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What Is Normal Pressure Hydrocephalus (NPH)?

Normal pressure hydrocephalus (NPH) is a condition with an abnormally high amount of cerebrospinal fluid in the brain’s ventricles (cavities). NPH is rare, occurring in 1 of 100,000 people. People of any age can have it, but it occurs most often in elderly people.

What Causes NPH?

In almost 50% of NPH cases, the cause is unknown. It’s called idiopathic. The rest of the cases result from trauma, brain surgery, meningitis, infection, or bleeding into the subarachnoid space, the part between the brain and thin tissues that cover it.

NPH isn’t contagious or passed from parents to children.

What Are the Symptoms of NPH?

Symptoms often start slowly and progress. Symptoms include walking problems, mental impairment (dementia), and problems holding urine in the bladder (incontinence).

Most people have a slow, shuffling, and wide-based walk. Many complain of problems starting to walk, with the feeling that the feet are stuck to the floor (called magnet gait).

Dementia involves slowed thinking, memory loss, forgetfulness, problems focusing, and lack of attention.

In early stages of NPH, people need to urinate often and have sudden urges to urinate. Later, incontinence occurs. Incontinence is usually urinary, but people may also have problems with bowel movement (stool) incontinence.

How Is NPH Diagnosed?

The diagnosis may be hard to make, because many symptoms aren’t specific and may be seen with other diseases (e.g., Parkinson’s, Alzheimer’s, and other types of dementia). Imaging studies, including computed tomography (CT) or magnetic resonance imaging (MRI), can help with diagnosis. CT uses special computer x-ray machines to develop pictures of the body. MRI uses radio waves and strong magnetic fields to develop pictures.

Lumbar puncture (spinal tap) is performed to help diagnosis. The doctor puts a needle through the lower back into the space containing cerebrospinal fluid around the spinal cord, and the fluid is removed and sent for study.

How Is NPH Treated?

No medicines are available for treatment. Treatment involves surgery. A shunt is put into the brain to drain excess cerebrospinal fluid through the shunt. The fluid drains into the abdomen, where it can be absorbed. This draining allows the brain ventricles to return to normal size.

DOs and DON’Ts in Managing NPH:

  • DO realize that about 30% of people with idiopathic NPH have significant improvement after shunts are used. If a cause of NPH is known, 60% will have significant improvement after this operation.
  • DO understand that people with a history of prior strokes have a poor prognosis after treatment compared with those without such a history.
  • DO call your health care provider if you have trouble walking.
  • DO call your health care provider if you or family members have problems with memory.
  • DO call your health care provider if you have urinary incontinence.
  • DON’T forget that NPH symptoms usually get worse over time if the condition isn’t treated, even though some people may show temporary improvements. Some people recover almost completely after treatment and have a good quality of life. Early diagnosis and treatment improve the chance of good recovery.

Contact the following sources:

  • Hydrocephalus Foundation, Inc.
    Tel: (781) 942-1161
  • Hydrocephalus Association
    Tel: (888) 598-3789

Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.

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