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Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a progressive brain disorder caused by a buildup of cerebrospinal fluid inside the hollow chambers of the brain. This causes a variety of symptoms including thinking and reasoning difficulties, abnormal gait and loss of bladder control. The condition is signified as “normal” because spinal taps checking the pressure often register as normal despite the presence of excess fluid.

Normal pressure hydrocephalus generally affects individuals between the ages of 60 and 70 years of age. Since the symptoms of NPH overlap those of other types of dementia and brain disorders, medical professionals are unsure how many older adults actually suffer from NPH.

Symptoms of Normal Pressure Hydrocephalus

Although normal pressure hydrocephalus can have symptoms similar to those sometimes experienced as one gets older, it’s wise to discuss any symptoms of concern and any changes your body is going through with a healthcare professional. NPH typically has the following three symptoms:

  • Memory loss and a decline in thinking skills such as slowed thought processes, reduced concentration, apathy, impaired decision-making and changes in personality and behavior
  • Shuffling gait or difficulty walking – often the first symptom that family and friends become concerned about. It’s sometimes compared to how a person walks when aboard a small boat – with body bent forward, legs spread apart and feet dragging and shuffling.
  • Loss of bladder control (tends to appear later in the disorder than the other two symptoms)

Brain or Physical Changes Associated with Normal Pressure Hydrocephalus

Abnormal amounts of cerebrospinal fluid in the ventricles (fluid-filled areas) of the brain cause pressure and damage to nearby brain tissue which produces the symptoms of normal pressure hydrocephalus.

Causes/Risk Factors of Normal Pressure Hydrocephalus

Most cases of normal pressure hydrocephalus have no known cause. A smaller percentage of cases can be caused by:

  • Head injury
  • Surgery to the brain
  • Subarachnoid hemorrhage
  • Infections or inflammations
  • Tumor or cyst
  • Bleeding during or after surgery

Diagnosis, Treatment and Care of Normal Pressure Hydrocephalus

Currently, there is no single test to determine the presence of normal pressure hydrocephalus. And, even though the three “classic” signs listed above go a long way towards diagnosis, not everyone with NPH has all three.

During the initial exam, which often includes a physical and neurological exam, a medical professional will:

  • Discuss and observe the patient’s gait
  • Discuss urinary habits including urgency, frequency and incontinence
  • Assess mental cognition, attention, emotional state, reasoning skills, language skills and reactionary time

Additional tests may be used to evaluate the potential of normal pressure hydrocephalus including:

  • Imaging studies, such as magnetic resonance imaging (MRI)
  • Removal and testing of cerebrospinal fluid (large-volume drainage resulting in improved symptoms points to a likely NPH diagnosis)

Patients may be referred to a neurologist who has extensive experience with brain disorders that affect movement, physical functions and thinking skills since symptoms of NPH overlap those of Alzheimer’s disease and other dementias.

If NPH is suspected and the patient experiences an improvement following a large-volume spinal tap, the patient may benefit from the surgical placement of a shunt to drain excess fluid into the abdomen. This surgery often improves difficulties with gait, but cognition and bladder control are less likely to improve. Additionally, some studies indicate that there’s a significant rate of postsurgical complications and that benefits of the shunt insertion decline over time.

There are currently no nonsurgical treatments for NPH.

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