The purpose of this study is to make clear our long-term follow up results of lumboperitoneal (LP) shunt operation to patients with normal pressure hydrocephalus (NPH) complicated to stroke, because there is no clear indication of this operation and we have experienced cases of functional deterioration with time after resulting in good functional recovery following to the operation.
We operated LP shunt on 25 patients (69.8±5.8 years; 57-78 years) and followed them for more than five years. Preoperatively the subjects had following symptoms and findings: clinical triad, characteristic of NPH, (that is, dementia, gait disturbance, urinary incontinence), enlargement of the lateral ventricles accompanied with periventricular lucency by CT scan, ventricular reflux, stasis of a contrast medium in CT cisternography. Our own form was used for the evaluation of LP shunt operation.
Eleven patients among 25 had died, the cause of which was mainly due to pneumonia. Eleven patients were dependent in ADL among 14 survivors. In 12 patients, the improvement was seen at least in one of clinical triad by LP shunt operation but had deteriorated in many subjects with time. In 5 subjects among them, marked effectiveness had continued. These had shown mild cerebral atrophy, decreased lateral ventricle's size on CT scan postoperatively. Mild effectiveness, however, was obtained by LP shunt operation in patients with severe cerebral atrophy. The long-term results were good in patients with subarachnoid hemorrhage, relatively poor in cerebral infarction and intracerebral hemorrhage.
These results suggest that LP shunt operation should be considered as one of the therapeutic procedures for stroke patients complicated with NPH for whom no significant improvement can be seen by routine rehabilitation exercises.

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We describe a 68-year-old female patient with Parkinson's disease of 10 years' duration who had latently kyphosis and compression fractures of lumbar vertebrae, and had suffered from fractures by falls 4 times in the past three years. Twenty years ago the patient had a subtotal gastrectomy because of peptic ulcer. Causal factors of repeated fractures in this patient are speculated to be (1) Parkinson's disease itself, (2) aged female, (3) gastrectomy, and (4) insufficient management of exercise and fall prevention.

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