Normal Pressure Hydrocephalus

What is Normal Pressure Hydrocephalus

Normal pressure hydrocephalus, often called NPH, is a neurological condition in which cerebrospinal fluid build up in the brain’s ventricles, causing them to enlarge. This buildup interferes with normal brain function, particularly in areas responsible for movement, bladder control and thinking. Unlike many other causes of dementia, NPH symptoms can improve with appropriate treatment.

Who is Affected

• Mainly older adults (60+)
• Men and women are affected at normal rates
• Normal pressure hydrocephalus most

What are the Causes and Risk Factors?

Normal pressure hydrocephalus occurs when cerebrospinal fluid doesn’t drain properly from the brain, leading to enlarged ventricles.

It can occur with the following conditions:

• Head injury
• Brain surgery 
• Bleeding in the brain
• Infection affecting the brain or spinal cord
• Or for unknown reasons

Uncontrollable Risk Factors

• Older age
• Prior brain injury
• History of brain surgery or bleeding

Controllable Risk Factors

• None that are known

Who is Most at Risk

• Older adults
• Individuals with history of neurological injury or brain-related condition

What are the Signs & Symptoms?

Normal hydrocephalus is commonly associated with three groups of symptoms:

Movement, Gait & Balance: Difficulty with walking, balance or a shuffling gait are often the earliest and most noticeable symptoms.

Bladder Control & Incontinence: This can include frequent or urgent urination or urinary incontinence (loss of blader control).

Cognition, Memory & Decision Making: This can include a wide range of cognitive issues including problems with memory, attention and decision making. Memory-related symptoms can mimic other dementias, such as Alzheimer’s Disease.

How is Normal Pressure Hydrocephalus Diagnosed?

Diagnosis is based on a combination of symptoms, physical examination and imaging studies.

Tests may include:

• Neurological examination
• Brain imaging (such as MRI or CT)
• Lumbar puncture to test cerebrospinal fluid
• Gait and cognitive testing after treatment

How is Normal Hydrocephalus Treated?

Treatment focuses on reducing the build up of cerebrospinal fluid through placement of a surgical shunt. The other treatments noted are part of improving symptoms and helping individuals recover after surgery.

Lifestyle

• Fall prevention strategies
• Support for daily activities

Devices

• Assistive devices for balance or walking as needed.

Medical

• There are none that treat the fluid buildup.

Surgical

• Surgical placement of a shunt to drain excess cerebrospinal fluid from the brain to another part of the body.

Other

• Physical therapy to improve walking and balance
• Occupational therapy to support daily function
• Ongoing follow up to monitor shunt function

When to See Your Doctor

You should see a doctor if you or a loved one develops problems with walking, bladder control or memory that worsen over time, especially if the symptoms occur together.

When to Seek Emergency Medical Care

See emergency medical care if symptoms appear suddenly, worsen rapidly or if there are signs of infection, severe headache or sudden neurological changes.

Remember Normal Pressure Hydrocephalus is treatable, so talk to your physician if there are concerns about memory, walking, gait and bladder control.

Visit Understanding Memory to learn more about the many things than can impact memory.