To the Editor.—
The syndrome of normal-pressure hydrocephalus has assumed much importance recently as a treatable cause of dementia and deserves to be widely recognized. The report of James et al (213:1615, 1970) is disturbing, however, because of its lack of documentation and apparent neglect of recent developments in this admittedly complex field.
The authors state that
Since normal-pressure hydrocephalus is a treatable form of dementia, accurate diagnosis based on clinical manifestations, findings from lumbar puncture, pneumoencephalography, and cisternography is mandatory.
Yet they fail to provide either clinical, lumbar puncture, or pneumoencephalographic data on their eight patients, with abnormal iodinated I 131 serum albumin (RISA) cisternograms. On what criteria was the diagnosis based in these patients, and was their dementia, in fact, surgically correctible?
Any diagnostic test for occult or normal-pressure hydrocephalus is of clinical value only insofar as it correlates with reversibility of signs and symptoms. Unfortunately, data of
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