Case study 26 - Normal Pressure Hydrocephalus (NPH), a curable cause of dementia EXPLAINED

Case study 26 - What is normal pressure hydrocephalus?

The brain has chambers called ventricles that normally contain fluid. This fluid is called cerebrospinal fluid (CSF). It cushions the brain and spinal cord. Normally your body makes just enough CSF each day and absorbs that same amount. Sometimes, however, too much fluid can build up in the ventricles. This can lead to a normal pressure hydrocephalus (NPH).

What causes normal pressure hydrocephalus?

The cause of excess fluid in the ventricles of the brain may be due to injury, bleeding, infection, brain tumor, or surgery on the brain. However, the cause is often not known. When excess fluid builds up in the ventricles, they enlarge and press against nearby brain tissue. This extra fluid and pressure can lead to brain damage.

NPH though rare, most often affects older adults, and its symptoms can be similar to those of Alzheimer and Parkinson diseases. A healthcare provider familiar with these conditions can often tell the difference between these diseases and NPH after special testing.

Who is at risk for normal pressure hydrocephalus?

You are at increased risk for NPH if you:

Are age over 60 years
Have a brain infection
Have had a head injury
Have a brain tumor
Have undergone brain surgery
What are the symptoms of normal pressure hydrocephalus?

These are possible symptoms of NPH:
Trouble walking (feels like the feet are stuck to the ground)
Poor balance
Falling
Changes in the way you walk
Forgetfulness and confusion
Mood changes
Depression
Difficulty responding to questions
Loss of bladder control

How is normal pressure hydrocephalus diagnosed?
Your medical team may need to do a number of tests to confirm NPH, such as:

Physical exam and review of your symptoms
Evaluation of the way you walk
CT or MRI scans of your brain
Spinal tap to remove a sample of your cerebrospinal fluid

How is normal pressure hydrocephalus treated?

A commonly used treatment for NPH is surgery to place a tube, called a shunt, into the brain to drain the excess fluid. The shunt is usually inserted into a ventricle in the brain and then passed under your skin from your head through your neck and chest to your abdomen. The extra fluid in your brain flows through the shunt into your abdomen, where your body absorbs it. The ventricles in your brain may then go back to their normal size. The shunt stays in place as long as there is too much CSF in the brain.

Implanting a shunt doesn’t work for everyone, but some people do benefit from it. Getting prompt diagnosis and treatment helps improve your chances of a good outcome.

What are the complications of normal pressure hydrocephalus?
The complications of NPH include:
Difficulty walking
Trouble thinking
Loss of bladder control

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