• Itai Pillar, Orly Yakir, and Dr Dan Paz.
• Radiology Department, Galilee Medical Center, Nahariya, 221001, Israel; The Azrieli Faculty of Medicine, Bar-Ilan University, Safed, 1311502, Israel.
• World Neurosurg. 2025 Jan 20: 123670123670.

ObjectiveThis study was conducted to evaluate the time gap between earliest head CT with a significant Radscale score and ventriculo-peritoneal (VP) shunt placement.Material And MethodsThe study is a retrospective observational analytic study. The study population includes idiopathic normal pressure hydrocephalus (iNPH) patients treated with a VP shunt in a single center between the years 2016 and 2022 and have at least 2 CTs, one in proximity to diagnosis and another obtained at an earlier time point. The correlation among the parameters will be tested with statistical analysis software.Results34 patients (mean age 72.32 years (SD ± 7.24), were evaluated. Based on the diagnostic CT among the Radscale parameters: 94.1% of patients had high Evans index score, 79.4% had enlarged sylvian fissures and 85.3% had enlargement of the temporal horns. 79.4% had normal structure of sulci. The median time duration between the earliest CT with a significant Radscale score and VP shunt placement was 9.2 months, interquartile range (IQR) 1.9 - 27.2 months.ConclusionEvans index, enlarged sylvian fissures and enlargement of the temporal horns have been observed in the majority of diagnostic CTs. The median diagnosis time of iNPH since appearance of the radiological markers is 9.2 months, making the awareness and the communication between the referral and the radiologist crucial.Clinical Relevance StatementEvaluation of the time gap between the appearance of the earliest radiological signs and clinical diagnosis of idiopathic normal pressure hydrocephalus.Copyright © 2025 The Author(s). Published by Elsevier Inc. All rights reserved.

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