by Jos Van der Poel

General outline

NPH is an accumulation of cerebrospinal fluid, which causes the ventricles of the brain to enlarge. This is thought to stretch the brain tissue, causing a triad of symptoms. Whether NPH is a disease-entity, is discutable.

Symptoms and course

• Gait disturbances (swaying, with stiff leggs)
• Urinary incontinence
• Mild dementia

Causes and risk factors

In most cases, the cause of this disorder is unknown. In some patients a brain operation or infection has led to the condition.

Frequency

6 – 10 % of all dementia patients.

Diagnostic procedures

• CT-scan to detect enlarged ventricles
• MRI to detect enlarged ventricles and oedema at sides of ventricles
• Lumbar puncture to estimate CSF pressure and analysis of the fluid

Care and treatment

Placement of CSF shunt.

Available services

The Hydrocephalus Association http://www.hydroassoc.org/

References

• Bakker S, Boon A, Wijnhoud A, Dippel D, Delwel E, Koudstaal P; Cerebral hemodynamics before and after shunting in normal pressure hydrocephalusActa Neurologica Scandinavia, 2002, 106(3), 123-7
• Tans J, Boon A; How to select patients with normal pressure hydrocephalus for shuntingActa Neurochirurgica Supplement, 2002, 81, 3-5
• Egeler-Peerdeman S, Barkhof F, Walchenbach R, Valk J; Cine phrase-contrast MR imaging in normal pressure hydrocephalus patients. Relation with outcomeClinical Neurology and Neurosurgery, 1997, 99, S262
• Zeilstra D, Bergen H; Value of brain biopsy in decision to shunt patients with idiopathic normal pressure hydrocephalus (NPH)Clinical Noerology and Neurosurgery, 1997, 99, S214
• Nakamizo A et al ; Occurrence of subdural hematoma and resolution of gait disturbance in a patient treated with shunting for normal pressure hydrocephalus Clinical Neurology and Neurosurgery, 2002, 104, 315-317
• Savolainen S et al ; Five-year outcome of normal pressure hydrocephalus with or without a shunt : pedictive value of the clinical signs, neurophysological evaluation and infusion test Acta Neurochirurgica, 2002, 144: 515-523
• Bateman G; Pulse-waved encephalopathy: a comparative study of the hydrodynamics of leukoaraiosis and normal-pressure hydrocephalus Neuroradiology. 2002, 44(9), 740-8
• Mitchell P, Mathew B; Third ventriculostomy in normal pressure hydrocephalusBritisch Journal of Neurosurgery, August 1999
• Hakim R, Black P; Correlation between lumboventricular perfusion and MRI-CSF flow studies in idiopathic normal pressure hydrocephalusSurg Neurol, 1998, 49, 14-20
• www.allaboutnph.com