Miller Fisher Test

05 November 2004

A test designed to predict benefit of shunting in patients with normal pressure hydrocephalus.

Pre LP

Check CT brain (before carrying out LP)

Assess cognitive function by neuropsychological testing such as Trails test (consisting of practice paper, pre LP paper and post LP paper). The dementia in NPH is subcortical, therefore MMSE is not useful.

Assess gait (with assistance of physiotherapists and video session if resources permit): measure ambulation velocity, up & go test, postural stability.

Lumbar puncture (LP)

Perform in lateral position to ensure accurate pressure measurements

Measure pressure

Remove 50 ml of CSF

Send CSF to lab for routine testing (MCS, cell count, cytology, protein, glucose)

Post LP

This assessment usually performed 1-2 hours post LP

Assess cognitive function by neuropsychological testing such as Trails test (consisting of practice paper, pre LP paper and post LP paper). The dementia in NPH is subcortical, therefore MMSE is not useful.

Assess gait (with assistance of physiotherapists and video session if resources permit): measure ambulation velocity, up & go test, postural stability.

For more information, see section on Normal Pressure Hydrocephalus.