Normal Pressure Hydrocephalus (NPH)

What is normal pressure hydrocephalus (NPH)?

Normal pressure hydrocephalus (NPH) is a neurological disorder characterized by the buildup of cerebrospinal fluid (CSF) in the brain’s ventricles, leading to enlargement of these fluid-filled spaces. Despite the increased amount of CSF, the pressure within the brain remains within the normal range.

Symptoms

These symptoms typically develop slowly over time and often include gait disturbances, urinary incontinence, and cognitive decline.
One of the hallmark symptoms of NPH is gait disturbances, which may manifest as difficulty walking, shuffling steps, or a feeling of instability. Patients with NPH often exhibit a wide-based, hesitant gait, where they may appear unsteady and have trouble maintaining balance. This symptom can significantly impact mobility and increase the risk of falls. Urinary incontinence is another common symptom of NPH. Patients may experience difficulties with bladder control, leading to involuntary leakage or the frequent urge to urinate. This symptom can be distressing and embarrassing for individuals affected by NPH, impacting their quality of life.

Causes

The exact cause of NPH is often unknown, but several factors may contribute to its development:
Idiopathic: In many cases, the cause of NPH is not clear, and it is referred to as idiopathic NPH.
Secondary to other conditions: NPH can sometimes develop as a result of other medical conditions or events that affect the normal flow or absorption of CSF in the brain.
These conditions may include traumatic brain injury, subarachnoid hemorrhage, meningitis, brain tumors, or prior brain surgery.

Diagnosis and Tests

The diagnosis of NPH typically involves a combination of clinical assessment, imaging studies, and sometimes additional tests.
Clinical Assessment: A thorough clinical evaluation includes medical history, physical examination, and symptom assessment.
Imaging Studies: MRI and CT scans help confirm the diagnosis by showing enlarged ventricles.
Cerebrospinal Fluid Tap Test: Involves removing CSF to monitor symptom improvement.

Treatment

The primary treatment for NPH typically involves surgical intervention.
Shunt Placement: A shunt diverts excess CSF from the brain’s ventricles to another part of the body.
Endoscopic Third Ventriculostomy (ETV): A hole is created to allow CSF flow out of the brain.
Physical and Occupational Therapy: Help improve gait, balance, and daily functioning.
Medication: May help manage symptoms but does not address the underlying condition.

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