Definition

What is normal pressure hydrocephalus?

Normal pressure hydrocephalus (NPH) is a neurological disorder that causes dementia. It’s characterized by walking abnormalities, dementia, and impaired bladder control. There are two types of NPH. The first type is idiopathic (iNPH). The cause of iNPH is unknown, but it most commonly occurs over the age of 60. It affects both men and women equally. The second type of NPH is known as secondary form. It’s caused by secondary disorders or symptoms that can occur at any age. The only effective treatment for NPH is ventricular shunting. This is a surgical procedure used to relieve pressure in your brain. Most people show significant improvement after shunt placement. In fact, NPH is one of only a few causes of dementia that is potentially reversible.

How common is normal pressure hydrocephalus?

Recent population-based studies have estimated the prevalence of NPH to be about 0.5% in those over 65 years old, with an incidence of about 5.5 patients per 100,000 of people per year.

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of normal pressure hydrocephalus?

The three main signs and symptoms that characterize NPH are walking abnormalities, dementia, and impaired bladder control.

Minor symptoms in early NPH include:

  • Dizziness
  • Difficulty in walking slopes or stairs
  • Difficulty in rising/sitting on a chair

Over time these symptoms will become more noticeable.

Walking Abnormalities

Examples of walking abnormalities include:

  • Feeling unsteady when walking
  • Slowness from short steps
  • Walking with shuffling, halting steps

Bladder Symptoms

Bladder symptoms caused by NPH include:

Dementia

Dementia symptoms include:

  • A slowing between cognitive function and physical movement
  • Lack of attention and concentration
  • Loss of complex cognitive activities, such as conceptualizing information and carrying out multi-step actions
  • Loss of motor control and self-regulation
  • Difficulty understanding or expressing ideas
  • Trouble interpreting the environment

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consulting with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes normal pressure hydrocephalus?

Until now the exact cause of idiopathic NPH is still unknown. However, some studies have theorized that iNPH is related to:

  • Weakening of veins that impairs the normal absorption of cerebral spinal fluid (CSF)
  • Swelling of the brain’s white matter that hinders blood flow to vital areas, like the frontal and prefrontal lobe

Secondary form NPH is precipitated by another physiologic or disease process. Conditions that may cause this type of NPH include:

Risk factors

What increases my risk for normal pressure hydrocephalus?

You may have higher risks for this condition if you are experiencing these following conditions:

 

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is normal pressure hydrocephalus diagnosed?

If your doctor suspects that you may experience this condition, a physical examination will be performed and some tests will be also recommended by your doctor. To help rule out other neurological conditions, your doctor will test your mental function. This will include a mini-mental state examination, which tests your cognitive function. Your doctor may also use other assessments to test your attention and executive function, including:

  • Digit spat spatial span
  • Word fluency test
  • Frontal assessment battery tests

Imaging tests of the brain are helpful, though insufficient for a diagnosis. Examples of these include:

  • CT scan
  • PET scan
  • MRI

Invasive diagnostic tests help to confirm the diagnosis of NPH. These tests include:

  • Lumbar tap test

This is an in-office procedure where a needle is inserted in your lower back to remove cerebrospinal fluid (CSF).

  • Lumbar drainage

This procedure involves placing a temporary catheter, or small tube, in your lumbar spine. This tube drains CSF at a slow rate over a two- to seven-day period in the hospital. Your doctor will monitor any changes in your condition to assess the procedure’s success.

How is normal pressure hydrocephalus treated?

The only successful treatment for NPH is ventricular shunting. A ventricular shunt is a medical device implanted in your brain that relieves pressure caused by fluid accumulation. Ventricular shunts are surgically implanted to drain excess CSF, which in turn relieves pressure.

Three types of shunts are used:

  • Ventriculoperitoneal (the most common type)
  • Ventriculopleural
  • Ventriculoatrial (used rarely because of tendency to cause long-term complications)

The shunt will have valves to control the amount of CSF drainage. The options for valves include:

  • Adjustable-shunt valves

The valve pressure can be adjusted without another operation

  • Gravity-controlled valves

Valve pressure is determined by the position of the body and adjusts to avoid over-drainage (recommended for mobile patients)

 

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage normal pressure hydrocephalus?

Although the cause of many cases of normal pressure hydrocephalus is unknown, commonsense steps can help reduce your risk for head injury, which can result in NPH. Always wear your safety belt when driving and insist that all passengers wear theirs. Always wear a safety helmet when biking, skating, rollerblading, skiing, or snowboarding.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: July 6, 2017 | Last Modified: July 6, 2017

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