Normal pressure hydrocephalus

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

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

• Bleeding from a blood vessel or aneurysm in the brain (subarachnoid hemorrhage)
• Certain head injuries
• Meningitis or similar infections
• Surgery on the brain (craniotomy)

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 of NPH often begin slowly. There are 3 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.

The doctor will perform a physical examination and ask about the symptoms. If you have NPH, the doctor 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 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 ventricoperitoneal shunt.

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.

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

Call your health care 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.