry and Biological Markers Unit, 1st Department of Neurology, School of Medicine, Eginition Hospital, National and Kapodistrian University of Athens, 74 Vass. Sophias Ave., 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/B978-0-12-802395-2.00005-5","article-title":"Cerebrospinal fluid circulation and hydrocephalus","volume":"145","author":"Leinonen","year":"2017","journal-title":"Handb. Clin. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1590\/1980-57642018dn13-020001","article-title":"Normal-pressure hydrocephalus: A critical review","volume":"13","author":"Oliveira","year":"2019","journal-title":"Dement. Neuropsychol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1007\/s10143-019-01201-5","article-title":"Normal pressure hydrocephalus-an overview of pathophysiological mechanisms and diagnostic procedures","volume":"43","author":"Skalicky","year":"2020","journal-title":"Neurosurg. Rev."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic Occult Hydrocephalus with \u201cNormal\u201d Cerebrospinal-Fluid Pressure. A Treatable Syndrome","volume":"273","author":"Adams","year":"1965","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/0022-510X(65)90016-X","article-title":"The special clinical problem of symptomatic hydrocephalus with normal cerebrospinal fluid pressure. Observations on cerebrospinal fluid hydrodynamics","volume":"2","author":"Hakim","year":"1965","journal-title":"J. Neurol. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1111\/ane.13182","article-title":"A systematic review on the epidemiology of normal pressure hydrocephalus","volume":"141","author":"Zaccaria","year":"2020","journal-title":"Acta Neurol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1977","DOI":"10.1007\/s00701-013-1835-5","article-title":"Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus","volume":"155","author":"Toma","year":"2013","journal-title":"Acta Neurochir."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1002\/mdc3.12335","article-title":"A Review of Clinical Outcomes for Gait and Other Variables in the Surgical Treatment of Idiopathic Normal Pressure Hydrocephalus","volume":"3","author":"Shaw","year":"2016","journal-title":"Mov. Disord. Clin. Pract."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jns.2016.01.028","article-title":"CSF tap test\u2014Obsolete or appropriate test for predicting shunt responsiveness? A systemic review","volume":"362","author":"Mihalj","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1227\/01.NEU.0000168185.29659.C5","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","article-title":"Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): Endorsed by the Japanese Society of Normal Pressure Hydrocephalus","volume":"61","author":"Nakajima","year":"2021","journal-title":"Neurol. Med. Chir."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"625","DOI":"10.4103\/aian.AIAN_583_19","article-title":"The Utility of Neuroimaging Parameters in Discriminating Patients of Normal-Pressure Hydrocephalus with Positive Cerebrospinal Fluid Tap Test Response from Healthy Controls","volume":"23","author":"Onder","year":"2020","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"P27","DOI":"10.1186\/2045-8118-12-S1-P27","article-title":"The NPH radscale; a new radiological scale for evaluation of suspected normal pressure hydrocephalus","volume":"12","author":"Kockum","year":"2015","journal-title":"Fluids Barriers CNS"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1111\/ene.13555","article-title":"The idiopathic normal-pressure hydrocephalus Radscale: A radiological scale for structured evaluation","volume":"25","author":"Kockum","year":"2018","journal-title":"Eur. J. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s00234-019-02273-2","article-title":"Standardized image evaluation in patients with idiopathic normal pressure hydrocephalus: Consistency and reproducibility","volume":"61","author":"Kockum","year":"2019","journal-title":"Neuroradiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"831","DOI":"10.3174\/ajnr.A4124","article-title":"CSF Flow in the Brain in the Context of Normal Pressure Hydrocephalus","volume":"36","author":"Bradley","year":"2015","journal-title":"Am. J. Neuroradiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1159\/000111149","article-title":"Validation of grading scale for evaluating symptoms of idiopathic normal-pressure hydrocephalus","volume":"25","author":"Kubo","year":"2008","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"148","DOI":"10.3171\/2015.12.JNS151663","article-title":"Walking assessment after lumbar puncture in normal-pressure hydrocephalus: A delayed improvement over 3 days","volume":"126","author":"Schniepp","year":"2017","journal-title":"J. Neurosurg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. A practical method for grading the cognitive state of patients for the clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1212\/WNL.55.11.1621","article-title":"The FAB: A Frontal Assessment Battery at bedside","volume":"55","author":"Dubois","year":"2000","journal-title":"Neurology"},{"key":"ref_21","first-page":"1696","article-title":"\u201cThe 5 words\u201d: A simple and sensitive test for the diagnosis of Alzheimer\u2019s disease","volume":"31","author":"Dubois","year":"2002","journal-title":"Presse Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1136\/jnnp.64.5.588","article-title":"CLOX: An executive clock drawing task","volume":"64","author":"Royall","year":"1998","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"775","DOI":"10.2176\/nmc.52.775","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: Second edition","volume":"52","author":"Mori","year":"2012","journal-title":"Neurol. Med. Chir."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1590\/1980-57642015DN94000350","article-title":"Neuroimaging in normal pressure hydrocephalus","volume":"9","author":"Damasceno","year":"2015","journal-title":"Dement. Neuropsychol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Zhou, X., and Xia, J. (2022). Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review. Front. Aging Neurosci., 13.","DOI":"10.3389\/fnagi.2021.783092"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2637","DOI":"10.1007\/s10072-019-03966-5","article-title":"Revisiting the diagnostic value of Evans\u2019 index: Lessons from an unusual case of normal pressure hydrocephalus with Evans\u2019 index less than 0.3","volume":"40","author":"Park","year":"2019","journal-title":"Neurol. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"86","DOI":"10.2519\/jospt.1996.24.2.86","article-title":"Walking speed: Reference values and correlates for older adults","volume":"24","author":"Bohannon","year":"1996","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1053\/apmr.2001.9396","article-title":"Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment","volume":"82","author":"Rossier","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2045-8118-9-1","article-title":"The value of the cerebrospinal fluid tap test for predicting shunt effectiveness in idiopathic normal pressure hydrocephalus","volume":"9","author":"Ishikawa","year":"2012","journal-title":"Fluids Barriers CNS"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s12987-016-0044-z","article-title":"Early and delayed assessments of quantitative gait measures to improve the tap test as a predictor of shunt effectiveness in idiopathic normal pressure hydrocephalus","volume":"13","author":"Ishikawa","year":"2016","journal-title":"Fluids Barriers CNS"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"117239","DOI":"10.1016\/j.jns.2020.117239","article-title":"Can the radiological scale \"iNPH Radscale\" predict tap test response in idiopathic normal pressure hydrocephalus?","volume":"420","author":"Laticevschi","year":"2021","journal-title":"J. Neurol. Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1159\/000472712","article-title":"Frontal Assessment Battery and Cerebrospinal Fluid Tap Test in Idiopathic Normal-Pressure Hydrocephalus","volume":"77","author":"Ko","year":"2017","journal-title":"Eur. Neurol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1007\/s00415-014-7489-2","article-title":"Cognitive functions after spinal tap in patients with normal pressure hydrocephalus","volume":"261","author":"Schmidt","year":"2014","journal-title":"J. Neurol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"399","DOI":"10.3171\/2009.4.JNS081664","article-title":"Cognitive and motor improvement after retesting in normal-pressure hydrocephalus: A real change or merely a learning effect?","volume":"112","author":"Solana","year":"2010","journal-title":"J. Neurosurg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1007\/s00234-021-02782-z","article-title":"Quantitative imaging features predict spinal tap response in normal pressure hydrocephalus","volume":"64","author":"Lotan","year":"2021","journal-title":"Neuroradiology"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Ammar, A. (2017). Idiopathic Normal-Pressure Hydrocephalus Syndrome: Is It Understood? The Comprehensive Idiopathic Normal-Pressure Hydrocephalus Theory (CiNPHT). Hydrocephalus: What Do We Know? And What Do We Still Not Know?, Springer International Publishing.","DOI":"10.1007\/978-3-319-61304-8_5"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"729706","DOI":"10.3389\/fncel.2021.729706","article-title":"Clearance Systems in the Brain, From Structure to Function","volume":"15","author":"Liu","year":"2022","journal-title":"Front. Cell. Neurosci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1111\/cns.13695","article-title":"Novel therapeutics for hydrocephalus: Insights from animal models","volume":"27","author":"Wang","year":"2021","journal-title":"CNS Neurosci. Ther."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1056\/NEJM197009172831201","article-title":"Diagnosis of Normal-Pressure Hydrocephalus","volume":"283","author":"Benson","year":"1970","journal-title":"N. Engl. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.ncl.2019.09.003","article-title":"Neuroimaging of Normal Pressure Hydrocephalus and Hydrocephalus","volume":"38","author":"Capone","year":"2020","journal-title":"Neurol. Clin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e240","DOI":"10.5114\/pjr.2019.86881","article-title":"Imaging of cerebrospinal fluid flow: Fundamentals, techniques, and clinical applications of phase-contrast magnetic resonance imaging","volume":"84","author":"Korbecki","year":"2019","journal-title":"Pol. J. Radiology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12984-019-0638-1","article-title":"The effects of cerebrospinal fluid tap-test on idiopathic normal pressure hydrocephalus: An inertial sensors based assessment","volume":"17","author":"Ferrari","year":"2020","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"106402","DOI":"10.1016\/j.clineuro.2020.106402","article-title":"A comprehensive clinico-radiological, neuropsychological and biomechanical analysis approach to patients with idiopathic normal pressure hydrocephalus","volume":"201","author":"Wolfsegger","year":"2021","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"S17","DOI":"10.1227\/01.NEU.0000168184.01002.60","article-title":"The value of supplemental prognostic tests for the preoperative assessment of idiopathic normal-pressure hydrocephalus","volume":"57","author":"Marmarou","year":"2005","journal-title":"Neurosurgery"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1111\/j.1600-0404.1986.tb04601.x","article-title":"Normal pressure hydrocephalus. Predictive value of the cerebrospinal fluid tap-test","volume":"73","author":"Andersson","year":"1986","journal-title":"Acta Neurol. Scand."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Sahuquillo, J., and Poca, M.A. (2020). To Shunt or Not to Shunt Patients with Idiopathic Normal Pressure Hydrocephalus? A Reappraisal of an Old Question. J. Clin. Med., 9.","DOI":"10.3390\/jcm9124120"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/10\/2898\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:15:37Z","timestamp":1760138137000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/10\/2898"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,20]]},"references-count":46,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,5]]}},"alternative-id":["jcm11102898"],"URL":"https:\/\/doi.org\/10.3390\/jcm11102898","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,5,20]]}}}