Normal Pressure Hydrocephalus (NPH)

Normal Pressure Hydrocephalus (NPH)

Normal pressure hydrocephalus (NPH) is a syndrome of walking dysfunction, problems with thinking, and bladder muscle overactivity. NPH is rare relative to other potential causes of these symptoms in the elderly, but timely diagnosis could lead to the reversal of symptoms through ventricular shunting. There are many tests used to predict possible response to surgery, such as MRI of the brain, formalized neuropsychological and walk testing, large-volume lumbar puncture, and prolonged lumbar drainage, but no single test has been validated to rule out potential response to surgery.

Neurologic Signs & Symptoms

Gait Disturbance

Although no one feature is diagnostic of the walking disturbance in NPH, the most common descriptors include “shuffling,” “magnetic,” and “wide-based.” Unsteadiness and slowness of walking (due to short steps and feelings of off balance) are common, and the latter feature is more likely to respond to shunting.

Urinary Incontinence

The bladder symptoms of NPH are directly caused by bladder muscle overactivity, which can result in urinary frequency, urgency, or frank incontinence.

Behavior and Thinking Deficits

Behaviour and thinking deficits can be the earliest cognitive signs of NPH. Significant improvement in these disturbances can occur after shunting.

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