Normal Pressure Hydrocephalus (NPH)

What is Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus is a buildup of fluid (cerebrospinal fluid, CSF) inside the brain. This may or may not increase the pressure inside the brain (intracranial pressure).

CSF is normally present in the brain, but when too much CSF increases pressure on the brain, it can affect brain function.

NPH usually occurs in people who are older than age 60.

Many symptoms of NPH are also associated with aging or certain medical conditions. It is important to pay attention to changes in behavior and mental function.

What are the causes?

Normal Pressure Hydrocephalus may be caused by anything that blocks the flow of CSF, such as:

• Head injury.
• Infections.
• Brain surgery.
• Bleeding from a blood vessel in the brain.
• Tumors or cancer.

In many cases, the cause of this condition is not known.

What are the signs or symptoms of Normal Pressure Hydrocephalus?

Symptoms of this condition may include:

• Difficulty walking, such as:
  • Shuffling feet when walking.
  • Unsteadiness.
  • Problems when beginning to walk.
  • Feet feeling as though they are stuck or “frozen” to the floor.
• Problems with bowel and bladder control.
• Memory problems, such as:
  • Forgetfulness.
  • Lack of concentration.
  • Mood problems.
  • Confusion.

How is this diagnosed?

Normal Pressure Hydrocephalus is diagnosed based on:

• Your medical history.
• A physical exam. This can reveal walking (gait) changes or twitching or sudden muscle tightening (spasms) in the legs.
• Other tests to confirm the diagnosis and identify the best options for treatment. These tests include:
  • Removal and examination of a small amount of CSF (lumbar puncture).
  • CT scan of your head.
  • MRI scan of your head.

How is this treated?

Normal Pressure Hydrocephalus may be treated with surgery in which a narrow tube (ventriculoperitoneal shunt, or VP shunt) is placed in the brain to drain excess CSF. After a shunt is placed, you will be monitored to make sure CSF is draining properly.

Depending on your age and overall health condition, you may not be a candidate for surgery.

If your symptoms are mild, your condition may be monitored on a regular basis before a decision is made about whether a shunt is needed.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Avoid taking medicines that can affect thinking, such as pain or sleeping medicines.

Lifestyle

• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Drink enough fluid to keep your urine clear or pale yellow.

If you have a shunt:

• Do not wear tight-fitting hats or headgear.
• Before having an MRI or abdominal surgery, tell your health care provider that you have a shunt.
• Watch for signs of infection around the shunt, such as:
  • Fever.
  • Redness, pain, or swelling of the skin along the shunt path.
  • Headache or stiff neck.
  • Nausea or vomiting.

General instructions

• Work with your health care provider to determine what you need help with and what your safety needs are.
• Ask your health care provider when you can resume your normal activities.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have any new symptoms.
• Your symptoms get worse.
• Your symptoms do not improve after surgery.

Get help right away if:

• You have:
  • A fever or other signs of infection.
  • New or worsening confusion.
  • New or worsening sleepiness.
  • A hard time staying awake.
  • A headache that is getting worse.
• You start to twitch or shake (seizure).
• You lose coordination or balance.
• Your or your family members become concerned for your safety.

Summary

• Normal pressure hydrocephalus (NPH) is a buildup of fluid (cerebrospinal fluid, CSF) inside the brain. Too much CSF can put pressure on the brain and affect its function.
• Anything that blocks the flow of CSF can cause this condition. In some cases, the cause of this condition is not known.
• Depending on your age, overall health condition, and diagnostic tests, you may be a good candidate for a shunt to drain excess CSF.