Abstract
Objective: To describe clinical and radiological features and evaluate the outcomes of cerebrospinal fluid (CSF) tap test in patients with Hakim – Adams syndrome. Methods: A case-series study of 18 patients with Hakim–Adams syndrome at the National Geriatric Hospital from June 2025 to August 2026. Results: Mean age was 76.0 ± 5.8 years; 55.6% were female. Gait disturbance and urinary dysfunction were present in 100% of patients, and cognitive decline in 94.4%; the initial symptom was always gait disturbance or cognitive decline, never urinary dysfunction. Mean MMSE score was 17.56 ± 5.59; language and immediate recall were relatively preserved, whereas attention–calculation, visuospatial function, and especially delayed recall were markedly impaired. All patients had an Evans index > 0.3; callosal angle < 90° in 83.3%; DESH positive in 22.2%. After the tap test, TUG time decreased significantly (median 34.5 to 23.5 seconds; p < 0.001), with a 94.4% motor response. MMSE score increased significantly (17.56 to 19.50; p < 0.001), with a 44.4% cognitive response. Urinary dysfunction showed no significant improvement (p = 0.414), with only an 11.1% response. Overall response in ≥ 1 domain was achieved in 18/18 patients (100%). Conclusion: The CSF tap test markedly improved motor function, moderately improved cognitive function, but had limited effect on urinary control in patients with Hakim–Adams syndrome, consistent with the disease’s classic recovery sequence. These findings suggest that the test plays a supportive role in diagnosis and in short-term treatment response, and in prognosis of treatment response.
