BACK TOTOP Browse A-ZSearchBrowse A-ZABCDEFGHIJKLMNOPQRSTUVWXYZ0-9 E-mail FormEmail ResultsName:Email address:Recipients Name:Recipients address:Message: Print-FriendlyBookmarksbookmarks-menuNormal pressure hydrocephalusHydrocephalus - occult; Hydrocephalus - idiopathic; Hydrocephalus - adult; Hydrocephalus - communicating; Dementia - hydrocephalus; NPHHydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means "water on the brain."HydrocephalusHydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...ImageRead Article Now Book Mark Article 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. Causes There is no known cause for NPH. But the chance of developing NPH is high in someone who previously had any of the following:Bleeding from a blood vessel or aneurysm in the brain (subarachnoid hemorrhage) AneurysmAn aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. When an aneurysm occurs in a blood ve...ImageRead Article Now Book Mark Article Subarachnoid hemorrhageSubarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid sp...Read Article Now Book Mark Article Certain head injuries Meningitis or similar infections MeningitisMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.ImageRead Article Now Book Mark Article Surgery on the brain (craniotomy)CraniotomyBrain surgery is an operation to treat problems in the brain and surrounding structures.ImageRead Article Now Book Mark Article 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. Symptoms 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) Urinary incontinenceUrinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...ImageRead Article Now Book Mark Article Bowel incontinenceBowel incontinence is the loss of bowel control, causing you to unexpectedly pass stool. This can range from sometimes leaking a small amount of sto...ImageRead Article Now Book Mark Article Diagnosis of NPH can be made if any of the above symptoms occur and NPH is suspected and testing is done. Exams and Tests Your health care provider will perform a physical examination and ask about the symptoms. If you have NPH, your provider will likely find that your walking (gait) is not normal. You may also have memory problems. Tests that may be done include:Head CT scan or MRI of the head Head CT scanA head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.ImageRead Article Now Book Mark Article MRI of the headA head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...ImageRead Article Now Book Mark Article Lumbar puncture (spinal tap) with careful testing of walking before and right after the spinal tapLumbar punctureCerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...ImageRead Article Now Book Mark Article Treatment 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.Ventriculoperitoneal shuntVentriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain (hydrocephalus)....ImageRead Article Now Book Mark Article Outlook (Prognosis) 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. Possible Complications 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 DementiaDementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, j...ImageRead Article Now Book Mark Article Injury from falls Shortened life span When to Contact a Medical Professional Contact 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.Change in mental statusConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...ImageRead Article Now Book Mark Article Open ReferencesReferencesFrim 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.AllVideoImagesTogVentricles of the brain - illustration The ventricles of the brain are hollow chambers filled with cerebrospinal fluid (CSF), which supports the tissues of the brain.Ventricles of the brainillustrationVentricles of the brain - illustration The ventricles of the brain are hollow chambers filled with cerebrospinal fluid (CSF), which supports the tissues of the brain.Ventricles of the brainillustration Tests for Normal pressure hydrocephalus Cerebrospinal fluid (CSF) collectionRelated Information Dementia(Condition)Hydrocephalus(Condition)Cerebrospinal fluid (CSF) collection(Medical Test)Brain surgery(Surgery)Meningitis(Condition)Subarachnoid hemorrhage(Condition)Ventriculoperitoneal shunt - discharge(Discharge)Alzheimer disease - InDepth(In-Depth) Review Date: 3/31/2024 Reviewed By: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. 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Normal pressure hydrocephalusHydrocephalus - occult; Hydrocephalus - idiopathic; Hydrocephalus - adult; Hydrocephalus - communicating; Dementia - hydrocephalus; NPHHydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means "water on the brain."HydrocephalusHydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...ImageRead Article Now Book Mark Article 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. Causes There is no known cause for NPH. But the chance of developing NPH is high in someone who previously had any of the following:Bleeding from a blood vessel or aneurysm in the brain (subarachnoid hemorrhage) AneurysmAn aneurysm is a weak area in the wall of a blood vessel that causes the blood vessel to bulge or balloon out. When an aneurysm occurs in a blood ve...ImageRead Article Now Book Mark Article Subarachnoid hemorrhageSubarachnoid hemorrhage is bleeding in the area between the brain and the thin tissues that cover the brain. This area is called the subarachnoid sp...Read Article Now Book Mark Article Certain head injuries Meningitis or similar infections MeningitisMeningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.ImageRead Article Now Book Mark Article Surgery on the brain (craniotomy)CraniotomyBrain surgery is an operation to treat problems in the brain and surrounding structures.ImageRead Article Now Book Mark Article 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. Symptoms 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) Urinary incontinenceUrinary (or bladder) incontinence occurs when you are not able to keep urine from leaking out of your urethra. The urethra is the tube that carries ...ImageRead Article Now Book Mark Article Bowel incontinenceBowel incontinence is the loss of bowel control, causing you to unexpectedly pass stool. This can range from sometimes leaking a small amount of sto...ImageRead Article Now Book Mark Article Diagnosis of NPH can be made if any of the above symptoms occur and NPH is suspected and testing is done. Exams and Tests Your health care provider will perform a physical examination and ask about the symptoms. If you have NPH, your provider will likely find that your walking (gait) is not normal. You may also have memory problems. Tests that may be done include:Head CT scan or MRI of the head Head CT scanA head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.ImageRead Article Now Book Mark Article MRI of the headA head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...ImageRead Article Now Book Mark Article Lumbar puncture (spinal tap) with careful testing of walking before and right after the spinal tapLumbar punctureCerebrospinal fluid (CSF) collection is a test to look at the fluid that surrounds the brain and spinal cord. CSF acts as a cushion, protecting the b...ImageRead Article Now Book Mark Article Treatment 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.Ventriculoperitoneal shuntVentriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain (hydrocephalus)....ImageRead Article Now Book Mark Article Outlook (Prognosis) 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. Possible Complications 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 DementiaDementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, j...ImageRead Article Now Book Mark Article Injury from falls Shortened life span When to Contact a Medical Professional Contact 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.Change in mental statusConfusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...ImageRead Article Now Book Mark Article Open ReferencesReferencesFrim 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.