ArticleActa neurologica Belgica2026
High Evans Index in progressive supranuclear palsy may mimic normal pressure hydrocephalus: a retrospective cross-sectional study.
Article in Acta neurologica Belgica, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDifferentiating true normal pressure hydrocephalus (NPH) from neurodegenerative disorders with ex-vacuo ventriculomegaly remains a clinical challenge. Misdiagnosis can lead to inappropriate and risky shunt surgeries.
objectiveTo evaluate the diagnostic utility of NPH-specific magnetic-resonance-imaging (MRI) markers, namely Evans Index (EI), callosal angle (CA), and disproportionatelyenlarged subarachnoid-space hydrocephalus (DESH) pattern, across different movement disorders.
methodsIn this retrospective cross-sectional study, we evaluated 125 consecutive patientsdiagnosed with Parkinson's disease (PD, n = 43), essential tremor (ET, n = 43), dystonia (DYT, n = 19), and progressive supranuclear palsy (PSP, n = 20). Three movement disorder specialists measured the EI, CA, and DESH pattern on structural cranial MRIs. Kruskal-Wallis and Fisher's exact tests were utilized for group comparisons.
resultsThe PSP group had a significantly higher median EI (0.27 ± 0.04) than PD (0.23 ± 0.02), ET (0.22 ± 0.02), and DYT (0.22 ± 0.02) (p < 0.001). Notably, EI exceeded the traditional NPH cutoff (> 0.3) only in the PSP group. However, the DESH pattern was absent in all 125 patients (0%). Furthermore, the median CA remained preserved (> 90°) across all groups (PSP: 123.5°, PD: 124.0°, ET: 126.0°, DYT: 129.0°), with no significant intergroup difference (p = 0.096). MMSE scores differed significantly among groups (p = 0.024).
conclusionPatients with PSP may demonstrate marked ventriculomegaly mimicking NPH. However, the absence of the DESH pattern and preserved CAs strongly indicate ex-vacuo hydrocephalus secondary to central atrophy rather than true NPH. Relying solely on the EI in movement disorders may lead to critical misdiagnoses.
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