Normal pressure hydrocephalus
Hydrocephalus is a buildup of spinal fluid inside the fluid chambers of the brain. Hydrocephalus means "water on the brain."
Hydrocephalus
Hydrocephalus is a buildup of fluid inside the skull that leads to the brain pushing against the skull. Hydrocephalus means "water on the brain. "...
Read Article Now Book Mark ArticleNormal 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)
Aneurysm
An 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...
Read Article Now Book Mark ArticleSubarachnoid hemorrhage
Subarachnoid 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
Meningitis
Meningitis is an infection of the membranes covering the brain and spinal cord. This covering is called the meninges.
Read Article Now Book Mark Article - Surgery on the brain (craniotomy)
Craniotomy
Brain surgery is an operation to treat problems in the brain and surrounding structures.
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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 incontinence
Urinary (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 ...
Read Article Now Book Mark ArticleBowel incontinence
Bowel incontinence is the loss of bowel control, causing you to unexpectedly pass stool. This can range from sometimes leaking a small amount of sto...
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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 scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
Read Article Now Book Mark ArticleMRI of the head
A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
Read Article Now Book Mark Article - Lumbar puncture (spinal tap) with careful testing of walking before and right after the spinal tap
Lumbar puncture
Cerebrospinal 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...
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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 shunt
Ventriculoperitoneal shunting is surgery to treat excess cerebrospinal fluid (CSF) in the cavities (ventricles) of the brain (hydrocephalus)....
Read Article Now Book Mark ArticleOutlook (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
Dementia
Dementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, j...
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- 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 status
Confusion is the inability to think as clearly or quickly as you normally do. You may feel disoriented and have difficulty paying attention, remembe...
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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 C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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.