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Normal pressure hydrocephalus

Hydrocephalus - occult; Hydrocephalus - idiopathic; Hydrocephalus - adult; Hydrocephalus - communicating; Dementia - hydrocephalus; NPH

Hydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means "water on the brain."

Normal pressure hydrocephalus (NPH) is a rise in the amount of cerebrospinal fluid (CSF) in the brain that affects brain function. However, the pressure of the fluid is usually normal.

Causes

There is no known cause for NPH. But the chance of developing NPH is high in someone who has had any of the following:

As CSF builds up in the brain, the fluid-filled chambers (ventricles) of the brain swell. This causes pressure on brain tissue. This can damage or destroy parts of the brain.

Symptoms

Symptoms of NPH often begin slowly. There are three main symptoms of NPH:

  • Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feel as if they are stuck to the ground (magnetic gait)
  • Slowing of mental function: forgetfulness, difficulty paying attention, apathy or no mood
  • Problems controlling urine (urinary incontinence), and sometimes controlling stools (bowel incontinence)

Diagnosis of NPH can be made if any of the above symptoms occur and NPH is suspected and testing is done.

Exams and Tests

The health care provider will perform a physical examination and ask about the symptoms. If you have NPH, the provider will likely find that your walking (gait) is not normal. You may also have memory problems.

Tests that may be done include:

  • Lumbar puncture (spinal tap) with careful testing of walking before and right after the spinal tap
  • Head CT scan or MRI of the head

Treatment

Treatment for NPH is usually surgery to place a tube called a shunt that routes the excess CSF out of the brain ventricles. This is called a ventriculoperitoneal shunt.

Outlook (Prognosis)

Without treatment, symptoms often get worse and could lead to death.

Surgery improves symptoms in some people. Those with mild symptoms have the best outcome. Walking is the symptom most likely to improve.

Possible Complications

Problems that may result from NPH or its treatment include:

  • Complications of surgery (infection, bleeding, shunt that does not work well)
  • Loss of brain function (dementia) that becomes worse over time
  • Injury from falls
  • Shortened life span

When to Contact a Medical Professional

Call your provider if:

  • You or a loved one is having increasing problems with memory, walking, or urine incontinence.
  • A person with NPH worsens to the point where you are unable to care for the person yourself.

Go to the emergency room or call the local emergency number (such as 911) if a sudden change in mental status occurs. This may mean that another disorder has developed.

References

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In: Daroff RB, Jankovic J, Mazziotta JC, Pomeroy SL, eds. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; 2016:chap 88.

Williams MA, Malm J. Diagnosis and treatment of idiopathic normal pressure hydrocephalus. Continuum (Minneap Minn). 2016; 22(2 Dementia):579-599. PMCID: PMC5390935 www.ncbi.nlm.nih.gov/pmc/articles/PMC5390935.

    • Central nervous system and peripheral nervous system

      Central nervous system and peripheral nervous system - illustration

      The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

      Central nervous system and peripheral nervous system

      illustration

    • Ventricles of the brain

      Ventricles of the brain - illustration

      The ventricles of the brain are hollow chambers filled with cerebrospinal fluid (CSF), which supports the tissues of the brain.

      Ventricles of the brain

      illustration

      • Central nervous system and peripheral nervous system

        Central nervous system and peripheral nervous system - illustration

        The central nervous system is comprised of the brain and spinal cord. The peripheral nervous system includes all peripheral nerves.

        Central nervous system and peripheral nervous system

        illustration

      • Ventricles of the brain

        Ventricles of the brain - illustration

        The ventricles of the brain are hollow chambers filled with cerebrospinal fluid (CSF), which supports the tissues of the brain.

        Ventricles of the brain

        illustration

      Tests for Normal pressure hydrocephalus

       

      Review Date: 2/27/2018

      Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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