Normal Pressure Hydrocephalus (NPH) happens when too much fluid builds up in the brain, causing problems like trouble walking, memory loss, and bladder control issues.

Unlike other brain fluid problems, the pressure inside the skull stays normal in NPH.
Spotting NPH can be tricky because its symptoms can look like other conditions, such as Alzheimer’s or Parkinson’s disease.

If NPH is mistaken for another condition, people might get treatments that don’t help and can make things worse.

Recognising NPH early is really important – it can stop lasting brain damage and make treatments more effective but because the symptoms of NPH can also show up in other conditions like Alzheimer’s or Parkinson’s, sometimes doctors might not realize it’s NPH right away.

With timely diagnosis and treatment, many NPH patients experience significant symptom improvement, particularly in walking and urinary function, although cognitive deficits may persist.
Regular follow-up is crucial for monitoring progress and adjusting treatment as needed. By understanding NPH’s complexities and treatment options, patients and caregivers can better navigate its challenges, enhancing quality of life and preserving independence.

Symptoms of Normal Pressure Hydrocephalus

The hallmark symptoms of NPH are often referred to as the “triad,” which includes:

Gait Disturbance: Individuals with NPH may have trouble walking, characterized by a shuffling gait and instability.

  • Cognitive Impairment: Memory loss, difficulty concentrating, and other cognitive deficits are common in NPH.
  • Urinary Incontinence: NPH can affect bladder control, leading to frequent urination or urge incontinence.
  • These symptoms may develop slowly over time, and this is why making diagnosis is challenging – the symptoms can mimic other conditions such as Alzheimer’s disease or Parkinson’s disease.

Causes of Normal Pressure Hydrocephalus

The exact cause of NPH is often unknown. However, certain factors may contribute to its development, including:

  • Prior Brain Injury: Traumatic brain injury or bleeding in the brain can disrupt the normal flow of cerebrospinal fluid, leading to NPH.
  • Infections: Conditions such as meningitis or encephalitis can cause inflammation in the brain, affecting CSF circulation.
  • Subarachnoid Hemorrhage: Bleeding in the space surrounding the brain can interfere with CSF absorption, contributing to NPH.
  • Brain Tumors: Tumors can block the flow of CSF, leading to its accumulation and subsequent hydrocephalus.

Diagnosis of Normal Pressure Hydrocephalus

Diagnosing NPH typically involves a combination of medical history assessment, physical examination, and diagnostic tests. These may include:

  • Neurological Examination: Assessing gait, balance, and cognitive function can help identify characteristic signs of NPH.
  • Imaging Studies: CT scans or MRI scans can reveal enlarged ventricles and other abnormalities associated with hydrocephalus.
  • Lumbar Puncture (Spinal Tap): This procedure involves measuring the pressure of cerebrospinal fluid and can help differentiate NPH from other conditions.

Treatment Options for Normal Pressure Hydrocephalus

The primary treatment for NPH is surgical intervention, aimed at diverting or draining excess cerebrospinal fluid from the brain. Common procedures include:

  • Shunt Placement: A shunt is a thin tube implanted in the brain to divert excess CSF to another part of the body, such as the abdomen, where it can be absorbed.
  • Endoscopic Third Ventriculostomy (ETV): This involves creating a new pathway for CSF to flow, bypassing the obstruction.

What happens if the wrong diagnosis is made?

If, for example, NPH is mistaken for Alzheimer’s disease, patients may undergo unnecessary treatments for dementia without addressing the underlying cause of their symptoms, leading to frustration and a decline in quality of life.

Similarly, mistaking NPH for Parkinson’s disease might result in unnecessary medication adjustments or therapies targeting movement disorders, which may not effectively address the hydrocephalus-related symptoms.

Most importantly, misdiagnosis can prolong the period of functional decline, reducing the window of opportunity for effective treatment interventions.

Early diagnosis and intervention are crucial in NPH to prevent irreversible neurological damage and improve outcomes.

Normal Pressure Hydrocephalus Awareness Week 13 to 19 May 2024

We’re supporting Shine’s campaign to raise more awareness among healthcare professionals about the distinguishing features of NPH to ensure timely and accurate diagnosis, to improve patient care and long-term prognosis.