Normal Pressure Hydrocephalus (NPH)

Definition of NPH


button for booklet about normal pressure hydrocephalus a book for adults and their families

Normal pressure hydrocephalus (NPH) is an abnormal accumulation of cerebrospinal fluid (CSF) that causes the ventricles in the brain to become enlarged, sometimes with little or no increase in intracranial pressure (ICP).

The name “normal pressure hydrocephalus” came out of Dr. Salomon Hakim’s 1964 paper describing certain cases of hydrocephalus where a triad of neurologic symptoms occurred in the presence of “normal” CSF pressure. This was before continuous pressure-recording techniques were available.

We now know that the phrase “normal pressure” is misleading, because many patients have fluctuations in CSF pressure ranging from high to normal to low. However, normal pressure hydrocephalus, or NPH, continues to be the common name for the condition.

It is most commonly seen in older adults, and is accompanied by some or all of the following triad of symptoms:

These symptoms may not occur all at the same time, at the same level of seriousness and sometimes only one or two symptoms are present.

Definitions of the NPH Triad of Symptoms

  • Mild dementia can be described as a loss of interest in daily activities, forgetfulness, difficulty dealing with routine tasks and short-term memory loss. NPH is one of the few treatable forms of dementia.
  • Impairment in bladder control is usually characterized by urinary frequency and urgency in mild cases, whereas a complete loss of bladder control (urinary incontinence)

    can occur in more severe cases. Some people never display signs of bladder problems.
  • Gait disturbances range in severity from mild imbalance to the inability to stand or walk at all. Gait is often widebased, short-stepped, slow and shuffling. Gait disturbance is often the most pronounced symptom and the first to become apparent.


NPH Resources

HA Published Material

WEBINAR: What if it isn’t Alzheimer’s or Parkinson’s?
Presenter: Dr. Michael A Williams, M.D.
Suggested Audience: This webinar is ideal for individuals who have been diagnosed with NPH or may have been exhibiting the classic symptoms of the condition, caregivers of older adults, medical professionals, nursing home staff and anyone who has been treated with Parkinson’s, Alzheimer’s and dementia.

Questions to ask your Doctor
Creating and maintaining a good relationship with qualified doctors is one of the most important elements of overall healthcare planning. Some people feel nervous when speaking with a doctor-especially a neurosurgeon. It is important, however, to find out about the doctor’s experience and whether there is a good “fit” between the doctor and your family before entrusting him or her with your care or the care of someone you love. We have compiled lists of questions that we believe will help you discover important information and establish a good relationship.

Shunt Systems
This fact sheet provides an overview of how shunts treat hydrocephalus. It explains the basic components of the shunt, how shunts function and manage hydrocephalus, and what complications may arise with the shunt.

Durable Power of Attorney
A Durable Power of Attorney for Health Care (DPAHC) gives the person, or persons, you designate as your agent the power to make health care decisions for you in the event you are unable to do so. For people with hydrocephalus over 18, a DPAHC can be a critical tool to assist with independent living and to insure continuation of appropriate medical care. This article explains DPAHC in further detail and provides a sample form.

Second Opinions
The need to acquire a second opinion is a legitimate right of all patients. This information sheet is designed to give you the tools to pursue this.


HA’s Online NPH Resources

Online Directory of Neurosurgeons & Neurologists Who Treat Adults. This directory contains neurosurgeons and neurologists who have experience in diagnosing and treating hydrocephalus in adults, including normal pressure hydrocephalus (NPH).

Partner’s Network
The Hydrocephalus Association maintains a network of Support Groups across the United States. Find the one nearest you.

Hydrocephalus Resource Library
A tool to provide answers not contained elsewhere in our site, or on the internet. Hydrocephalus is a condition fraught with complications. As always, we strive to provide our members with the best information possible.

Here are the top four NPH results in our Resource Library:

Changes in Aqueductal CSF Stroke Volume and Pregression of Symptoms.pdf


Other Websites

The Adult Hydrocephalus Center at Sinai Hospital of Baltimore
Part of The Sandra and Malcolm Berman Brain & Spine Institute, provides internationally recognized expertise in the diagnosis, treatment, and longitudinal care of adults with hydrocephalus, including pediatric hydrocephalus patients transitioning into adulthood. The team of experts, led by Michael A. Williams, MD, is actively involved in research, patient/family education, and patient advocacy efforts.

Life NPH
Codman, a national shunt manufacturer and subsidiary of Johnson & Johnson has a website full of great resources for people dealing with NPH. This includes a 5 Step Diagnostic tool.

Normal Pressure Hydrocephalus From Diagnosis to Treatment, Adam S. Mednick, M.D., Ph.D.
Dr. Adam Mednick, neurologist, draws from twenty years experience to provide concise information to help individuals understand how NPH is diagnosed and treated.


Online Directory of Neurosurgeons & Neurologists Who Treat Adults

To find a treating neurologist or neurosurgeon in your area, please select which age category, whether you are looking for a neurologist or a neurosurgeon and the state in which you are searching. Then click the Search button.