Normal Pressure Hydrocephalus (NPH) Frequently Asked Questions

What is Normal Pressure Hydrocephalus (NPH)?
NPH is a clinical syndrome that is characterized by gait apraxia (a disorder of voluntary movement while walking), incontinence (lack of bladder control) and dementia (deterioration of intellectual faculties). Although the cause of NPH is not known in most cases, some patients with NPH have a history of closed head injury or subarachnoid hemorrhage. In all NPH cases, enlarged ventricles are seen in the context of minimal atrophy of the brain. Therefore, the increase in ventricle size is not due to tissue loss, but rather due to changes in cerebral spinal fluid (CSF).

How is NPH different from traditional hydrocephalus?
The CSF pressures, when measured via lumbar puncture or ventricular puncture, are normal in patients with NPH. Traditional hydrocephalus always involves increased CSF pressure.

How do you diagnose NPH?
Currently, NPH is diagnosed by the symptoms listed above in conjunction with brain imaging, lumbar puncture and/or drainage of CSF.

How do you treat NPH?
By placement of a ventricular shunt, the neurosurgical standard of care.

Is my NPH cureable?
NPH is not a hopeless situation. If the cause of NPH is known, success rates can be as high as 80 percent. In cases in which a cause is not known, the success rate varies from 25 to 74 percent.

What kind of lifestyle can I expect to have while I have NPH?
The symptoms of abnormal gait, dementia and bladder control may improve within days of shunt surgery, or may take weeks to months to abate. Generally, patients with an implanted shunt system are not restricted in their daily activities, except those involving great physical exertion. Most patients can look forward to a normal future. But because hydrocephalus is an ongoing condition, patients do require long-term, follow-up care by a doctor. Regular checkups are sensible and encouraged. 

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