Ian Purcell MD PhD Monali Patel MD Otoneurology Call 858 223 2172
Educational Resources
Patient education

Normal Pressure Hydrocephalus

Normal pressure hydrocephalus is a buildup of fluid in the brain that classically causes walking difficulty, memory problems, and bladder urgency, and it can improve with treatment.

At a glance

Symptoms
Shuffling, unsteady walking, memory problems, and urinary urgency
Common causes
Impaired absorption of spinal fluid, often with no clear trigger
How it's diagnosed
Brain imaging, gait assessment, and a trial removal of spinal fluid
Treatment
A surgically placed shunt that drains the excess fluid

Overview

Normal Pressure Hydrocephalus (NPH) is a condition characterized by an accumulation of cerebrospinal fluid (CSF) that causes the ventricles in the brain to become enlarged, often without increased intracranial pressure. This can lead to walking difficulties, urinary incontinence, and cognitive impairments.

Symptoms

  • Gait Disturbance: The most common early sign, manifesting as difficulty walking or a feeling of the feet being stuck.
  • Cognitive Decline: Mild dementia including memory loss, difficulty problem-solving, and a general slowing of mental faculties.
  • Urinary Incontinence: Urgency or difficulty in controlling the bladder, typically occurring later in the disease progression.

Diagnosis

  • MRI or CT Scans: Imaging tests to visualize the enlargement of brain ventricles and rule out other causes.
  • Lumbar Puncture (Spinal Tap): To remove a small amount of CSF, which can temporarily improve symptoms and help confirm the diagnosis.
  • Neuropsychological Testing: Assesses the cognitive function of patients suspected of having NPH.

Treatment

  • Surgical Intervention: The primary treatment for NPH is the surgical insertion of a shunt system, which drains excess CSF from the brain to another part of the body where it can be absorbed.
  • Physical and Occupational Therapy: To improve mobility and assist with daily activities.
  • Regular Monitoring and Follow-Up: Essential to adjust shunt settings and manage symptoms effectively.

At our clinic

  • Computerized Dynamic Posturography (CDP): Helps evaluate how NPH affects a patient’s ability to maintain balance.
  • Electroencephalogram (EEG): While not directly diagnostic for NPH, it helps rule out other neurological disorders.

Living with NPH:Managing NPH involves a combination of treatments tailored to alleviate symptoms and improve quality of life:

  • Lifestyle Adjustments: Including safety modifications at home to prevent falls.
  • Supportive Care: Counseling and support for patients and caregivers to handle the challenges of NPH.

Testing that can help

Testing is chosen from your history and examination. These are the tests most often used here.

Computerized Dynamic Posturography (CDP)Balance platform testing that measures how vision, vestibular input, and body sensation contribute to postural control.
Specialty care: Gait AtaxiaGait ataxia is a form of ataxia (lack of muscle control) that affects walking and is characterized by uncoordinated movement.Memory Loss/DementiaMemory loss has many causes, some of them treatable. A neurologic evaluation separates normal aging from dementia, medication effects, and other conditions.Parkinson's DiseaseParkinson's disease is a progressive movement disorder that causes tremor, slowness, stiffness, and balance problems, and it can also affect blood pressure control.PresbyastasisPresbyastasis is the gradual, age-related decline in balance caused by changes in the inner ear, vision, sensation, and strength, and it raises the risk of falls.

When to seek urgent care

Call 911 or go to the nearest emergency department if dizziness or imbalance starts suddenly together with any of the following, since these can be signs of a stroke or another emergency:

  • Weakness or numbness of the face, arm, or leg, especially on one side
  • Trouble speaking or understanding speech
  • Double vision or sudden loss of vision
  • A sudden, severe headache
  • Inability to walk or stand
  • Chest pain, fainting, or a seizure

Further reading

This article is for general education and does not replace a medical evaluation. Testing and treatment are chosen for each patient after a full history and examination.