Learn About Normal Pressure Hydrocephalus

What is the definition of Normal Pressure Hydrocephalus?

Hydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means "water on the brain."

Normal pressure hydrocephalus (NPH) is a rise in the amount of cerebrospinal fluid (CSF) in the brain that affects brain function. However, the pressure of the fluid is usually normal.

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What are the alternative names for Normal Pressure Hydrocephalus?

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

What are the causes of Normal Pressure Hydrocephalus?

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.

What are the symptoms of Normal Pressure Hydrocephalus?

Symptoms of NPH often begin slowly. There are three main symptoms of NPH:

  • Changes in the way a person walks: difficulty when beginning to walk (gait apraxia), feeling as if your feet 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.

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What are the current treatments for Normal Pressure Hydrocephalus?

Treatment for NPH usually requires surgery to place a tube called a shunt that routes the excess CSF out of the brain ventricles and into the abdomen. This is called a ventriculoperitoneal shunt.

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What is the outlook (prognosis) for Normal Pressure Hydrocephalus?

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.

What are the possible complications of Normal Pressure Hydrocephalus?

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
When should I contact a medical professional for Normal Pressure Hydrocephalus?

Call your 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 911 or the local emergency number if a sudden change in mental status occurs. This may mean that another disorder has developed.

Central nervous system and peripheral nervous system
Ventricles of the brain
What are the latest Normal Pressure Hydrocephalus Clinical Trials?
Non-invasive Neurostimulation as a Tool for Diagnostics and Management for Neurodegenerative Diseases

Summary: Double blinded, sham-controlled, randomized trial on repeated transcranial alternating current brain stimulation (tACS) in neurodegenerative diseases. The investigators will evaluate whether a 4-times daily repeated stimulation with gamma tACS on the posterior parietal cortex can improve symptoms in patients with neurodegenerative diseases, including dementia with Lewy Bodies, Alzheimer's disease,...

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US Pilot Study to Evaluate the Safety and Effectiveness of the CereVasc® eShunt® System in the Treatment of Normal Pressure Hydrocephalus

Summary: The eShunt® System is a minimally invasive method of treating communicating hydrocephalus. The eShunt System includes a proprietary eShunt Delivery System and the eShunt Implant, a permanent implant deployed in a minimally invasive, neuro-interventional procedure. The eShunt System is intended to shunt cerebrospinal fluid from the intracranial subarachnoid space to the venous system for the treatm...

What are the Latest Advances for Normal Pressure Hydrocephalus?
Gait, falls, cognitive function, and health-related quality of life after shunt-treated idiopathic normal pressure hydrocephalus-a single-center study.
Lumbo-Peritoneal Shunt for Patients with Idiopathic Normal Pressure Hydrocephalus:Surgical Technique.
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Japanese Subarachnoid Aneurysm Trial of Neurosurgical Clipping versus Endovascular Coiling in 1863 Patients with Ruptured Intracranial Aneurysms.
Who are the sources who wrote this article ?

Published Date: January 23, 2022
Published By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Frim DM, Vivas-Buitrago T, Rigamonti D, Lacy M. Surgical management of hydrocephalus in the adult. In: Quiñones-Hinojosa A, ed. Schmidek and Sweet: Operative Neurosurgical Techniques. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 81.

Rosenberg GA. Brain edema and disorders of cerebrospinal fluid circulation. In:  Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's  Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 88.

Sivakumar W, Drake JM, Riva-Cambrin J. The role of endoscopic third ventriculostomy: a critical review. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 45.