What is normal pressure hydrocephalus?
Normal pressure hydrocephalus (NPH) is an excessive cerebrospinal fluid (CSF) accumulation in the brain in adults and is frequently overdiagnosed or misdiagnosed as dementia. When the normal flow of CSF is disrupted, the ventricles (fluid-filled cavities in the brain) enlarge and result in harmful compression of the brain and surrounding tissues.
CSF plays a vital role in brain function because it:
- Cushions the brain to prevent injury
- Keeps the heavy brain buoyant (floating) in the skull
- Maintains a constant pressure within the brain and compensates for changes in blood pressure within it
- Removes waste from the brain
What causes normal pressure hydrocephalus?
NPH occurs when there is an imbalance between the amount of CSF being produced by the body and the amount being absorbed into the bloodstream. This may be due to:
- Obstruction, either from one ventricle in the brain to another or from ventricles to other places in the brain
- Overproduction of CSF that can’t be absorbed
- Poor absorption of CSF from blood vessels, often the result of inflammation due to disease or trauma
What are the symptoms of normal pressure hydrocephalus?
Symptoms of NPH in young and middle-aged adults may include:
- Decline in concentration, memory and other thinking skills
- Difficulty in remaining awake or waking up
- Headache
- Impaired vision
- Loss of bladder control or a frequent urge to urinate
- Loss of coordination or balance
In adults over 60 years of age, symptoms may include:
- Gradual loss of thinking or reasoning skills
- Loss of bladder control or a frequent urge to urinate
- Memory loss
- Poor balance or coordination
- Slowing down of movements in general
- Trouble with walking (may be described as a shuffle or the feeling of feet being stuck)
How is normal pressure hydrocephalus diagnosed?
First, an extensive physical and neurological exam that includes assessing muscle condition, sensory status, movement status and the psychiatric condition will be conducted. Then, Dr. Goodman will perform an advanced spinal drain technique that simulates a shunt to determine if a surgical intervention will be beneficial to the patient.
In addition, diagnostic scans of the brain, such as an ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scan may be performed to confirm a diagnosis.
How is normal pressure hydrocephalus treated?
Surgery is required to effectively treat NPH. Surgical procedures include:
Shunting. The most common treatment for this condition, this procedure involves surgically placing a long flexible tube that regulates the direction and pressure of flow of CSF from one part of the brain to another part of the body, such as a chamber in the heart or the abdomen.
Endoscopic third ventriculostomy (ETV). During an ETV, a small scope (a tube with a camera) is inserted through an incision, which allows the surgeon to see inside the brain. Then, using specialized tools, an opening is made in the bottom of one of the ventricles (or in between the ventricles) so that the CSF may drain out of the brain.
