Normal pressure hydrocephalus (NPH) is an unhealthy increase in the amount of cerebrospinal fluid (CSF) in the brain’s ventricles, or cavities. This condition occurs if the normal flow of CSF throughout the brain and spinal cord is blocked in some way. NPH causes the ventricles to enlarge, putting pressure on the brain:
NPH can occur in people of all ages, but it most commonly afflicts adults in their 60s, 70s, and 80s. (See Ref 1) NPH is often misdiagnosed as Parkinson’s disease, Creutzfeldt-Jakob disease, Alzheimer’s disease, or another type dementia.
Symptoms of Normal Pressure Hydrocephalus include:
– Difficulty with balance and walking. This can include extreme weakness in the legs, where patients can find it very hard to lift their feet off the ground.
– Dementia and memory loss symptoms
– Urinary incontinence: usually manifests in the later stages of NPH
NPH can be diagnosed with a variety of tests, including brain scans (CT and/or MRI), a spinal tap or lumbar puncture, intracranial pressure monitoring, and neurocognitive testing for memory and cognitive impairment.
Treatment Options for Normal Pressure Hydrocephalus:
NPH is usually treated by surgically implanting a ventricle shunt to drain excess cerebrospinal fluid to the abdomen where it is absorbed. Once the shunt is in place, the ventricles usually diminish in size in 3 to 4 days.
Importantly, the NPH patients that tend to achieve the most improvement are those that show only gait disturbance, mild or no incontinence, and mild or no dementia symptoms. In other words, correctly diagnosing early, and quickly treating NPH will yield the best outcomes.(See Ref 2)
Ref 1. Younger, D.S. (2005). Adult Normal Pressure Hydrocephalus. In Younger, D.S. (Ed.), Motor Disorders (2nd edition) (pp. 581-584).
Ref 2. Vanneste, J; Augustijn, P; Dirven, C; Tan, WF; Goedhart, ZD (1992 Jan). “Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review.” Neurology 42(1): 54–9. ISSN 0028-3878. PMID 1734324.