Normal Pressure Hydrocephalus FAQs


NPH is a type of hydrocephalus that usually occurs in people aged 65 and older. It is different than other types of hydrocephalus because it develops slowly over time. The cerebral spinal fluid (CSF) is blocked gradually, and the excess fluid builds up slowly. This means the fluid pressure in the brain may not be as high as in other types of hydrocephalus. The ventricles still become enlarged and press on the brain causing the triad of symptoms loss of bladder control, altered walking gait and a decline in cognitive processes such as memory and problem solving.

In most cases if NPH is suspected, your family doctor will refer you to a neurologist. The neurologist may do an exam that includes evaluation of how you walk, process information, speak and inquire about your bladder function. They may also order an MRI, CT scan or a lumbar puncture.

The symptoms of NPH are similar to Alzheimer’s and Parkinson’s diseases, however, the combination of dementia-like symptoms, altered walking (shuffling feet, short steps, a feeling like one’s feet are stuck to the floor) and urinary incontinence should alert your health care provider to consider NPH. If Normal Pressure Hydrocephalus is determined to be likely, then a referral to a neurosurgeon is the next step to discuss treatment options.
The most common treatment for NPH is the surgical placement of a shunt, a device that drains excess cerebral spinal fluid (CSF) from the brain to another part of the body. A shunt is a flexible piece of tubing that is attached to a valve that controls the flow of CSF.

Endoscopic third ventriculostomy (ETV) surgery is an alternative for some individuals to shunting. An ETV involves making an opening in the floor of the third ventricle at the base of the brain. The CSF can flow around the brain through the new pathway. An ETV can also fail or become blocked. Not everyone with hydrocephalus is a candidate for ETV surgery. A neurosurgeon will make the determination of the best course of treatment on a case-by-case basis.
It is a long-term condition, however, if diagnosed early and with treatment, many of the symptoms of NPH can be alleviated and in some cases reversed.
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, individuals with a shunt are not restricted in their daily activities, except those involving great physical exertion. Most people can look forward to a normal future. But because hydrocephalus is an ongoing condition, follow-up and long-term care by a neurosurgeon or neurologist is sensible and encouraged. Especially if symptoms come back.