Arunmozhimaran Elavarasi, Sagar Poudel, Deepa Dash, Alfonso Fasano, Pramod Kumar Pal, Debashish Chowdhury, Sanjay Pandey, Soaham Desai, Hrishikesh Kumar, Prashanth Lingappa Kukkle, Divya KP, Ajith Cherian, Rajeswari Aghoram, Rukmini Mridula Kandadai, Pankaj Agarwal, Niraj Kumar, Anand Kumar, Saranya B Gomathy, Animesh Das, Rajesh Kumar Singh, Deepti Vibha, Jasmine Parihar, Manjari Tripathi
INTRODUCTION: This cross-sectional study explores the diagnostic and management practices of normal pressure hydrocephalus (NPH) in India. METHODS: A 16-question online survey based on the Checklist for Reporting Results of Internet E-Surveys checklist was disseminated via closed social media and academic groups. RESULTS: A total of 59 neurologists responded. There was significant variability in how the cerebrospinal fluid (CSF) tap test (TT) was implemented. Although 95% of practitioners performed a CSF TT before referring patients for surgery, there were differences in the volume of CSF removed, the assessment tools used, thresholds, and the timing of post-test evaluations. Notably, 36% of neurologists relied on subjective assessment instead of objective scoring to determine CSF TT responsiveness. One-third still considered surgical referral even if the CSF TT was negative, especially when imaging was strongly suggestive of the diagnosis. CONCLUSION: This study highlights considerable heterogeneity in the evaluation of NPH in India. We need evidence-based practice parameters to ensure accurate diagnosis, informed treatment decisions, and improved patient outcomes.