Normal Pressure Hydrocephalus

What is Normal Pressure Hydrocephalus?

Overview

Normal Pressure Hydrocephalus (NPH) is a neurological condition that occurs when cerebrospinal fluid (CSF) builds up in the brain’s ventricles, causing them to enlarge. Despite this buildup, the fluid pressure within the brain typically remains within normal limits — hence the name.

NPH most commonly affects older adults and can lead to a unique set of symptoms, including difficulty walking, problems with bladder control, and cognitive decline. Because its symptoms often overlap with those of other neurological conditions, NPH can be challenging to diagnose but is often treatable once identified.

Who is Affected?

NPH primarily affects adults over the age of 60. Many patients are initially misdiagnosed with other age-related conditions such as Alzheimer’s disease, Parkinson’s disease, or general age-related cognitive decline. Prompt evaluation by a specialist is essential for accurate diagnosis and treatment.

Normal Pressure Hydrocephalus Symptoms & Causes

Symptoms

Normal Pressure Hydrocephalus (NPH) is a condition characterized by enlarged ventricles and a clinical triad of cognitive decline, urinary incontinence and ambulatory difficulties.

The hallmark features of NPH are known as Hakim’s triad:

• Cognitive decline (dementia): Often slow and progressive, with symptoms developing over months or years.
• Urinary incontinence: Typically related to impaired bladder control, rather than obstruction or overflow issues.
• Gait disturbance: Frequently described as a “magnetic gait,” where the feet seem stuck to the floor and initiating movement is difficult.

Other symptoms may include fatigue, decreased balance, and difficulty performing daily activities.

Causes

The exact cause of NPH is not always clear. It may develop:

• Idiopathically (without a clear cause)
• After head injury, stroke, meningitis, or brain surgery
• As a result of subarachnoid hemorrhage or other CSF flow disruptions

When to See a Doctor

If you or a loved one experiences unexplained difficulty walking, cognitive decline, or bladder control issues, especially in combination, it’s important to seek medical evaluation. Early diagnosis and treatment can significantly improve outcomes and quality of life. Contact our clinic at 310-582-7450.

Normal Pressure Hydrocephalus Diagnosis

Because NPH symptoms mimic those of other neurological disorders, a thorough evaluation is critical.

Lumbar Puncture (Tap Test)

A small amount of CSF is removed. Temporary symptom improvement often suggests that a shunt may help.

Extended Lumbar Drainage

In some cases, a longer trial of CSF drainage through a lumbar drain is performed for a more accurate assessment.

Brain Imaging (MRI or CT)

Used to evaluate ventricular enlargement and rule out other causes.

Despite the enlarged ventricles, intracranial pressure is typically normal, which gives this condition its name.

Normal Pressure Hydrocephalus Treatment & Outcomes

Treatment Options

Once a diagnosis of Normal Pressure Hydrocephalus has been made, a ventriculoperitoneal shunt may be indicated as a more definitive treatment option. We typically implant shunts with programmable valves to help fine-tune the amount of CSF drainage. This is conducted with subjective and objective tests during routine follow-up visits, typically upwards of 3-6 months after surgery.

Patient Outcomes

When treated early and appropriately, many patients experience significant improvement in walking ability, bladder control, and cognitive function. However, outcomes vary based on the severity and duration of symptoms before treatment. Regular follow-up and monitoring are essential for achieving the best results.

Managing Normal Pressure Hydrocephalus

Living with NPH requires ongoing care. Patients benefit from:

Meet our Expert Specialists & Surgeons

Garni Barkhoudarian, MD

Neurosurgery

Adi Iyer, MD, MS

Neurosurgery, Neuro-interventional Surgery

Experience Compassionate, Expert Care

At Pacific Neuroscience Institute, our team provides comprehensive, patient-centered care for those living with NPH. From advanced diagnostic evaluations to state-of-the-art surgical treatments, we are committed to helping patients achieve the best possible quality of life.

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