Normal Pressure Hydrocephalus (NPH)

Cerebral spinal fluid accumulation presenting with gait disturbance, forgetfulness, and urinary incontinence

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CSF Dynamics and Hydrocephalus

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1Overview

Quick and clear information for patients

What is this Condition?

Normal pressure hydrocephalus (NPH) is a clinical presentation resulting from accumulation of cerebrospinal fluid in the brain ventricles, causing enlargement of these spaces. The term 'normal pressure' in its name derives from the fact that measured pressure does not appear significantly elevated; nevertheless, the enlarged spaces place a burden on the brain. Three typical symptoms are seen together: small-stepped, unsteady, and slow gait; forgetfulness and mental slowness; difficulty with urinary continence. These symptoms typically appear in advanced age and progress gradually. Because symptoms can be confused with dementia, accurate diagnosis is important, since NPH is a treatable condition. In suitable patients, placement of a system (shunt) that drains fluid can result in marked improvement in gait, particularly. Certain tests are performed beforehand to predict which patients will benefit from this treatment. The process is managed through combined evaluation by neurology and neurosurgery, and early initiation of treatment positively affects outcomes.

Symptoms

Small-stepped, unsteady, and slow gait

Tendency to fall or difficulty initiating gait

Decreased attention, memory, and planning ability

Frequent urination or urinary incontinence

Generalized slowness in movements

Diagnosis Methods

Diagnosis involves evaluation of the patient's symptoms, enlargement of brain cavities on brain magnetic resonance imaging (MRI) or computed tomography (CT), and exclusion of other diseases that could cause similar symptoms. In selected patients, a test is performed in which a small amount of cerebrospinal fluid is drained from the lower back (tap test), or temporary drainage is performed; improvement in gait following this procedure indicates likelihood of benefit from shunt treatment. This entire process proceeds with joint decision-making by neurology and neurosurgery.

Treatment Methods

In suitable candidates, the primary treatment is placement of a drainage system (ventriculoperitoneal shunt) that directs fluid from the brain ventricle to the abdominal cavity. The shunt flow rate is customized for each individual, and during follow-up, changes in symptoms are monitored and the settings are readjusted as needed. Patients most expected to benefit from the shunt are identified through preliminary testing; for this reason, patient selection is important. Physical therapy and gait rehabilitation in the early treatment period support gains achieved and facilitate return to daily activities.

Ventriculoperitoneal Shunt - Drainage System Directing Fluid to the Abdominal Cavity

Personalized Adjustment of Shunt Flow Rate

Physical Therapy and Gait Rehabilitation

Pre-treatment Fluid Drainage Tests (Tap Test / Temporary Drainage)

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Shunt Placement

Shunt Placement procedure

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Endoscopic Third Ventriculostomy

Endoscopic Third Ventriculostomy procedure

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Endoscopic Aqueductoplasty

Endoscopic Aqueductoplasty procedure

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External Ventricular Drainage

External Ventricular Drainage procedure

Open treatment detail

Editorial Notes

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Normal-Pressure Hydrocephalus. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Surgical Management of Hydrocephalus in the Adult. In: Quiñones-Hinojosa A, ed. Schmidek and Sweet Operative Neurosurgical Techniques. 7th ed. Elsevier; 2021.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Normal Pressure Hydrocephalus (NPH)

CSF Dynamics and Hydrocephalus

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Shunt Placement

Endoscopic Third Ventriculostomy

Endoscopic Aqueductoplasty

External Ventricular Drainage

Related Blog Posts